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Quaschning K, Koerner M, Wirtz MA. Analyzing the effects of barriers to and facilitators of medication adherence among patients with cardiometabolic diseases: a structural equation modeling approach. BMC Health Serv Res 2022; 22:588. [PMID: 35501793 PMCID: PMC9063142 DOI: 10.1186/s12913-022-07987-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/22/2022] [Indexed: 12/29/2022] Open
Abstract
Background Based on the theoretical model of medication adherence (WHO, 2003), the aims of the study were (1) to develop and test a theory-based multidimensional model for the predictive power of barriers to and facilitators of medication adherence and (2) to identify the mediating effects of barriers to medication adherence on drug-related patient outcomes (barrier “MedAd- “: forget; facilitator “MedAd + ”: regular intake). Methods Within a cross-sectional study entitled “Increasing medication adherence to improve patient safety in cardiological rehabilitation (PaSiMed)”, the model was evaluated in structural analytical terms based on data collected online of N = 225 patients with cardiometabolic diseases. The revised “Freiburg questionnaire on medication adherence (FF-MedAd-R)" was used to measure the latent constructs (e.g., facilitator: communication; barrier: reservations).” Results The structural equation model proved to exhibit an appropriate data fit (RMSEA: .05; CFI: .92). For all first-order facilitators of medication adherence, a high proportion of variance (62–94%) could be explained by the second-order factor “Physician–patient relationship (PPR)”. All paths from “PPR” to the constructs depicting barriers to medication adherence showed significant negative effects. Facilitators (“MedAd + ”) and barriers (“MedAd-”) accounted for 20% and 12% of the variance, respectively, in global items of medication adherence. Whereas “Carelessness” showed a full mediation for “MedAd-”, ‘‘Reservations’’ showed a partial mediation for “MedAd + ”. Conclusions “PPR” is an important predictor of patient medication adherence. The results underline the importance of a trustful physician–patient relationship in reducing barriers and enhancing medication adherence. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07987-3.
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Affiliation(s)
- Katharina Quaschning
- Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Hebelstraße 29, 79104, Freiburg, Germany.
| | - Mirjam Koerner
- Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Hebelstraße 29, 79104, Freiburg, Germany
| | - Markus Antonius Wirtz
- Department of Research Methods in the Health Sciences, Institute of Everyday Culture, Sports and Health, University of Education Freiburg, Kunzenweg 21, 79117, Freiburg, Germany
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102
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Schneider MP, Burnier M. Partnership between patients and interprofessional healthcare providers along the multifaceted journey to medication adherence. Br J Clin Pharmacol 2022. [DOI: 10.1111/bcp.15325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/06/2022] [Accepted: 03/13/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Marie P. Schneider
- School of Pharmaceutical Sciences University of Geneva Geneva Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland University of Geneva Geneva Switzerland
| | - Michel Burnier
- Faculty of Biology and Medicine University of Lausanne Lausanne Switzerland
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103
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Doherty M, Finik J, Blinder V. Work Status Reduction and Cost-Related Nonadherence during Cancer Treatment. HEALTH & SOCIAL WORK 2022; 47:123-130. [PMID: 35253845 PMCID: PMC9226655 DOI: 10.1093/hsw/hlac004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/21/2020] [Accepted: 01/15/2022] [Indexed: 06/14/2023]
Abstract
Many cancer patients experience a reduction in work status during cancer treatment. Authors analyzed cross-sectional survey data from U.S. cancer patients and survivors to examine the relationship between reduced work status and cost-related nonadherence, defined as skipping or forgoing medical treatments or medications due to cost. Of 381 respondents who were working at the time of diagnosis, 143 reported a reduction in work status during treatment. Age, racial identity, level of education, and treatment type were associated with reductions in work status. Respondents who reduced work status had higher odds of engaging in cost-related nonadherence than those with stable employment. Authors conclude that reduced work status is associated with nonadherence that can undermine treatment benefit and lead to disease progression. This association is troubling given that African American respondents were more likely to report reduced work status during treatment, potentially exacerbating existing cancer health disparities. To reduce treatment nonadherence, social workers should assess for potential employment problems and be prepared to intervene through counseling, community resource referrals, and direct financial assistance. Social workers should be aware of how structural racism is reproduced through inequitable labor policies and practices that have direct implications for health and access to care.
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104
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Acquadro M, Marrel A, Manso-Silván MA, Guittet C, Joukoff S, Bertholet-Thomas A. Lived experiences of patients with distal renal tubular acidosis treated with ADV7103 and of their caregivers: a qualitative study. Orphanet J Rare Dis 2022; 17:141. [PMID: 35346296 PMCID: PMC8962487 DOI: 10.1186/s13023-022-02294-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/27/2022] [Indexed: 12/30/2022] Open
Abstract
Background Consequences of distal renal tubular acidosis (dRTA) on growth, bone and kidney, sometimes associated with hearing loss, may significantly affect quality of life (QoL). This descriptive qualitative study explores QoL linked to dRTA and gathers the impressions of patients with this rare disease (and caregivers) 5 years after enrolment in a clinical study, during which patients were treated with ADV7103, a prolonged-release granule formulation combining potassium citrate and potassium bicarbonate. Semi-structured, one-hour interviews with 6 adult and 13 paediatric patients with a confirmed diagnosis of dRTA and with parents of paediatric patients were performed using an interview guide. Qualitative analysis of anonymized interview transcripts based on grounded theory was conducted. Results The main QoL domains impacted by dRTA and its treatment were education/work, social/family life, and emotional and physical well-being. ADV7103 (administered twice daily) was compared with the standard of care (SoC) taken before study entry (more than twice daily). Patients/parents reported that switching from previous SoC to ADV7103 had changed their lives:Difficulties at school due to burdensome administrative issues and need to explain disease and treatment affecting all families of paediatric patients (n = 13) disappeared, facilitating parents who had stopped working (to deal with their child’s treatment) to return to work, Family functioning was improved (n = 18), as travel and holidays became easier to organise and patients/parents stopped thinking about managing treatment daily/nightly, reducing tension in the family or couple, The emotional burden of disease perceived was relieved (n = 12) in the absence of treatment-related invasive questions from others, Gastro-intestinal adverse events and taste problems improved with ADV7103 (n = 18) and better compliance led to milder physical impacts and less need to be hospitalised.
The mean satisfaction score with ADV7103 compared to SoC was 9 out of 10 (10 = very satisfied). ADV7103 exceeded or met the expectations of 14 out of 17 patients that commented on that. Conclusions Qualitative interviews show that dRTA and its treatment have a significant impact on QoL of patients and parents and that ADV7103 helps improve daily-life and reduces treatment burden, resulting in greater overall satisfaction of the patients and their families. Trial registration EU Clinical Trials Register, EudraCT 2013-003828-36 on the 3rd of September 2013.
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Affiliation(s)
| | | | | | | | - Sophie Joukoff
- Advicenne S.A., 21 Allée Boissy d'Anglas, 30000, Nîmes, France
| | - Aurélia Bertholet-Thomas
- Centre de Référence des Maladies Rénales Rares-Néphrogones-Hôpital Femme Mère Enfant, Hospices Civils de Lyon-Filière ORKiD, Bron, France
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105
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Effects of Intensive Lifestyle Intervention on All-Cause Mortality in Older Adults With Type 2 Diabetes and Overweight/Obesity: Results From the Look AHEAD Study. Diabetes Care 2022; 45:dc211805. [PMID: 35312758 PMCID: PMC9174966 DOI: 10.2337/dc21-1805] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/13/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Look AHEAD, a randomized trial comparing intensive lifestyle intervention (ILI) and diabetes support and education (DSE) (control) in 5,145 individuals with overweight/obesity and type 2 diabetes, found no significant differences in all-cause or cardiovascular mortality or morbidity during 9.6 (median) years of intervention. Participants in ILI who lost ≥10% at 1 year had lower risk of composite cardiovascular outcomes relative to DSE. Since effects of ILI may take many years to emerge, we conducted intent-to-treat analyses comparing mortality in ILI over 16.7 years (9.6 years of intervention and then observation) to DSE. In a secondary exploratory analysis, we compared mortality by magnitude of weight loss in ILI relative to DSE. RESEARCH DESIGN AND METHODS Primary outcome was all-cause mortality from randomization to 16.7 years. Other outcomes included cause-specific mortality, interactions by subgroups (age, sex, race/ethnicity, and cardiovascular disease history), and an exploratory analysis by magnitude of weight loss in ILI versus DSE as reference. Analyses used proportional hazards regression and likelihood ratio. RESULTS The incidence of all-cause mortality did not differ significantly in ILI and DSE (549 and 589 participants, respectively) (hazard ratio [HR] 0.91 [95% CI 0.81, 1.02]; P = 0.11). There were no significant differences between treatments in cause-specific mortality or within prespecified subgroups. ILI participants who lost ≥10% at 1 year had a 21% reduced risk of mortality (HR 0.79 [95% CI 0.67, 0.94]; P = 0.007) relative to DSE. CONCLUSIONS ILI focused on weight loss did not significantly affect mortality risk. However, ILI participants who lost ≥10% had reduced mortality relative to DSE.
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106
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COUNTERPOINT: Should Asymptomatic OSA Be Treated in Patients With Significant Cardiovascular Disease? No. Chest 2022; 161:607-611. [DOI: 10.1016/j.chest.2021.12.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022] Open
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Chang DS, Chen WL, Wang R. Impact of the bidirectional relationship between communication and cognitive efficacy on orthopedic patient adherence behavior. BMC Health Serv Res 2022; 22:199. [PMID: 35164761 PMCID: PMC8845262 DOI: 10.1186/s12913-022-07575-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 02/01/2022] [Indexed: 02/03/2023] Open
Abstract
Background There is growing interest in patient autonomy, and communication between physicians and patients has become the essential cornerstone for improving the quality of healthcare services. Previous research has concentrated on the direct effect of physician-patient communication on service outcomes. In the present study, we examined the influence among constructs in the service process and the impact on healthcare outcomes. The present study used behavioral theory to expand the process aspect of the Donabedian healthcare service quality structure-process-outcome model to examine the impact of cognitive changes and communication feedback on patients’ adherence behavior. In addition, the moderating effect of hospital facility levels is examined. Methods A conceptual model was developed and tested using a questionnaire administered to patients in eight hospitals. A total of 397 respondents returned usable surveys, with a response rate of 92.11%. Structural equation modeling was used to analyze the data in two steps that involved a measurement model and a structural model. The former was applied to estimate the Cronbach’s alphas, intercorrelations of factors, and descriptive statistics; the latter was used to test the hypothesized relationships of the constructs. Results The results identified three mediators of the healthcare process within the healthcare services framework: physician-patient communication, cognitive efficacy, and adherence behavior. Physician-patient communication influenced cognitive efficacy (β = 0.16, p < 0.001), and cognitive efficacy influenced physician-patient communication (β = 0.18, p < 0.001). The effect of this bidirectional relationship on adherence behavior was positive (β = 0.38, p < 0.001). The healthcare structure influenced healthcare outcomes via these three healthcare process constructs. The adherence behavior of patients who were treated in the medical center has greater influences by the structure and physician-patient communication than it was treated in the regional hospitals. Conclusions This study revealed a complex pattern in relationships among process constructs for healthcare services. The findings of this study acknowledge the important potential interrelationships among the healthcare service constructs to improve the quality of healthcare outcomes. Trial registration CRREC104107. Date: 22/01/2016. Prospectively Registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07575-5.
