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Read S, Morgan J, Gillespie D, Nollett C, Weiss M, Allen D, Anderson P, Waterman H. Chronic Conditions and Behavioural Change Approaches to Medication Adherence: Rethinking Clinical Guidance and Recommendations. Patient Prefer Adherence 2020; 14:581-586. [PMID: 32210543 PMCID: PMC7075430 DOI: 10.2147/ppa.s239916] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/04/2020] [Indexed: 12/13/2022] Open
Abstract
Patient adherence to medication is an ongoing concern for clinicians, obfuscating treatment efficacy and resulting in wastage of medicine, reduced clinical benefit, and increased mortality. Despite this, procedural guidance on how clinicians should best engage patients regarding their medicine-taking is limited in the United Kingdom. Adherence for chronic conditions is notably complex, requiring clear education, communication, and behavioural shifts to initiate and sustain daily regimens successfully. This article explores current clinician guidance on assuring patient adherence to medication within the National Health Service, comparing it to that provided for healthcare workers in the field of behavioural change. Outlining the inertia of the former and the progress of the latter, we consider what steps should be taken to address this deficit, including greater focus on patient concerns, as well as knowledge translation for healthcare professionals in future adherence research. Current United Kingdom clinical guidance for assuring patient adherence is largely outdated based on inconclusive evidence for best practice. However, efforts to encourage behavioural change in the public health setting demonstrate evidence-based success. Integrating knowledge generated around adherence behaviour and the practical application of adherence and behavioural change research, as well as funding for longer-term studies with a focus on clinical outcomes, may help to solidify the NICE guidance on adherence and further progress the field. This would require close involvement from patient groups and networks informing ethical aspects of study design and clinical implementation.
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Affiliation(s)
- Simon Read
- School of Healthcare Sciences, Cardiff University, Cardiff, Wales, UK
- Correspondence: Simon Read Cardiff University, Room 12.14, Eastgate House, 35-43 Newport Road, CardiffCF24 0AB, Wales, UKTel +44 2920 688930 Email
| | - James Morgan
- Cardiff and Vale University Health Board, Cardiff, Wales, UK
| | - David Gillespie
- Centre for Trials Research, Cardiff University, Cardiff, Wales, UK
| | - Claire Nollett
- Centre for Trials Research, Cardiff University, Cardiff, Wales, UK
| | - Marjorie Weiss
- School of Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - Davina Allen
- School of Healthcare Sciences, Cardiff University, Cardiff, Wales, UK
| | - Pippa Anderson
- Swansea Centre for Health Economics, Swansea University, Swansea, Wales, UK
| | - Heather Waterman
- School of Healthcare Sciences, Cardiff University, Cardiff, Wales, UK
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Oliveira GL, Lula-Barros DS, Silva DLM, Leite SN. Fatores relacionados à adesão ao tratamento sob a perspectiva da pessoa idosa. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2020. [DOI: 10.1590/1981-22562020023.200160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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403
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Muraywid B, Butkievich LE, Myers B. Effect of a Virtual Pharmacy Review Program: A Population Health Case Study. J Manag Care Spec Pharm 2020; 26:24-29. [PMID: 31880223 PMCID: PMC10390918 DOI: 10.18553/jmcp.2020.26.1.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The growing emphasis on value-based health care has created a need for innovative population health management strategies. Pharmacists are underused resources for implementation of meaningful population health models that ensure appropriate medication use through optimization of electronic medical record (EMR) technology and pharmacist knowledge. The objective of our program was to improve the health outcomes of a patient population with diabetes while also reducing costs. PROGRAM DESCRIPTION A virtual pharmacy review (ViPRx) program was used to remotely provide previsit comprehensive medication reviews for patients in the defined population. The pharmacist used the EMR to review medications and relevant histories and to intervene when needed to ensure appropriate medication use. Pharmacist recommendations and supporting statements were delivered to the provider's EMR in-box 1-2 days before a scheduled visit. The information technology resources and virtual model allow the pharmacist to manage patient care and collaborate with providers electronically across multiple clinic locations. OBSERVATIONS The pharmacist managed a panel of over 700 patients in this virtual model. The program has yielded improvements in key diabetes metrics. Most notable is a 6% increase in the percentage of patients with a hemoglobin A1c (HbA1c) value of 9% or less and a 7% improvement in the controlled low-density lipoprotein (LDL) measure. Monitoring parameters (nephropathy screening, HbA1c, and LDL) increased by 8%-12% from baseline. Additional positive outcomes include improved medication adherence in the defined population as seen by a 1.5% improvement in medication possession ratio for diabetes medications. Reductions in per member per month (PMPM) prescription costs are estimated at $11 per month through discontinuation of unnecessary and duplicate medications. IMPLICATIONS The results of this case study on the effect of a virtual pharmacy review program demonstrate an opportunity for pharmacists to engage in a population health management model that improves patient outcomes and may reduce the rate at which PMPM prescription drug costs increase. DISCLOSURES No outside funding supported this work. The authors have no conflicts of interest to disclose. This work was presented at the 2017 Vizient Connections Summit; April 6, 2017; Las Vegas, NV, and the 2018 Cerner Health Conference; October 10, 2018; Kansas City, MO.
