301
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Wang Y, Li X, Jia D, Lin B, Fu B, Qi B, Zhang Z. Exploring polypharmacy burden among elderly patients with chronic diseases in Chinese community: a cross-sectional study. BMC Geriatr 2021; 21:308. [PMID: 33985446 PMCID: PMC8117611 DOI: 10.1186/s12877-021-02247-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/23/2021] [Indexed: 11/18/2022] Open
Abstract
Background In the long-term use of multiple medications for elderly patients diagnosed with chronic diseases, medication problems are prominent, which seriously reduces their quality of life. The burden of medications of patients critically affects their medication beliefs, behaviors and disease outcomes. It may be a solution to stress the burden of medications of patients. Its medication issues develops a novel perspective. The present study aimed to exploit the Chinese version of Living with Medicines Questionnaire-3(C-LMQ-3) to quantify the medicines burden of elderly patients diagnosed with chronic diseases in China, and evaluate the relevant demographic characteristics of sub-populations with high medicines burden. Methods The survey was distributed to elderly patients aged ≥ 60 years with chronic disease by using ≥ 5 medicines, C-LMQ-3 scores and domain scores were compared by the characteristics of elderly patients by employing descriptive statistics and performing statistical tests. Results On the whole, 430 responses were analyzed, and the participants were aged between 60 and 91 years, with the average age of 73.57 years (SD: 7.87). Most of the responses were female (61.7 %) with middle school education (38.5 %). Moreover, 54.1 % of the participants lived with spouse only, 16.2 % had both spouse and children, and 10.0 % lived alone. As indicated from regression analysis, higher C-LMQ-3 scores were associated with those who were with low education level, 60–69 years-old, using ≥ 11 medicines, using medicines ≥ 3 times a day, income per month (RMB) ≤ 3000, and who having higher monthly self-paid medication (RMB) ≥ 300 (p < 0.01). Burden was mainly driven by cost-related burden, concerns about medicines, and the lack of autonomy over medicine regimens. Conclusions This study presents the preliminary evidence to elderly patients diagnosed with chronic diseases in mainland China that pay attention to multiple medications burden may help reduce the Drug Related Problems, whereas some elderly patients have a higher burden of medication. Chinese health care providers are required to primarily evaluate and highlight such patients, and formulate relevant intervention strategies to ensure medication adherence and daily medication management of elderly patients with polypharmacy.
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Affiliation(s)
- Yongli Wang
- School of Nursing and Health, Zhengzhou University, No.100 Science Avenue, Henan, Zhengzhou, China.,Peking University People's Hospital, Xicheng Dist, Beijing, China
| | - Xiaodan Li
- Peking University People's Hospital, Xicheng Dist, Beijing, China
| | - Dongmei Jia
- Peking University People's Hospital, Xicheng Dist, Beijing, China
| | - Beilei Lin
- School of Nursing and Health, Zhengzhou University, No.100 Science Avenue, Henan, Zhengzhou, China
| | - Bo Fu
- School of Nursing and Health, Zhengzhou University, No.100 Science Avenue, Henan, Zhengzhou, China
| | - Bei Qi
- School of Nursing and Health, Zhengzhou University, No.100 Science Avenue, Henan, Zhengzhou, China
| | - Zhenxiang Zhang
- School of Nursing and Health, Zhengzhou University, No.100 Science Avenue, Henan, Zhengzhou, China.
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302
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Sadeq AS, Elnour AA, Hamrouni AM, Baraka MA, Al Meslamani AZ, Adel A, Al Kaabi M, Ibrahim OM, Al Mazrouei N. Development of a multivariable model to predict medication non-adherence risk factor for patients with acute coronary syndrome. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmab005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objective
The aim of this study was to develop a risk prediction model for non-adherence to prescribed medication based on self-reported risk factors in patients with the acute coronary syndrome (ACS).
Methods
This is a prospective follow-up cohort study of 210 patients with ACS at a tertiary hospital in Al Ain city in the United Arab Emirates. Patients with ACS in the electronic registry who were discharged from the hospital but continued to attend outpatient clinics and were prescribed evidence-based medications were identified and interviewed. Univariate and multivariate logistic regression models were constructed and used as appropriate. SPSS V24 was used for data analysis.
Key findings
A final predictive model of eight variables was developed for ACS medication non-adherence. The significant predicted risk factors identified in the final model with their odds ratios (ORs) and confidence intervals (CIs) were as follows: poor knowledge of prescribed medications (OR = 1.81; CI = 1.032–3.34; P = 0.010), five or more prescribed medicines (OR = 4.97; CI = 1.98–2.49; P = 0.007), more than twice daily dosing regimen (OR = 2.21; CI = 1.04–4.67; P = 0.039), unpleasant side-effects (OR = 2.97; CI = 1.98–2.49; P = 0.007), patients believed that side-effects were the cause of health problems (OR = 4.28; CI = 1.78–10.39; P = 0.001), patients undertaking regular exercise (OR = 2.14; CI = 1.06–4.32; P = 0.035), and comorbid diabetes (OR = 1.97; CI = 1.00–3.87; P = 0.049).
Conclusion
This study indicates poor knowledge, polypharmacy and comorbidity as risk factors associated with medication non-adherence among patients with ACS. Identification of predictors of non-adherence and strategies has the potential to reduce non-adherence dramatically.
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Affiliation(s)
- Adel Shaban Sadeq
- Clinical pharmacy department, College of Pharmacy, Al Ain University, Al Ain, United Arab Emirates
| | - Asim Ahmed Elnour
- Clinical pharmacy department, College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Amar Mansour Hamrouni
- Pharmaceutical Sciences, College of Pharmacy, Al Ain University, Al Ain, United Arab Emirates
| | - Mohamed A Baraka
- Clinical pharmacy department, College of Pharmacy, Al Ain University, Al Ain, United Arab Emirates
- Clinical Pharmacy Department, College of Pharmacy, Al Azhar University, Cairo, Egypt
| | - Ahmad Z Al Meslamani
- Pharmaceutical Sciences, College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Asil Adel
- Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Trinity College of Dublin, Republic of Ireland
| | | | - Osama Mohamed Ibrahim
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, United Arab Emirates
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Egypt
| | - Nadia Al Mazrouei
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, United Arab Emirates
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303
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Wedlund L, Kvedar J. Wearables as a tool for measuring therapeutic adherence in behavioral health. NPJ Digit Med 2021; 4:79. [PMID: 33972676 PMCID: PMC8110516 DOI: 10.1038/s41746-021-00458-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/16/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
| | - Joseph Kvedar
- Harvard Medical School, Boston, MA, USA.,Mass General Brigham, Boston, MA, USA
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304
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Chew CC, Chan HK, Chang CT, Hss AS, Hassali MA. Medication-related knowledge, administration practice and adherence among caregivers of chronically ill children in Malaysia. BMC Pediatr 2021; 21:216. [PMID: 33941117 PMCID: PMC8091478 DOI: 10.1186/s12887-021-02691-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/26/2021] [Indexed: 11/15/2022] Open
Abstract
Background Caregivers’ knowledge, practice and adherence in medication administration who care for children with chronic illness requiring long-term pharmacological treatments are factors associating with children medication safety at home. This study aimed to determine the medication-related knowledge, administration practice and adherence among caregivers of chronically ill children in Malaysia. This cross-sectional study was conducted at the paediatric outpatient clinic of a tertiary public hospital. Caregivers of chronically ill children, who engaged in medication administration at home for at least 3 months, were conveniently recruited. Their medication-related knowledge and administration practice were evaluated based on a checklist, while their adherence to medication administration was assessed using a validated 5-point scale. The associated factors were also explored. Results Of the 141 participants, most were mothers (90.8%) and had a full-time job (55.3%). Most of them had adequate medication-related knowledge (71.6%) and an appropriate administration practice (83.0%). The majority of them (83.0%) also rated themselves as adherent to medication administration. The participants with a child above 5 years of age (91.2%) were found to have a better practice than those with younger children (75.3%) in medication administration (p = 0.012). However, those with a child taking two (adjusted OR: 12.53) or three (adjusted OR: 8.29) medications, getting their refills from private health institutions apart from this hospital (adjusted OR = 7.06) and having multiple illnesses (adjusted OR = 21.25) were more likely to be not adherent to medication administration. Conclusion Caregivers of chronically ill children in Malaysia generally have sufficient knowledge and an appropriate practice of medication administration at home. Yet, strategies to improve the adherence to medication administration, particularly in those who care for children with complicated health conditions, are warranted.
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Affiliation(s)
- Chii-Chii Chew
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia. .,Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia.
| | - Huan-Keat Chan
- Clinical Research Centre, Hospital Sultanah Bahiyah, Ministry of Health, 05460 Alor Setar, Kedah, Malaysia
| | - Chee-Tao Chang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia
| | - Amar-Singh Hss
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia
| | - Mohamed Azmi Hassali
- Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
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305
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Menditto E, Cahir C, Malo S, Aguilar-Palacio I, Almada M, Costa E, Giardini A, Gil Peinado M, Massot Mesquida M, Mucherino S, Orlando V, Parra-Calderón CL, Pepiol Salom E, Kardas P, Vrijens B. Persistence as a Robust Indicator of Medication Adherence-Related Quality and Performance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4872. [PMID: 34063641 PMCID: PMC8124987 DOI: 10.3390/ijerph18094872] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/18/2022]
Abstract
Medication adherence is a priority for health systems worldwide and is widely recognised as a key component of quality of care for disease management. Adherence-related indicators were rarely explicitly included in national health policy agendas. One barrier is the lack of standardised adherence terminology and of routine measures of adherence in clinical practice. This paper discusses the possibility of developing adherence-related performance indicators highlighting the value of measuring persistence as a robust indicator of quality of care. To standardise adherence and persistence-related terminology allowing for benchmarking of adherence strategies, the European Ascertaining Barriers for Compliance (ABC) project proposed a Taxonomy of Adherence in 2012 consisting of three components: initiation, implementation, discontinuation. Persistence, which immediately precedes discontinuation, is a key element of taxonomy, which could capture adherence chronology allowing the examination of patterns of medication-taking behaviour. Advances in eHealth and Information Communication Technology (ICT) could play a major role in providing necessary structures to develop persistence indicators. We propose measuring persistence as an informative and pragmatic measure of medication-taking behaviour. Our view is to develop quality and performance indicators of persistence, which requires investing in ICT solutions enabling healthcare providers to review complete information on patients' medication-taking patterns, as well as clinical and health outcomes.
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Affiliation(s)
- Enrica Menditto
- CIRFF, Center of Pharmacoeconomics and Drug Utilization Research, Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy; (S.M.); (V.O.)
| | - Caitriona Cahir
- Data Science Centre, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland;
| | - Sara Malo
- Preventive Medicine and Public Health Department, Zaragoza University, Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain; (S.M.); (I.A.-P.)
| | - Isabel Aguilar-Palacio
- Preventive Medicine and Public Health Department, Zaragoza University, Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain; (S.M.); (I.A.-P.)
| | - Marta Almada
- UCIBIO/REQUIMTE, Competences Centre on Active and Healthy Ageing of the University of Porto, Porto4Ageing, Faculty of Pharmacy, University of Porto, 4099-002 Porto, Portugal; (M.A.); (E.C.)
| | - Elisio Costa
- UCIBIO/REQUIMTE, Competences Centre on Active and Healthy Ageing of the University of Porto, Porto4Ageing, Faculty of Pharmacy, University of Porto, 4099-002 Porto, Portugal; (M.A.); (E.C.)
| | - Anna Giardini
- IT Department, Istituti Clinici Scientifici Maugeri IRCCS Pavia, Pavia 27100, Italy;
| | - María Gil Peinado
- Drug Information Centre and Pharmaceutical Care Department, Muy Ilustre Colegio Oficial de Farmacéuticos de Valencia (MICOF Valencia), 46003 Valencia, Spain;
| | - Mireia Massot Mesquida
- Servei d’Atenció Primària Vallès Occidental, Institut Català de la Salut, 08202 Barcelona, Spain;
| | - Sara Mucherino
- CIRFF, Center of Pharmacoeconomics and Drug Utilization Research, Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy; (S.M.); (V.O.)
| | - Valentina Orlando
- CIRFF, Center of Pharmacoeconomics and Drug Utilization Research, Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy; (S.M.); (V.O.)
| | - Carlos Luis Parra-Calderón
- Group of Research and Innovation in Biomedical Informatics, Biomedical Engineering and Health Economy, Institute of Biomedicine of Seville, IBiS/Virgen del Rocío University Hospital/CSIC/University of Seville, 41004 Sevilla, Spain;
| | - Enrique Pepiol Salom
- International Committee, Muy Ilustre Colegio Oficial de Farmacéuticos de Valencia (MICOF Valencia), 46003 Valencia, Spain;
| | - Przemyslaw Kardas
- Medication Adherence Research Centre, Medical University of Lodz, 90-136 Lodz, Poland;
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306
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Stecher C, Mukasa B, Linnemayr S. Uncovering a behavioral strategy for establishing new habits: Evidence from incentives for medication adherence in Uganda. JOURNAL OF HEALTH ECONOMICS 2021; 77:102443. [PMID: 33831632 PMCID: PMC8122069 DOI: 10.1016/j.jhealeco.2021.102443] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 01/06/2021] [Accepted: 02/24/2021] [Indexed: 05/14/2023]
Abstract
Incentives are used to improve many health-related behaviors, but evidence is mixed for their effectiveness both during the incentivization period and, even more so, on the persistence of the behavior after incentives are withdrawn. In this paper, we present the results of a randomized controlled trial that successfully uses incentives to improve medication adherence among HIV-infected patients in Uganda over 20 months, and follows the sample for another 6 months to measure the persistence of these behavioral improvements. Our study contributes to the literature on habit formation by identifying a behavioral strategy that is associated with persistently high medication adherence after controlling for observable individual-level characteristics and the receipt of incentives. We find evidence supporting a psychological theory of habits as reflexive context-behavior associations, which suggests new ways of designing incentive-based interventions for better promoting persistent, healthier behaviors.
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Affiliation(s)
- Chad Stecher
- Arizona State University, 500 N 3rd Street, Phoenix, AZ 85004, United States.