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Affiliation(s)
- Dong-Shang Chang
- Department of Business Administration, National Central University, Taoyuan, Taiwan
| | - Wil-Lie Chen
- School of Nursing, China Medical University, Taichung, Taiwan.
| | - Rouwen Wang
- Department of Business Administration, National Central University, Taoyuan, Taiwan
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108
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Norberg H, Sjölander M, Glader EL, Gustafsson M. Self-reported medication adherence and pharmacy refill adherence among persons with ischemic stroke: a cross-sectional study. Eur J Clin Pharmacol 2022; 78:869-877. [PMID: 35156130 PMCID: PMC9005421 DOI: 10.1007/s00228-022-03284-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/24/2022] [Indexed: 12/20/2022]
Abstract
Purpose To describe and compare self-reported medication adherence assessed with the 5-item version of Medication Adherence Report Scale (MARS-5) and pharmacy refill adherence based on data from the Swedish Prescribed Drug Register (SPDR) among persons with ischemic stroke, and to investigate independent predictors associated with respective assessments. Methods A study questionnaire was sent to persons with ischemic stroke registered in the Swedish Stroke Register between Dec 2011 and March 2012, and who lived at home 3 months after discharge. The primary outcome was dichotomized to adherent/non-adherent based on MARS-5 and SPDR and analyzed with multivariable logistic regression. Adherence according to MARS-5 was defined as score 23 or higher (out of 25). Adherence according to SPDR was defined as at least one filled statin prescription recorded in SPDR in each 6-month interval during 2 years of follow-up. Results Of 420 participants, 367 (87%) and 329 (78%) were adherent according to MARS-5 and SPDR, respectively, and 294 (70%) participants were adherent according to both assessments. A significant association was shown between medication adherence according to the two assessments (p = 0.020). Independent predictors associated with medication adherence according to MARS-5 were female sex, while factors associated with SPDR were male sex and being younger. Conclusions The majority of participants were classified as adherent, 87% according to MARS-5 and 78% based on data from SPDR. However, only 70% were adherent according to both MARS-5 and SPDR, and different predictors were associated with the different measurements, suggesting that these assessments are measuring different aspects of adherence. Supplementary information The online version contains supplementary material available at 10.1007/s00228-022-03284-4.
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Affiliation(s)
- Helena Norberg
- Department of Integrative Medical Biology, Umeå University, S-901 87, Umea, Sweden.
| | - Maria Sjölander
- Department of Integrative Medical Biology, Umeå University, S-901 87, Umea, Sweden
| | - Eva-Lotta Glader
- Department of Public Health and Clinical Medicine, Umeå University, S-901 87, Umea, Sweden
| | - Maria Gustafsson
- Department of Integrative Medical Biology, Umeå University, S-901 87, Umea, Sweden
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Bristow SM, Bolland MJ, Gamble GD, Leung W, Reid IR. Dietary calcium intake and change in bone mineral density in older adults: a systematic review of longitudinal cohort studies. Eur J Clin Nutr 2022; 76:196-205. [PMID: 34131304 DOI: 10.1038/s41430-021-00957-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 05/28/2021] [Indexed: 02/05/2023]
Abstract
Many older adults do not achieve recommended intakes of calcium and there is some concern over the potential impact of this on bone health. The objective of this review was to examine evidence from cohort studies on the relationship between calcium intake and change in bone mineral density (BMD) in older adults, something not undertaken in the last two decades. Data sources included Ovid Medline, Embase, and PubMed and references from retrieved reviews and articles. The final search was performed in February 2021. We included cohort studies of calcium intake in participants aged >50 years with change in BMD over ≥1 year as an outcome. We identified 23 studies of women and 7 of men. Most studies found no association between calcium intake and change in BMD in women (71%) or men (71%). Among women, five studies reported high rates (>30% of participants) of hormone treatment or osteoporosis therapy (HT/OT) use; 80% of these studies reported a positive association between calcium intake and change in BMD, compared with 10% of studies in which HT/OT use was low. No study in women in which the mean age was >60 years reported a positive association between calcium intake and change in BMD. We conclude that calcium intake across the ranges consumed in these studies (mean intake in all but one study >500 mg/day) is not an important determinant of bone loss, particularly among women >60 years. The positive findings in studies with high rates of HT/OT use are likely to arise from confounding as a result of co-administration of calcium supplements with these medications.
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Affiliation(s)
- Sarah M Bristow
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Mark J Bolland
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Greg D Gamble
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - William Leung
- Department of Medicine, University of Auckland, Auckland, New Zealand.,Department of Public Health, University of Otago, Wellington, New Zealand
| | - Ian R Reid
- Department of Medicine, University of Auckland, Auckland, New Zealand.
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Avataneo V, Fanelli E, De Nicolò A, Rabbia F, Palermiti A, Pappaccogli M, Cusato J, De Rosa FG, D'Avolio A, Veglio F. A Non-Invasive Method for Detection of Antihypertensive Drugs in Biological Fluids: The Salivary Therapeutic Drug Monitoring. Front Pharmacol 2022; 12:755184. [PMID: 35069191 PMCID: PMC8766966 DOI: 10.3389/fphar.2021.755184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives: Arterial hypertension is still the most frequent cause of cardiovascular and cerebrovascular morbidity and mortality. Antihypertensive treatment has proved effective in reduction of cardiovascular risk. Nevertheless, lifestyle interventions and pharmacological therapy in some cases are ineffective in reaching blood pressure target values, despite full dose and poly-pharmacological treatment. Poor adherence to medications is an important cause of treatment failure. Different methods to assess therapeutic adherence are currently available: Therapeutic drug monitoring in biological fluids has previously demonstrated its efficacy and reliability. Plasma and urine have been already used for this purpose, but they may be affected by some practical limitations. Saliva may represent a feasible alternative. Methods: Fourteen antihypertensive drugs and two metabolites were simultaneously tested in plasma, urine, and saliva. Tested molecules included: atenolol, nebivolol, clonidine, ramipril, olmesartan, telmisartan, valsartan, amlodipine, nifedipine, doxazosin, chlorthalidone, hydrochlorothiazide, indapamide, sacubitril, ramiprilat, and sacubitrilat. Therapeutic drug monitoring was performed using ultra-high performance liquid chromatography, coupled to tandem mass spectrometry (UHPLC-MS/MS). The method has been preliminarily evaluated in a cohort of hypertensive patients. Results: The method has been validated according to US Food and Drug Administration (FDA) and European Medicines Agency (EMA) guidelines. The application on a cohort of 32 hypertensive patients has demonstrated sensibility and specificity of 98% and 98.1%, respectively, with a good feasibility in real-life clinical practice. Conclusion: Saliva may represent a feasible biological sample for therapeutic drug monitoring by non-invasive collection, prompt availability, and potential accessibility also in out-of-clinic settings.
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Affiliation(s)
- Valeria Avataneo
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Elvira Fanelli
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, A.O.U. Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Amedeo De Nicolò
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Franco Rabbia
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, A.O.U. Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Alice Palermiti
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Marco Pappaccogli
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, A.O.U. Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Jessica Cusato
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Francesco Giuseppe De Rosa
- Division of Infectious Diseases, Department of Medical Sciences, A.O.U. Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Antonio D'Avolio
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Franco Veglio
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, A.O.U. Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
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Dodd M, Fielding K, Carpenter JR, Thompson JA, Elbourne D. Statistical methods for non-adherence in non-inferiority trials: useful and used? A systematic review. BMJ Open 2022; 12:e052656. [PMID: 35022173 PMCID: PMC8756274 DOI: 10.1136/bmjopen-2021-052656] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 12/16/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In non-inferiority trials with non-adherence to interventions (or non-compliance), intention-to-treat and per-protocol analyses are often performed; however, non-random non-adherence generally biases these estimates of efficacy. OBJECTIVE To identify statistical methods that adjust for the impact of non-adherence and thus estimate the causal effects of experimental interventions in non-inferiority trials. DESIGN A systematic review was conducted by searching the Ovid MEDLINE database (31 December 2020) to identify (1) randomised trials with a primary analysis for non-inferiority that applied (or planned to apply) statistical methods to account for the impact of non-adherence to interventions, and (2) methodology papers that described such statistical methods and included a non-inferiority trial application. OUTCOMES The statistical methods identified, their impacts on non-inferiority conclusions, and their advantages/disadvantages. RESULTS A total of 24 papers were included (4 protocols, 13 results papers and 7 methodology papers) reporting relevant methods on 26 occasions. The most common were instrumental variable approaches (n=9), including observed adherence as a covariate within a regression model (n=3), and modelling adherence as a time-varying covariate in a time-to-event analysis (n=3). Other methods included rank preserving structural failure time models and inverse-probability-of-treatment weighting. The methods identified in protocols and results papers were more commonly specified as sensitivity analyses (n=13) than primary analyses (n=3). Twelve results papers included an alternative analysis of the same outcome; conclusions regarding non-inferiority were in agreement on six occasions and could not be compared on six occasions (different measures of effect or results not provided in full). CONCLUSIONS Available statistical methods which attempt to account for the impact of non-adherence to interventions were used infrequently. Therefore, firm inferences about their influence on non-inferiority conclusions could not be drawn. Since intention-to-treat and per-protocol analyses do not guarantee unbiased conclusions regarding non-inferiority, the methods identified should be considered for use in sensitivity analyses. PROSPERO REGISTRATION NUMBER CRD42020177458.
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Affiliation(s)
- Matthew Dodd
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Katherine Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - James R Carpenter
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
- MRC Clinical Trials Unit, UCL, London, UK
| | - Jennifer A Thompson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Diana Elbourne
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
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Sachkouskaya A, Sharshakova T, Kovalevsky D, Rusalenko M, Savasteeva I, Goto A, Yokokawa H, Kumagai A, Takahashi J. Barriers to Prevention and Treatment of Type 2 Diabetes Mellitus Among Outpatients in Belarus. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 2:797857. [PMID: 36994323 PMCID: PMC10012060 DOI: 10.3389/fcdhc.2021.797857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022]
Abstract
Objectives This study aimed to determine the main barriers and reasons for non-adherence to preventive measures and treatment for type 2 diabetes mellitus among outpatients in Belarus. Methods An anonymous questionnaire survey was conducted with 814 adults aged 18 years and over who visited outpatient health care units and hospitals in Belarus. The questionnaire was developed to analyze the perceived barriers that limit adherence to preventive measures and treatment for type 2 diabetes. Results The proportion of respondents who reported doing daily physical activity was 53.2%, and 46.6% consumed at least 400 grams of fruit and vegetables per day. Among the 42.8% of respondents with a prescribed treatment for type 2 diabetes mellitus, 50.1% sometimes forgot to take their medicine. The specific barriers to treatment most frequently identified by survey respondents were "Financial situation" (23.5% of respondents), and "Fear of side effects" (25.2%). Those for lifestyle instructions were "Insufficient knowledge" (29.3%), "Financial situation" (27.9%), and "Lack of motivation" (21.7%). Conclusions The study revealed that the main barriers to adherence were insufficient knowledge of diabetes and its treatment and an underestimation of the role of behavioral risk factors in health, combined with financial difficulties. We recommend that physicians should take a patient-centered approach to raising awareness of behavioral risk factors for type 2 diabetes mellitus, and suggest that the importance of adhering to preventative measures and treatment should be promoted in consultations in Belarus.