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Affiliation(s)
| | | | - Brad Myers
- University of Missouri Health Care, Columbia
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404
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Kamat T. Digital therapeutics can improve medication adherence in diabetes. J Family Med Prim Care 2020; 9:5806-5807. [PMID: 33532443 PMCID: PMC7842486 DOI: 10.4103/jfmpc.jfmpc_1252_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 12/02/2022] Open
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Zijp TR, Touw DJ, van Boven JFM. User Acceptability and Technical Robustness Evaluation of a Novel Smart Pill Bottle Prototype Designed to Support Medication Adherence. Patient Prefer Adherence 2020; 14:625-634. [PMID: 32256053 PMCID: PMC7093103 DOI: 10.2147/ppa.s240443] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 02/27/2020] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Smart medication adherence monitoring devices can provide objective and granular drug utilization data and help patients engaging with their treatment. In this proof-of-concept study, the acceptability and technical robustness of a novel smart pill bottle prototype (SPBP) were assessed in order to allow further optimization. METHODS The SPBP is an app-controlled automatic dispense system, capturing real-time data on a web-based platform, which sends text reminders and measures storage conditions. A heterogeneous group of ten volunteers was asked to dispense placebo capsules with the SPBP and to follow a predefined dosing schedule for a trial period of 2 weeks. Afterwards, a questionnaire was filled out during a short interview. Primary outcome was dispense adherence as measured by the bottle. Other study outcomes included system acceptability (System Usability Scale [SUS]), self-reported adherence (MARS) and technical robustness of the bottle's mechanics (electronic pill dispenser) and sensors (bottle temperature). RESULTS The overall dispense adherence rate as measured by the SPBP was 88%. All participants completed the study and four participants had an adherence rate of 100% during the study. The dispense adherence rates corresponded well with participants' self-reported adherence with an average MARS total score of 23.6 (out of 25). Participants judged the system easy to use, with a mean SUS score of 79.3 (range: 57.5-97.5). The overall mean temperature difference between the bottle sensor and calibrated external sensor was -0.82°C (range: -1.37°C to -0.21°C). CONCLUSION The SPBP was well accepted and this study provides data for further optimization and follow-up studies. Smart adherence technologies such as these may change the way healthcare professionals, trialists and patients manage medication adherence.
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Affiliation(s)
- Tanja R Zijp
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Pharmaceutical Analysis, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, the Netherlands
- Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, the Netherlands
| | - Job F M van Boven
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, the Netherlands
- Correspondence: Job FM van Boven University Medical Center Groningen, Hanzeplein 1 (Internal Postcode EB70), Groningen9700 RB, the NetherlandsTel +31503617893 Email
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406
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Navaie M, Dembek C, Cho-Reyes S, Yeh K, Celli BR. Device use errors with soft mist inhalers: A global systematic literature review and meta-analysis. Chron Respir Dis 2020; 17:1479973119901234. [PMID: 31984767 PMCID: PMC6985977 DOI: 10.1177/1479973119901234] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/28/2019] [Indexed: 11/30/2022] Open
Abstract
Inhaled bronchodilators are the cornerstone of treatment for chronic obstructive pulmonary disease (COPD). Soft mist inhalers (SMIs) are devices that deliver bronchodilators. Although correct device use is paramount to successful medication delivery, patient errors are common. This global systematic literature review and meta-analysis examined device use errors with SMIs among patients with obstructive lung diseases. PubMed, EMBASE, PsycINFO, Cochrane, and Google Scholar were searched to identify studies published between 2010 and 2019 that met the following inclusion criteria: (a) English language; (b) a diagnosis of COPD, bronchitis, or emphysema; and (c) reported device use errors among adults receiving long-acting bronchodilator treatment with Respimat® SMI (i.e. Spiriva®, Stiolto®, Spiolto®, and Striverdi®). Descriptive statistics examined sociodemographics, clinical characteristics, and device use errors. Meta-analysis techniques were employed with random-effects models to generate pooled mean effect sizes and 95% confidence intervals (CIs) for overall and step-by-step errors. The I2 statistic measured heterogeneity. Twelve studies (n = 1288 patients) were included in this meta-analysis. Eighty-eight percent of patients had COPD, and most had moderate/very severe airflow limitation (Global Initiative for Chronic Obstructive Lung Disease spirometric stages II to IV). Aggregate results revealed that 58.9% (95% CI: 42.4-75.5; I2 = 92.8%) of patients made ≥1 device use errors. Among 11 studies with step-by-step data, the most common errors were failure to (1) exhale completely and away from the device (47.8% (95% CI: 33.6-62.0)); (2) hold breath for up to 10 seconds (30.6% (95% CI: 17.5-43.7)); (3) take a slow, deep breath while pressing the dose release button (27.9% (95% CI: 14.5-41.2)); (4) hold the inhaler upright (22.6% (95% CI: 6.2-39.0)); and (5) turn the base toward the arrows until it clicked (17.6% (95% CI: 3.0-32.2)). Device use errors occurred in about 6 of 10 patients who used SMIs. An individualized approach to inhalation device selection and ongoing training and monitoring of device use are important in optimizing bronchodilator treatment.
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Affiliation(s)
- Maryam Navaie
- Advance Health Solutions, LLC, New York, NY, USA
- School of Professional Studies, Columbia University, New York, NY, USA
| | - Carole Dembek
- Global Health Economics and Outcomes Research, Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
| | | | - Karen Yeh
- Advance Health Solutions, LLC, New York, NY, USA
| | - Bartolome R Celli
- Chronic Obstructive Pulmonary Disease Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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407
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Intermittent treatment interruption and its effect on multidrug resistant tuberculosis treatment outcome in Ethiopia. Sci Rep 2019; 9:20030. [PMID: 31882784 PMCID: PMC6934462 DOI: 10.1038/s41598-019-56553-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/12/2019] [Indexed: 11/21/2022] Open
Abstract
Treatment interruption is one of the main risk factors of poor treatment outcome and occurrence of additional drug resistant tuberculosis. This study is a national retrospective cohort study with 10 years follow up period in MDR-TB patients in Ethiopia. We included 204 patients who had missed the treatment at least for one day over the course of the treatment (exposed group) and 203 patients who had never interrupted the treatment (unexposed group). We categorized treatment outcome into successful (cured or completed) and unsuccessful (lost to follow up, failed or died). We described treatment interruption by the length of time between interruptions, time to first interruption, total number of interruption episodes and percent of missed doses. We used Poisson regression model with robust standard error to determine the association between treatment interruption and outcome. 82% of the patients interrupted the treatment in the first six month of treatment period, and considerable proportion of patients demonstrated long intervals between two consecutive interruptions. Treatment interruption was significantly associated with unsuccessful treatment outcome (Adjusted Risk Ratio (ARR) = 1.9; 95% CI (1.4–2.6)). Early identification of patients at high risk of interruption is vital in improving successful treatment outcome.