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307
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Chang S, Stebbins M, Witt EA, Kirkham H, Santos T, Cocohoba J. Medication‐related problems in chronic inflammatory conditions: A pharmacy claims and electronic health record analysis. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Susan Chang
- University of California San Francisco School of Pharmacy San Francisco California USA
- Global Access & Health Economics Roche Molecular Systems Pleasanton California USA
| | - Marilyn Stebbins
- University of California San Francisco School of Pharmacy San Francisco California USA
| | - Edward A. Witt
- Health Analytics, Research, and Reporting, Walgreen Co Deerfield Illinois USA
| | - Heather Kirkham
- Health Analytics, Research, and Reporting, Walgreen Co Deerfield Illinois USA
| | - Troy Santos
- University of California San Francisco School of Pharmacy San Francisco California USA
| | - Jennifer Cocohoba
- University of California San Francisco School of Pharmacy San Francisco California USA
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308
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Rubio-Valera M, Marqués-Ercilla S, Peñarrubia-María MT, Urbanos-Garrido RM, Borrell C, Bosch J, Sánchez-Viñas A, Aznar-Lou I. Who Suffers From Pharmaceutical Poverty and What Are Their Needs? Evidence From a Spanish Region. Front Pharmacol 2021; 12:617687. [PMID: 33959003 PMCID: PMC8093809 DOI: 10.3389/fphar.2021.617687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Pharmaceutical poverty occurs when a patient cannot afford the cost of prescribed medication and/or medical products. Nonprofit organizations are covering the cost of medication to those patients in some contexts. The aim of the study was to describe the population of beneficiaries of the PB, a nongovernmental organization based on the primary healthcare system, which provides free-of-charge access to medicines and their utilization pattern of medicines and healthcare products. Methods: This was an observational study using PB beneficiary data collected between November 2017 and December 2018 in Catalonia. The Catalan Health Service provided information from the general population. A descriptive analysis of the beneficiaries' characteristics was conducted and compared to the general population. Results: The beneficiaries (N = 1,206) were mainly adults with a low level of education, unemployed, with functional disability, and with ≥1 child. Compared with the general population, the beneficiaries were older, had a lower level of education, showed a higher prevalence of functional disability, were less likely to be Spanish, and were more likely to be divorced and unemployed. The beneficiaries were polymedicated, and most were using medication related to the nervous (79%), musculoskeletal (68%), and cardiovascular system (56%) and alimentary tract and metabolism (68%). Almost 19% of beneficiaries used healthcare products. Female beneficiaries were older and more likely to be divorced or widowed, employed, and with children. Compared to men, women were more likely to use medicines for pain and mental disorders. The pediatric group used medications for severe, chronic conditions (heart diseases, autoimmune diseases, conduct disorders, and attention deficit hyperactivity disorder). Conclusion: Patients with severe, chronic, and disabling conditions are affected by pharmaceutical poverty. While the system of copayment remains unchanged, family physicians and pediatricians should explore economic barriers to treatment and direct their patients to resources that help to cover the cost of treatment.
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Affiliation(s)
- Maria Rubio-Valera
- Research and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- The Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Silvia Marqués-Ercilla
- Centre d’Atenció Primària Bartomeu Fabrés Anglada, Direcció d'Atenció Primària Costa de Ponent, Institut Català de la Salut, Gavà, Spain
- Unitat de Suport a la Recerca Costa de Ponent, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Cornellà de Llobregat, Spain
| | - M Teresa Peñarrubia-María
- The Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Centre d’Atenció Primària Bartomeu Fabrés Anglada, Direcció d'Atenció Primària Costa de Ponent, Institut Català de la Salut, Gavà, Spain
- Unitat de Suport a la Recerca Costa de Ponent, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Cornellà de Llobregat, Spain
| | - Rosa M. Urbanos-Garrido
- Department of Applied Economics, Public Economics and Political Economy, The Complutense University of Madrid, Madrid, Spain
| | - Carme Borrell
- The Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
| | | | - Alba Sánchez-Viñas
- Research and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- The Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ignacio Aznar-Lou
- Research and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- The Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
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309
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Pandrangi VC, Farrell NF, Mace JC, Detwiller KY, Smith TL, Geltzeiler M. Perceived Financial Insecurity Impacts Healthcare Decision-Making Among Patients With Sinusitis. Laryngoscope 2021; 131:2403-2412. [PMID: 33851727 DOI: 10.1002/lary.29561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/16/2021] [Accepted: 04/04/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES/HYPOTHESIS The economic burden of sinusitis is significant, and socioeconomic factors can impact patient decision-making. The purpose of this study was to examine the impact of perceived financial insecurity on healthcare decision-making and treatment compliance among sinusitis patients. STUDY DESIGN Cross-sectional study using the 2018 National Health Interview Survey. METHODS Survey responses to nine questions regarding financial stressors and nine questions regarding cost-saving healthcare actions were recorded, which included seeking lower cost medication, medication noncompliance, and avoiding care visits due to costs. RESULTS There was a total weighted sample size of 28.9 million patients who self-reported a diagnosis of sinusitis (12% of the U.S. population). Sinusitis patients who reported cost-saving actions had an increased severity of perceived financial insecurity than those without cost-saving actions (P < .001). Sinusitis patients with perceived financial insecurity had the highest odds of at least one cost-saving action (odds ratio [OR] = 5.94, 95% CI = 5.911-5.970, P < .001), followed by lack of health insurance (OR = 5.13, 95% CI = 5.107-5.159, P < .001), and poor self-reported health status (OR = 2.81, 95% CI = 2.792-2.822, P < .001). Increasing the number of financial stressors increased the odds of at least one cost-saving action (P < .001). Across all financial stressors, the most commonly performed cost-saving action was asking for lower cost medication. CONCLUSIONS Perceived financial insecurity is associated with cost-saving healthcare actions among sinusitis patients, including treatment noncompliance. Interventions to assess financial insecurity among sinusitis patients may facilitate shared decision-making for optimal, individualized treatment plans that may lead to improved outcomes and quality of life. LEVEL OF EVIDENCE NA. Laryngoscope, 2021.
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Affiliation(s)
- Vivek C Pandrangi
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Nyssa Fox Farrell
- Department of Otolaryngology-Head and Neck Surgery, Washington University, St. Louis, Missouri, USA
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Kara Y Detwiller
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
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310
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Suhail M, Saeed H, Saleem Z, Younas S, Hashmi FK, Rasool F, Islam M, Imran I. Association of health literacy and medication adherence with health-related quality of life (HRQoL) in patients with ischemic heart disease. Health Qual Life Outcomes 2021; 19:118. [PMID: 33849547 PMCID: PMC8045399 DOI: 10.1186/s12955-021-01761-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 04/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medication Adherence (MA) and Health Related Quality of Life (HRQoL) are two inter-connected concepts, co-influenced by Health Literacy (HL), with significant impact on patient management and care. Thus, we aimed to estimate the association of HL and MA with HRQoL in IHD patients. METHODS Cross-sectional study of 251 IHD patients recruited from Lahore over 6 months period. HL, MA and HRQoL was assessed using validated questionnaires; 16-items of HL, Morisky Green Levine Scale (MGLS) and SF-12, respectively. Chi-square for significance, logistic-regression for association and linear regression for predictions were used. RESULTS IHD patients; males (p = 0.0001), having secondary-higher education (p = 0.0001), middle/upper class (p = 0.0001) and employed (p = 0.005) had adequate HL, and were more likely to be adherent (OR; 4.3, p = 0.014). Both physical (PCS-12) and mental (MCS-12) component scores of HRQoL for age, gender, education, area of residence, employment and MA were significantly higher in patients with adequate HL. In multinomial regression, improved PCS-12 scores tend to be higher in subjects having secondary-higher education (OR; 3.5, p = 0.067), employed (OR; 6.1, p = 0.002) and adherent (OR; 2.95, p = 0.218), while MCS-12 scores tend to be higher in patients < 65 years (OR; 2.2, p = 0.032), employed (OR; 3, p = 0.002) and adherent (OR; 4, p = 0.004). In adjusted model, HL (β;0.383, p = 0.0001) and MA (β; - 0.133, p = 0.018) were significantly associated with PCS-12, and MCS-12 with MA (β; - 0.161, p = 0.009) only. CONCLUSION Data suggested that adequate HL was significantly associated with adherence and both physical and mental dimensions of HRQoL were higher in IHD patients with adequate HL. Besides, HL and MA are independent predictors of HRQoL in IHD patients.
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Affiliation(s)
- Muzna Suhail
- Department of Pharmaceutics, University College of Pharmacy, Universality of the Punjab, Allama Iqbal Campus, Lahore, 54000 Pakistan
| | - Hamid Saeed
- Department of Pharmaceutics, University College of Pharmacy, Universality of the Punjab, Allama Iqbal Campus, Lahore, 54000 Pakistan
| | - Zikria Saleem
- Department of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Saman Younas
- Department of Pharmaceutics, University College of Pharmacy, Universality of the Punjab, Allama Iqbal Campus, Lahore, 54000 Pakistan
| | - Furqan Khurshid Hashmi
- Department of Pharmaceutics, University College of Pharmacy, Universality of the Punjab, Allama Iqbal Campus, Lahore, 54000 Pakistan
| | - Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Muhammad Islam
- Department of Pharmaceutics, University College of Pharmacy, Universality of the Punjab, Allama Iqbal Campus, Lahore, 54000 Pakistan
| | - Imran Imran
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
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Fendrick AM, Brixner D, Rubin DT, Mease P, Liu H, Davis M, Mittal M. Sustained long-term benefits of patient support program participation in immune-mediated diseases: improved medication-taking behavior and lower risk of a hospital visit. J Manag Care Spec Pharm 2021; 27:1086-1095. [PMID: 33843252 PMCID: PMC10394214 DOI: 10.18553/jmcp.2021.20560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Patient support programs (PSPs) improve medication-taking behavior in the first 12 months of treatment for patients with immune-mediated diseases, but it is unknown if these benefits are sustained. As immune-mediated diseases continue to increase in prevalence and economic burden, understanding the potential value of PSPs in helping patients adhere to their long-term treatment plan and avoid costly hospital visits is crucial. Launched nationally in 2015, HUMIRA Complete (a PSP for adalimumab patients) provides an opportunity to study long-term effects of PSP participation, including the impact on medication-taking behavior and hospital visits. OBJECTIVE: To evaluate the sustained relationship between PSP participation, long-term medication-taking behavior, and hospital visits. METHODS: A longitudinal, retrospective matched-cohort study was conducted of patients initiating adalimumab between January 2015 and February 2016 with or without enrolling in the PSP, using patient-level data from the HUMIRA Complete PSP linked with Symphony Health claims. The sample included adult, commercially insured patients diagnosed with an indicated disease who were biologic-naive and had data available for ≥ 6 months before and ≥ 12 months after initiating adalimumab. Adherence (proportion of days covered) and hospital visits were assessed at 12, 24, and 36 months for patients with sufficient follow-up data. Multivariable generalized models estimated differences between cohorts, controlling for baseline characteristics and hospital visits. Duration of persistence and time to a hospital visit were compared using Kaplan-Meier analyses. Hazard ratios were estimated using multivariable Cox proportional hazards models. RESULTS: The matched cohort included 2,268 patients (1,134 per cohort), and patient attrition was similar across cohorts. The PSP cohort consistently demonstrated higher adalimumab adherence than the non-PSP cohort at 12 (64.8% vs. 50.1%, P < 0.0001; 29% greater), 24 (49.4% vs. 38.4%; P < 0.0001; 29% greater), and 36 (39.4% vs. 35.1%; P = 0.02; 12% greater) months. PSP participation was associated with a 30% lower hazard of discontinuation (P < 0.0001), and median duration of persistence was 4.8 months longer for the PSP cohort (13.2 vs. 8.4 months; P < 0.0001). The PSP cohort had lower rates of hospital visits at 12 (30% vs. 37%; P < 0.001; 19% lower), 24 (44% vs. 53%; P = 0.01; 17% lower), and 36 (55% vs. 65%; P < 0.01; 16% lower) months, and PSP participation was associated with a 25% lower hazard of a hospital visit (P < 0.0001). Median time to a hospital visit was 10.8 months longer for the PSP cohort (32.7 vs. 21.9 months; P < 0.0001). Findings were consistent across therapeutic areas: hazard of a hospital visit was 28%, 27%, and 37% lower for rheumatology, gastroenterology, and dermatology patients participating in the PSP (all P < 0.05). CONCLUSIONS: Patients with immune-mediated diseases receiving adalimumab and utilizing this PSP had improved long-term medication-taking behavior and lower risk of hospital visits, demonstrating the potential of PSPs to improve patient outcomes and lower the burden to the health care system. DISCLOSURES: Design, study conduct, and financial support for the study were provided by AbbVie Inc., which participated in the interpretation of data, review, and approval of the manuscript. Fendrick has received personal fees from Merck, AstraZeneca, Trizetto, Amgen, Lilly, AbbVie, Johnson & Johnson, and Sanofi; grants from the National Pharmaceutical Council, PhRMA, the Gary and Mary West Health Foundation, the states of New York and Michigan, the Laura and John Arnold Foundation, the Robert Wood Johnson Foundation, and the Agency for Healthcare Research and Quality; and equity in Zansors, Sempre Health, Wellth, and V-BID Health. Brixner has received consulting fees from AbbVie, Novartis, Xcenda, Elevar Therapeutics, Sanofi, UCB Pharma, and the Millcreek Outcomes Group. Rubin has received consulting fees from AbbVie, Abgenomics, Allergan Inc., Amgen, Celgene Corporation, Forward Pharma, Genentech/Roche, Janssen Pharmaceuticals, Merck & Co., Miraca Life Sciences, Mitsubishi Tanabe Pharma Development America, Napo Pharmaceuticals, Pfizer, Salix Pharmaceuticals Inc., Samsung Bioepis, Sandoz Pharmaceuticals, Shire, Takeda, and Target Pharmaceuticals; and research support from AbbVie, Genentech/Roche, Janssen Pharmaceuticals, Prometheus Laboratories, Shire, Takeda, and UCB Pharma. Mease has received grant/research support from AbbVie, Amgen, BMS, Celgene, Janssen, Lilly, Merck, Novartis, Pfizer, SUN Pharma, and UCB; consulting fees from AbbVie, Amgen, BMS, Boehringer Ingelheim, Celgene, Galapagos, Genentech, Gilead, GlaxoSmithKline, Janssen, Lilly, Novartis, Pfizer, SUN Pharma, and UCB; and has served on the speakers bureau for AbbVie, Amgen, Celgene, Janssen, Lilly, Novartis, Pfizer, and UCB. Liu has no financial conflict of interest. Davis is an employee of Medicus Economics, which received payment from AbbVie to participate in this research. Mittal is an employee and stockholder of AbbVie. This study used a cohort of patients previously described in Brixner D, Rubin DT, Mease P, et al. Patient support program increased medication adherence with lower total health care costs despite increased drug spending. J Manag Care Spec Pharm. 2019 Jul;25(7):770-79 (doi: 10.18553/jmcp.2019.18443). As such, the sample selection and select baseline characteristics and 12-month outcomes have been published previously; however, the hospital visit outcomes and the longer-term medication-taking behavior outcomes have not been previously published or presented.