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Affiliation(s)
- Anastasiya Sachkouskaya
- Public Health Department and Public Health Services, Gomel State Medical University, Gomel, Belarus
| | - Tamara Sharshakova
- Public Health Department and Public Health Services, Gomel State Medical University, Gomel, Belarus
| | - Dmitry Kovalevsky
- Public Health Department and Public Health Services, Gomel State Medical University, Gomel, Belarus
| | - Maria Rusalenko
- Administration Department, Republican Research Center for Radiation Medicine and Human Ecology, Gomel, Belarus
| | - Irina Savasteeva
- Information and Analytical Department, Republican Research Center for Radiation Medicine and Human Ecology, Gomel, Belarus
| | - Aya Goto
- Center for Integrated Science and Humanities, Fukushima Medical University, Fukushima, Japan
| | | | - Atsushi Kumagai
- Department of Radiation Emergency Medicine, The National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Jumpei Takahashi
- Office of Global Relations, Nagasaki University, Nagasaki, Japan
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Carratalá-Munuera C, Cortés-Castell E, Márquez-Contreras E, Castellano JM, Perez-Paramo M, López-Pineda A, Gil-Guillen VF. Barriers and Solutions to Improve Therapeutic Adherence from the Perspective of Primary Care and Hospital-Based Physicians. Patient Prefer Adherence 2022; 16:697-707. [PMID: 35300358 PMCID: PMC8923680 DOI: 10.2147/ppa.s319084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/03/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To identify the barriers affecting treatment adherence in patients with chronic disease and to determine solutions through the physician's opinion of primary care and hospital settings. METHODS An observational study using the nominal group technique was performed to reach a consensus from experts. A structured face-to-face group discussion was carried out with physicians with more than 10 years of experience in the subject of treatment adherence/compliance in either the primary care setting or the hospital setting. The experts individually rated a list of questions using the Likert scale and prioritized the top 10 questions to identify barriers and seek solutions afterward. The top 10 questions that obtained the maximum score for both groups of experts were prioritized. During the final discussion group, participating experts analyzed the prioritized items and debated on each problem to reach consensual solutions for improvement. RESULTS A total of 17 professionals experts participated in the study, nine of them were from a primary care setting. In the expert group from the primary care setting, the proposed solution for the barrier identified as the highest priority was to simplify treatments, measure adherence and review medication. In the expert group from the hospital setting, the proposed solution for the barrier identified as the highest priority was training on motivational clinical interviews for healthcare workers undergraduate and postgraduate education. Finally, the expert participants proposed implementing an improvement plan with eight key ideas. CONCLUSION A consensual improvement plan to facilitate the control of therapeutic adherence in patients with chronic disease was developed, taking into account expert physicians' opinions from primary care and hospital settings about barriers and solutions to address therapeutic adherence in patients with chronic disease.
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Affiliation(s)
| | - Ernesto Cortés-Castell
- Department of Pharmacology, Pediatrics, and Organic Chemistry, Miguel Hernandez University, San Juan de Alicante, Spain
| | | | - José Maria Castellano
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- Centro Integral de Enfermedades Cardiovasculares (CIEC), Hospital Universitario Monteprincipe, Grupo HM Hospitales, Madrid, Spain
| | | | - Adriana López-Pineda
- Department of Clinical Medicine, Miguel Hernandez University, San Juan de Alicante, Spain
- Correspondence: Adriana López-Pineda, Miguel Hernandez University, Ctra. Nnal. 332 Alicante-Valencia s/n, San Juan de Alicante, 03550, Spain, Tel +1 34 965919309, Email
| | - Vicente F Gil-Guillen
- Department of Clinical Medicine, Miguel Hernandez University, San Juan de Alicante, Spain
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Fu TS, Huang TS, Sun CC, Shyu YC, Chen FP. Impact of bisphosphonates and comorbidities on initial hip fracture prognosis. Bone 2022; 154:116239. [PMID: 34688941 DOI: 10.1016/j.bone.2021.116239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/28/2021] [Accepted: 10/18/2021] [Indexed: 11/29/2022]
Abstract
The aim of this study is to investigate the impact of bisphosphonate treatment on the prognosis of patients with initial hip fracture. Patients aged fifty years and older with initial hip fracture were identified from the Taiwan National Health Insurance Research Database between 2002 and 2011. A multi-state model was established to evaluate the transition between "first to second hip fracture", "first hip fracture to death", and "second hip fracture to death". Transition probability and cumulative hazards were used to compare the prognosis of initial hip fracture in a bisphosphonate treated cohort versus non-treated cohort. In addition, Deyo-Charlson comorbidities, both vertebral and non-vertebral fractures, and cataracts were also included for analysis. After 10-year follow-up, there is decreased cumulative transition probability for both second hip fracture and mortality after both first and second hip fracture in the bisphosphonate treated cohort. Multivariable, transition-specific time-dependent Cox model revealed that bisphosphonate treatment significantly reduced risk for second hip fracture in the first 5 years of the treatment (HR 0.88; 95% CI 0.79-0.99; P: 0.034), first hip fracture mortality (HR 0.88; 95% CI 0.83-0.93; P < 0.001), and second hip fracture mortality in the first 2 years of the treatment (HR 0.78; 95% CI 0.65-0.95; P = 0.011). Female sex, both vertebral and non-vertebral fractures, cataracts, dementia in the first 2 years, and DM with complication were all significantly associated with risk of a second hip fracture. Cerebrovascular disease and hemiplegia comorbidities had less risk of a second hip fracture. The risk of mortality after both first and second hip fracture was significantly associated with congestive heart failure, renal disease, myocardial infarction, and moderate to severe liver disease. Our study demonstrated that bisphosphonate treatment and strict management of comorbidities after the initial hip fracture significantly decrease the risk for a second hip fracture and mortality.
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Affiliation(s)
- Tsai-Sheng Fu
- Department of Orthopaedic Surgery, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan 259, Taiwan; Osteoporosis Prevention and Treatment Center, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Ting-Shuo Huang
- Osteoporosis Prevention and Treatment Center, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; Department of General Surgery, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; Department of Chinese Medicine, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan 259, Taiwan; Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Chi-Chin Sun
- Osteoporosis Prevention and Treatment Center, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; Department of Chinese Medicine, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan 259, Taiwan; Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Yu-Chiau Shyu
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; Institute of Molecular Biology, Academia Sinica, Nankang, 115 Taipei, Taiwan
| | - Fang-Ping Chen
- Department of Medicine, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan 259, Taiwan; Osteoporosis Prevention and Treatment Center, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; Department of Obstetrics and Gynecology, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan.
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Sohn IS, Kim CJ, Yoo BS, Kim BJ, Choi JW, Kim DI, Lee SH, Song WH, Jeon DW, Cha TJ, Kim DK, Lim SH, Nam CW, Shin JH, Kim U, Kwak JJ, Park JB, Cha JH, Kim YJ, Choi J, Lee J. Clinical impact of guideline-based practice and patients' adherence in uncontrolled hypertension. Clin Hypertens 2021; 27:26. [PMID: 34911572 PMCID: PMC8672596 DOI: 10.1186/s40885-021-00183-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Chronic diseases like hypertension need comprehensive lifetime management. This study assessed clinical and patient-reported outcomes and compared them by treatment patterns and adherence at 6 months among uncontrolled hypertensive patients in Korea. Methods This prospective, observational study was conducted at 16 major hospitals where uncontrolled hypertensive patients receiving anti-hypertension medications (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg) were enrolled during 2015 to 2016 and studied for the following 6 months. A review of medical records was performed to collect data on treatment patterns to determine the presence of guideline-based practice (GBP). GBP was defined as: (1) maximize first medication before adding second or (2) add second medication before reaching maximum dose of first medication. Patient self-administered questionnaires were utilized to examine medication adherence, treatment satisfaction and quality of life (QoL). Results A total of 600 patients were included in the study. Overall, 23% of patients were treated based on GBP at 3 months, and the GBP rate increased to 61.4% at 6 months. At baseline and 6 months, 36.7 and 49.2% of patients, respectively, were medication adherent. The proportion of blood pressure-controlled patients reached 65.5% at 6 months. A higher blood pressure control rate was present in patients who were on GBP and also showed adherence than those on GBP, but not adherent, or non-GBP patients (76.8% vs. 70.9% vs. 54.2%, P < 0.001). The same outcomes were found for treatment satisfaction and QoL (P < 0.05). Conclusions This study demonstrated the importance of physicians’ compliance with GBP and patients’ adherence to hypertensive medications. GBP compliance and medication adherence should be taken into account when setting therapeutic strategies for better outcomes in uncontrolled hypertensive patients. Supplementary Information The online version contains supplementary material available at 10.1186/s40885-021-00183-1.
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Affiliation(s)
- Il Suk Sohn
- Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Chong Jin Kim
- Department of Cardiology, CHA University Gangnam Medical Center, Seoul, Republic of Korea.
| | - Byung-Su Yoo
- Wonju Severance Christian Hospital, Yonsei University Health System, Wonju, Republic of Korea
| | - Byung Jin Kim
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Doo-Il Kim
- Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Sang-Hak Lee
- Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woo-Hyuk Song
- Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Dong Woon Jeon
- National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Tae Jun Cha
- Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Dae-Kyeong Kim
- Inje University Busan Paik Hospital, Busan, Republic of Korea
| | | | - Chang-Wook Nam
- Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | | | - Ung Kim
- Yeungnam University Hospital, Daegu, Republic of Korea
| | - Jae-Jin Kwak
- Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Jun-Bean Park
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin-Hye Cha
- Viatris Korea Ltd., Seoul, Republic of Korea
| | | | - Jimi Choi
- Korea University College of Medicine, Seoul, Republic of Korea
| | - Juneyoung Lee
- Korea University College of Medicine, Seoul, Republic of Korea
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Abstract
PURPOSE OF REVIEW Obstructive sleep apnea (OSA) is associated with incident coronary and cerebral vascular disease. The mechanisms underlying this association are thought to include increased sympathetic nervous system activity, oxidative stress, and systemic inflammation, with these effects mediated in part by elevated blood pressure and impaired glucose metabolism. In observational studies, OSA treatment with positive airway pressure (PAP) is associated with a reduction in cardiovascular disease risk. The aim of this review is to evaluate evidence from recent clinical trials that tested the impact of OSA treatment on major cardiovascular disease outcomes. RECENT FINDINGS Multicenter randomized trials have demonstrated a significant, albeit modest, reduction in blood pressure with OSA treatment. Treatment of OSA has generally not demonstrated improvement in type 2 diabetes mellitus, although limited evidence suggests that treatment may be effective in the prediabetic period. However, recent randomized trials of PAP treatment for OSA failed to demonstrate a reduction in incident or recurrent cardiovascular disease events. This may reflect the enrollment of a mostly non-sleepy study sample, as recent evidence suggests that sleepiness is a predictor of adverse cardiovascular outcomes from OSA. PAP treatment of OSA lowers blood pressure and may improve glucose metabolism; however, randomized clinical trials do not indicate a reduction in cardiovascular risk with treatment of minimally symptomatic OSA patients.
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Affiliation(s)
- Daniel J Gottlieb
- VA Boston Healthcare System, 1400 VFW Parkway (111PI), West Roxbury, MA, 02132, USA.
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, Boston, MA, USA.
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.
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Assessment of Metastatic Colorectal Cancer Patients’ Preferences for Biologic Treatments in Germany Using a Discrete Choice Experiment. Clin Colorectal Cancer 2021; 21:122-131. [DOI: 10.1016/j.clcc.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 12/10/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022]
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Gorbenko AV, Skirdenko YP, Nikolaev NA, Livzan MA, Andreev KA, Fedorin MM. Potential adherence to treatment in gastroenterological patients. EXPERIMENTAL AND CLINICAL GASTROENTEROLOGY 2021:134-141. [DOI: 10.31146/1682-8658-ecg-192-8-134-141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
Objective. To assess the level of potential adherence to treatment in patients with gastrointestinal syndromes.Material and Methods. The open-label, cross- sectional study included 264 respondents who underwent preventive examinations. To identify gastroenterological syndromes we used Gastrointestinal Simptom Rating Scale (GSRS) questionnaire, which allows assessing the presence and the intensity of diarrheal, dyspeptic, constipation, refl ux syndrome and abdominal pain syndrome. The study group includes respondents who, according to the results of the GSRS questionnaire, have at least one syndrome (from 2 or more points) (N = 140). The comparison group included participants without gastrointestinal syndromes (N = 124). The level of adherence was assessed using the Quantitative Adherence Assessment Questionnaire (QAA-25). A score of less than 50% corresponds to a low level of adherence; a score between 50% and 75% corresponds to a medium level of adherence. Of 75% and above is considered to be a high and suffi cient level of adherence in the respondent.Results. Absolutely all respondents demonstrated an insuffi cient level of adherence to both drug therapy and medical support and lifestyle modifi cations. One in ten study participants had an medium level of adherence. The other 90% of patients from all groups had a low level of compliance (less than 50%) in all three areas of treatment adherence.Conclusions. Participants in our study were potentially unprepared for adherence to treatment that is consistent with optimal protocols. This demonstrates the need to work with adherence, both using ways to increase adherence and using patientcentered approaches that take into account the individual level of adherence.