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408
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Gomes D, Placido AI, Mó R, Simões JL, Amaral O, Fernandes I, Lima F, Morgado M, Figueiras A, Herdeiro MT, Roque F. Daily Medication Management and Adherence in the Polymedicated Elderly: A Cross-Sectional Study in Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:E200. [PMID: 31892177 PMCID: PMC6981635 DOI: 10.3390/ijerph17010200] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 12/21/2019] [Accepted: 12/23/2019] [Indexed: 01/30/2023]
Abstract
The presence of age-related comorbidities prone elderly patients to the phenomenon of polypharmacy and consequently to a higher risk of nonadherence. Thus, this paper aims to characterize the medication consumption profile and explore the relationship of beliefs and daily medication management on medication adherence by home-dwelling polymedicated elderly people. A questionnaire on adherence, managing, and beliefs of medicines was applied to polymedicated patients with ≥65 years old, in primary care centers of the central region of Portugal. Of the 1089 participants, 47.7% were considered nonadherent. Forgetfulness (38.8%), difficulties in managing medication (14.3%), concerns with side effects (10.7%), and the price of medication (9.2%) were pointed as relevant medication nonadherence-related factors. It was observed that patients who had difficulties managing medicines, common forgetfulness, concerns with side effects, doubting the need for the medication, considered prices expensive, and had a lack of trust for some medicines had a higher risk of being nonadherent. This study provides relevant information concerning the daily routine and management of medicines that can be useful to the development of educational strategies to promote health literacy and improve medication adherence in polymedicated home-dwelling elderly.
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Affiliation(s)
- Daniel Gomes
- Research Unit for Inland Development—Polytechnic of Guarda (UDI-IPG), 6300 Guarda, Portugal; (D.G.); (A.I.P.); (I.F.); (M.M.)
- Centre for Health Studies and Research of the University of Coimbra, 3000 Coimbra, Portugal
| | - Ana Isabel Placido
- Research Unit for Inland Development—Polytechnic of Guarda (UDI-IPG), 6300 Guarda, Portugal; (D.G.); (A.I.P.); (I.F.); (M.M.)
| | - Rita Mó
- Health Sciences Faculty, University of Beira Interior (FCS-UBI), 6200 Covilhã, Portugal;
| | - João Lindo Simões
- Center for Health Technology and Services Research (CINTESIS), 4000 Porto, Portugal;
| | - Odete Amaral
- Health Sciences School, Polytechnic of Viseu IPV, 3430 Viseu, Portugal;
| | - Isabel Fernandes
- Research Unit for Inland Development—Polytechnic of Guarda (UDI-IPG), 6300 Guarda, Portugal; (D.G.); (A.I.P.); (I.F.); (M.M.)
| | - Fátima Lima
- Local Health Unit of Guarda (ULS Guarda), 6300 Guarda, Portugal;
| | - Manuel Morgado
- Research Unit for Inland Development—Polytechnic of Guarda (UDI-IPG), 6300 Guarda, Portugal; (D.G.); (A.I.P.); (I.F.); (M.M.)
- Health Sciences Faculty, University of Beira Interior (FCS-UBI), 6200 Covilhã, Portugal;
- Pharmaceutical Services, University Hospital Center of Cova da Beira (CHUCB), 6200 Covilhã, Portugal
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200 Covilhã, Portugal
| | - Adolfo Figueiras
- Department of Preventive Medicine, University of Santiago de Compostela, 15702 Santiago de Compostela, Spain;
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER-ESP), 28001 Madrid, Spain
| | - Maria Teresa Herdeiro
- Department of Medical Sciences and Institute of Biomedicine, University of Aveiro (iBIMED-UA), 3800 Aveiro, Portugal;
| | - Fátima Roque
- Research Unit for Inland Development—Polytechnic of Guarda (UDI-IPG), 6300 Guarda, Portugal; (D.G.); (A.I.P.); (I.F.); (M.M.)
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200 Covilhã, Portugal
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409
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Ofori-Asenso R, Ilomaki J, Chin KL, Mazidi M, Zomer E, Bell JS, Magliano DJ, Liew D. Dynamics of switching, adherence, and persistence of dipeptidyl peptidase-4 inhibitors use: A nationwide cohort study. Diabetes Res Clin Pract 2019; 158:107909. [PMID: 31697992 DOI: 10.1016/j.diabres.2019.107909] [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] [Received: 08/23/2019] [Revised: 10/23/2019] [Accepted: 10/28/2019] [Indexed: 11/29/2022]
Abstract
AIMS To characterise the patterns of switching, adherence, and persistence among adults aged ≥18 years with diabetes prescribed dipeptidyl peptidase-4 inhibitors (DPP-4is) in Australia. METHODS The analysis included 15,915 adults newly prescribed DPP-4is (sitagliptin = 9576; vildagliptin = 1130; saxagliptin = 1126; linagliptin = 3560; and alogliptin = 523). Multivariable logistic regression model was used to compare the non-adherence (proportion of days covered [PDC] <0.80) rates whereas Cox proportional hazards regression models were used to compare switching and non-persistence (≥90-day gap) among different DPP4-is over 12-months. RESULTS Overall, 36.0% (5722/15,915) of DPP-4i users were non-adherent and 30.0% (4775/15,915) were non-persistent at 12-months. Compared to sitagliptin, vildagliptin, linagliptin, and alogliptin were not associated with higher non-adherence and non-persistence. However, saxagliptin was associated with a higher likelihood of being non-adherent (odds ratio 1.41, 95% confidence interval [CI] 1.23-1.60) or non-persistent (hazard ratio 1.27, 95% CI 1.15-1.42) compared to sitagliptin. Just 3.2% of people switched between different DPP-4is. Compared to sitagliptin, people initiated on vildagliptin, saxagliptin, alogliptin, and linagliptin were more likely to switch. CONCLUSIONS We found no significant differences in the adherence and persistence rates between alogliptin, vildagliptin or linagliptin and sitagliptin. However, saxagliptin was associated with higher non-adherence and non-persistence compared to sitagliptin. Switching was lowest amongst users of sitagliptin.