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Affiliation(s)
| | - Diana Brixner
- University of Utah College of Pharmacy, Salt Lake City
| | - David T Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL
| | - Philip Mease
- Swedish Medical Center/Providence St. Joseph Health and University of Washington School of Medicine, Seattle, WA
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312
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Brennan V, Mulvey C, Greene G, Hale EM, Costello RW. A Clinical Perspective on the Role of Electronic Devices in Monitoring and Promoting Adherence in Airways Disease. FRONTIERS IN MEDICAL TECHNOLOGY 2021; 3:604475. [PMID: 35047901 PMCID: PMC8757727 DOI: 10.3389/fmedt.2021.604475] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/16/2021] [Indexed: 11/17/2022] Open
Abstract
Poor adherence to treatment is a common reason why patients with chronic disease have worse outcomes than might be expected. Poor treatment adherence is of particular concern among people with airways disease because, apart from not taking treatment as prescribed, inhaled medication can also be administered incorrectly. Recently, a number of technological advances that accurately document when an inhaled treatment has been used and, in certain instances, how it was used have been developed. There is good evidence from a number of research groups that these devices, either by patient reminders or physician feedback, promote adherence to inhaled treatments. What is less certain is how, in a real-world setting, these devices change outcomes. In this perspective article, the role of electronic devices in quantifying treatment use and addressing poor treatment adherence and their potential role in clinical practice outside of clinical validation trials are described.
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Affiliation(s)
- Vincent Brennan
- Clinical Research Center, Royal College of Surgeons in Ireland, Dublin, Ireland
- Beaumont Hospital, Dublin, Ireland
| | - Christopher Mulvey
- Clinical Research Center, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Garrett Greene
- Clinical Research Center, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elaine Mac Hale
- Clinical Research Center, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Richard W. Costello
- Clinical Research Center, Royal College of Surgeons in Ireland, Dublin, Ireland
- Beaumont Hospital, Dublin, Ireland
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313
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Patel T, McDougall A, Ivo J, Carducci J, Pritchard S, Chang F, Faisal S, Lee C. Development and Content Validation of an Instrument to Measure Medication Self-Management in Older Adults. PHARMACY 2021; 9:78. [PMID: 33920490 PMCID: PMC8167785 DOI: 10.3390/pharmacy9020078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND For older adults, the capacity to self-manage medications may be limited by several factors. However, currently available tools do not permit a comprehensive assessment of such limitations. The Domain Specific Limitation in Medication Management Capacity (DSL-MMC) was developed to address this need. This study aimed to establish the face and content validity of the DSL-MMC. METHODS The DSL-MMC tool consisted of 4 domains and 12 sub-domains with 42 items including: 1. physical abilities (vision, dexterity, hearing); 2. cognition (comprehension, memory, executive functioning); 3. medication regimen complexity (dosing regimen, non-oral administration, polypharmacy); and 4. access/caregiver (prescription refill, new prescription, caregiver). Pharmacists assessed each item for relevance, importance, readability, understandability, and representation. Items with content validity index (CVI) scores of <0.80 for relevance were examined for revision or removal. RESULTS Twelve pharmacists participated in the study. CVI scores for relevance and importance of domains were 1.0; of the sub-domains, two were below 0.80. Among the 42 items, 35 (83%) and 30 (71%) maintained CVI scores above 0.80 for relevance and importance, respectively. Five items were removed, three were merged and seven were modified due to low CVI scores and/or feedback. CONCLUSION The DSL-MMC has been validated for content.
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Affiliation(s)
- Tejal Patel
- School of Pharmacy, University of Waterloo, 10 Victorial St S., Kitchener, ON N2G 1C5, Canada; (J.I.); (F.C.); (S.F.)
- Centre for Family Medicine Family Health Team, 10 Victoria St S., Kitchener, ON N2G 1C5, Canada; (A.M.); (J.C.); (S.P.); (C.L.)
- Schlegel—University of Waterloo Research Institute of Aging, 250 Laurelwood Drive, Waterloo, ON N2J 0E2, Canada
| | - Aidan McDougall
- Centre for Family Medicine Family Health Team, 10 Victoria St S., Kitchener, ON N2G 1C5, Canada; (A.M.); (J.C.); (S.P.); (C.L.)
| | - Jessica Ivo
- School of Pharmacy, University of Waterloo, 10 Victorial St S., Kitchener, ON N2G 1C5, Canada; (J.I.); (F.C.); (S.F.)
| | - Jillian Carducci
- Centre for Family Medicine Family Health Team, 10 Victoria St S., Kitchener, ON N2G 1C5, Canada; (A.M.); (J.C.); (S.P.); (C.L.)
| | - Sarah Pritchard
- Centre for Family Medicine Family Health Team, 10 Victoria St S., Kitchener, ON N2G 1C5, Canada; (A.M.); (J.C.); (S.P.); (C.L.)
| | - Feng Chang
- School of Pharmacy, University of Waterloo, 10 Victorial St S., Kitchener, ON N2G 1C5, Canada; (J.I.); (F.C.); (S.F.)
| | - Sadaf Faisal
- School of Pharmacy, University of Waterloo, 10 Victorial St S., Kitchener, ON N2G 1C5, Canada; (J.I.); (F.C.); (S.F.)
| | - Catherine Lee
- Centre for Family Medicine Family Health Team, 10 Victoria St S., Kitchener, ON N2G 1C5, Canada; (A.M.); (J.C.); (S.P.); (C.L.)
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314
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Hanlon M, Hogan M, Durand H, Pilch M, Harney O, Molloy G, Murphy AW. Designing an e-learning tool to support health practitioners caring for patients taking multiple medications. HRB Open Res 2021; 3:59. [PMID: 33954278 PMCID: PMC8063539 DOI: 10.12688/hrbopenres.13110.2] [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] [Accepted: 03/24/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Population ageing and improvements in healthcare mean the number of people living with two or more chronic conditions, or 'multimorbidity', is rapidly increasing. This presents a challenge to current disease-specific care delivery models. Adherence to prescribed medications appears particularly challenging for individuals living with multimorbidity, given the often-complex drug regimens required to treat multiple conditions. Poor adherence is associated with increased mortality, as well as wasted healthcare resources. Supporting medication adherence is a key priority for general practitioners (GPs) and practice nurses as they are responsible for much of the disease counselling and medication prescribing associated with chronic illnesses. Despite this, practical resources and training for health practitioners on how to promote adherence in practice is currently lacking. Informed by the principles of patient and public involvement (PPI), the aim of this research was to develop a patient informed e-learning resource to help GPs and nurses support medication adherence. Method: Utilising collective intelligence (CI) and scenario-based design (SBD) methodology, input was gathered from key stakeholders in medication adherence to gain insights into barriers to supporting people with multimorbidity who are receiving polypharmacy, strategies for overcoming these barriers, and user needs and requirements to inform the design of the e-learning tool. Results: In total, 67 barriers to supporting people who are taking multiple medications were identified across 8 barrier categories. 162 options for overcoming the identified barriers were then generated. This data was used in the design of a flexible e-learning tool for continuous professional development, that has been integrated into general practice and clinical education programmes as a supportive tool. Conclusions: Using CI and SBD methodology was an effective way of facilitating collaboration, idea-generation, and the co-creation of design solutions amongst a diverse group of stakeholders. This approach could be usefully applied to address other complex healthcare-related challenges.
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Affiliation(s)
| | - Michael Hogan
- School of Psychology, NUI Galway, Galway, H91 TK33, Ireland
| | - Hannah Durand
- School of Psychology, NUI Galway, Galway, H91 TK33, Ireland
| | - Monika Pilch
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Owen Harney
- The Ryan Institute, NUI Galway, Galway, H91 R8EC, Ireland
| | - Gerard Molloy
- School of Psychology, NUI Galway, Galway, H91 TK33, Ireland
| | - Andrew W. Murphy
- HRB Primary Care Clinical Trials Network Ireland, NUI Galway, Galway, Ireland; and College of Medicine Nursing & Health Sciences, NUI Galway, Galway, Ireland
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315
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Webster RK, Rubin GJ. Predicting Expectations of Side-Effects for Those Which Are Warned Versus Not Warned About in Patient Information Leaflets. Ann Behav Med 2021; 55:1253-1261. [PMID: 33821932 DOI: 10.1093/abm/kaab015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Research investigating predictors of side-effect expectations is disparate and largely based on hypothetical vignettes. PURPOSE To carry out a secondary analysis of a randomized controlled trial and investigate the predictors of side-effect expectations for side-effects that were, or were not, warned about. METHODS Two hundred and three healthy adults completed measures concerning demographics, psychological factors, baseline symptoms, and medication-related beliefs before reading one of two types of patient information leaflet (PIL) (standard or positively framed PIL) for a sham medication and asking them about their side-effect expectations. Associations between these measures and side-effect expectations whilst controlling for the PIL received were assessed using regression analyses. RESULTS 82.8% of participants expected side-effects that were warned about in the PIL, and 29.1% expected side-effects that were not warned about. Participants who were younger, from White backgrounds, less optimistic, experienced increased anxiety and received the standard PIL were more likely to expect side-effects that were warned about. Those with higher beliefs about medicine overuse and lower trust in medicine development were more likely to expect side-effects that were not warned about. Higher somatization, baseline symptoms, modern health worries scores, and lower trust in pharmaceutical companies were associated with increased expectations for all side-effects. The results suggest we can not only rely on altering side-effect risk communication to reduce side-effect expectations and therefore nocebo effects. We must also consider patients' beliefs about trust in medicines. More work is needed to investigate this in a patientsample in which the medication is known to them.
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Affiliation(s)
- Rebecca K Webster
- Department of Psychology, University of Sheffield, Cathedral Court, Sheffield, UK
| | - G James Rubin
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Weston Education Centre, Denmark Hill, London, UK.,Department of Psychological Medicine, National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response, King's College London, London, UK
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316
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Mishuk AU, Chen L, Li C, Huo N, Hansen RA, Harris I, Kiptanui Z, Qian J. Patient factors associated with oral generic olanzapine initiation and substitution among Medicaid beneficiaries: a new user cohort study. Curr Med Res Opin 2021; 37:655-664. [PMID: 33507825 DOI: 10.1080/03007995.2021.1882413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Generic drugs typically are less expensive than branded products; however, several factors can limit generic drug utilization. This study assesses the associations of patient factors with generic olanzapine initiation and substitution. METHODS A retrospective new user cohort study was conducted using the 2011-2012 Medicaid administrative claims data. Beneficiaries continuously enrolled during the 6 month washout period prior to their initial oral brand or generic olanzapine prescription were included and followed up to 12 months. Among brand olanzapine new users, time to generic substitution and competing risk outcomes was estimated using the Fine-Gray cumulative incidence function. Patient demographic and health service utilization factors were assessed in the multivariate cause-specific hazards model. RESULTS Among olanzapine new users, 70.7% patients initiated generic treatment. Beneficiaries aged ≥21, and living in the Midwest and West regions were more likely to initiate generic olanzapine. Among brand new users, 28.2% switched to generic olanzapine, 23.6% switched to an alternative atypical antipsychotic treatment and 38.0% discontinued within 12 months. Beneficiaries who resided in urban areas (adjusted hazard ratio [AHR) = 0.53, 95% CI = 0.37-0.75) and had prior hospitalizations (AHR = 0.85, 95% CI = 0.75-0.96) had lower rates of generic substitution, whereas those with emergency department (ED) visits (AHR = 1.06, 95% CI = 1.02-1.10) had a higher rate of generic substitution. In addition, beneficiaries in different age subgroups also had different rates of generic substitution in different regions. CONCLUSION Medicaid beneficiaries' age, geographic region, prior hospitalization and ED utilization were associated with generic olanzapine initiation and substitution. Tailored educational outreach targeting these patient subgroups might improve generic olanzapine utilization.
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Affiliation(s)
| | - Li Chen
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Chao Li
- Auburn University Harrison School of Pharmacy, Auburn, AL, USA
| | - Nan Huo
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Jingjing Qian
- Auburn University Harrison School of Pharmacy, Auburn, AL, USA
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317
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Abstract
: Suboptimal adherence to antihypertensive medication is a major contributor to poor blood pressure control. Several methods, direct or indirect, are available for measuring adherence, including the recently developed biochemical screening, although there is no gold-standard method routinely used in clinical practice to accurately assess the different facets of adherence. Adherence to treatment is a complex phenomenon and several of the barriers to adherence will need to be addressed at the healthcare system level; however, when looking at adherence from a more practical side and from the practitioner's perspective, the patient-practitioner relationship is a key element both in detecting adherence and in attempting to choose interventions tailored to the patient's profile. The use of single-pill combinations enabling simplification of treatment regimen, the implementation of a collaborative team-based approach and the development of electronic health tools also hold promise for improving adherence, and thus impacting cardiovascular outcomes and healthcare costs.
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318
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Studer B, Timm A, Sahakian BJ, Kalenscher T, Knecht S. A decision-neuroscientific intervention to improve cognitive recovery after stroke. Brain 2021; 144:1764-1773. [PMID: 33742664 PMCID: PMC8320292 DOI: 10.1093/brain/awab128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/22/2021] [Accepted: 02/08/2021] [Indexed: 11/24/2022] Open
Abstract
Functional recovery after stroke is dose-dependent on the amount of rehabilitative training. However, rehabilitative training is subject to motivational hurdles. Decision neuroscience formalizes drivers and dampers of behaviour and provides strategies for tipping motivational trade-offs and behaviour change. Here, we used one such strategy, upfront voluntary choice restriction (‘precommitment’), and tested if it can increase the amount of self-directed rehabilitative training in severely impaired stroke patients. In this randomized controlled study, stroke patients with working memory deficits (n = 83) were prescribed daily self-directed gamified cognitive training as an add-on to standard therapy during post-acute inpatient neurorehabilitation. Patients allocated to the precommitment intervention could choose to restrict competing options to self-directed training, specifically the possibility to meet visitors. This upfront choice restriction was opted for by all patients in the intervention group and highly effective. Patients in the precommitment group performed the prescribed self-directed gamified cognitive training twice as often as control group patients who were not offered precommitment [on 50% versus 21% of days, Pcorr = 0.004, d = 0.87, 95% confidence interval (CI95%) = 0.31 to 1.42], and, as a consequence, reached a 3-fold higher total training dose (90.21 versus 33.60 min, Pcorr = 0.004, d = 0.83, CI95% = 0.27 to 1.38). Moreover, add-on self-directed cognitive training was associated with stronger improvements in visuospatial and verbal working memory performance (Pcorr = 0.002, d = 0.72 and Pcorr = 0.036, d = 0.62). Our neuroscientific decision add-on intervention strongly increased the amount of effective cognitive training performed by severely impaired stroke patients. These results warrant a full clinical trial to link decision-based neuroscientific interventions directly with clinical outcome.