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Wu CS, Hsu LY, Pan YJ, Wang SH. Associations Between Antidepressant Use and Advanced Diabetes Outcomes in Patients with Depression and Diabetes Mellitus. J Clin Endocrinol Metab 2021; 106:e5136-e5146. [PMID: 34259856 DOI: 10.1210/clinem/dgab443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Comorbid depression in patients with diabetes deteriorates the prognosis. Antidepressants might attenuate the adverse effects of depression; however, they are associated with cardiometabolic adverse effects. OBJECTIVE This study aimed to explore the association between antidepressant treatment and advanced diabetic complications and mortality among patients with depression and diabetes mellitus. METHODS We conducted a nationwide retrospective cohort study of 36 276 patients with depression and newly treated diabetes mellitus using Taiwan's universal health insurance database. Antidepressant treatment patterns within a 6-month window were classified into none, poor, partial, and regular use, and we accounted for time-dependent variables in the Cox proportional hazards regression analysis with adjustment for time-dependent comorbidity and concomitant use of medications. Different classes of antidepressants were compared. Macro- and microvascular complications, as well as all-cause mortality, were the main outcomes. Benzodiazepines were chosen as negative control exposure. RESULTS Compared with poor use of antidepressants, regular use was associated with a 0.92-fold decreased risk of macrovascular complications and a 0.86-fold decreased risk of all-cause mortality but not associated with microvascular complications. Regular use of selective serotonin reuptake inhibitors was associated with a 0.83- and 0.75-fold decreased risk of macrovascular complications and all-cause mortality, respectively. Regular use of tricyclic or tetracyclic antidepressants was associated with a 0.78-fold decreased risk of all-cause mortality. Regular use of benzodiazepine showed no association with diabetic outcomes. CONCLUSION Regular antidepressant use was associated with lower risk of advanced diabetic complications compared with poor adherence. Clinicians should emphasize antidepressant treatment adherence among patients with depression and diabetes mellitus.
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Affiliation(s)
- Chi-Shin Wu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, 100, Taiwan
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, 350, Taiwan
| | - Le-Yin Hsu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, 100, Taiwan
| | - Yi-Jiun Pan
- School of Medicine, China Medical University, Taichung, 404, Taiwan
| | - Shi-Heng Wang
- Department of Occupational Safety and Health, China Medical University, Taichung, 406, Taiwan
- Department of Public Health, China Medical University, Taichung, 406, Taiwan
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Paulus MP, Kuplicki R, Victor TA, Yeh HW, Khalsa SS. Methylphenidate augmentation of escitalopram to enhance adherence to antidepressant treatment: a pilot randomized controlled trial. BMC Psychiatry 2021; 21:582. [PMID: 34798853 PMCID: PMC8603485 DOI: 10.1186/s12888-021-03583-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/29/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Adherence to treatment, i.e. the extent to which a patient's therapeutic engagement coincides with the prescribed treatment, is among the most important problems in mental health care. The current study investigated the influence of pairing an acute positive reinforcing dopaminergic/noradrenergic effect (methylphenidate, MPH) with a standard antidepressant on the rates of adherence to medication treatment. The primary objective of this study was to determine whether MPH + escitalopram resulted in higher rates of medication adherence relative to placebo + escitalopram. METHODS Twenty participants with moderate to severe depression were 1-1 randomized to either (1) 5 mg MPH + 10 mg escitalopram or (2) placebo + 10 mg escitalopram with the possibility for a dose increase at 4 weeks. A Bayesian analysis was conducted to evaluate the outcomes. RESULTS First, neither percent Pill count nor Medication Electronic Monitoring System adherence showed that MPH was superior to placebo. In fact, placebo showed slightly higher adherence rates on the primary (7.82% better than MPH) and secondary (7.07% better than MPH) outcomes. There was a less than 25% chance of MPH augmentation showing at least as good or better adherence than placebo. Second, both groups showed a significant effect of treatment on the QIDS-SR with a median effect of an 8.6-point score reduction. Third, neither subjective measures of adherence attitudes nor socio-demographic covariates had a significant influence on the primary or secondary outcome variables. CONCLUSIONS These data do not support the use of MPH to increase adherence to antidepressant medication in individuals with moderate to severe depression. CLINICALTRIALS. GOV IDENTIFIER NCT03388164 , registered on 01/02/2018.
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Affiliation(s)
- Martin P. Paulus
- grid.417423.70000 0004 0512 8863Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK 74136-3326 USA ,grid.267360.60000 0001 2160 264XOxley College of Health Sciences, The University of Tulsa, Tulsa, OK USA
| | - Rayus Kuplicki
- grid.417423.70000 0004 0512 8863Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK 74136-3326 USA
| | - Teresa A. Victor
- grid.417423.70000 0004 0512 8863Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK 74136-3326 USA
| | - Hung-Wen Yeh
- grid.417423.70000 0004 0512 8863Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK 74136-3326 USA ,grid.239559.10000 0004 0415 5050Health Services & Outcomes Research, Children’s Mercy Hospital, Kansas City, MO USA
| | - Sahib S. Khalsa
- grid.417423.70000 0004 0512 8863Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK 74136-3326 USA ,grid.267360.60000 0001 2160 264XOxley College of Health Sciences, The University of Tulsa, Tulsa, OK USA
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121
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Lasala R, Santoleri F. Association between adherence to oral therapies in cancer patients and clinical outcome: A systematic review of the literature. Br J Clin Pharmacol 2021; 88:1999-2018. [PMID: 34784654 DOI: 10.1111/bcp.15147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 01/23/2023] Open
Abstract
AIMS Adherence to therapy is a key factor in successful treatment. The aim of this systematic review is to assess the extent to which patients with better adherence to oral therapy have better clinical outcomes among cancer patients. METHODS All studies published in PubMed up to 20 October 2020, which considered the use of oral anticancer drugs for cancer patients and which correlated treatment adherence with a clinical outcome, were considered. RESULTS From the 42 studies considered in the systematic review, 14 were for oncological indications and 28 for haematological indications. There was considerable variance in calculation methods, outcomes considered, and in the definitions of adherence. However, it emerged that most studies reported a significant correlation between adherence to therapy and clinical outcome. CONCLUSION As adherence to therapy is a key factor in achieving a better clinical outcome, future studies with large samples, robust endpoints and the use of at least two methods of assessing adherence would be desirable in order to produce more robust evidence.
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Better Medications Adherence Lowers Cardiovascular Events, Stroke, and All-Cause Mortality Risk: A Dose-Response Meta-Analysis. J Cardiovasc Dev Dis 2021; 8:jcdd8110146. [PMID: 34821699 PMCID: PMC8624664 DOI: 10.3390/jcdd8110146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 12/02/2022] Open
Abstract
Aims: We investigated the association between vascular medication adherence, assessed by different methods, and the risk of cardio-cerebrovascular events and all-cause mortality. Methods: A meta-analysis with a systematic search of PubMed, Web of Science, EMBASE, and Cochrane databases from inception date to 21 June 2021 was used to identify relevant studies that had evaluated the association between cardiovascular medication adherence levels and cardiovascular events (CVEs), stroke, and all-cause mortality risks. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects meta-analysis. Restricted cubic splines were used to model the dose-response association. Results: We identified 46 articles in the dose-response meta-analysis. The dose-response analysis indicated that a 20% increment in cardiovascular medication, antihypertensive medication, and lipid-lowering medication adherence level were associated with 9% (RR: 0.91, 95% CI 0.88–0.94), 7% (RR 0.93, 95% CI: 0.84–1.03), and 10% (RR 0.90, 95% CI: 0.88–0.92) lowers risk of CVEs, respectively. The reduced risk of stroke respectively was 16% (RR: 0.84, 95% CI: 0.81–0.87), 17% (RR 0.83, 95% CI: 0.78–0.89), and 13% (RR 0.87, 95% CI: 0.84–0.91). The reduced risk of all-cause mortality respectively was 10% (RR: 0.90, 95% CI: 0.87–0.92), 12% (RR 0.88, 95% CI: 0.82–0.94), and 9% (RR 0.91, 95% CI: 0.89–0.94). Conclusions: A better medication adherence level was associated with a reduced risk of cardio-cerebrovascular events and all-cause mortality.
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Choi GW, Lee S, Kang DW, Kim JH, Kim JH, Cho HY. Long-acting injectable donepezil microspheres: Formulation development and evaluation. J Control Release 2021; 340:72-86. [PMID: 34715262 DOI: 10.1016/j.jconrel.2021.10.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/17/2021] [Indexed: 11/15/2022]
Abstract
Novel formulations of donepezil (DNP)-loaded microspheres based on a bio-degradable polymer of poly(lactic-co-glycolic acid) (PLGA) with a one-month duration of effect were developed, aimed at reducing dosing frequency and adverse effects and improving patient adherence. The spherical and monodispersed DNP-loaded microspheres were precisely fabricated by the Inventage Lab Precision Particle Fabrication method (IVL-PPFM®) based on micro-electromechanical systems (MEMS) and microfluidic technology. The types of polymers and end-groups, the drug/polymer ratio (DPR), and the routes of administration for DNP were studied to ensure an effective concentration and desired duration. Laser-light particle size analysis and scanning electron microscopy were used to characterization. Also, non-clinical animal models of beagle dogs are used to optimize DNP formulations and evaluate their pharmacokinetic properties. The PK results showed that the DPR was a critical factor in determining the exposure level and duration of DNR release. Furthermore, the lactide ratio, which varied depending upon the type of polymer, determined the hydrophobic interaction and was also an important factor affecting the desired DNP release. Since DNP shows a large inter-species variation between dogs and humans, PK modeling and simulation of the reference drug (i.e., Aricept®) and DNP-loaded microspheres were used for formulation development to overcome and interpret these variations. In addition, the developed PK model was extrapolated to humans using the estimated PK parameter and published clinical pharmacology data for DNP. The predicted PK profile of the DNP-loaded microsphere in humans showed that the formulation with PLGA 7525A and the DPR of 1/9 could maintain drug concentration for a month and could control initial burst release. The data obtained from the study could be used as scientific evidence for decision-making in future formulation development.
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Affiliation(s)
- Go-Wun Choi
- College of Pharmacy, CHA University, 335 Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13488, Republic of Korea
| | - Sangno Lee
- Headquarter, Inventage Lab, Inc., 12, Yanghyeon-ro 405beon-gil, Jungwon-gu, Seongnam-si, Gyeonggi-do 13438, Republic of Korea
| | - Dong Wook Kang
- College of Pharmacy, CHA University, 335 Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13488, Republic of Korea
| | - Ju Hee Kim
- Headquarter, Inventage Lab, Inc., 12, Yanghyeon-ro 405beon-gil, Jungwon-gu, Seongnam-si, Gyeonggi-do 13438, Republic of Korea
| | - Ju Hee Kim
- College of Pharmacy, CHA University, 335 Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13488, Republic of Korea
| | - Hea-Young Cho
- College of Pharmacy, CHA University, 335 Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13488, Republic of Korea.