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Affiliation(s)
- Richard Ofori-Asenso
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Copenhagen Centre for Regulatory Science (CORS), Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Jenni Ilomaki
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.
| | - K L Chin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Melbourne Medical School, The University of University, Melbourne, Victoria, Australia.
| | - Mohsen Mazidi
- Twin Research and Genetic Epidemiology, Kings College London, London, United Kingdom.
| | - Ella Zomer
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - J S Bell
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia; School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.
| | | | - Danny Liew
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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410
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Abbott K, Shao H, Shi L. Policy options for addressing the high cost of specialty pharmaceuticals. GLOBAL HEALTH JOURNAL 2019. [DOI: 10.1016/j.glohj.2019.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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411
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Chatziefstratiou A, Giakoumidakis K, Fotos NV, Baltopoulos G, Brokalaki H. Scales for assessing medication adherence in patients with hypertension. ACTA ACUST UNITED AC 2019; 28:1388-1392. [PMID: 31778338 DOI: 10.12968/bjon.2019.28.21.1388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND the choice of the appropriate tool for assessing level of medication adherence is a significant barrier in scientific research. AIMS to translate into Greek and test the reliability of the Hill-Bone and A-14 scales among patients with hypertension. Also, to compare patients' responses in the Hill-Bone scale, A-14 scale and Morisky Medication Adherence Scale (MMAS). METHODS data collection occurred between February 2016 and March 2016 at a general hospital in Athens, Greece. The sample consisted of hypertensive patients (n=34) and non-hypertensive patients (n=34). FINDINGS the coefficient alpha in hypertensive patients was 0.76 for Hill-Bone, 0.64 for MMAS and 0.91 for the A-14 scale. In non-hypertensive patients, the Cronbach's alpha for MMAS was 0.81 and 0.78 for A-14. A statistically significant difference was found among the mean scores of the scales, whereas strong correlation was found only between two pairs of questions with similar meaning. CONCLUSION all tools are appropriate to assess the level of medication adherence in Greek hypertensive patients. However, careful translation of the scales is essential since items with the same meaning could be understudied in a different way.
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Affiliation(s)
| | - Konstantinos Giakoumidakis
- Associate Professor, Department of Nursing, School of Health Sciences and Welfare, University of West Attica, Greece
| | - Nikolaos V Fotos
- Assistant Professor, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - George Baltopoulos
- Emeritus Professor, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Hero Brokalaki
- Emeritus Professor, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
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412
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Brar Prayaga R, Agrawal R, Nguyen B, Jeong EW, Noble HK, Paster A, Prayaga RS. Impact of Social Determinants of Health and Demographics on Refill Requests by Medicare Patients Using a Conversational Artificial Intelligence Text Messaging Solution: Cross-Sectional Study. JMIR Mhealth Uhealth 2019; 7:e15771. [PMID: 31738170 PMCID: PMC6887813 DOI: 10.2196/15771] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/05/2019] [Accepted: 10/22/2019] [Indexed: 01/12/2023] Open
Abstract
Background Nonadherence among patients with chronic disease continues to be a significant concern, and the use of text message refill reminders has been effective in improving adherence. However, questions remain about how differences in patient characteristics and demographics might influence the likelihood of refill using this channel. Objective The aim of this study was to evaluate the efficacy of an SMS-based refill reminder solution using conversational artificial intelligence (AI; an automated system that mimics human conversations) with a large Medicare patient population and to explore the association and impact of patient demographics (age, gender, race/ethnicity, language) and social determinants of health on successful engagement with the solution to improve refill adherence. Methods The study targeted 99,217 patients with chronic disease, median age of 71 years, for medication refill using the mPulse Mobile interactive SMS text messaging solution from December 2016 to February 2019. All patients were partially adherent or nonadherent Medicare Part D members of Kaiser Permanente, Southern California, a large integrated health plan. Patients received SMS reminders in English or Spanish and used simple numeric or text responses to validate their identity, view their medication, and complete a refill request. The refill requests were processed by Kaiser Permanente pharmacists and support staff, and refills were picked up at the pharmacy or mailed to patients. Descriptive statistics and predictive analytics were used to examine the patient population and their refill behavior. Qualitative text analysis was used to evaluate quality of conversational AI. Results Over the course of the study, 273,356 refill reminders requests were sent to 99,217 patients, resulting in 47,552 refill requests (17.40%). This was consistent with earlier pilot study findings. Of those who requested a refill, 54.81% (26,062/47,552) did so within 2 hours of the reminder. There was a strong inverse relationship (r10=−0.93) between social determinants of health and refill requests. Spanish speakers (5149/48,156, 10.69%) had significantly lower refill request rates compared with English speakers (42,389/225,060, 18.83%; X21 [n=273,216]=1829.2; P<.001). There were also significantly different rates of refill requests by age band (X26 [n=268,793]=1460.3; P<.001), with younger patients requesting refills at a higher rate. Finally, the vast majority (284,598/307,484, 92.23%) of patient responses were handled using conversational AI. Conclusions Multiple factors impacted refill request rates, including a strong association between social determinants of health and refill rates. The findings suggest that higher refill requests are linked to language, race/ethnicity, age, and social determinants of health, and that English speakers, whites, those younger than 75 years, and those with lower social determinants of health barriers are significantly more likely to request a refill via SMS. A neural network–based predictive model with an accuracy level of 78% was used to identify patients who might benefit from additional outreach to narrow identified gaps based on demographic and socioeconomic factors.