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Affiliation(s)
- Bettina Studer
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.,Department of Neurology, Mauritius Hospital Meerbusch, Meerbusch, Germany
| | - Alicja Timm
- Department of Neurology, Mauritius Hospital Meerbusch, Meerbusch, Germany
| | | | - Tobias Kalenscher
- Comparative Psychology, Institute of Experimental Psychology, University of Düsseldorf, Düsseldorf, Germany
| | - Stefan Knecht
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.,Department of Neurology, Mauritius Hospital Meerbusch, Meerbusch, Germany
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319
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Andreae SJ, Andreae LJ, Cherrington AL, Richman JS, Johnson E, Clark D, Safford MM. Peer coach delivered storytelling program improved diabetes medication adherence: A cluster randomized trial. Contemp Clin Trials 2021; 104:106358. [PMID: 33737200 DOI: 10.1016/j.cct.2021.106358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/13/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Because medication adherence is linked to better diabetes outcomes, numerous interventions have aimed to improve adherence. However, suboptimal adherence persists and necessitate continued research into intervention strategies. This study evaluated the effectiveness of an intervention that combined storytelling and peer support to improve medication adherence and health outcomes in adults with diabetes. METHODS Living Well with Diabetes was a cluster randomized controlled trial. Intervention participants received a six-month, 11-session peer-delivered behavioral diabetes self-care program over the phone. Control participants received a self-paced general health program. Outcomes were changes in medication adherence and physiologic measures (hemoglobin A1c, systolic blood pressure, low-density lipoprotein cholesterol, body mass index). RESULTS Of the 403 participants with follow-up data, mean age was 57 (±SD 11), 78% were female, 91% were African American, 56.4% had high school education or less, and 70% had an annual income of < $20,000. At follow-up, compared to controls, intervention participants had greater improvement in medication adherence (β = -0.25 [95% CI -0.35, -0.15]). Physiologic measures did not change significantly in either group. Intervention participants had significant improvements in beliefs about the necessity of medications (β = 0.87 [95% CI 0.27, 1.47]) concerns about the negative effects of medication (β = -0.91 [95% CI -1.35, -0.47]), and beliefs that medications are harmful (β = -0.50 [95% CI -0.89, -0.10]). In addition, medication use self-efficacy significantly improved in intervention participants (β = 1.0 [95% CI 0.23, 1.76]). 473 individuals were enrolled in the study and randomized. DISCUSSION Living Well intervention resulted in improved medication adherence, medication beliefs, and medication use self-efficacy but not improved risk factor levels.
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Affiliation(s)
- Susan J Andreae
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States of America.
| | - Lynn J Andreae
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Andrea L Cherrington
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Joshua S Richman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Ethel Johnson
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Debra Clark
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Monika M Safford
- Department of Medicine, Weill Medical College of Cornell University, New York, NY, United States of America
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320
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Naser AY. Cost-related nonadherence for prescription medications: a cross-sectional study in Jordan. Expert Rev Pharmacoecon Outcomes Res 2021; 22:497-503. [PMID: 33666532 DOI: 10.1080/14737167.2021.1899814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Cost-related nonadherence to medications is a commonly encountered problem posed by many patients, and specifically among elderly patients who use multiple chronic medications. This study aims to explore the prevalence of medication cost-related nonadherence and its predictors in Jordan.Method: A cross-sectional study was conducted between February 2019 and May 2019 in Jordan. The CRN questionnaire was used as a measure to assess the prevalence of cost-related nonadherence. Logistic regression was used to determine predictors of medication cost-related nonadherence.Results: The prevalence rate of CRN was 29.6% (95% CI: 27.0-32.3). Participants who are married or widowed were found to have higher odds of being non-adherent due to medication costs, with an odds ratio of 1.55 (95%CI: 1.19-2.00) and 1.95 (95%CI: 1.20-3.15), respectively. Lower educational level was associated with higher odds of being non-adherent 1.95 (95%CI: 1.25-3.05). Being retired was associated with higher odds of being non-adherent (2.20 (95%CI: 1.49-3.27)).Conclusion: Cost-related nonadherence is a common problem in Jordan and was most prevalent among those with hypertension and diabetes mellitus, low-income, and low levels of education. Our findings could help in developing interventions to improve cost-related medication nonadherence in developing countries.
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Affiliation(s)
- Abdallah Y Naser
- Department of Applied Pharmac eutics and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
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321
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Chong CC, Redzuan AM, Sathar J, Makmor-Bakry M. Patient Perspective on Iron Chelation Therapy: Barriers and Facilitators of Medication Adherence. J Patient Exp 2021; 8:2374373521996958. [PMID: 34179377 PMCID: PMC8205330 DOI: 10.1177/2374373521996958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Nonadherence to iron chelation therapy (ICT) remains a long-standing and serious issue in thalassemia, especially in resource-constrained developing countries. Barriers and facilitators of adherence to ICT in transfusion-dependent thalassemia (TDT) adult patients in Malaysia are not completely understood. This qualitative study explored factors affecting adherence to ICT among TDT adult patients at a public tertiary hospital in Malaysia. Data were collected through 21 semistructured in-depth interviews conducted among purposively sampled patients using a pretested interview guide. All interviews were audio-recorded and transcribed verbatim. Data were analyzed manually using thematic analysis method and managed using Atlas.Ti software. The most frequently discussed subthemes of barriers to adherence included patient-related factors, medications-related factors, sociocultural-related factors, environmental context and resources, and patient–health care provider relationship factors. The facilitators to adherence included having insights of their illness, prevailing sources of motivation emphasizing on strong self-efficacy, low medication burden, and having enabling environment. This study has identified barriers and facilitators that are unique to Malaysian thalassemic adults related to medication adherence. Options for future multifaceted interventions are suggested.
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Affiliation(s)
- Chia Chee Chong
- Faculty of Pharmacy, Centre of Quality Management of Medicines, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Adyani Md Redzuan
- Faculty of Pharmacy, Centre of Quality Management of Medicines, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Jameela Sathar
- Hematology Department, Hospital Ampang, Pandan Mewah, Ampang, Selangor, Malaysia
| | - Mohd Makmor-Bakry
- Faculty of Pharmacy, Centre of Quality Management of Medicines, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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322
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Faisal S. Lessons in reflexivity of a pharmacist conducting ethnographic research. Res Social Adm Pharm 2021; 17:1849-1855. [PMID: 33640335 DOI: 10.1016/j.sapharm.2021.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Abstract
The practice of reflexivity is widely recognized in ethnographic research as a strategy to identify and explore a researcher's self-knowledge, beliefs, experiences, and their influence on research. In this article, I explore my journey from a practising pharmacist to a researcher within an ethnographic informed study pertaining to patients with chronic diseases and their medication intake behaviour. Ethnography allowed me to explore the lived experiences of ten participants using a smart medication adherence product. Through in-depth at home observations, photo-elicitation and semi-structured interviews over a period of 6 months, I was able to gather the invisible meanings associated with their in-home medication intake process. Extensive field notes were written after each home visit in addition to a reflexive journal documenting my inner thoughts, questions and reflections. A key finding of this activity was the intersectionality of my profession with race and gender, something I had not anticipated. Secondly, my social location as a woman and person of color resulted in questions being asked of me that was unexpected and at times left me feeling uncertain and uncomfortable. I entered this study believing that the boundary I erected between my roles of pharmacist and researcher would ensure clarity, and perhaps a sense of protection to some degree. I now realize this may have been naive and by relinquishing control of these roles, I was able to gain a deeper understanding of myself, my role as a clinician/researcher, and the older adults I serve as a pharmacist. Being reflexive during the study period offered me an opportunity to first identify and then analyze my beliefs and how they may impact the information I gathered during fieldwork. The practice of reflexivity is a critical tool for clinician-researchers and should be practiced throughout the course of fieldwork.
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Affiliation(s)
- Sadaf Faisal
- University of Waterloo, School of Pharmacy, Kitchener, Ontario, Canada.
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323
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Appiah B, Kretchy IA, Yoshikawa A, Asamoah-Akuoko L, France CR. Perceptions of a mobile phone-based approach to promote medication adherence: A cross-sectional application of the technology acceptance model. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 1:100005. [PMID: 35479503 PMCID: PMC9031033 DOI: 10.1016/j.rcsop.2021.100005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/10/2021] [Accepted: 03/28/2021] [Indexed: 11/01/2022] Open
Abstract
Background Objectives Methods Results Conclusion Medication adherence strategies using mobile phones are common New mobile phone-based approach called caller tunes was tested for feasibility Intention to use the caller tunes for enhancing medication adherence was high Making caller tunes free to download increased intention to use Caller tunes could be a novel strategy to promote medication adherence
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324
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Johnstone BH, Messner F, Brandacher G, Woods EJ. A Large-Scale Bank of Organ Donor Bone Marrow and Matched Mesenchymal Stem Cells for Promoting Immunomodulation and Transplant Tolerance. Front Immunol 2021; 12:622604. [PMID: 33732244 PMCID: PMC7959805 DOI: 10.3389/fimmu.2021.622604] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/08/2021] [Indexed: 12/11/2022] Open
Abstract
Induction of immune tolerance for solid organ and vascular composite allografts is the Holy Grail for transplantation medicine. This would obviate the need for life-long immunosuppression which is associated with serious adverse outcomes, such as infections, cancers, and renal failure. Currently the most promising means of tolerance induction is through establishing a mixed chimeric state by transplantation of donor hematopoietic stem cells; however, with the exception of living donor renal transplantation, the mixed chimerism approach has not achieved durable immune tolerance on a large scale in preclinical or clinical trials with other solid organs or vascular composite allotransplants (VCA). Ossium Health has established a bank of cryopreserved bone marrow (BM), termed "hematopoietic progenitor cell (HPC), Marrow," recovered from deceased organ donor vertebral bodies. This new source for hematopoietic cell transplant will be a valuable resource for treating hematological malignancies as well as for inducing transplant tolerance. In addition, we have discovered and developed a large source of mesenchymal stem (stromal) cells (MSC) tightly associated with the vertebral body bone fragment byproduct of the HPC, Marrow recovery process. Thus, these vertebral bone adherent MSC (vBA-MSC) are matched to the banked BM obtained from each donor, as opposed to third-party MSC, which enhances safety and potentially efficacy. Isolation and characterization of vBA-MSC from over 30 donors has demonstrated that the cells are no different than traditional BM-MSC; however, their abundance is >1,000-fold higher than obtainable from living donor BM aspirates. Based on our own unpublished data as well as reports published by others, MSC facilitate chimerism, especially at limiting hematopoietic stem and progenitor cell (HSPC) numbers and increase safety by controlling and/or preventing graft-vs.-host-disease (GvHD). Thus, vBA-MSC have the potential to facilitate mixed chimerism, promote complementary peripheral immunomodulatory functions and increase safety of BM infusions. Both HPC, Marrow and vBA-MSC have potential use in current VCA and solid organ transplant (SOT) tolerance clinical protocols that are amenable to "delayed tolerance." Current trials with HPC, Marrow are planned with subsequent phases to include vBA-MSC for tolerance of both VCA and SOT.
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Affiliation(s)
- Brian H. Johnstone
- Ossium Health, Indianapolis, IN, United States
- Department of Biomedical Sciences, College of Osteopathic Medicine, Marian University, Indianapolis, IN, United States
| | - Franka Messner
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Erik J. Woods
- Ossium Health, Indianapolis, IN, United States
- Department of Biomedical Sciences, College of Osteopathic Medicine, Marian University, Indianapolis, IN, United States
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, United States
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325
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Edifor EE, Brown R, Smith P, Kossik R. Non-Adherence Tree Analysis (NATA)-An adherence improvement framework: A COVID-19 case study. PLoS One 2021; 16:e0247109. [PMID: 33606789 PMCID: PMC7895356 DOI: 10.1371/journal.pone.0247109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 02/01/2021] [Indexed: 01/12/2023] Open
Abstract
Poor medication adherence is a global phenomenon that has received a significant amount of research attention yet remains largely unsolved. Medication non-adherence can blur drug efficacy results in clinical trials, lead to substantial financial losses, increase the risk of relapse and hospitalisation, or lead to death. The most common methods of measuring adherence are post-treatment measures; that is, adherence is usually measured after the treatment has begun. What the authors are proposing in this multidisciplinary study is a new technique for predicting the factors that are likely to cause non-adherence before or during medication treatment, illustrated in the context of potential non-adherence to COVID-19 antiviral medication. Fault Tree Analysis (FTA), allows system analysts to determine how combinations of simple faults of a system can propagate to cause a total system failure. Monte Carlo simulation is a mathematical algorithm that depends heavily on repeated random sampling to predict the behaviour of a system. In this study, the authors propose a new technique called Non-Adherence Tree Analysis (NATA), based on the FTA and Monte Carlo simulation techniques, to improve adherence. Firstly, the non-adherence factors of a medication treatment lifecycle are translated into what is referred to as a Non-Adherence Tree (NAT). Secondly, the NAT is coded into a format that is translated into the GoldSim software for performing dynamic system modelling and analysis using Monte Carlo. Finally, the GoldSim model is simulated and analysed to predict the behaviour of the NAT. NATA is dynamic and able to learn from emerging datasets to improve the accuracy of future predictions. It produces a framework for improving adherence by analysing social and non-social adherence barriers. Novel terminologies and mathematical expressions have been developed and applied to real-world scenarios. The results of the application of NATA using data from six previous studies in relation to antiviral medication demonstrate a predictive model which suggests that the biggest factor that could contribute to non-adherence to a COVID-19 antiviral treatment is a therapy-related factor (the side effects of the medication). This is closely followed by a condition-related factor (asymptomatic nature of the disease) then patient-related factors (forgetfulness and other causes). From the results, it appears that side effects, asymptomatic factors and forgetfulness contribute 32.44%, 22.67% and 18.22% respectively to discontinuation of medication treatment of COVID-19 antiviral medication treatment. With this information, clinicians can implement relevant interventions and measures and allocate resources appropriately to minimise non-adherence.
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Affiliation(s)
- Ernest Edem Edifor
- Operations, Technology, Events and Hospitality Management, Manchester Metropolitan University, Manchester, Lancashire, United Kingdom
- * E-mail:
| | - Regina Brown
- Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Paul Smith
- Marketing, Retail and Tourism, Manchester Metropolitan University, Manchester, Lancashire, United Kingdom
| | - Rick Kossik
- Research and Development, GoldSim Technology Group LLC, Seattle, Washington, United States of America
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326
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Yazdi-Feyzabadi V, Nakhaee N, Mehrolhassani MH, Naghavi S, Homaie Rad E. Development and validation of a questionnaire to determine medical orders non-adherence: a sequential exploratory mixed-method study. BMC Health Serv Res 2021; 21:136. [PMID: 33579267 PMCID: PMC7881677 DOI: 10.1186/s12913-021-06147-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background Patients’ non-adherence with medical orders of physicians in outpatient clinics can lead to reduced clinical effectiveness, inadequate treatment, and increased medical care expenses. This study was conducted to develop and validate a questionnaire to determine the reasons for patients’ non-adherence with physicians’ medical orders. Methods A sequential exploratory mixed-method study was conducted in two stages. The first stage comprised a qualitative stage to generate the primary items of the questionnaire. This stage provided findings of two sub-stages comprising a literature review and the findings of a qualitative conventional content analysis of 19 semi-structured interviews held with patients, physicians, and managers of the outpatient clinics in Kerman, an area located in southeastern Iran. The second stage comprised a quantitative study aiming evaluation of the instrument psychometric properties, including the face, content, construct, and reliability assessment of the questionnaire. Construct validity assessment was evaluated using exploratory factor analysis (EFA). The reliability assessment was done using assessing internal consistency (Cronbach’s alpha). To assess the construct validity of the questionnaire, four hundred and forty patients referred to outpatient clinics in Kerman were selected using stratified convenience sampling to fill out the questionnaire. The sample size was calculated using the Cochran formula. Qualitative and quantitative data were analyzed by MAXQDA 10 and Stata version 14, respectively. Results The primary items contained 57 items, of which 42 met the minimum acceptable value of 0.78 for item-level content validity index (I-CVI = 1 for 24 items and I-CVI = 0.8 for 18 items). Item-level content validity ratio (I-CVR) was confirmed for 18 items with a minimum acceptable value of 0.99 for five experts. Finally, 18 items obtained the acceptable value for both I-CVI and I-CVR indicators and were confirmed. Using EFA, four factors (intrapersonal-psychological, intrapersonal-cognitive, provider-related, and socio-economic reasons) with 18 items and Cronbach’s alpha coefficient of 0.70, 0.66, 0.73, and 0.71, respectively, were identified and explained 51% of the variance. The reliability of the questionnaire (r = 0.70) was confirmed. Conclusion The questionnaire with four dimensions is a valid and reliable instrument that can help determine the perceived reasons for non-adherence with medical orders in the outpatient services system. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06147-3.