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Ngandu T, Lehtisalo J, Korkki S, Solomon A, Coley N, Antikainen R, Bäckman L, Hänninen T, Lindström J, Laatikainen T, Paajanen T, Havulinna S, Peltonen M, Neely AS, Strandberg T, Tuomilehto J, Soininen H, Kivipelto M. The effect of adherence on cognition in a multidomain lifestyle intervention (FINGER). Alzheimers Dement 2021; 18:1325-1334. [PMID: 34668644 DOI: 10.1002/alz.12492] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/02/2021] [Accepted: 09/07/2021] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Lifestyle interventions may prevent cognitive decline, but the sufficient dose of intervention activities and lifestyle changes is unknown. We investigated how intervention adherence affects cognition in the FINGER trial (pre-specified subgroup analyses). METHODS FINGER is a multicenter randomized controlled trial examining the efficacy of multidomain lifestyle intervention (ClinicalTrials.gov NCT01041989). A total of 1260 participants aged 60 to 77 with increased dementia risk were randomized to a lifestyle intervention and control groups. Percentage of completed intervention sessions, and change in multidomain lifestyle score (self-reported diet; physical, cognitive, and social activity; vascular risk) were examined in relation to change in Neuropsychological Test Battery (NTB) scores. RESULTS Active participation was associated with better trajectories in NTB total and all cognitive subdomains. Improvement in lifestyle was associated with improvement in NTB total and executive function. DISCUSSION Multidomain lifestyle changes are beneficial for cognitive functioning, but future interventions should be intensive enough, and supporting adherence is essential.
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Affiliation(s)
- Tiia Ngandu
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Jenni Lehtisalo
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
| | - Saana Korkki
- Department of Psychology, University of Cambridge, Cambridge, UK.,Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Alina Solomon
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Stockholm, Sweden.,Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland.,Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
| | - Nicola Coley
- Faculté de Médecine, INSERM-University of Toulouse UMR1295 (CERPOP), Toulouse, France.,Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Riitta Antikainen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Lars Bäckman
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Tuomo Hänninen
- Neurocenter, Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Jaana Lindström
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tiina Laatikainen
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Joint municipal authority for North Karelia social and health services (Siun sote), Joensuu, Finland
| | - Teemu Paajanen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Satu Havulinna
- Department of Public Health and Welfare, Functioning and Service Needs Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Markku Peltonen
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Anna Stigsdotter Neely
- Department of Social Psychological Sciences, Karlstad University, Karlstad, Sweden.,Engineering Psychology, Luleå University of Technology, Luleå, Sweden
| | - Timo Strandberg
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Department of Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Jaakko Tuomilehto
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland.,Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.,South Ostrobothnia Central Hospital, Seinäjoki, Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland.,Neurocenter, Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Miia Kivipelto
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Stockholm, Sweden.,Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Theme Aging, Karolinska University Hospital, Solna, Sweden
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125
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de Moura AP, e Sousa HFP, Dinis MAP, Ferros LL, Jongenelen I, Negreiros J. Outpatient Drug and Alcohol Treatment Programs: Predictors of Treatment Effectiveness. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-020-00235-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
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Achouri MY, Tounsi F, Messaoud M, Senoussaoui A, Ben Abdelaziz A. Prevalence of poor medication adherence in type 2 diabetics in North Africa. Systematic review and meta-analysis. LA TUNISIE MEDICALE 2021; 99:932-945. [PMID: 35288893 PMCID: PMC8972177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Medication adherence is the cornerstone of the successful drug management of a chronic disease. AIM To develop a systematic review and meta-analysis of the prevalence and the factors associated with non-adherence in patients with type 2 diabetes in North African countries. METHODS A literature search was conducted on Medline via Pubmed with a complementary search on Google Scholar. The meta-analysis was conducted using the Metaprop function of R software. The Cochrane Q test and Higgins I² statistic were used to estimate the heterogeneity. RESULTS In total, 16 studies measuring the prevalence of medication adherence in North African countries were selected in this systematic review. The combined prevalence of non-adherence was 38% (95% CI 30%-47%) with a random-effects model. The meta-analysis revealed a significant heterogeneity between studies (I² = 96%, p <0.01). Factors associated with non-adherence in type 2 diabetics were education level, social security coverage, therapeutic education, cost of medication, socioeconomic level, the duration of diabetes, unbalanced diabetic diet, polypharmacy, female gender, family support and age. CONCLUSION The combined prevalence of non-adherence among type 2 diabetics in North Africa was high and multifactorial, requiring global and integrated management by patients, physicians and pharmacists.
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Affiliation(s)
- Mohamed Yacine Achouri
- 1. Département de Pharmacie, Faculté de Médecine, Université Djilali Liabès de Sidi Bel-Abbès (Algérie)
| | - Feriel Tounsi
- 3. Département de Pharmacie, Faculté de Médecine, Université Ahmad Ben Bella d’Oran 1
| | - Malika Messaoud
- 3. Département de Pharmacie, Faculté de Médecine, Université Ahmad Ben Bella d’Oran 1
| | - Amel Senoussaoui
- 3. Département de Pharmacie, Faculté de Médecine, Université Ahmad Ben Bella d’Oran 1
| | - Ahmed Ben Abdelaziz
- 4. Directeur du Laboratoire de Recherche LR19SP01 «Mesure et Appui à la Performance des Etablissements de Santé». Hôpital Sahloul. Université de Sousse (Tunisie)
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127
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Loots E, Goossens E, Vanwesemael T, Morrens M, Van Rompaey B, Dilles T. Interventions to Improve Medication Adherence in Patients with Schizophrenia or Bipolar Disorders: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10213. [PMID: 34639510 PMCID: PMC8508496 DOI: 10.3390/ijerph181910213] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022]
Abstract
Adherence to prescribed medication regimes improves outcomes for patients with severe mental illness such as schizophrenia or bipolar disorders. The aim of this systematic review and meta-analysis was to compare the effectiveness among interventions to improve medication adherence in patients with schizophrenia or bipolar disorders. Literature published in the last decade was searched for interventions studies to improve adherence in patients with schizophrenia or a bipolar disorder. Interventions were categorised on the basis of type, and the context and effectiveness of the interventions were described. Two review authors independently extracted and assessed data, following criteria outlined by the Cochrane Handbook for Systematic Reviews of Interventions. The GRADEPro (McMaster University, 2020, Ontario, Canada) was used for assessing the quality of the evidence. Twenty-three publications met the selection criteria. Different types of interventions aiming to improve adherence were tested: educational, behavioural, family-based, technological, or a combination of previous types. Meta-analysis could be performed for 10 interventions. When considered separately by subgroups on the basis of intervention type, no significant differences were found in adherence among interventions (p = 0.29; I2 = 19.9%). This review concluded that successful interventions used a combination of behavioural and educational approaches that seem easy to implement in daily practice.
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Affiliation(s)
- Elke Loots
- Centre For Research and Innovation in Care (CRIC), Department of Nursing Science and Midwifery, Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (E.G.); (T.V.); (B.V.R.); (T.D.)
| | - Eva Goossens
- Centre For Research and Innovation in Care (CRIC), Department of Nursing Science and Midwifery, Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (E.G.); (T.V.); (B.V.R.); (T.D.)
- Department of Public Health and Primary Care, University of Leuven, 3000 Leuven, Belgium
- Research Foundation Flanders (FWO), 1000 Brussels, Belgium
- Department of Patient Care, Antwerp University Hospital (UZA), 2610 Antwerp, Belgium
| | - Toke Vanwesemael
- Centre For Research and Innovation in Care (CRIC), Department of Nursing Science and Midwifery, Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (E.G.); (T.V.); (B.V.R.); (T.D.)
| | - Manuel Morrens
- Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, 2610 Antwerp, Belgium;
| | - Bart Van Rompaey
- Centre For Research and Innovation in Care (CRIC), Department of Nursing Science and Midwifery, Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (E.G.); (T.V.); (B.V.R.); (T.D.)
| | - Tinne Dilles
- Centre For Research and Innovation in Care (CRIC), Department of Nursing Science and Midwifery, Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (E.G.); (T.V.); (B.V.R.); (T.D.)
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128
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Federman AD, Barry M, Moas E, Davenport C, McGeough C, Tejeda M, Rivera L, Gutierrez S, Mejias H, Belton D, Mathew C, Lindenauer PK, McDermott D, O'Conor R, Wolf MS, Wisnivesky JP. Protocol for a feasibility randomized trial of self-management support for people with chronic obstructive pulmonary disease using lay health coaches. Contemp Clin Trials 2021; 110:106570. [PMID: 34560265 DOI: 10.1016/j.cct.2021.106570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
Challenges with self-management are a major contributor to poor outcomes among adults with chronic obstructive pulmonary disease (COPD). The causes of poor self-management in COPD are manifold, and they arise from physical, cognitive, socioeconomic, environmental and societal sources. To address this complexity, we developed the Supporting self-Management Behaviors in Adults with COPD (SaMBA-COPD) model, which uses lay health coaches to identify a patient's barriers to effective COPD self-management and provide tailored support to help them overcome those barriers, reduce their symptoms and need for urgent care and improve their quality of life. The 6-month intervention includes referral of patients to a pharmacist for prescription of antibiotic and oral steroid "rescue packs" and support for a structured home exercise routine. All interactions of coaches and patients will take place by telephone or video call. We will test the feasibility and preliminary efficacy of SaMBA-COPD in a trial of 58 patients randomized 1:1 to the intervention or a COPD education control. Outcomes will be assessed at 6 and 9 months. Data from the trial will be used to inform the design of a fully powered, multi-site randomized trial of the intervention.
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Affiliation(s)
- Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Michele Barry
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Esther Moas
- Mount Sinai Health System, New York, NY, United States of America
| | - Claire Davenport
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | | | | | - Leny Rivera
- City Health Works, New York, NY, United States of America
| | | | - Hilda Mejias
- City Health Works, New York, NY, United States of America
| | - Destini Belton
- City Health Works, New York, NY, United States of America
| | - Cathleen Mathew
- Mount Sinai Hospital, New York, NY, United States of America
| | - Peter K Lindenauer
- Institute for Healthcare Delivery and Population Sciences, University of Massachusetts Medical School-Baystate, Springfield, MA, United States of America
| | | | - Rachel O'Conor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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129
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Kirsch V, Matthes J. A simulation-based module in pharmacology education reveals and addresses medical students' deficits in leading prescription talks. Naunyn Schmiedebergs Arch Pharmacol 2021; 394:2333-2341. [PMID: 34522985 PMCID: PMC8514349 DOI: 10.1007/s00210-021-02151-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/02/2021] [Indexed: 11/29/2022]
Abstract
Although doctor-patient communication is essential for drug prescription, the literature reveals deficits in this area. An educational approach at the Cologne medical faculty aims at identifying and addressing those deficits in medical students.Fifth-year medical students first conducted a simulated prescription talk spontaneously. Subsequently, the conversation was discussed with peer students. A pharmacist moderated the discussion based upon a previously developed conversation guide. Afterwards, the same student had the conversation again, but as if for the first time. Conversations were video-recorded, transcribed and subjected to quantitative content analysis. Four days after the simulation, the students who conducted the talk, those who observed and discussed it, and students who did neither, completed a written test that focused on the content of an effective prescription talk.Content analysis revealed clear deficits in spontaneously led prescription talks. Even essential information as on adverse drug reactions were often lacking. Prescription talks became clearly more informative and comprehensive after the short, guided peer discussion. With regard to a comprehensive, informative prescription talk, the written test showed that both the students who conducted the talk and those who only observed it performed clearly better than the students who did not participate in the educational approach.Deficits regarding prescription talks are present in 5th year medical students. We provide an approach to both identify and address these deficits. It thus may be an example for training medical students in simulated and clinical environments like the EACPT recommended to improve pharmacology education.
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Affiliation(s)
- Verena Kirsch
- Center of Pharmacology, Institute II, University of Cologne, Gleueler Strasse 24, 50931, Cologne, Germany
| | - Jan Matthes
- Center of Pharmacology, Institute II, University of Cologne, Gleueler Strasse 24, 50931, Cologne, Germany.
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130
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Gavina C. Patient adherence to direct oral anticoagulants: To take or not to take, is it a patient's choice? Rev Port Cardiol 2021; 40:677-678. [PMID: 34503706 DOI: 10.1016/j.repce.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Cristina Gavina
- Serviço de Cardiologia, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.