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Affiliation(s)
| | - Ridhika Agrawal
- mPulse Mobile, Inc, Encino, CA, United States.,Grinnell College, Grinnell, IA, United States
| | - Benjamin Nguyen
- mPulse Mobile, Inc, Encino, CA, United States.,Grinnell College, Grinnell, IA, United States
| | - Erwin W Jeong
- Medicare Medication Therapy Management & Medication Adherence programs, Kaiser Permanente Southern California, Downey, CA, United States
| | - Harmony K Noble
- Regional Pharmacy Clinical Operations, Kaiser Permanente Southern California, Downey, CA, United States
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413
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Audrain-Pontevia AF, Menvielle L, Ertz M. Effects of Three Antecedents of Patient Compliance for Users of Peer-to-Peer Online Health Communities: Cross-Sectional Study. J Med Internet Res 2019; 21:e14006. [PMID: 31710295 PMCID: PMC6878099 DOI: 10.2196/14006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 08/06/2019] [Accepted: 08/31/2019] [Indexed: 01/02/2023] Open
Abstract
Background Over the past 50 years, patient noncompliance has appeared as a major public health concern and focus of a great deal of research because it endangers patient recovery and imposes a considerable financial burden on health care systems. Meanwhile, online health communities (OHCs) are becoming more common and are commonly used by individuals with health problems, and they may have a role in facilitating compliance. Despite this growing popularity, little is known about patient compliance predictors for OHCs’ users. Objective This study aimed to investigate the extent to which participating in OHCs may trigger higher levels of compliance. It identified 3 interrelated predictors that may affect patient compliance: patient empowerment gained through peer-to-peer OHCs, satisfaction with the physician, and commitment to the physician. Methods A Web-based survey tested the conceptual model and assessed the effects of patient empowerment gained through OHCs on patient satisfaction and commitment to the physician, as well as the effects of these 3 predictors on patient compliance with the proposed treatment. Members of peer-to-peer OHCs were asked to answer an online questionnaire. A convenience sample of 420 patients experiencing chronic illness and using peer-to-peer OHCs was surveyed in August 2018 in Québec, Canada. A path analysis using structural equation modeling tested the proposed relationships between the predictors and their respective paths on patient compliance. The mediation effects of these predictor variables on patient compliance were estimated with the PROCESS macro in SPSS. Results The findings indicated that patient empowerment gained through OHCs was positively related to patient commitment to the physician (beta=.69; P<.001) and patient compliance with the proposed treatment (beta=.35; P<.001). Patient commitment also positively influenced patient compliance (beta=.74; P<.001). Patient empowerment did not exert a significant influence on patient satisfaction with the physician (beta=.02; P=.76), and satisfaction did not affect compliance (beta=−.07; P=.05); however, patient satisfaction was positively related to patient commitment to the physician (beta=.14; P<.01). The impact of empowerment on compliance was partially mediated by commitment to the physician (beta=.32; 95% CI 0.22-0.44) but not by satisfaction. Conclusions This study highlights the importance of peer-to-peer OHCs for two main reasons. The primary reason is that patient empowerment gained through peer-to-peer OHCs both directly and indirectly enhances patient compliance with the proposed treatment. The underlying mechanisms of these effects were shown. Second, commitment to the physician was found to play a more critical role than satisfaction with the physician in determining patient-physician relationship quality. Overall, our findings support the assumption that health care stakeholders should encourage the use of peer-to-peer OHCs to favor patient empowerment and patient commitment to the physician to increase patient compliance with the proposed treatment.
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Affiliation(s)
| | | | - Myriam Ertz
- Université du Québec à Chicoutimi, Chicoutimi, QC, Canada
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414
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Mauro J, Mathews KB, Sredzinski ES. Effect of a Smart Pill Bottle and Pharmacist Intervention on Medication Adherence in Patients with Multiple Myeloma New to Lenalidomide Therapy. J Manag Care Spec Pharm 2019; 25:1244-1254. [PMID: 31663462 PMCID: PMC10398191 DOI: 10.18553/jmcp.2019.25.11.1244] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND U.S. specialty drug spend is expected to reach $400 billion by 2020, with significant growth in oncology. New oral oncology approvals have allowed for more convenient outpatient administration compared with physician-administered chemotherapies; however, patients may encounter challenges with adherence when taking medications at home. Emerging medication adherence technology (MAT) attempts to provide at-home adherence support, and while one such technology, smart pill bottles (SPB), claims to improve medication adherence, few studies have formally assessed their effects. OBJECTIVES To assess the effect of an SPB with pharmacist intervention on medication adherence in adult patients with multiple myeloma (MM) new to lenalidomide therapy (≤ 5 cycle dispenses). Secondary objectives were to evaluate treatment cycles completed, evaluate the significance of real-time pharmacist engagement (intervention group only), determine the incremental cost-effectiveness ratio (ICER), and evaluate patient satisfaction and likelihood to use an SPB. METHODS This prospective, random assignment, single-site, and single-blinded study recruited 40 adult patients diagnosed with MM new to lenalidomide at a specialty pharmacy. Recruitment was completed January-February 2016, and the length of study was 6 months. Participants were randomized 1:1 between the intervention and control groups. The intervention group received lenalidomide in activated SPBs with light, chimes, text message reminders, and pharmacist follow-up if weekly SPB adherence rates dropped below 80%. The control group received lenalidomide in identical SPBs with all alerts deactivated. SBPs contained cellular capabilities, enabling around-the-clock data transmission and captured data upon bottle-uncapping events. Patient adherence was calculated by dividing the number of bottle-uncapping events by the total number of doses supplied for each dosing cycle. Lenalidomide cycles completed and pharmacist outreach to the same patient were counted to determine pharmacist intervention. The ICER was calculated to determine SPB cost-effectiveness, and a Likert scale survey was given to the intervention group to evaluate patient satisfaction with the full-service SPB. RESULTS Sixteen participants in each arm completed the study; 4 patients in each arm were lost to follow-up. Median adherence was improved for the intervention group compared with the control group (median = 100% vs. 87.4%; P = 0.001). The ICER per patient percentage adherence increase was found to be $96.03. Sixty percent of patients in the intervention group who responded to the post-satisfaction survey rated the full SPB service very positively. CONCLUSIONS In this study, SPB interventions were associated with increased medication adherence and patient satisfaction. This pilot also provides empirical data on the cost-effectiveness of adherence technology used in a specialty pharmacy oncology setting. DISCLOSURES This study was supported by Avella Specialty Pharmacy and AdhereTech. All authors are employees of Avella; Eric Sredzinski was an option holder of Avella; and none of the Avella authors had a financial interest in AdhereTech. AdhereTech provided the SPBs and data services for the duration of this study. The authors report no other potential conflicts of interest. Interim study data were presented at the 2016 Southwestern States Residency Conference (SSRC) on June 20, 2016, in Phoenix, AZ.