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Affiliation(s)
- Vahid Yazdi-Feyzabadi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Nouzar Nakhaee
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Hossein Mehrolhassani
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Soheila Naghavi
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Enayatollah Homaie Rad
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
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327
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Lee WK, Lee J. Evaluation and improvement of adherence to medication. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.2.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Medication adherence refers to the extent to which a patient takes medication according to prescription. In many cases, adherence to medication is defined as the proportion of prescribed drugs taken as prescribed over a certain period. However, there is no satisfactory level of adherence that can be applied uniformly to all diseases and medications. Patients with poor adherence experience worsening of conditions, complications, and increased risk for death, which increases medical expenses. Therefore, to improve medication adherence, healthcare providers should try to identify poor adherence, adjust prescriptions to optimize treatment according to the patient’s lifestyle, and educate patients to help them understand the value of medical treatment and the effects of adherence. The most practical way to identify poor adherence during clinical visits is by asking patients about their medication adherence in a non-judgmental manner. Reducing the number of doses is more effective than reducing the number of tablets to increase compliance. It is necessary to adopt innovative methods based on information technology in our healthcare system because of the labor-intensive nature of educational intervention to improve adherence.
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328
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Kim H, Alten R, Cummings F, Danese S, D'Haens G, Emery P, Ghosh S, Gilletta de Saint Joseph C, Lee J, Lindsay JO, Nikiphorou E, Parker B, Schreiber S, Simoens S, Westhovens R, Jeong JH, Peyrin-Biroulet L. Innovative approaches to biologic development on the trail of CT-P13: biosimilars, value-added medicines, and biobetters. MAbs 2021; 13:1868078. [PMID: 33557682 PMCID: PMC7889098 DOI: 10.1080/19420862.2020.1868078] [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] [Indexed: 12/18/2022] Open
Abstract
The biosimilar concept is now well established. Clinical data accumulated pre- and post-approval have supported biosimilar uptake, in turn stimulating competition in the biologics market and increasing patient access to biologics. Following technological advances, other innovative biologics, such as “biobetters” or “value-added medicines,” are now reaching the market. These innovative biologics differ from the reference product by offering additional clinical or non-clinical benefits. We discuss these innovative biologics with reference to CT-P13, initially available as an intravenous (IV) biosimilar of reference infliximab. A subcutaneous (SC) formulation, CT-P13 SC, has now been developed. Relative to CT-P13 IV, CT-P13 SC offers clinical benefits in terms of pharmacokinetics, with comparable efficacy, safety, and immunogenicity, as well as increased convenience for patients and reduced demands on healthcare system resources. As was once the case for biosimilars, nomenclature and regulatory pathways for innovative biologics require clarification to support their uptake and ultimately benefit patients.
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Affiliation(s)
- HoUng Kim
- Celltrion Healthcare , Incheon, Republic of Korea.,Department of Pharmacology, College of Medicine, Chung-Ang University , Seoul, Republic of Korea
| | - Rieke Alten
- Rheumatology Research Center, Schlosspark-Klinik Charité, University Medicine Berlin , Berlin, Germany
| | - Fraser Cummings
- Department of Gastroenterology, University Hospital Southampton NHS Foundation Trust , Southampton, UK
| | - Silvio Danese
- Humanitas Clinical and Research Center - IRCCS and Department of Biomedical Sciences, Humanitas University , Milan, Italy
| | - Geert D'Haens
- Department of Inflammatory Bowel Disease, Amsterdam University Medical Centers , Amsterdam, The Netherlands
| | - Paul Emery
- Leeds NIHR Biomedical Research Centre, The Leeds Teaching Hospital Trust, and Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds , UK
| | - Subrata Ghosh
- The Institute of Translational Medicine, Immunology and Immunotherapy, NIHR BRC, University of Birmingham , Birmingham, UK
| | | | - JongHyuk Lee
- Department of Pharmaceutical Engineering, College of Life and Health Science, Hoseo University , Asan, Republic of Korea
| | - James O Lindsay
- Department of Gastroenterology, The Royal London Hospital, Barts Health NHS Trust , London, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College, London, and Rheumatology Department, King's College Hospital , London, UK
| | - Ben Parker
- Kellgren Centre for Rheumatology, Manchester Royal Infirmary, NIHR Manchester Biomedical Research Centre , Manchester, UK
| | - Stefan Schreiber
- Department of Medicine I, Christian-Albrechts-University, University Hospital Schleswig-Holstein , Kiel, Germany
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven , Leuven, Belgium
| | - Rene Westhovens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center , Leuven, Belgium
| | - Ji Hoon Jeong
- Department of Global Innovative Drugs, Graduate School of Chung-Ang University and Department of Pharmacology, College of Medicine, Chung-Ang University , Seoul, Republic of Korea
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital , Vandoeuvre-Les-Nancy, France.,Inserm U1256 NGERE, Lorraine University , Vandoeuvre-Les-Nancy, France
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329
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Evans C, Marrie RA, Yao S, Zhu F, Walld R, Tremlett H, Blackburn D, Kingwell E. Medication adherence in multiple sclerosis as a potential model for other chronic diseases: a population-based cohort study. BMJ Open 2021; 11:e043930. [PMID: 33550262 PMCID: PMC7925877 DOI: 10.1136/bmjopen-2020-043930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To determine whether better medication adherence in multiple sclerosis (MS) might be due to specialised disease-modifying drug (DMD) support programmes by: (1) establishing higher adherence in MS than in other chronic diseases and (2) determining if higher adherence is associated with patient-specific or treatment-specific factors. DESIGN Retrospective cohort study with data from 1 January 1996 to 31 December 2015. SETTING Population-based health administrative data from three Canadian provinces. PARTICIPANTS Individual cohorts were created using validated case definitions for MS, epilepsy, Parkinson's disease (PD) and rheumatoid arthritis (RA). Subjects were included if they received ≥1 dispensation for a disease-related drug between 1 January 1997 and 31 December 2014. MAIN OUTCOME MEASURES Proportion of subjects with optimal adherence (≥80%) measured by the medication possession ratio 1 year after the index date (first dispensation of disease-related drug). RESULTS 126 478 subjects were included in the primary analysis (MS, n=6271; epilepsy, n=55 739; PD, n=21 304; RA, n=43 164). Subjects with epilepsy (adjusted OR, aOR 0.29; 95% CI 0.19 to 0.45), PD (aOR 0.42; 95% CI 0.29 to 0.63) or RA (aOR 0.26; 95% CI 0.19 to 0.35) were less likely to have optimal 1-year adherence compared with subjects with MS. Within the MS cohort, adherence was higher for DMD than for chronic-use non-MS medications, and no consistent patient-related predictors of adherence were observed across all four non-MS medication classes, including having optimal adherence to DMD. CONCLUSIONS Subjects with MS were significantly more likely to have optimal 1-year adherence than subjects with epilepsy, RA and PD, and optimal adherence appears related to treatment-specific factors rather than patient-related factors. This supports the hypothesis that higher adherence to the MS DMDs could be due to the specialised support programmes; these programmes may serve as a model for use in other chronic conditions.
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Affiliation(s)
- Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ruth Ann Marrie
- Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shenzhen Yao
- Saskatchewan Health Quality Council, Saskatoon, Saskatchewan, Canada
| | - Feng Zhu
- Neurology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Randy Walld
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Helen Tremlett
- Neurology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - David Blackburn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Elaine Kingwell
- Neurology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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330
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Rampamba EM, Meyer JC, Helberg E, Godman B. Medicines Availability among Hypertensive Patients in Primary Health Care Facilities in a Rural Province in South Africa: Findings and Implications. J Res Pharm Pract 2021; 9:181-185. [PMID: 33912500 PMCID: PMC8067899 DOI: 10.4103/jrpp.jrpp_20_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/24/2020] [Indexed: 11/26/2022] Open
Abstract
Objective: Controlling blood pressure (BP) in hypertensive patients is a challenge, with the lack of antihypertensive medicines negatively impacting on BP control. Consequently, we assessed the availability of prescribed antihypertensives among patients with chronic hypertension attending primary health care (PHC) facilities in a rural province of South Africa and explored any association between medicines availability, the number of prescribed antihypertensive medicines and BP control. Methods: Secondary data that included patients' demographics, BP, and data on medicines availability of the intervention group from a 3 months' operational study conducted in rural PHC facilities in South Africa were analyzed. The association between medicines availability, the number of antihypertensive medicines, and BP control was explored. Findings: Fifty-five African patients (89.1% females) with a mean age of 61.3 years were included. Two-thirds (67.2%) received all their medicines during their monthly visits, 25.5% received some, and for 7.3%, there was no record of whether medicines were dispensed or not. Patients with controlled BP (60.0%) were more likely to have been prescribed only one antihypertensive medicine compared to patients with uncontrolled BP (20.7%) (P = 0.017; odds ratio: 5.75; 95% confidence interval: 1.46, 22.61). Conclusion: It is concerning that one-third of patients went home without all of their antihypertensive medicines from PHC facilities in this Province of South Africa where there is evidence of use of herbal medicines and uncontrolled BP contributing to high morbidity and mortality from cardiovascular diseases. Additional studies are needed to fully explore the association between medicines availability, their use, and BP control among patients.
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Affiliation(s)
- Enos M Rampamba
- Division of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa.,Department of Pharmacy, Tshilidzini Regional Hospital, Limpopo Province, South Africa
| | - Johanna C Meyer
- Division of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
| | - Elvera Helberg
- Division of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
| | - Brian Godman
- Division of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa.,Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.,School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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331
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Du Plessis JM, Poggenpoel M, Myburgh C, Temane A. Family members' lived experiences of non-compliance to psychiatric medication given to female adults living with depression. Curationis 2021; 44:e1-e9. [PMID: 33567850 PMCID: PMC7876956 DOI: 10.4102/curationis.v44i1.2105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/13/2020] [Accepted: 10/28/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Family members face the burden of adult females living with depression who do not comply with psychiatric medication. Discomfort, tension, anxiety, frustration, and related feelings of hopelessness and dysfunction were identified by family members. There have also been records of financial problems, physical ill-health, limitations on social and recreational opportunities and a general deterioration in their quality of life. There is a shortage of published literature and information on the reasons for non-compliance to psychiatric medications. The existing body of information needs to be strengthened and future approaches encouraged. The study aimed to improve compliance of adult females dealing with depression to psychiatric medical treatment and the effect it has on family members caring for adult females living with depression. OBJECTIVES To describe family members' lived experiences of non-compliance to psychiatric medication by adult females living with depression. METHOD A qualitative, exploratory, descriptive and contextual study design was used. A purposive sample of family members aged between 20 and 45 years was made. Data were collected by conducting eight in-depth, phenomenological interviews, and field notes were taken. The interviews focused on the central question: 'Tell me your experiences of living with your wife, mother, sister and daughter living with depression and not taking their medication as ordered by the doctor?' Tesch's method for data analysis was used, and an independent coder analysed the data and met with the researcher for a consensus discussion of the results. Measures to ensure trustworthiness were applied and ethical principles were adhered to. RESULTS The three themes identified were: experienced psycho-social effects, experienced treatment refusal and experienced challenges in caring for adult females living with depression who are non-compliant to psychiatric medication. As a result, the absence of social help, disturbance of family working, shame, separation and troublesome conduct of the adult females who are non-compliant to psychiatric medication developed as principal subjects. CONCLUSIONS The results demonstrated that family members experienced debilitation because they needed information about their relatives living with depression who are non-compliant to psychiatric medication. More information about the management of non-compliance of psychiatric medication was needed; a comprehensive awareness of the ramifications of the findings, treatment and care are required from mental health care professionals and service providers.
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Affiliation(s)
- Jeanne M Du Plessis
- Department of Nursing, Faculty of Health Sciences, University of Johannesburg, Johannesburg.
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332
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Kardas P, Dabrowa M, Witkowski K. Adherence to treatment in paediatric patients - results of the nationwide survey in Poland. BMC Pediatr 2021; 21:16. [PMID: 33407266 PMCID: PMC7786916 DOI: 10.1186/s12887-020-02477-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 12/16/2020] [Indexed: 11/24/2022] Open
Abstract
Background Due to high prevalence, non-adherence to prescribed treatment seriously undermines the effectiveness of evidence-based therapies in paediatric patients. In order to change this negative scenario, physicians need to be aware of adherence problem, as well as of possible solutions. Unfortunately, full potential of adherence-targeting interventions is still underused in Poland. Therefore, the aim of this study was to assess the knowledge, attitudes and behaviours toward non-adherence in Polish paediatricians. Methods An anonymous cross-sectional nationwide survey was conducted in the convenience sample of Polish doctors providing care to paediatric patients. The survey focused on the prevalence of non-adherence, its causes, and interventions employed. Primary studied parameter was perceived prevalence of non-adherence in paediatric patients. Reporting of this study adheres to STROBE guidelines. Results One thousand and thirty-three responses were eligible for analysis. Vast majority of respondents were female (85.9%), most of them worked in primary care (90.6%). The respondents represented all 16 Polish Voivodeships, with the biggest number coming from the Mazowieckie Voivodeship (n = 144, 13.9%). Survey participants believed that on average 28.9% of paediatric patients were non-adherent to medication. More than half of the respondents (n = 548, 53.0%) were convinced that their own patients were more adherent than average. Duration of the professional practice strongly correlated with a lower perceived prevalence of non-adherence. Professionals with more than 40 years of practice believed that the percentage of non-adherent patients was <=20% particularly often (OR = 3.82 (95% CI 2.11–6.93) versus those up to 10 years in practice). Out of all respondents, they were also most often convinced that their own patients were more adherent than the general population (P < 0.01). Consequently, they underestimated the need for training in this area. Conclusions Physicians taking care of Polish paediatric patients underestimated the prevalence of medication non-adherence and believed that this was a problem of other doctors. This optimistic bias was particularly pronounced in older doctors. These results identify important barriers toward improving patient adherence that are worth addressing in the pre- and post-graduate education of Polish physicians. They also put some light over the challenges that educational activities in this area may face.