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131
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Foley L, Larkin J, Lombard-Vance R, Murphy AW, Hynes L, Galvin E, Molloy GJ. Prevalence and predictors of medication non-adherence among people living with multimorbidity: a systematic review and meta-analysis. BMJ Open 2021; 11:e044987. [PMID: 34475141 PMCID: PMC8413882 DOI: 10.1136/bmjopen-2020-044987] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This systematic review aimed to describe medication non-adherence among people living with multimorbidity according to the current literature, and synthesise predictors of non-adherence in this population. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. PubMed, EMBASE, CINAHL and PsycINFO were searched for relevant articles published in English language between January 2009 and April 2019. Quantitative studies reporting medication non-adherence and/or predictors of non-adherence among people with two or more chronic conditions were included in the review. A meta-analysis was conducted with a subgroup of studies that used an inclusive definition of multimorbidity to recruit participants, rather than seeking people with specific conditions. Remaining studies reporting prevalence and predictors of non-adherence were narratively synthesised. RESULTS The database search produced 10 998 records and a further 75 were identified through other sources. Following full-text screening, 178 studies were included in the review. The range of reported non-adherence differed by measurement method, at 76.5% for self-report, 69.4% for pharmacy data, and 44.1% for electronic monitoring. A meta-analysis was conducted with eight studies (n=8949) that used an inclusive definition of multimorbidity to recruit participants. The pooled prevalence of non-adherence was 42.6% (95% CI: 34.0 - 51.3%, k=8, I2=97%, p<0.01). The overall range of non-adherence was 7.0%-83.5%. Frequently reported correlates of non-adherence included previous non-adherence and treatment-related beliefs. CONCLUSIONS The review identified a heterogeneous literature in terms of conditions studied, and definitions and measures of non-adherence used. Results suggest that future attempts to improve adherence among people with multimorbidity should determine for which conditions individuals require most support. The variable levels of medication non-adherence highlight the need for more attention to be paid by healthcare providers to the impact of multimorbidity on chronic disease self-management. PROSPERO REGISTRATION NUMBER CRD42019133849.
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Affiliation(s)
- Louise Foley
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - James Larkin
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Richard Lombard-Vance
- Department of Psychology, National University of Ireland Maynooth, Maynooth, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
- HRB Primary Care Clinical Trials Network Ireland, National University of Ireland Galway, Galway, Ireland
| | - Lisa Hynes
- Health Programmes, Croí Heart & Stroke Centre, Galway, Ireland
| | - Emer Galvin
- School of Pharmacy & Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gerard J Molloy
- School of Psychology, National University of Ireland Galway, Galway, Ireland
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132
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Gavina C. Patient adherence to direct oral anticoagulants: To take or not to take, is it a patient's choice? Rev Port Cardiol 2021. [DOI: 10.1016/j.repc.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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133
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Yfantopoulos J, Protopapa M, Chantzaras A, Yfantopoulos P. Doctors' views and strategies to improve patients' adherence to medication. Hormones (Athens) 2021; 20:603-611. [PMID: 33914291 PMCID: PMC8082220 DOI: 10.1007/s42000-021-00294-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/18/2021] [Indexed: 11/30/2022]
Affiliation(s)
- John Yfantopoulos
- MBA-Health, National and Kapodistrian University of Athens, 6 Themistokleous Str, Athens, Greece.
| | - Marianna Protopapa
- MBA-Health, National and Kapodistrian University of Athens, 6 Themistokleous Str, Athens, Greece
| | - Athanasios Chantzaras
- MBA-Health, National and Kapodistrian University of Athens, 6 Themistokleous Str, Athens, Greece
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134
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Impact of pharmacist-led shared medication reviews on adherence among polymedicated older patients: an observational retrospective French study. J Am Pharm Assoc (2003) 2021; 62:150-156.e1. [PMID: 34548232 DOI: 10.1016/j.japh.2021.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Inappropriate medication use or suboptimal medication adherence among polymedicated older patients is a public health concern. To tackle this issue, a pharmacist-led shared medication review (SMR) system was implemented in French community pharmacies in March 2018. SMR is an analysis of the drug treatments of the older patient with multiple medications. SMR takes place in the form of several interviews, at the pharmacy with the pharmacist, in a confidential space. OBJECTIVES This observational real-world study evaluated the impact of the SMR service on medication adherence among polymedicated older patients in France. The risk of drug-related iatrogenic events in this population and the extent to which pharmacist SMR recommendations were followed by prescribers were also assessed. METHODS Data were collected using the Observia webtool made by Observia society, a purpose-built digital platform distributed nationwide to community pharmacies to facilitate the SMR process. RESULTS Data were analyzed from 439 patients (aged 65-75 years or older) who had completed their SMR at one of 297 French community pharmacies equipped with the Observia webtool. Overall, 186 patients had suboptimal adherence before SMR; 47% of these patients (n = 88) improved to have good adherence after completing the review. The rate of SMR-recommended prescription changes implemented by prescribers was low (14.7%; 38 of 258), with changes being implemented precisely as recommended in 47.4% of cases (n = 18). Potential iatrogenic events were identified in 20 patients. CONCLUSIONS Although the SMR service is in the early stages of implementation in France, this study revealed that the process had a positive impact on medication adherence among older polymedicated patients. However, improvements are needed to reinforce prescriber and patient confidence in the system and further improve health outcomes.
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135
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Passaglia LG, Brant LCC, Silva JLPD, Nascimento BR, Ribeiro ALP. Text Messages to Promote Secondary Prevention after Acute Coronary Syndrome (IMPACS trial). INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20200378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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136
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Examining Adherence to Medication in Patients With Atrial Fibrillation: The Role of Medication Beliefs, Attitudes, and Depression. J Cardiovasc Nurs 2021; 35:337-346. [PMID: 32084080 DOI: 10.1097/jcn.0000000000000650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND/OBJECTIVES This study examined whether beliefs about medicines, drug attitudes, and depression independently predicted anticoagulant and antiarrhythmic adherence (focusing on the implementation phase of nonadherence) in patients with atrial fibrillation (AF). METHODS This cross-sectional study was part of a larger longitudinal study. Patients with AF (N = 118) completed the Patient Health Questionnaire-8. The Beliefs about Medicines Questionnaire, Drug Attitude Inventory, and Morisky-Green-Levine Medication Adherence Scale (self-report adherence measure), related to anticoagulants and antiarrhythmics, were also completed. Correlation and multiple logistic regression analyses were conducted. RESULTS There were no significant differences in nonadherence to anticoagulants or antiarrhythmics. Greater concerns (r = 0.23, P = .01) were significantly, positively associated with anticoagulant nonadherence only. Depression and drug attitudes were not significantly associated with anticoagulant/antiarrhythmic adherence. Predictors reliably distinguished adherers and nonadherers to anticoagulant medication in the regression model, explaining 14% of the variance, but only concern beliefs (odds ratio, 1.20) made a significant independent contribution to prediction (χ = 11.40, P = .02, with df = 4). When entered independently into a regression model, concerns (odds ratio, 1.24) significantly explained 10.3% of the variance (χ = 7.97, P = .01, with df = 1). Regressions were not significant for antiarrhythmic medication (P = .30). CONCLUSIONS Specifying medication type is important when examining nonadherence in chronic conditions. Concerns about anticoagulants, rather than depression, were significantly associated with nonadherence to anticoagulants but not antiarrhythmics. Anticoagulant concerns should be targeted at AF clinics, with an aim to reduce nonadherence and potentially modifiable adverse outcomes such as stroke.
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137
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Kronish IM, Thorpe CT, Voils CI. Measuring the multiple domains of medication nonadherence: findings from a Delphi survey of adherence experts. Transl Behav Med 2021; 11:104-113. [PMID: 31580451 DOI: 10.1093/tbm/ibz133] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Consensus on a gold-standard measure of patient medication nonadherence has been elusive, in part because medication nonadherence involves multiple, distinct behaviors across three phases (initiation, implementation, and persistence). To assess these behaviors, multiple measurement approaches may be needed. The purpose of this study was to identify expert-recommended approaches to measuring nonadherence behaviors. Thirty medication nonadherence experts were e-mailed two consecutive surveys. In both, respondents rated their agreement with definitions of nonadherence behaviors and measurement approaches. In the second survey, respondents rated the suitability of each measurement approach for assessing each behavior and identified the optimal measurement approach for each behavior. Consensus was achieved for eight patient medication nonadherence behaviors: not filling initial prescription and not taking first dose (noninitiation); refilling prescription late, missing doses, taking extra doses, taking doses at wrong time, and improperly administering medication (incorrect implementation); and discontinuing medication early (nonpersistence). Consensus was achieved for seven measurement approaches: self-report, prescription fill data, pill count, drug levels, electronic drug monitoring (EDM), smart technology, and direct observation. Self-report questionnaires were most commonly rated "at least somewhat suitable" for measuring behaviors. EDM was rated as optimal for measuring missing doses, taking extra doses, and taking doses at the wrong time. Prescription fill data were rated as optimal for not filling initial prescription, refilling late, and discontinuing. Direct observation was rated as optimal for measuring improper administration. Suitable and optimal measurement approaches varied across nonadherence behaviors. Researchers should select the measurement approach best suited to assessing the behavior(s) targeted in their research.
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Affiliation(s)
- Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Carolyn T Thorpe
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina, Eshelman School of Pharmacy, Chapel Hill, NC, USA.,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System's, Pittsburgh, PA, USA
| | - Corrine I Voils
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Center for Health Services Research in Primary Care, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
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Bekker CL, Aslani P, Chen TF. The use of medication adherence guidelines in medication taking behaviour research. Res Social Adm Pharm 2021; 18:2325-2330. [PMID: 34393079 DOI: 10.1016/j.sapharm.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 08/10/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
Medication nonadherence continues to be a serious issue in a range of long-term medical conditions and has been studied extensively over the past few decades. However, despite the plethora of research studies on medication adherence, poor methodological rigour in many studies has contributed to limited generalisability of the positive findings, limited impact on patients' medication adherence, and inability to compare between studies. This paper focuses on current guidelines designed specifically for research on medication adherence. It discusses key elements to consider during study design, selection of adherence measurements, and reporting on medication adherence research, to ensure a higher quality of research in medication adherence. Overall, there appears to be variations in adherence terminology reported in the literature despite improvements in defining medication taking behaviour and the availability of taxonomies. In addition, limited guidance exists on how best to measure adherence. Recommendations are provided on appropriate adherence measures for the adherence behaviour being investigated, including careful consideration of adherence concepts, validity of adherence instruments, appropriate instrument selection, definition of nonadherence threshold, and how to report medication adherence. Improving adherence research requires greater clarity and standardisation of descriptions of nonadherence behaviour, increased methodological rigour in study designs, better selection of adherence measurements, and comprehensive reporting.