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415
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Ofori-Asenso R, Liew D, Lalic S, Mazidi M, Magliano DJ, Ademi Z, Bell JS, Ilomaki J. Adherence, Persistence, and Switching Among People Prescribed Sodium Glucose Co-transporter 2 Inhibitors: A Nationwide Retrospective Cohort Study. Adv Ther 2019; 36:3265-3278. [PMID: 31482509 DOI: 10.1007/s12325-019-01077-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Non-adherence and non-persistence to diabetes medications are associated with worse clinical outcomes. In this study, we aimed to characterise the 1-year switching, adherence, and persistence patterns among people with diabetes aged 18 years and older prescribed sodium-glucose co-transporter 2 inhibitors (SGLT2is) in Australia. METHODS Using data from Australia's national Pharmaceutical Benefits Scheme (PBS), we identified 11,981 adults (mean age 60.9 years; 40.5% female) newly initiated on SGLT2is (5993 dapagliflozin; 5988 empagliflozin) from September 2015 to August 2017. Adherence was assessed via the proportion of days covered (PDC), persistence was defined as the continuous use of SGLT2i without a gap of ≥ 90 days, and switching was defined as the first change from dapagliflozin to empagliflozin or vice versa. Generalised linear models (GLMs) were used to compare the adherence (PDC = continuous), logistic regression models were used to compare the likelihoods of being adherent (PDC ≥ 0.80), and Cox proportional hazard models were used to compare the likelihoods of persistence and switching between people prescribed empagliflozin and dapagliflozin. RESULTS Overall, 65.8% (7879/11,981) of people dispensed SGLT2is were adherent (PDC ≥ 0.80) and 72.1% (8644/11,981) were persistent at 12 months. The mean PDC was 0.79 ± 0.27. The use of empagliflozin was associated with higher adherence (PDC = continuous) [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.03-1.05], being adherent (OR 1.39, 95% CI 1.29-1.51), and persisting for 12 months [hazard ratio (HR) 1.14, 95% CI 1.06-1.22] compared with dapagliflozin. Only 4.3% (509/11,981) of people switched between the SGLT2i. Compared with dapagliflozin, people initiated on empagliflozin were less likely to switch [HR 0.46, 95% CI 0.38-0.55]. CONCLUSIONS A considerable proportion of Australians prescribed SGLT2is were non-adherent or non-persistent. However, empagliflozin was associated with better adherence and persistence rates and a lower likelihood of switching compared with dapagliflozin.
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Affiliation(s)
- Richard Ofori-Asenso
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Samanta Lalic
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - Mohsen Mazidi
- Division of Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Dianna J Magliano
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Zanfina Ademi
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - J Simon Bell
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
| | - Jenni Ilomaki
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
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416
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Walsh CA, Cahir C, Tecklenborg S, Byrne C, Culbertson MA, Bennett KE. The association between medication non-adherence and adverse health outcomes in ageing populations: A systematic review and meta-analysis. Br J Clin Pharmacol 2019; 85:2464-2478. [PMID: 31486099 PMCID: PMC6848955 DOI: 10.1111/bcp.14075] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 07/03/2019] [Accepted: 07/12/2019] [Indexed: 01/16/2023] Open
Abstract
AIMS The aim of this systematic review and meta-analysis was to synthesise the evidence relating to medication non-adherence and its association with health outcomes in people aged ≥50 years. METHODS Seven databases were searched up to February 2019 for observational studies that measured medication (non-)adherence as a predictor of the following health outcomes in adults aged ≥50 years: healthcare utilisation (hospitalisation, emergency department visits, outpatient visits and general practitioner visits), mortality, adverse clinical events and quality of life. Screening and quality assessment using validated criteria were completed by 2 reviewers independently. Random effects models were used to generate pooled estimates of association using adjusted study results. The full methodological approach was published on PROSPERO (ID: CRD42017077264). RESULTS Sixty-six studies were identified for qualitative synthesis, with 11 of these studies eligible for meta-analyses. A meta-analysis including 3 studies measuring medication non-adherence in adults aged ≥55 years showed a significant association with all-cause hospitalisation (adjusted odds ratio 1.17, 95% confidence interval [CI] 1.12, 1.21). A meta-analysis including 2 studies showed that medication non-adherence was not significantly associated with an emergency department visit (adjusted odds ratio 1.05, 95% CI 0.90, 1.22). Good adherence was associated with a 21% reduction in long-term mortality risk in comparison to medication non-adherence (adjusted hazard ratio 0.79, 95% CI 0.63, 0.98). CONCLUSION Medication non-adherence may be significantly associated with all-cause hospitalisation and mortality in older people. Medication adherence should be monitored and addressed in this cohort to minimise hospitalisation, improve clinical outcomes and reduce healthcare costs.
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Affiliation(s)
- Caroline A. Walsh
- Division of Population Health SciencesRoyal College of Surgeons in IrelandDublinIreland
| | - Caitriona Cahir
- Division of Population Health SciencesRoyal College of Surgeons in IrelandDublinIreland
| | - Sarah Tecklenborg
- Division of Population Health SciencesRoyal College of Surgeons in IrelandDublinIreland
| | - Catherine Byrne
- Division of Population Health SciencesRoyal College of Surgeons in IrelandDublinIreland
| | | | - Kathleen E. Bennett
- Division of Population Health SciencesRoyal College of Surgeons in IrelandDublinIreland
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417
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Ali M, Grogan S, Powell S, Staniford L, Nazir J, Landeira M, Covernton PJO, Jaggi A, Fatoye F, Holt M. Qualitative Analysis of Factors Influencing Patient Persistence and Adherence to Prescribed Overactive Bladder Medication in UK Primary Care. Adv Ther 2019; 36:3110-3122. [PMID: 31559603 PMCID: PMC6822799 DOI: 10.1007/s12325-019-01098-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Indexed: 12/01/2022]
Abstract
Introduction Pharmacotherapy for overactive bladder (OAB) is generally associated with low rates of persistence and adherence. This study was conducted to explore the patient journey in a UK primary care setting (experiences, perceptions, attitudes, and levels of engagement and expectations) and identify self-reported reasons for patient non-adherence and/or non-persistence to medications for OAB. Methods This was a qualitative, non-interventional study involving one-to-one semi-structured, face-to-face or phone interviews with individuals aged 40–80 years, diagnosed with OAB, and currently taking, or having taken, either antimuscarinic or β3-adrenoceptor agonist medications within the last 12 months. Thematic analyses of interview transcripts identified themes surrounding the participants’ experiences with OAB. Results A total of 20 interviews were conducted (face-to-face, n = 13; telephone, n = 7). Interviews from five men and 13 women (mean age 70 years) were included in the final analysis. The most common OAB symptoms reported included urgency, frequency, incontinence and nocturia. Several key themes of factors influencing persistence and/or adherence to prescribed OAB medication were identified: patients’ attitude and condition adaptation behaviour; support with treatment; unmet efficacy/tolerability expectations; drug/condition hierarchy. Non-adherence and/or non-persistence to OAB medication was largely intentional, with patients balancing side effects against perceived clinical benefits. Perceived lack of efficacy was the primary reason for discontinuing treatment. Other factors cited included side effects of medication (either experienced or a fear of future effects), a general aversion to long-term medication taking, drug/condition hierarchy relative to other comorbidities, and limited healthcare professional (HCP) support/engagement. Patients expressed condition adaptation behaviours to help self-manage their condition. Conclusion Persistence and adherence to OAB medication may be suboptimal. HCPs might be able to improve persistence and adherence by fostering realistic treatment expectations and scheduling regular medication reviews. These measures may help optimise patient care and support more adherent behaviours, thus minimising the impact of undertreated OAB on patient quality of life. Funding Innovate UK and Astellas Pharma Europe Ltd (APEL). Electronic Supplementary Material The online version of this article (10.1007/s12325-019-01098-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mahmood Ali
- Manchester Metropolitan University, Manchester, UK.