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Affiliation(s)
- Przemyslaw Kardas
- Department of Family Medicine, Medical University of Lodz, 60, Narutowicza St., 90-136, Lodz, Poland.
| | - Marek Dabrowa
- Department of Biopharmacy, Medical University of Lodz, Lodz, Poland
| | - Konrad Witkowski
- Department of Family Medicine, Medical University of Lodz, 60, Narutowicza St., 90-136, Lodz, Poland
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Skladany L, Vnencakova J, Laffers L, Skvarkova B, Hrubá E, Molcan P, Koller T. Adherence to Oral Nutritional Supplements After Being Discharged from the Hospital is Low but Improves Outcome in Patients with Advanced Chronic Liver Disease. Patient Prefer Adherence 2021; 14:2559-2572. [PMID: 33447017 PMCID: PMC7802017 DOI: 10.2147/ppa.s283034] [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: 09/23/2020] [Accepted: 11/20/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Patients with advanced chronic liver disease (ACLD) often have a poor nutritional status. In the management, current guidelines recommend dietary counseling and oral nutritional supplements (ONS). Nutritional goals and adherence to ONS are difficult to achieve while studies addressing adherence are scarce. We aimed to evaluate adherence to ONS, the associated factors, and its impact on outcome among ALCD patients who are discharged from the hospital. PATIENTS AND METHODS We identified consecutive hospitalized patients with ACLD from the cirrhosis registry and ONS prescription at discharge. Baseline demographics, anthropometrics, hand-grip strength (HGS), nutritional, and laboratory parameters were recorded. Adherence was assessed at 30, 90, and 180 days, but not in patients who did not survive or in those who underwent liver transplantation (LT) before the time-point. RESULTS From the registry containing 1004 patients, we included 450 cases, the median age was 56.3 (IQR 47-62), 60% were males, 63.8% had alcoholic etiology, and the median model for end-stage liver disease score (MELD) was 16 (11-21). During follow-up, 13.6%, 23.6%, and 31.1% of patients have died within 30, 90, and 180 days, respectively, and 21 underwent LT. Adherence to ONS in surviving patients was observed in 46%, 26.1%, and 16.9% within 30, 90, and 180 days, respectively. Baseline refractory ascites (HR=0.43, 0.24-0.76), HGS (HR=1.03, 1.01-1.06), and mid-arm circumference (HR=0.93, 0.88-0.99) were independently associated with 30-day adherence. Among patients who survived beyond 30 days, adherents for >30 days had improved synthetic liver function, HGS, a higher probability of LT (HR=1.7, 1.03-2.8) and lower risk of death (HR=0.65, 0.45-0.89), particularly those with MELD>16 (OR=0.55, 0.36-0.85) and low HGS (OR=0.61, 0.39-0.93). CONCLUSION In ACLD patients after discharge, adherence to ONS steeply declined and was associated with baseline refractory ascites and low muscle strength. Adherence to ONS also improved liver function, muscle strength, and survival.
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Affiliation(s)
- Lubomir Skladany
- Hepatology, Gastroenterology and Transplantation (HEGITO) Department of the 2nd Department of Medicine, Slovak Medical University, FD Roosevelt Hospital, Banska Bystrica, Slovakia
| | - Jana Vnencakova
- Hepatology, Gastroenterology and Transplantation (HEGITO) Department of the 2nd Department of Medicine, Slovak Medical University, FD Roosevelt Hospital, Banska Bystrica, Slovakia
| | - Lukas Laffers
- Department of Mathematics, Faculty of Natural Sciences, Matej Bel University, Banska Bystrica, Slovakia
| | - Beata Skvarkova
- Hepatology, Gastroenterology and Transplantation (HEGITO) Department of the 2nd Department of Medicine, Slovak Medical University, FD Roosevelt Hospital, Banska Bystrica, Slovakia
| | - Eva Hrubá
- Hepatology, Gastroenterology and Transplantation (HEGITO) Department of the 2nd Department of Medicine, Slovak Medical University, FD Roosevelt Hospital, Banska Bystrica, Slovakia
| | - Pavol Molcan
- Hepatology, Gastroenterology and Transplantation (HEGITO) Department of the 2nd Department of Medicine, Slovak Medical University, FD Roosevelt Hospital, Banska Bystrica, Slovakia
| | - Tomas Koller
- Gastroenterology and Hepatology Subdiv. of the 5th Department of Medicine, Comenius University Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia
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Choo E, Jung M, Shin J, Lee S. Comparing the Sensitivities of Measures of Adherence to Antihypertensive Drugs Using Korean National Health Insurance Claims Data. Patient Prefer Adherence 2021; 15:1717-1728. [PMID: 34408405 PMCID: PMC8360770 DOI: 10.2147/ppa.s322745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/29/2021] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Numerous studies have utilized various forms of adherence measures. However, methods for measuring adherence are inconsistent. Moreover, few studies are available that have compared sensitivities of the effects of several criteria on medication adherence. This study aims to compare measures of adherence using varied analytical decisions. MATERIALS AND METHODS We included three measures for adherence: proportion of days covered with one or more medications (PDCwith≥1), duration weighted mean PDC (PDCwm), and daily polypharmacy possession ratio (DPPR). We compared the sensitivities of the measures by changing parameters in the Korean nationwide claims database. First, we used PDCwith≥1 as our base model. Then, we divided an adherence measure algorithm into three categories: (1) definition of data cleaning, (2) inclusion criteria and observation period, and (3) calculation methods of medication adherence. The categories included eight decision nodes that incorporated 25 alternative options. Finally, we assessed the medication adherence for the base-case with commonly used values and then varied to measure with each alternative option. RESULTS The base-case included 14,288 beneficiaries with antihypertensives. Among eight decisions, both handling an end-date-of-study and overlaps had the strongest impacts on measuring PDCwith≥1, PDCwm, and DPPR, with small differences in sample size. Instead of the estimates of adherence from PDCwm, those of PDCwith≥1 and DPPR were similar. Furthermore, a tendency toward a higher medication adherence was observed with a smaller study population. CONCLUSION The decisions regarding identifying an end-date-of-study and overlaps showed meaningful impacts of all three measures including PDCwith≥1, PDCwm, and DPPR on measuring medication adherence.
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Affiliation(s)
- Eunjung Choo
- Division of Clinical Pharmacy, College of Pharmacy, Ajou University, Suwon, Republic of Korea
| | - Minji Jung
- Division of Clinical Pharmacy, College of Pharmacy, Ajou University, Suwon, Republic of Korea
| | - Jaekyu Shin
- Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, CA, USA
| | - Sukhyang Lee
- Division of Clinical Pharmacy, College of Pharmacy, Ajou University, Suwon, Republic of Korea
- Correspondence: Sukhyang Lee Division of Clinical Pharmacy, College of Pharmacy, Ajou University, 206 Worldcup-ro Yeongtong-gu, Suwon, 16499, Republic of KoreaTel +82-31-219-3443Fax +82-31-219-3435 Email
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Mitkova Z, Petrova G. Utilization, Cost, and Affordability of Antihypertensive Therapy in Bulgaria. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2021; 20:403-416. [PMID: 34567170 PMCID: PMC8457736 DOI: 10.22037/ijpr.2020.113660.14418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ACE- inhibitors, angiotensin receptor blockers, beta-blockers, Ca- antagonists are recommended as first-line monotherapy for hypertension. The aim of the current study is to analyze expenditures paid by the National Health Insurance Fund (NHIF) after introducing the budget cap cost-containment measure and its impact on affordability and utilization. The study is a retrospective, observational analysis of expenditure on main groups' antihypertensive medicines: beta blockers, calcium channel blockers, ACE- inhibitors, and AT receptor blockers. The cost paid by the NHIF two years before (2016-2017), and after (2018-2019) the introduction of the budget cap measure was evaluated. Utilization and affordability data covering antihypertensive therapy were retrospectively calculated and analyzed during 2016-2019. The reimbursed expenditures on sartans, ACE-inhibitors, and β-blockers decreased in absolute terms in 2019 compared to that in 2016. There are no statistically significant differences, excluding the group of sartans. The result reveals decreasing utilization of ACE-inhibitors and β-blockers, which is the most significant for enalapril and bisoprolol. Affordability increases during the observed period because less than a working day income is sufficient for monthly therapy. Patients with hypertension in Bulgaria have access to affordable first-line antihypertensive medicines. Despite the stable and low prices, utilization mainly decreases. The reimbursed amount is reduced with a low rate or remains similar to that found at the beginning of the observed period. The results of the implemented budget cap as a measure to control NHIF cost are not evident and not fully expressed on the market for the first-line antihypertensive therapy.
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Affiliation(s)
- Zornitsa Mitkova
- Department of Organization and Economy of Pharmacy, Faculty of Pharmacy,Medical University of Sofia, Sofia, Bulgaria.
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Dijkstra NE, Vervloet M, Sino CGM, Heerdink ER, Nelissen-Vrancken M, Bleijenberg N, de Bruin M, Schoonhoven L. Home Care Patients' Experiences with Home Care Nurses' Support in Medication Adherence. Patient Prefer Adherence 2021; 15:1929-1940. [PMID: 34511888 PMCID: PMC8420798 DOI: 10.2147/ppa.s302818] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/09/2021] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To describe nurses' support interventions for medication adherence, and patients' experiences and desired improvements with this care. PATIENTS AND METHODS A two-phase study was performed, including an analysis of questionnaire data and conducted interviews with members of the care panel of the Netherlands Patients Federation. The questionnaire assessed 14 types of interventions, satisfaction (score 0-10) with received interventions, needs, experiences, and desired improvements in nurses' support. Interviews further explored experiences and improvements. Data were analyzed using descriptive statistics and a thematic analysis approach. RESULTS Fifty-nine participants completed the questionnaire, and 14 of the 59 participants were interviewed. The satisfaction score for interventions was 7.9 (IQR 7-9). The most common interventions were: "noticing when I don't take medication as prescribed" (n = 35), "helping me to find solutions to overcome problems with using medications" (n = 32), "helping me with taking medication" (n = 32), and "explaining the importance of taking medication at the right moment" (n = 32). Fifteen participants missed ≥1 of the 14 interventions. Most mentioned the following: "regularly asking about potential problems with medication use" (33%), "regularly discussing whether using medication is going well" (29%), and "explaining the importance of taking medication at the right moment" (27%). Twenty-two participants experienced the following as positive: improved self-management of adequate medication taking, a professional patient-nurse relationship to discuss adherence problems, and nurses' proactive attitude to arrange practical support for medication use. Thirteen patients experienced the following as negative: insufficient timing of home visits, rushed appearance of nurses, and insufficient expertise about side effects and taking medication. Suggested improvements included performing home visits on time, more time for providing support in medication use, and more expertise about side effects and administering medication. CONCLUSION Overall, participants were satisfied, and few participants wanted more interventions. Nurses' support improved participants' self-management of medication taking and enabled patients to discuss their adherence problems. Adequately timed home visits, more time for support, and accurate medication-related knowledge are desired.
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Affiliation(s)
- Nienke E Dijkstra
- Research Group Care for the Chronically Ill, University of Applied Sciences Utrecht, Utrecht, the Netherlands
- Research Group Innovation in Pharmaceutical Care, University of Applied Sciences Utrecht, Utrecht, the Netherlands
- Correspondence: Nienke E Dijkstra, Research Group Proactive Care for Elderly People Living at Home, University of Applied Sciences Utrecht, Heidelberglaan 7, Utrecht, 3584 CS, the NetherlandsTel +31 641620681 Email
| | - Marcia Vervloet
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Carolien G M Sino
- Research Group Care for the Chronically Ill, University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Eibert R Heerdink
- Research Group Innovation in Pharmaceutical Care, University of Applied Sciences Utrecht, Utrecht, the Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | | | - Nienke Bleijenberg
- Research Group Care for the Chronically Ill, University of Applied Sciences Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Marijn de Bruin
- IQ Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southhampton, UK
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Lopes J, Santos P. Determinants of Non-Adherence to the Medications for Dyslipidemia: A Systematic Review. Patient Prefer Adherence 2021; 15:1853-1871. [PMID: 34465984 PMCID: PMC8403077 DOI: 10.2147/ppa.s319604] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/06/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Dyslipidemia is a major cardiovascular risk factor, and its control leads to less cardiovascular events. Many patients will need some medications to achieve ideal targets. Non-adherence to medications is a complex problem with high impact on their effectiveness. This study aims to identify the determinants of non-adherence to medications in patients with dyslipidemia. PATIENTS AND METHODS We conducted a systematic review. PubMed and Scopus databases were searched for original articles, published between 2000 and 2020, using the MeSH terms "Dyslipidemias" and "Medication Adherence". RESULTS From the initial 3502 identified articles, we selected 46 to include in the final qualitative synthesis. The determinants associated with non-adherence were lower age (≤50 years), female sex, African American ethnicity, smoking habits, being a new user of lipid-lowering medications, reporting or having concerns about lipid-lowering medication side effects and some comorbidities (chronic obstructive pulmonary disease, Alzheimer's disease/dementia, depression and diabetes). On the contrary, adherence is higher in older patients, alcohol drinking habits, taking β-blockers, having a higher number of comorbidities, having a history of cardiovascular events, cardiac interventions or revascularization procedures, having health insurance and having more provider follow-up visits. CONCLUSION There are important identifiable determinants of non-adherence in patients with dyslipidemia. These patients benefit from a specific approach to minimize the problem and maximize the potential benefit of the prescription.
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Affiliation(s)
- João Lopes
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- Correspondence: João Lopes Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, PortugalTel +351 220426600 Email
| | - Paulo Santos
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
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Shrestha R, Sapkota B, Khatiwada AP, Shrestha S, Khanal S, KC B, Paudyal V. Translation, Cultural Adaptation and Validation of General Medication Adherence Scale (GMAS) into the Nepalese Language. Patient Prefer Adherence 2021; 15:1873-1885. [PMID: 34475753 PMCID: PMC8407778 DOI: 10.2147/ppa.s320866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/29/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The General Medication Adherence Scale (GMAS) evaluates intentional and unintentional behaviour of patients, disease and medication burden and cost-related burden associated with non-adherence. GMAS was developed and validated among Urdu-speaking patients with chronic diseases. However, validated tool in Nepalese language to measure medication adherence among chronic illness patients currently does not exist. AIM To translate, culturally adapt, and validate the English version of GMAS into the Nepalese language to measure medication adherence among chronic illness patients. METHODS The study was conducted among patients with chronic diseases in both hospital and community pharmacies of Nepal. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Good Practice Guideline for linguistic translation and cultural adaptation was used to translate and culturally adapt the English version of GMAS into the Nepalese version. The translated version was validated amongst patients with chronic diseases in Nepal. Exploratory factor analysis was carried out using principal component analysis with varimax rotation. Test-retest reliability and internal consistency were analysed. RESULTS A total of 220 (53.6% females, and 51.4% of 51 to 70 aged patients) patients with chronic diseases participated in the study. The majority of patients took two medications (27.3%) from six months to five and half years (68.2%). Kaiser Meyer Olkin was found to be 0.83. A principal axis factor analysis was conducted on the 3 items of GMAS without and with orthogonal rotation (varimax). The scree plot showed an inflexion on the third item that meant three components were present. The overall Cronbach's alpha value of the full-phase study was 0.82. CONCLUSION The General Medication Adherence Scale was successfully translated into the Nepalese language, culturally adapted, and validated amongst chronic diseases patients of Nepal. Therefore, the GMAS-Nepalese version can be used to evaluate medication adherence among Nepalese-speaking patients with chronic disease.