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Affiliation(s)
- Charlotte L Bekker
- Radboud University Medical Center, Research Institute for Health Sciences, Department of Pharmacy, Nijmegen, the Netherlands.
| | - Parisa Aslani
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Timothy F Chen
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
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139
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Thom B, Benedict C, Friedman DN, Watson SE, Zeitler MS, Chino F. Economic distress, financial toxicity, and medical cost-coping in young adult cancer survivors during the COVID-19 pandemic: Findings from an online sample. Cancer 2021; 127:4481-4491. [PMID: 34351638 PMCID: PMC8426858 DOI: 10.1002/cncr.33823] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 12/14/2022]
Abstract
Background Young adult (YA) cancer survivors are at risk for financial toxicity during and after cancer treatment. Financial toxicity has been associated with medical‐related cost‐coping behaviors such as skipping or delaying treatment. The coronavirus disease 2019 (COVID‐19) pandemic has resulted in dire economic consequences that may worsen financial hardship among young survivors. Methods This was a cross‐sectional survey; data collection occurred online. A convenience sample was recruited through YA cancer advocacy groups and social media. Negative economic events associated with the COVID‐19 pandemic (eg, income loss, increased debt, and decreased job security) and medical‐related cost‐coping were documented. A validated measure assessed cancer‐related financial toxicity. Results Participants (N = 212) had a mean age of 35.3 years at survey completion and a mean age of 27.4 years at diagnosis. Financial toxicity (mean, 14.0; SD, 9.33) was high. Two‐thirds of the sample experienced at least 1 negative economic event during COVID‐19, and 71% engaged in at least 1 medical cost‐coping behavior. Cost‐coping and pandemic‐related negative economic events were significantly correlated with cancer‐related financial toxicity. In multivariable analyses, pandemic‐related negative economic events and financial toxicity were associated with cost‐coping. Conclusions Acute negative economic events associated with the COVID‐19 pandemic may exacerbate cancer‐related financial toxicity and overall financial hardship among YAs and lead to cost‐coping behaviors that can compromise survivorship care and health outcomes. Multilevel, systematic interventions are needed to address the financial needs of YA survivors after the global pandemic. This study illustrates how the acute negative economic events associated with the coronavirus disease 2019 pandemic may have exacerbated existing cancer‐related financial toxicity and general financial hardship among young adult cancer survivors. These negative economic events and financial toxicity are associated with cost‐coping behaviors that can compromise survivorship care and health outcomes.
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Affiliation(s)
- Bridgette Thom
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Catherine Benedict
- Stanford Cancer Institute, Stanford University School of Medicine, Palo Alto, California
| | - Danielle N Friedman
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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140
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Casellas F, González-Lama Y, Ginard Vicens D, García-López S, Muñoz F, Marín Sánchez L, Camacho L, Cabez A, Fortes P, Gómez S, Bella Castillo P, Barreiro-de Acosta M. Adherence improvement in patients with ulcerative colitis: a multidisciplinary consensus document. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 114:156-165. [PMID: 34254522 DOI: 10.17235/reed.2021.8130/2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES 1)To analyze evidence about poor adherence / non-adherence including their prevalences, associated factors, and interventions in ulcerative colitis (UC) patients; 2)To provide a framework to improve poor adherence / non-adherence. METHODS A qualitative approach was applied. A literature review was performed using Medline. Primary searches were performed with Mesh and free texts to identify articles that analyzed prevalence, causes, associated factors, and interventions designed to improve poor adherence/ non-adherence in UC patients. The studies' quality was evaluated using the Oxford scale. The results were presented and discussed in a nominal group meeting, comprising a multidisciplinary committee of six gastroenterologists, one psychologist, one nurse, and one patient. Several overarching principles and recommendations were generated. A consensus procedure was implemented via a Delphi process during which each committee member produced a score ranging from 0 = totally disagree to 10 = totally agree. Agreement was considered if at least 70% of the participants voted ≥7. RESULTS The literature review included 75 articles. Non-adherence rates ranged from 7%-72%. We found a great variability in the methods employed to assess adherence, associated factors, and interventions designed to improve adherence. Overall, eight overarching principles and six recommendations were generated, all of them achieving the pre-established agreement level, including, among others, the identification, classification, and management of non-adherence. CONCLUSIONS Poor adherence / non-adherence are common in UC patients, being a relevant clinical concern. Health professionals should address this issue and actively involve the patients in implementing effective and individualized interventions to improve adherence.
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Affiliation(s)
| | - Yago González-Lama
- Unidad Enfermedad Inflamatoria Intestinal, Hospital Universitario Puerta de Hierro
| | | | | | - Fernando Muñoz
- Aparato Digestivo, Complejo Asistencial Universitario de Salamanca, Spain
| | - Laura Marín Sánchez
- Enfermedad Inflamatoria Intestinal, Hospital Universitario Germans Trias i Pujol
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141
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Burkhard A, Toliver J, Rascati K. Association between multiple sclerosis disease severity and adherence to disease-modifying therapies. J Manag Care Spec Pharm 2021; 27:915-923. [PMID: 34185555 PMCID: PMC10391086 DOI: 10.18553/jmcp.2021.27.7.915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: For multiple sclerosis (MS) patients taking disease-modifying therapies (DMTs), adherence to treatment is a key component of achieving beneficial outcomes, such as delayed disease progression and the reduction and prevention of symptoms and relapses. OBJECTIVES: The aim of this study was to assess the impact of a claims-based measure of MS disease severity on DMT adherence in a one-year study period. METHODS: Patients were identified from Humana Medicare Advantage claims data from January 1, 2013 to December 31, 2015. Patients over the age of 18 with at least 12 months of continuous enrollment and > 1 outpatient MS visit with DMT use prior to the index date were included. Patients who switched DMT type (oral, platform, IV) during the study period were excluded. Medication possession ratios (MPR) for DMTs were calculated from pharmacy and medical claims over 12 months of claims data, and a previously developed claims algorithm was used to determine MS disease severity. Patients with MPRs of 0.8 or higher were considered adherent to DMT treatment. Multivariable logistic regression was used to evaluate the association of MS disease severity, gender, DMT type, and age category with DMT adherence. RESULTS: The study population of 3,347 patients had an average MPR of 84.7 (75% were classified as adherent). Multivariable logistic analysis demonstrated that compared to the 18-45 age group, the 46-64 and 65+ age groups were 1.33 (OR: 1.33 [95% CI 1.08-1.64]) and 1.55 (OR: 1.55, [95% CI 1.18-2.05]) times more likely to be adherent. Patients with a high level of MS disease severity were 53% (OR: 0.47, [95% CI 0.36-0.62]) less likely to be adherent compared to those with low MS disease severity. No significant difference was identified for gender or DMT type (oral, platform, or IV). CONCLUSIONS: Increased age and lower MS disease severity were associated with better DMT adherence. MS disease severity should be considered when assessing risk for low DMT adherence. DISCLOSURES: No funding supported this project. The authors have nothing to disclose. Preliminary results were previously presented virtually at AMCP Annual 2020 in April 2020.
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142
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Mortelmans L, De Baetselier E, Goossens E, Dilles T. What Happens after Hospital Discharge? Deficiencies in Medication Management Encountered by Geriatric Patients with Polypharmacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7031. [PMID: 34209384 PMCID: PMC8293803 DOI: 10.3390/ijerph18137031] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/24/2021] [Accepted: 06/26/2021] [Indexed: 11/30/2022]
Abstract
This study aimed to describe post-discharge medication self-management by geriatric patients with polypharmacy, to describe the problems encountered and to determine the related factors. In a multicenter study from November 2019 to March 2020, data were collected at hospital discharge and two to five days post-discharge. Geriatric patients with polypharmacy were questioned about medication management using a combination of validated (MedMaIDE) and self-developed questionnaires. Of 400 participants, 70% did self-manage medication post-discharge. Patients had a mean of four different deficiencies in post-discharge medication management (SD 2.17, range 0-10). Knowledge-related deficiencies were most common. The number of medicines and the in-hospital provision of medication management by nurses were significant predictors of post-discharge medication management deficiencies. In addition to deficiencies in knowledge, medication-taking ability and obtaining medication, non-adherence and disrupted continuity of medication self-management were common in geriatric patients with polypharmacy post-discharge. Improvements in in-hospital preparation could avoid medication self-management problems at home.
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Affiliation(s)
- Laura Mortelmans
- Department of Nursing Science and Midwifery, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (E.D.B.); (E.G.); (T.D.)
| | - Elyne De Baetselier
- Department of Nursing Science and Midwifery, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (E.D.B.); (E.G.); (T.D.)
| | - Eva Goossens
- Department of Nursing Science and Midwifery, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (E.D.B.); (E.G.); (T.D.)
- Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium
- Research Foundation Flanders (FWO), 1000 Brussels, Belgium
- Department of Patient Care, Antwerp University Hospital (UZA), 2610 Antwerp, Belgium
| | - Tinne Dilles
- Department of Nursing Science and Midwifery, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (E.D.B.); (E.G.); (T.D.)
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143
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Malmborg M, Schmiegelow MDS, Gerds T, Schou M, Kistorp C, Torp-Pedersen C, Gislason G. Compliance in Primary Prevention With Statins and Associations With Cardiovascular Risk and Death in a Low-Risk Population With Type 2 Diabetes Mellitus. J Am Heart Assoc 2021; 10:e020395. [PMID: 34151606 PMCID: PMC8403278 DOI: 10.1161/jaha.120.020395] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background We examined whether primary prevention with statins and high adherence to statins reduce the associated risk of cardiovascular events or death in a low‐risk population with type 2 diabetes mellitus (T2D). Methods and Results Using Danish nationwide registers, we included patients with new‐onset T2D, aged 40 to 89 years, between 2005 and 2011, who were alive 18 months following the T2D diagnosis (index date). In patients who purchased statins within 6 months following T2D diagnosis, we calculated the proportion of days covered (PDC) within 1 year after the initial 6‐month period. We studied the combined end point of myocardial infarction, stroke, or all‐cause mortality, whichever came first, with Cox regression. Reported were standardized 5‐year risk differences for fixed comorbidity distribution according to statin treatment history, stratified by sex and age. Among 77 170 patients, 42 975 (56%) were treated with statins, of whom 31 061 (72%) had a PDC ≥80%. In men aged 70 to 79 years who were treated with statins, the standardized 5‐year risk was 22.9% (95% CI, 21.5%–24.3%), whereas the risk was 29.1% (95% CI, 27.4%–30.7%) in men not treated, resulting in a significant risk reduction of 6.2% (95% CI, 4.0%–8.4%), P<0.0001. The risk reduction associated with statins increased with advancing age group (women: age 40–49 years, 0.0% [95% CI, −1.0% to 1.0%]; age 80–89 years, 10.8% [95% CI, 7.2%–14.4%]). Standardizing to all patients treated with statins, PDC <80% was associated with increased risk difference (reference PDC ≥80%; PDC <20%, 4.2% [95% CI, 2.9%–5.6%]). Conclusions This study supports the use of statins as primary prevention against cardiovascular diseases or death in 18‐month surviving low‐risk patients with T2D, with the highest effect in the elderly and adherent patients.
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Affiliation(s)
| | | | - Thomas Gerds
- Danish Heart Foundation Copenhagen Denmark.,Department of Biostatistics University of Copenhagen Denmark
| | - Morten Schou
- Department of Cardiology Herlev and Gentofte Hospital Hellerup Denmark
| | - Caroline Kistorp
- Department of Endocrinology Copenhagen University Hospital Copenhagen Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Investigation and Cardiology Nordsjaellands Hospital Hillerød Denmark
| | - Gunnar Gislason
- Danish Heart Foundation Copenhagen Denmark.,Department of Cardiology Herlev and Gentofte Hospital Hellerup Denmark
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144
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Márquez Fosser S, Mahmoud N, Habib B, Weir DL, Chan F, El Halabieh R, Vachon J, Thakur M, Tran T, Bustillo M, Beauchamp C, Bonnici A, Buckeridge DL, Tamblyn R. Smart about medications (SAM): a digital solution to enhance medication management following hospital discharge. JAMIA Open 2021; 4:ooab037. [PMID: 34159299 PMCID: PMC8211568 DOI: 10.1093/jamiaopen/ooab037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/16/2021] [Accepted: 04/15/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To outline the development of a software solution to improve medication management after hospital discharge, including its design, data sources, intrinsic features, and to evaluate the usability and the perception of use by end-users. Materials and Methods Patients were directly involved in the development using a User Center Design (UCD) approach. We conducted usability interviews prior to hospital discharge, before a user started using the application. A technology acceptance questionnaire was administered to evaluate user self-perception after 2 weeks of use. Results The following features were developed; pill identification, patient-friendly drug information leaflet, side effect checker, and interaction checker, adherence monitoring and alerts, weekly medication schedule, daily pill reminders, messaging service, and patient medication reviews. The usability interviews show a 98.3% total success rate for all features, severity (on a scale of 1–4) 1.4 (SD 0.79). Regarding the self-perception of use (1–7 agreement scale) the 3 highest-rated domains were: (1) perceived ease of use 5.65 (SD 2.02), (2) output quality 5.44 (SD 1.65), and (3) perceived usefulness 5.29 (SD 2.11). Discussion Many medication management apps solutions have been created and most of them have not been properly evaluated. SAM (Smart About Medications) includes the user perspective, integration between a province drug database and the pharmacist workflow in real time. Its features are not limited to maintaining a medication list through manual entry. Conclusion We can conclude after evaluation that the application is usable and has been self-perceived as easy to use by end-users. Future studies are required to assess the health benefits associated with its use.