| | - Sarah Grogan
- Manchester Metropolitan University, Manchester, UK
| | - Sue Powell
- Manchester Metropolitan University, Manchester, UK
| | | | | | | | | | - Ashley Jaggi
- Manchester Metropolitan University, Manchester, UK
| | | | - Maxine Holt
- Manchester Metropolitan University, Manchester, UK
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418
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Bailey SC, Wallia A, Wright S, Wismer GA, Infanzon AC, Curtis LM, Brokenshire SA, Chung AE, Reuland DS, Hahr AJ, Hornbuckle K, Lockwood K, Hall L, Wolf MS. Electronic Health Record-Based Strategy to Promote Medication Adherence Among Patients With Diabetes: Longitudinal Observational Study. J Med Internet Res 2019; 21:e13499. [PMID: 31638592 PMCID: PMC6829279 DOI: 10.2196/13499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/29/2019] [Accepted: 06/15/2019] [Indexed: 01/17/2023] Open
Abstract
Background Poor medication adherence is common; however, few mechanisms exist in clinical practice to monitor how patients take medications in outpatient settings. Objective This study aimed to pilot test the Electronic Medication Complete Communication (EMC2) strategy, a low-cost, sustainable approach that uses functionalities within the electronic health record to promote outpatient medication adherence and safety. Methods The EMC2 strategy was implemented in 2 academic practices for 14 higher-risk diabetes medications. The strategy included: (1) clinical decision support alerts to prompt provider counseling on medication risks, (2) low-literacy medication summaries for patients, (3) a portal-based questionnaire to monitor outpatient medication use, and (4) clinical outreach for identified concerns. We recruited adult patients with diabetes who were prescribed a higher-risk diabetes medication. Participants completed baseline and 2-week interviews to assess receipt of, and satisfaction with, intervention components. Results A total of 100 patients were enrolled; 90 completed the 2-week interview. Patients were racially diverse, 30.0% (30/100) had a high school education or less, and 40.0% (40/100) had limited literacy skills. About a quarter (28/100) did not have a portal account; socioeconomic disparities were noted in account ownership by income and education. Among patients with a portal account, 58% (42/72) completed the questionnaire; 21 of the 42 patients reported concerns warranting clinical follow-up. Of these, 17 were contacted by the clinic or had their issue resolved within 24 hours. Most patients (33/38, 89%) who completed the portal questionnaire and follow-up interview reported high levels of satisfaction (score of 8 or greater on a scale of 1-10). Conclusions Findings suggest that the EMC2 strategy can be reliably implemented and delivered to patients, with high levels of satisfaction. Disparities in portal use may restrict intervention reach. Although the EMC2 strategy can be implemented with minimal impact on clinic workflow, future trials are needed to evaluate its effectiveness to promote adherence and safety.
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Affiliation(s)
- Stacy Cooper Bailey
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Amisha Wallia
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sarah Wright
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Guisselle A Wismer
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Alexandra C Infanzon
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States
| | - Laura M Curtis
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Samantha A Brokenshire
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States
| | - Arlene E Chung
- Division of General Internal Medicine & Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States.,Program on Health & Clinical Informatics, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Daniel S Reuland
- Division of General Internal Medicine & Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Allison J Hahr
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | | | - Lori Hall
- Eli Lilly and Company, Indianapolis, IN, United States
| | - Michael S Wolf
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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419
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Banerjee A, Benedetto V, Gichuru P, Burnell J, Antoniou S, Schilling RJ, Strain WD, Ryan R, Watkins C, Marshall T, Sutton CJ. Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study. Heart 2019; 106:119-126. [PMID: 31601729 PMCID: PMC6993026 DOI: 10.1136/heartjnl-2019-315307] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 08/21/2019] [Accepted: 08/29/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Despite simpler regimens than vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF), adherence (taking drugs as prescribed) and persistence (continuation of drugs) to direct oral anticoagulants are suboptimal, yet understudied in electronic health records (EHRs). OBJECTIVE We investigated (1) time trends at individual and system levels, and (2) the risk factors for and associations between adherence and persistence. METHODS In UK primary care EHR (The Health Information Network 2011-2016), we investigated adherence and persistence at 1 year for oral anticoagulants (OACs) in adults with incident AF. Baseline characteristics were analysed by OAC and adherence/persistence status. Risk factors for non-adherence and non-persistence were assessed using Cox and logistic regression. Patterns of adherence and persistence were analysed. RESULTS Among 36 652 individuals with incident AF, cardiovascular comorbidities (median CHA2DS2VASc[Congestive heart failure, Hypertension, Age≥75 years, Diabetes mellitus, Stroke, Vascular disease, Age 65-74 years, Sex category] 3) and polypharmacy (median number of drugs 6) were common. Adherence was 55.2% (95% CI 54.6 to 55.7), 51.2% (95% CI 50.6 to 51.8), 66.5% (95% CI 63.7 to 69.2), 63.1% (95% CI 61.8 to 64.4) and 64.7% (95% CI 63.2 to 66.1) for all OACs, VKA, dabigatran, rivaroxaban and apixaban. One-year persistence was 65.9% (95% CI 65.4 to 66.5), 63.4% (95% CI 62.8 to 64.0), 61.4% (95% CI 58.3 to 64.2), 72.3% (95% CI 70.9 to 73.7) and 78.7% (95% CI 77.1 to 80.1) for all OACs, VKA, dabigatran, rivaroxaban and apixaban. Risk of non-adherence and non-persistence increased over time at individual and system levels. Increasing comorbidity was associated with reduced risk of non-adherence and non-persistence across all OACs. Overall rates of 'primary non-adherence' (stopping after first prescription), 'non-adherent non-persistence' and 'persistent adherence' were 3.5%, 26.5% and 40.2%, differing across OACs. CONCLUSIONS Adherence and persistence to OACs are low at 1 year with heterogeneity across drugs and over time at individual and system levels. Better understanding of contributory factors will inform interventions to improve adherence and persistence across OACs in individuals and populations.