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Affiliation(s)
- Rajeev Shrestha
- Department of Pharmacy, District Hospital Lamjung, Besisahar, Province Gandaki, Nepal
- Correspondence: Rajeev Shrestha Department of Pharmacy, District Hospital Lamjung, Besisahar, Province Gandaki, NepalTel +977-9845445205 Email
| | - Binaya Sapkota
- Department of Pharmaceutical Sciences, Nobel College, Affiliated to Pokhara University, Kathmandu, Province Bagmati, Nepal
- Binaya Sapkota Department of Pharmaceutical Sciences, Nobel College, Affiliated to Pokhara University, Kathmandu, Province Bagmati, NepalTel +977-9851134925 Email
| | - Asmita Priyadarshini Khatiwada
- Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Province Bagmati, Nepal
| | - Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, 47500, Malaysia
| | - Saval Khanal
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Bhuvan KC
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, 47500, Malaysia
| | - Vibhu Paudyal
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Bjork JM, Reisweber J, Burchett JR, Plonski PE, Konova AB, Lopez-Guzman S, Dismuke-Greer CE. Impulsivity and Medical Care Utilization in Veterans Treated for Substance Use Disorder. Subst Use Misuse 2021; 56:1741-1751. [PMID: 34328052 DOI: 10.1080/10826084.2021.1949603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Impulsivity has been defined by acting rashly during positive mood states (positive urgency; PU) or negative mood states (negative urgency; NU) and by excessive de-valuation of deferred rewards. These behaviors reflect a "live in the now" mentality that is not only characteristic of many individuals with severe substance use disorder (SUD) but also impedes medical treatment compliance and could result in repeated hospitalizations or other poor health outcomes. Purpose/objectives: We sought preliminary evidence that impulsivity may relate to adverse health outcomes in the veteran population. Impulsivity measured in 90 veterans receiving inpatient or outpatient SUD care at a Veterans Affairs Medical Center was related to histories of inpatient/residential care costs, based on VA Health Economics Resource Center data. Results: We found that positive urgency, lack of persistence and lack of premeditation, but not sensation-seeking or preference for immediate or risky rewards, were significantly higher in veterans with a history of one or more admissions for VA-based inpatient or residential health care that either included (n = 30) or did not include (n = 29) an admission for SUD care. Among veterans with a history of inpatient/residential care for SUD, NU and PU, but not decision-making behavior, correlated with SUD care-related costs. Conclusions/Importance: In veterans receiving SUD care, questionnaire-assessed trait impulsivity (but not decision-making) related to greater care utilization within the VA system. This suggests that veterans with high impulsivity are at greater risk for adverse health outcomes, such that expansion of cognitive interventions to reduce impulsivity may improve their health.
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Affiliation(s)
- James M Bjork
- Hunter Holmes McGuire Veterans Affairs Medical Center, McGuire Research Institute, Richmond, Virginia, USA
| | - Jarrod Reisweber
- Hunter Holmes McGuire Veterans Affairs Medical Center, McGuire Research Institute, Richmond, Virginia, USA
| | - Jason R Burchett
- Hunter Holmes McGuire Veterans Affairs Medical Center, McGuire Research Institute, Richmond, Virginia, USA
| | - Paul E Plonski
- Hunter Holmes McGuire Veterans Affairs Medical Center, McGuire Research Institute, Richmond, Virginia, USA
| | - Anna B Konova
- Department of Psychiatry, University Behavioral Health Care, and the Brain Health Institute, Rutgers University-New Brunswick, Piscataway, NJ, USA
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Wirbka L, Haefeli WE, Meid AD. Estimated Thresholds of Minimum Necessary Adherence for Effective Treatment with Direct Oral Anticoagulants - A Retrospective Cohort Study in Health Insurance Claims Data. Patient Prefer Adherence 2021; 15:2209-2220. [PMID: 34594102 PMCID: PMC8478483 DOI: 10.2147/ppa.s324315] [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: 06/22/2021] [Accepted: 08/28/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND An essential contribution regarding the prevention of thromboembolic events in patients with (non-valvular) atrial fibrillation (AF) is good adherence to direct oral anticoagulants (DOACs). However, it is an open question what "good" adherence means for DOACs or below which threshold non-adherence is clinically relevant for AF patients. Ultimately, such a classification could prevent strokes and associated costs through adjusted treatment regimens or supportive measures. METHODS We selected 10,092 AF patients from health insurance claims data between 2014 and 2018 who were issued a majority (at least half of the number) of maximum approved strength prescriptions of one of the following DOACs, namely rivaroxaban, apixaban, or dabigatran. Due to the limited sample size, the prescriptions of dabigatran had to be finally excluded for the cut-off analysis. DOAC adherence was calculated as the proportion of days covered (PDC) by dividing the days of theoretical use (days covered) of the drug by the duration in days of the observation interval. PDC cut-off values were derived from stroke risk as a function of continuous PDC values in time-to-event analyses and corresponding dose-response models. The influence of adherence-promoting interventions (targeted and untargeted) on the occurrence of strokes and related costs was then projected, considering intervention costs per patient. RESULTS The population had a mean age of 74.5 years and 50% were female. The median PDC was 0.79 ± 0.28 with a median follow-up time of 1218 days, in which 2% of all DOAC patients had a stroke. The adherence cut-offs for good adherence were identified at 0.78 for rivaroxaban and 0.8 for apixaban. Targeted interventions appeared to be far more cost-effective than untargeted interventions. CONCLUSION Clear adherence cut-offs enable healthcare professionals to identify patients with clinically relevant non-adherence. Interventions based on these cut-offs appear to be a promising means to optimize DOAC treatment.
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Affiliation(s)
- Lucas Wirbka
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, 69120, Germany
| | - Walter Emil Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, 69120, Germany
| | - Andreas Daniel Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, 69120, Germany
- Correspondence: Andreas Daniel Meid Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, GermanyTel +49 6221 56 37113Fax +49 6221 56 4642 Email
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Dima AL, Allemann SS, Dunbar-Jacob J, Hughes DA, Vrijens B, Wilson IB. TEOS: A framework for constructing operational definitions of medication adherence based on Timelines-Events-Objectives-Sources. Br J Clin Pharmacol 2020; 87:2521-2533. [PMID: 33220097 DOI: 10.1111/bcp.14659] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/08/2020] [Accepted: 11/03/2020] [Indexed: 01/27/2023] Open
Abstract
AIMS Managing adherence to medications is a priority for health systems worldwide. Adherence research is accumulating, yet the quality of the evidence is reduced by various methodological limitations. In particular, the heterogeneity and low accuracy of adherence measures have been highlighted in many literature reviews. Recent consensus-based guidelines advise on best practices in defining adherence (ABC) and reporting of empirical studies (EMERGE). While these guidelines highlight the importance of operational definitions in adherence measurement, such definitions are rarely included in study reports. To support researchers in their measurement decisions, we developed a structured approach to formulate operational definitions of adherence. METHODS A group of adherence and research methodology experts used theoretical, methodological and practical considerations to examine the process of applying adherence definitions to various research settings, questions and data sources. Consensus was reached through iterative review of discussion summaries and framework versions. RESULTS We introduce TEOS, a four-component framework to guide the operationalization of adherence concepts: (1) describe treatment as four simultaneous interdependent timelines (recommended and actual use, conditional on prescribing and dispensing); (2) locate four key events along these timelines to delimit the three ABC phases (first and last recommended use, first and last actual use); (3) revisit study objectives and design to fine-tune research questions and assess measurement validity and reliability needs, and (4) select data sources (e.g., electronic monitoring, self-report, electronic healthcare databases) that best address measurement needs. CONCLUSION Using the TEOS framework when designing research and reporting explicitly on these components can improve measurement quality.
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Affiliation(s)
- Alexandra L Dima
- Health Services and Performance Research (HESPER EA 7425), University Claude Bernard Lyon 1, Lyon, France
| | - Samuel S Allemann
- Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
| | | | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, North Wales, UK
| | - Bernard Vrijens
- AARDEX Group & Department of Public Health Liège University, Liège, Belgium
| | - Ira B Wilson
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
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342
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Faisal S, Ivo J, Lee C, Carter C, Patel T. The Usability, Acceptability, and Functionality of Smart Oral Multidose Dispensing Systems for Medication Adherence: A Scoping Review. J Pharm Pract 2020; 35:455-468. [PMID: 33327873 DOI: 10.1177/0897190020977756] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Medication non-adherence is a leading cause of non-optimal disease management, resulting in poor health outcomes, poor quality of life, and increased healthcare costs. Smart oral multidose dispensing systems (SOMDS) are being developed to address non-adherence; however, little is known about their integration into daily use by patients. METHODS Using Arksey and O'Malley's scoping review framework, relevant literature was searched for in electronic databases (PubMed, EMBASE, International Pharmaceutical Abstracts, and Scopus). Observational and interventional studies reporting the integration and impact on adherence from SOMDS in adults ≥18 years and published after 1960 were included. RESULTS Thirteen articles including one case study, 8 cohort studies, and 4 randomized trials were eligible. SOMDS included smart blister packaging, automated dispensers, and electronic medication trays. The number of medications dispensed per SOMDS was one (n = 3), >1 (n = 2), placebo (n = 1) and not reported (n = 7). Reported outcomes included impact on medication adherence (n = 3), integration (n = 2) and both parameters (n = 8). CONCLUSION Although most studies reported that SOMDS appear usable, there was significant variability in the SOMDS types, patient populations, medication adherence definitions, and measurements; impacting the interpretation of results. Future studies should be designed to address effectiveness of SOMDS on medication adherence in patients with multi-drug therapy and the utilization of real-time adherence data for informing clinical decision making.
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Affiliation(s)
- Sadaf Faisal
- 8430University of Waterloo School of Pharmacy, Kitchener, Ontario, Canada
| | - Jessica Ivo
- 8430University of Waterloo School of Pharmacy, Kitchener, Ontario, Canada
| | - Catherine Lee
- 8430University of Waterloo School of Pharmacy, Kitchener, Ontario, Canada
| | - Caitlin Carter
- 8430University of Waterloo School of Pharmacy, Kitchener, Ontario, Canada
| | - Tejal Patel
- 8430University of Waterloo School of Pharmacy, Kitchener, Ontario, Canada.,Schlegel-8430University of Waterloo Research Institute of Aging, Waterloo, Ontario, Canada
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343
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Seangrung R, Ahuja M, Pasutharnchat K, Mahawan R. Factors influencing non-adherence to opioids in cancer patients: a mixed-methods cross-sectional study. F1000Res 2020; 9:1471. [PMID: 33815776 PMCID: PMC7984143 DOI: 10.12688/f1000research.27725.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 04/01/2024] Open
Abstract
Background: Strong opioids are mainly utilized to attenuate pain in cancer patients. Adherence to analgesic drugs significantly promotes adequate pain management and improves quality of life. We aimed to identify the factors influencing non-adherence to strong opioids in cancer patients. Methods: A descriptive, cross-sectional, two-phased, mixed methods design was conducted prospectively to evaluate a cohort of 101 cancer patients who are currently prescribed strong opioids from a pain clinic in Thailand between January and March 2018. Participants were asked to complete a questionnaire that included the following sections: general characteristics; the Medication Taking Behavior in Thai (MTB-Thai) for assessing adherence to medications; and factors influencing nonadherence, which were analyzed using multivariate logistic regression. In addition, face-to-face in depth interviews were conducted with patients showing non-adherence to strong opioids (MTB-Thai score ≤21) and analyzed using thematic content analysis. Results: Of 101 cancer pain patients that completed the questionnaire, 39.6% showed non-adherence to strong opioids. Illness understanding (P=0.047) and the use of more than three types of pain medication (P=0.032) were significant factors influencing non-adherence. Qualitative analysis indicated that fear of long-term outcomes, opioid side effects, ineffective pain control, attempts to make the regimen more acceptable, poor understanding, and non-acceptance of disease related to non-adherence. Conclusion: Non-adherence to opioids for cancer patients is a common problem. Awareness of patient factors, medication-related factors, and illness-related factors will provide the knowledge and adequate advice that may enhance adherence to medications.
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Affiliation(s)
- Rattaphol Seangrung
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Mallika Ahuja
- Department of Anesthesiology, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, 30000, Thailand
| | - Koravee Pasutharnchat
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Rungwipha Mahawan
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
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344
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Seangrung R, Ahuja M, Pasutharnchat K, Mahawan R. Factors influencing non-adherence to opioids in cancer patients: a mixed-methods cross-sectional study. F1000Res 2020; 9:1471. [PMID: 33815776 PMCID: PMC7984143 DOI: 10.12688/f1000research.27725.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Strong opioids are mainly utilized to attenuate pain in cancer patients. Adherence to analgesic drugs significantly promotes adequate pain management and improves quality of life. We aimed to identify the factors influencing non-adherence to strong opioids in cancer patients. Methods: A descriptive, cross-sectional, two-phased, mixed methods design was conducted prospectively to evaluate a cohort of 101 cancer patients who are currently prescribed strong opioids from a pain clinic in Thailand between January and March 2018. Participants were asked to complete a questionnaire that included the following sections: general characteristics; the Medication Taking Behavior in Thai (MTB-Thai) for assessing adherence to medications; and factors influencing nonadherence, which were analyzed using multivariate logistic regression. In addition, face-to-face in depth interviews were conducted with patients showing non-adherence to strong opioids (MTB-Thai score ≤21) and analyzed using thematic content analysis. Results: Of 101 cancer pain patients that completed the questionnaire, 39.6% showed non-adherence to strong opioids. Illness understanding (P=0.047) and the use of more than three types of pain medication (P=0.032) were significant factors influencing non-adherence. Qualitative analysis indicated that fear of long-term outcomes, opioid side effects, ineffective pain control, attempts to make the regimen more acceptable, poor understanding, and non-acceptance of disease related to non-adherence. Conclusion: Non-adherence to opioids for cancer patients is a common problem. Awareness of patient factors, medication-related factors, and illness-related factors will provide the knowledge and adequate advice that may enhance adherence to medications.