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Affiliation(s)
- Santiago Márquez Fosser
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada.,Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Nadar Mahmoud
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Bettina Habib
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Daniala L Weir
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Fiona Chan
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Rola El Halabieh
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Jeanne Vachon
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Manish Thakur
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Thai Tran
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Melissa Bustillo
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | | | - André Bonnici
- Pharmacy Department, McGill University Health Centre, Montreal, Canada
| | - David L Buckeridge
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada.,Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Robyn Tamblyn
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada.,Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada.,Department of Medicine, McGill University, Montréal, Canada
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145
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Wampold BE. Healing in a Social Context: The Importance of Clinician and Patient Relationship. FRONTIERS IN PAIN RESEARCH 2021; 2:684768. [PMID: 35295467 PMCID: PMC8915743 DOI: 10.3389/fpain.2021.684768] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/18/2021] [Indexed: 12/13/2022] Open
Abstract
When a patient presents to a health provider, the course of the disorder is composed of three effects: natural effects, specific effects, and contextual effects. Part of the contextual effect is due to the relationship between the healer and the patient. Social healing appears to be present in eusocial species and particularly well-developed in humans. Evidence for the importance of the relationship in healing is found in placebo studies, including placebo analgesics, medicine, and psychotherapy. Although the theory for how the relationship is therapeutic is not well-developed, four possible mechanisms are discussed. The implications for health care and the treatment of pain are discussed.
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Affiliation(s)
- Bruce E. Wampold
- Modum Bad Psychiatric Center, Research Institute, Vikersund, Norway
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI, United States
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146
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Aspects of Medication and Patient participation-an Easy guideLine (AMPEL). A conversation guide increases patients' and physicians' satisfaction with prescription talks. Naunyn Schmiedebergs Arch Pharmacol 2021; 394:1757-1767. [PMID: 34106304 PMCID: PMC8298249 DOI: 10.1007/s00210-021-02107-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 12/13/2022]
Abstract
Patients want more information and active participation in medical decisions. Information and active participation correlate with increased adherence. A conversation guide, combining patient-relevant drug information with steps of shared decision-making, was developed to support physicians in effective and efficient prescription talks. Six GP trainees in community-based primary care practices participated in a controlled pilot study in sequential pre-post design. Initially, they conducted 41 prescription talks as usual, i.e., without knowing the guide. Then, they conducted 23 talks considering the guide (post-intervention phase). Immediately after the respective talk, patients filled in a questionnaire on satisfaction with the information on medication and physician–patient interaction, and physicians about their satisfaction with the talk and the application of the guide. Patients felt better informed after guide-based prescription talks (e.g., SIMS-D in median 10 vs. 17, p < 0.05), more actively involved (KPF-A for patient activation 2.9 ± 0.8 vs. 3.6 ± 0.8, p < 0.05), and more satisfied with the physician–patient interaction. Physicians rated the guide helpful and feasible. Their satisfaction with the conversation was significantly enhanced during the post-intervention phase. The evaluation of the duration of the talk was not influenced. Enhanced patients’ and physicians’ satisfaction with prescription talks encourages further examinations of the conversation guide. We invite physicians to try our guide in everyday medical practice.
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147
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Komen JJ, Pottegård A, Mantel-Teeuwisse AK, Forslund T, Hjemdahl P, Wettermark B, Hellfritzsch M, Hallas J, Olesen M, Bennie M, Mueller T, Voss A, Schink T, Haug U, Kollhorst B, Karlstad Ø, Kjerpeseth LJ, Klungel OH. Persistence and adherence to non-vitamin K antagonist oral anticoagulant treatment in patients with atrial fibrillation across five Western European countries. Europace 2021; 23:1722-1730. [PMID: 34096584 PMCID: PMC8576279 DOI: 10.1093/europace/euab091] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/23/2021] [Indexed: 12/17/2022] Open
Abstract
AIMS To assess persistence and adherence to non-vitamin K antagonist oral anticoagulant (NOAC) treatment in patients with atrial fibrillation (AF) in five Western European healthcare settings. METHODS AND RESULTS We conducted a multi-country observational cohort study, including 559 445 AF patients initiating NOAC therapy from Stockholm (Sweden), Denmark, Scotland, Norway, and Germany between 2011 and 2018. Patients were followed from their first prescription until they switched to a vitamin K antagonist, emigrated, died, or the end of follow-up. We measured persistence and adherence over time and defined adequate adherence as medication possession rate ≥90% among persistent patients only. RESULTS Overall, persistence declined to 82% after 1 year and to 63% after 5 years. When including restarters of NOAC treatment, 85% of the patients were treated with NOACs after 5 years. The proportion of patients with adequate adherence remained above 80% throughout follow-up. Persistence and adherence were similar between countries and was higher in patients starting treatment in later years. Both first year persistence and adherence were lower with dabigatran (persistence: 77%, adherence: 65%) compared with apixaban (86% and 75%) and rivaroxaban (83% and 75%) and were statistically lower after adjusting for patient characteristics. Adherence and persistence with dabigatran remained lower throughout follow-up. CONCLUSION Persistence and adherence were high among NOAC users in five Western European healthcare settings and increased in later years. Dabigatran use was associated with slightly lower persistence and adherence compared with apixaban and rivaroxaban.
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Affiliation(s)
- Joris J Komen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Healthcare Development, Stockholm Region, Public Healthcare Services Committee, Stockholm, Sweden
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Aukje K Mantel-Teeuwisse
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Tomas Forslund
- Department of Healthcare Development, Stockholm Region, Public Healthcare Services Committee, Stockholm, Sweden.,Department of Medicine Solna, Clinical Epidemiology/Clinical Pharmacology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Paul Hjemdahl
- Department of Medicine Solna, Clinical Epidemiology/Clinical Pharmacology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Björn Wettermark
- Department of Pharmacy, Pharmacoepidemiology & Social Pharmacy, Uppsala University, Uppsala, Sweden
| | - Maja Hellfritzsch
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Morten Olesen
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Marion Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Public Health and Intelligence Strategic Business Unit, NHS National Services Scotland, Glasgow, UK
| | - Tanja Mueller
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Annemarie Voss
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Tania Schink
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.,Faculty of Human and Life Sciences, University of Bremen, Bremen, Germany
| | - Bianca Kollhorst
- Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Øystein Karlstad
- Chronic Diseases and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Lars J Kjerpeseth
- Chronic Diseases and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Olaf H Klungel
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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148
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Katsanos K, Kitrou P, Spiliopoulos S. The Rollercoaster of Paclitaxel in the Lower Limbs and Skeletons in the Closet: An Opinion Review. J Vasc Interv Radiol 2021; 32:785-791. [PMID: 33811999 DOI: 10.1016/j.jvir.2021.03.537] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 03/24/2021] [Indexed: 02/08/2023] Open
Abstract
There have been concerns about the long-term risk of all-cause death with the use of paclitaxel-coated devices in the lower limbs. Results from a 2018 meta-analysis were corroborated by the US Food and Drug Administration and later confirmed by an individual patient data meta-analysis. However, population-based observational studies have produced contradictory results and often claimed a survival benefit with the use of paclitaxel. The recently published Swedish drug-elution trial in peripheral arterial disease did not confirm a significant mortality risk. In this review, the authors discuss the key elements of the identified mortality signal and stress important facts and figures that remain underrecognized and elusive. They also highlight the important types of epidemiological bias that pertain to the ongoing debate on paclitaxel.
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Shin J, Kong SM, Kim TJ, Kim ER, Hong SN, Chang DK, Kim YH. Clinical Significance of Residual Nonrectal Inflammation in Ulcerative Colitis Patients in Clinical Remission. Gut Liver 2021; 15:401-409. [PMID: 32839361 PMCID: PMC8129662 DOI: 10.5009/gnl20078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 12/12/2022] Open
Abstract
Background/Aims The treatment goal of ulcerative colitis (UC) has been changed to achieve endoscopic remission (ER). However, there is insufficient clinical evidence to determine whether a step-up treatment should be performed to achieve ER in clinical remission (CR) without ER, and there are inadequate data on the need to consider the distribution and severity of residual inflammation. This retrospective study aimed to evaluate the prognostic significance of the distribution and severity of residual inflammation in UC patients in CR. Methods A total of 131 UC patients in CR who underwent endoscopic evaluation for more than three times between January 2000 and December 2018 were reviewed. The patients were allocated by the endoscopic healing state and the distribution of inflammation to ER (n=31, 23.7%), residual nonrectal inflammation with patchy distribution (NRI) (n=17, 13.0%) or residual rectal involvement with continuous or patchy distribution (RI) (n=83, 63.3%) groups. We reviewed clinical characteristics, endoscopic findings, and factors associated with poor outcome-free survival (PFS). Results In UC patients in CR, PFS was significantly higher in the ER and NRI groups than in the RI group (p=0.003). Patients in the ER and NRI groups had similar PFS (p=0.647). Cox proportional hazard model showed only RI (hazard ratio, 5.76; p=0.027) was associated with a higher risk of poor outcome. Conclusions We suggest that escalation of treatment modalities may be selectively performed in consideration of the residual mucosal inflammation pattern, even if ER has not been achieved, in UC patients with CR. (Gut Liver 2021;15-409)
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Affiliation(s)
- Jongbeom Shin
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Min Kong
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Jun Kim
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Ran Kim
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Noh Hong
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Kyung Chang
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Ho Kim
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Moriarty F, Thompson W, Boland F. Methods for evaluating the benefit and harms of deprescribing in observational research using routinely collected data. Res Social Adm Pharm 2021; 18:2269-2275. [PMID: 34034959 DOI: 10.1016/j.sapharm.2021.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/09/2021] [Accepted: 05/12/2021] [Indexed: 12/17/2022]
Abstract
Deprescribing is defined as "the planned and supervised process of dose reduction or stopping of medication that might be causing harm, or no longer be of benefit". Barriers to deprescribing include healthcare professional fear and lack of guidance. These may stem from limited available evidence on benefits and harms of deprescribing medications commonly used among older persons. Advances in pharmacoepidemiology and causal inference methods to evaluate comparative effectiveness and safety of prescribing medications have yet to be considered for deprescribing medication. This paper discusses select methods and how they can be applied to deprescribing research, using case studies of benzodiazepines and low-dose acetylsalicylic acid (aspirin). Target trial emulation involves the explicit application of design principles from randomised controlled trials to observational studies. Several design aspects, including defining eligibility criteria and time zero, require additional considerations for deprescribing studies. The active comparator new user design also presents challenges, including selection of an appropriate comparator. This paper discusses these aspects, and others, in relation to deprescribing studies. Furthermore, methods proposed to control for confounding, in particular, the prior event rate ratio and propensity scores, are discussed. Introduction of billing codes or mechanisms for accurately determining when deprescribing has occurred would enhance the ability to conduct research using routinely collected data. Although the approaches discussed in this paper may strengthen observational studies of deprescribing, their use may be best suited to certain scenarios or research questions, where randomised controlled trials may be less feasible.
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Affiliation(s)
- Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland.
| | - Wade Thompson
- Women's College Hospital Research Institute, Toronto, Ontario, Canada
| | - Fiona Boland
- Data Science Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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