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Affiliation(s)
- Rattaphol Seangrung
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Mallika Ahuja
- Department of Anesthesiology, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, 30000, Thailand
| | - Koravee Pasutharnchat
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Rungwipha Mahawan
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
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345
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Hein AE, Vrijens B, Hiligsmann M. A Digital Innovation for the Personalized Management of Adherence: Analysis of Strengths, Weaknesses, Opportunities, and Threats. FRONTIERS IN MEDICAL TECHNOLOGY 2020; 2:604183. [PMID: 35047888 PMCID: PMC8757755 DOI: 10.3389/fmedt.2020.604183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/11/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction: Personalized medicine and management of adherence are potential solutions for the suboptimal use of medicines. Digital medication management innovations currently under development combine both aspects. This research aims to investigate facilitators for and barriers to the translation of digital innovations for personalized medicine and adherence management into clinical practice from the policymaker and regulator perspective. Methods: A mixed-method study was used combining a scoping review to identify main interests, semi-structured interviews (n = 5) with representatives of European health policymaking and regulatory organizations, and a supplementary literature review to investigate key subthemes. The SWOT analysis was used for the qualitative analysis. Results: The literature reviews and the qualitative interviews suggested that digital solutions can facilitate the personalized management of medications and improve quality and safety, especially as the openness for digital health solutions is increasing. Digital solutions may, on the other hand, add complexity to the treatment, which can be perceived as a potential barrier for their uptake. As more multidisciplinary and participative structures are emerging, digital solutions can promote the implementation of new services. Nevertheless, change progresses slowly in the task-oriented structures of health systems. Integration of digital solutions depends on all stakeholders' willingness and abilities to co-create this change. Patients have different capabilities to self-manage their medical conditions and use digital solutions. Personalization of digital health solutions and integration in existing service structures are crucial to ensure equality among population segments. Developments in the digital infrastructure, although they are partly slow and not well-aligned, enable the implementation of innovations in clinical practice leading to further advances in data generation and usage for future innovations. Discussion: This study suggests that digital solutions have the potential to facilitate high-quality medication management and improve adherence to medications, enable new service structures, and are essential to drive further innovations in health care. Nevertheless, increasing the self-responsibility of patients can have undesirable effects on health outcomes, especially within vulnerable population segments. Digital health solutions can be an opportunity to optimize the use of medicines and thus their efficiency. Well-conceived development and implementation processes are needed to also realize improvements in equality and solidarity within health systems.
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Affiliation(s)
- Anna-Elisa Hein
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.,Faculty of Management, Economics and Social Sciences, University of Cologne, Cologne, Germany
| | - Bernard Vrijens
- AARDEX Group, Research and Development, Liège, Belgium.,Department of Public Health, University of Liège, Liège, Belgium
| | - Mickael Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
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346
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Killey J, Simons M, Tyack Z. Effectiveness of interventions for optimising adherence to treatments for the prevention and management of scars: A systematic review. Clin Rehabil 2020; 35:656-668. [PMID: 33305622 DOI: 10.1177/0269215520978528] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To identify the adherence interventions used with people receiving treatments to prevent or manage scarring, the effectiveness of these interventions, and the theoretical frameworks on which these interventions were based. DATA SOURCES Databases (PubMed, Embase, Web of Science, CINAHL, PsychINFO and OTseeker) were searched (09.10.2020) with no date or language restrictions. Grey literature databases, clinical trial registries and references lists of key papers were also searched. REVIEW METHODS Eligible randomised controlled trials included people using treatments for scarring following skin wounds, interventions that may improve adherence, and outcomes measuring adherence. Risk of bias (selection, performance, detection, attrition, reporting) and certainty of evidence (inconsistency, imprecision, indirectness, publication bias) were assessed. RESULTS Four randomised trials were included with 224 participants (17 children) with burn scars. Interventions involved educational (three trials) or technology-based components (four trials) and ranged in length from two weeks to six months. All four trials reported greater adherence rates in the intervention group compared with standard practice [standardised mean difference = 1.50 (95% confidence interval (CI) = 0.91-2.08); 2.01 (95% CI 1.05-2.98); odds ratio = 0.28 (95% CI = 0.11-0.69)]. One trial did not report original data. The certainty of evidence was very low. CONCLUSION Adherence interventions using education or technology for people receiving burn scar treatment may improve adherence. Further studies are needed particularly in children, with a focus on including outcomes of importance to patients (e.g. quality of life) and identifying core components of effective adherence interventions using theoretical frameworks.
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Affiliation(s)
- Jessica Killey
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Megan Simons
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia.,Department of Occupational Therapy, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Zephanie Tyack
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
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347
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Tibble H, Lay-Flurrie J, Sheikh A, Horne R, Mizani MA, Tsanas A. Linkage of primary care prescribing records and pharmacy dispensing Records in the Salford Lung Study: application in asthma. BMC Med Res Methodol 2020; 20:303. [PMID: 33302885 PMCID: PMC7731758 DOI: 10.1186/s12874-020-01184-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Records of medication prescriptions can be used in conjunction with pharmacy dispensing records to investigate the incidence of adherence, which is defined as observing the treatment plans agreed between a patient and their clinician. Using prescribing records alone fails to identify primary non-adherence; medications not being collected from the dispensary. Using dispensing records alone means that cases of conditions that resolve and/or treatments that are discontinued will be unaccounted for. While using a linked prescribing and dispensing dataset to measure medication non-adherence is optimal, this linkage is not routinely conducted. Furthermore, without a unique common event identifier, linkage between these two datasets is not straightforward. METHODS We undertook a secondary analysis of the Salford Lung Study dataset. A novel probabilistic record linkage methodology was developed matching asthma medication pharmacy dispensing records and primary care prescribing records, using semantic (meaning) and syntactic (structure) harmonization, domain knowledge integration, and natural language feature extraction. Cox survival analysis was conducted to assess factors associated with the time to medication dispensing after the prescription was written. Finally, we used a simplified record linkage algorithm in which only identical records were matched, for a naïve benchmarking to compare against the results of our proposed methodology. RESULTS We matched 83% of pharmacy dispensing records to primary care prescribing records. Missing data were prevalent in the dispensing records which were not matched - approximately 60% for both medication strength and quantity. A naïve benchmarking approach, requiring perfect matching, identified one-quarter as many matching prescribing records as our methodology. Factors associated with delay (or failure) to collect the prescribed medication from a pharmacy included season, quantity of medication prescribed, previous dispensing history and class of medication. Our findings indicate that over 30% of prescriptions issued were not collected from a dispensary (primary non-adherence). CONCLUSIONS We have developed a probabilistic record linkage methodology matching a large percentage of pharmacy dispensing records with primary care prescribing records for asthma medications. This will allow researchers to link datasets in order to extract information about asthma medication non-adherence.
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Affiliation(s)
- Holly Tibble
- Usher Institute, University of Edinburgh, Bioquarter 9, 9 Little France Road, Edinburgh, Scotland, EH16 4UX.
- Asthma UK Centre for Applied Research, Bioquarter 9, 9 Little France Road, Edinburgh, Scotland, EH16 4UX.
| | | | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Bioquarter 9, 9 Little France Road, Edinburgh, Scotland, EH16 4UX
- Asthma UK Centre for Applied Research, Bioquarter 9, 9 Little France Road, Edinburgh, Scotland, EH16 4UX
- Health Data Research U004B, Edinburgh, UK
| | - Rob Horne
- Asthma UK Centre for Applied Research, Bioquarter 9, 9 Little France Road, Edinburgh, Scotland, EH16 4UX
- Centre for Behavioural Medicine, UCL School of Pharmacy, London, UK
| | - Mehrdad A Mizani
- Usher Institute, University of Edinburgh, Bioquarter 9, 9 Little France Road, Edinburgh, Scotland, EH16 4UX
- Asthma UK Centre for Applied Research, Bioquarter 9, 9 Little France Road, Edinburgh, Scotland, EH16 4UX
| | - Athanasios Tsanas
- Usher Institute, University of Edinburgh, Bioquarter 9, 9 Little France Road, Edinburgh, Scotland, EH16 4UX
- Asthma UK Centre for Applied Research, Bioquarter 9, 9 Little France Road, Edinburgh, Scotland, EH16 4UX
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348
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von Wyl V, Ulyte A, Wei W, Radovanovic D, Grübner O, Brüngger B, Bähler C, Blozik E, Dressel H, Schwenkglenks M. Going beyond the mean: economic benefits of myocardial infarction secondary prevention. BMC Health Serv Res 2020; 20:1125. [PMID: 33276786 PMCID: PMC7718707 DOI: 10.1186/s12913-020-05985-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/30/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Using the example of secondary prophylaxis of myocardial infarction (MI), our aim was to establish a framework for assessing cost consequences of compliance with clinical guidelines; thereby taking cost trajectories and cost distributions into account. METHODS Swiss mandatory health insurance claims from 1840 persons with hospitalization for MI in 2014 were analysed. Included persons were predominantly male (74%), had a median age of 73 years, and 71% were pre-exposed to drugs for secondary prophylaxis, prior to index hospitalization. Guideline compliance was defined as being prescribed recommended 4-class drug prophylaxis including drugs from the following four classes: beta-blockers, statins, aspirin or P2Y12 inhibitors, and angiotension-converting enzyme inhibitors or angiotensin receptor blockers. Health care expenditures (HCE) accrued over 1 year after index hospitalization were compared by compliance status using two-part regression, trajectory analysis, and counterfactual decomposition analysis. RESULTS Only 32% of persons received recommended 4-class prophylaxis. Compliant persons had lower HCE (- 4865 Swiss Francs [95% confidence interval - 8027; - 1703]) and were more likely to belong to the most favorable HCE trajectory (with 6245 Swiss Francs average annual HCE and comprising 78% of all studied persons). Distributional analyses showed that compliance-associated HCE reductions were more pronounced among persons with HCE above the median. CONCLUSIONS Compliance with recommended prophylaxis was robustly associated with lower HCE and more favorable cost trajectories, but mainly among persons with high health care expenditures. The analysis framework is easily transferrable to other diseases and provides more comprehensive information on HCE consequences of non-compliance than mean-based regressions alone.
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Affiliation(s)
- Viktor von Wyl
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland. .,Institute for Implementation Science in Health Care, University of Zurich, Universitätsstrasse 84, 8006, Zurich, Switzerland.
| | - Agne Ulyte
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Wenjia Wei
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Dragana Radovanovic
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Oliver Grübner
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland.,Department of Geography, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland
| | - Beat Brüngger
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland.,Department of Health Sciences, Helsana Group, Zürichstrasse 130, 8600, Dübendorf, Switzerland
| | - Caroline Bähler
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland.,Department of Health Sciences, Helsana Group, Zürichstrasse 130, 8600, Dübendorf, Switzerland
| | - Eva Blozik
- Department of Geography, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.,Institute of Primary Care, University of Zurich and University Hospital Zurich, Pestalozzistrasse 24, 8091, Zürich, Switzerland
| | - Holger Dressel
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Matthias Schwenkglenks
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
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349
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Majercak KR, Magder LS, Villalonga-Olives E. Social capital and cost-related medication nonadherence (CRN): A retrospective longitudinal cohort study using the Health and Retirement Study data, 2006-2016. SSM Popul Health 2020; 12:100671. [PMID: 33088892 PMCID: PMC7559535 DOI: 10.1016/j.ssmph.2020.100671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/21/2020] [Accepted: 09/26/2020] [Indexed: 11/17/2022] Open
Abstract
Prescription drug spending and other financial factors (e.g., out-of-pocket costs) partially explain variation in cost-related medication nonadherence (CRN). Indicators of social capital such as neighborhood factors and social support may influence the health and well-being of older adults as they may rely on community resources and support from family and peers to manage conditions. Previous research on the relationship of social capital and CRN has limited evidence and contradictory findings. Hence, our objective is to assess the relationship of social capital indicators (neighborhood social cohesion, neighborhood physical disorder, positive social support, and negative social support) and CRN using a longitudinal design, 2006 to 2016, in a nationally representative sample of older adults in the United States (US). The Health and Retirement Study is a prospective panel study of US adults aged ≥ 50 years evaluated every two years. Data was pooled to create three waves and fitted using Generalized Estimating Equation modelling adjusting for both baseline and timevarying covariates (age, sex, education, race, total household income, and perceived health status). The three waves consisted of 11,791, 12,336, and 9,491 participants. Higher levels of neighborhood social cohesion and positive social support were related with lower CRN (OR 0.92, 95% CI 0.88-0.95 and OR 0.77, 95% CI 0.70-0.84, p<0.01). In contrast, higher levels of neighborhood physical disorder and negative social support were related to higher CRN (OR 1.07, 95% CI 1.03-1.11 and OR 1.46, 95% CI 1.32-1.62, p<0.01). Interventions targeting social capital are needed, reinforcing positive social support and neighborhood social cohesion and diminishing neighborhood physical disorder and negative social support for older adults.
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Affiliation(s)
- Kayleigh R. Majercak
- University of Maryland Baltimore, School of Pharmacy, Department of Pharmaceutical Health Services Research, 220 Arch Street, 12th Floor, Baltimore, MD 21201, Baltimore, MD, USA
| | - Laurence S. Magder
- University of Maryland Baltimore, School of Medicine, Department of Epidemiology and Public Health, 660 W. Redwood Street, Baltimore, MD 21201, Baltimore, MD, USA
| | - Ester Villalonga-Olives
- University of Maryland Baltimore, School of Pharmacy, Department of Pharmaceutical Health Services Research, 220 Arch Street, 12th Floor, Baltimore, MD 21201, Baltimore, MD, USA
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350
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Ellis JD, Struble CA, Fodor MC, Cairncross M, Lundahl LH, Ledgerwood DM. Contingency management for individuals with chronic health conditions: A systematic review and meta-analysis of randomized controlled trials. Behav Res Ther 2020; 136:103781. [PMID: 33302054 DOI: 10.1016/j.brat.2020.103781] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/24/2020] [Accepted: 11/16/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Contingency management (CM) interventions involve providing reinforcement for engaging in a desired behavior, and have been shown to increase treatment adherence and promote abstinence in the treatment of substance use disorders. This review was conducted to systematically review the literature on the effectiveness of CM when applied to a range of medical conditions outside of substance use disorders. METHOD The authors identified a total of 24 randomized studies examining the effects of CM on four outcomes: weight change, physical activity, medication/device adherence, and viral load that were included in the qualitative summary, and 20 studies included in the meta-analysis. RESULTS CM was associated with positive outcomes for physical activity and medication/device adherence compared to control conditions. Findings with weight loss and viral load were more mixed, and evidence for publication bias was found for both outcomes. The effects of CM tend to dissipate when the contingency is removed. Heterogeneity was observed across most outcomes. LIMITATIONS AND CONCLUSIONS This review provides preliminary support for the use of CM in increasing physical activity and improving adherence to medication for chronic health conditions while reinforcement is ongoing. Future studies should examine potential moderators and identify strategies to maintain these changes over time.
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Affiliation(s)
- Jennifer D Ellis
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA; Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, USA
| | - Cara A Struble
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA
| | - Marina C Fodor
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA
| | - Molly Cairncross
- Division of Physical Medicine and Rehabilitation, The University of British Columbia, Canada
| | - Leslie H Lundahl
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA
| | - David M Ledgerwood
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA.
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