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Affiliation(s)
- Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK .,School of Health Sciences, University of Central Lancashire, Preston, UK
| | - Valerio Benedetto
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom
| | | | - Jane Burnell
- School of Health Sciences, University of Central Lancashire, Preston, UK
| | | | - Richard J Schilling
- Department of Cardiology, Barts and The London NIHR Cardiovascular Biomedical Research Unit and The William Harvey Research Institute, London, UK
| | | | - Ronan Ryan
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Caroline Watkins
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom
| | - Tom Marshall
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Chris J Sutton
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
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420
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Narechania S, Torbic H, Tonelli AR. Treatment Discontinuation or Interruption in Pulmonary Arterial Hypertension. J Cardiovasc Pharmacol Ther 2019; 25:131-141. [PMID: 31594400 DOI: 10.1177/1074248419877409] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a progressive disease, which can be potentially fatal. The management of a complex disease like PAH requires a multidisciplinary approach from a team consisting of physicians, nurses, social workers, and pharmacists. Adherence to PAH-specific therapy is one of the key factors in the management of this disease. Poor adherence to treatment is a common problem in PAH as it is in many chronic diseases. Management of medication interruptions is a challenge in patients with PAH that can lead to negative consequences. However, for most PAH-specific drugs, there are no clear guidelines on how to manage temporary or abrupt medication discontinuations. In this review, we summarized the available literature and provide suggestions on how to manage interruptions of PAH-specific therapies.
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Affiliation(s)
- Shraddha Narechania
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Heather Torbic
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA
| | - Adriano R Tonelli
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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421
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Singh N, Varshney U. Medication adherence: A method for designing context-aware reminders. Int J Med Inform 2019; 132:103980. [PMID: 31586826 DOI: 10.1016/j.ijmedinf.2019.103980] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/30/2019] [Accepted: 09/24/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Several interventions have been proposed to improve medication adherence including those using reminders. Context-aware reminders can be effective because they operate when the dose is due, has not been taken, and is still safe to take. Although very promising, we find that there is no method to design context-aware reminders. To address these, we focus on proposing a method to design context-aware reminders. METHODS We conducted a systematic review of context-aware reminders for medication adherence using PRISMA approach. The analysis of literature leads to several interesting observations including the need for a method to design context-aware reminders. In this study, we present Method to Design Context-Aware Reminders (MDCAR) that can also meet special requirements. We used domain experts reasoning to evaluate the designed Context-Aware Reminders for Medication Adherence (CARS-MA). Further, we used analytical model to evaluate reliability, side effects, and cost of intervention. RESULTS This is the first paper that addresses "how to" design context-aware reminders. The proposed design method can lead to range of context-aware reminders including CARS-MA. The verification, validation, and evaluation of CARS-MA indicate that the context-aware reminders perform better than simple reminders in improving medication adherence. CONCLUSIONS The proposed method for context-aware reminders will help healthcare professionals and researchers to implement and select a suitable intervention to improve medication adherence. Further, it can lead to decision support systems for patients, healthcare professionals, researchers and policy makers for medication adherence. The design method can be extended for complex scenarios of multiple medications, persistent-reminders, and composite interventions.
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Affiliation(s)
- Neetu Singh
- University of Illinois at Springfield, Springfield, IL, 62703, USA.
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422
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Dashputre AA, S Gatwood K, Schmidt J, Gatwood J. Impact of oral oncolytic initiation on medication adherence for pre-existing comorbid chronic conditions. J Oncol Pharm Pract 2019; 26:835-845. [PMID: 31575355 DOI: 10.1177/1078155219875206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Oral oncolytics have improved survival in hematological cancers like chronic myeloid leukemia, chronic lymphocytic leukemia/small lymphocytic lymphoma, and multiple myeloma; however, it is unclear of the extent to which initiating these treatments might impact adherence to oral therapies for pre-existing comorbid chronic conditions. METHODS Adults diagnosed with and prescribed oral oncolytics for chronic myeloid leukemia, chronic lymphocytic leukemia/small lymphocytic lymphoma, or multiple myeloma between 2013 and 2016 and with continuous eligibility six months before and after oral oncolytic initiation were identified from the Truven Health MarketScan databases. Among those identified, patients with pre-existing diabetes, hypertension, and/or hyperlipidemia with ≥1 fill for oral comorbid therapies were selected. Adherence to oral oncolytics and comorbid therapies was measured using the proportion of days covered metric. Wilcoxon signed-rank tests assessed changes in adherence for comorbid therapies after initiation of an oral oncolytic. Unadjusted difference-in-difference models assessed the impact of adherence to oral oncolytics on changes in adherence to comorbid therapies. RESULTS Significant reductions in adherence after oncolytic initiation were observed across the comorbid therapies and were highest for patients taking lipid-lower agents (10.7-15.6%). Unadjusted difference-in-difference models revealed consistent and significantly lower reductions in adherence for those taking antihypertensives (chronic myeloid leukemia: p = 0.03; chronic lymphocytic leukemia/small lymphocytic lymphoma: p = 0.007; multiple myeloma: p = 0.09) and adherent to oral oncolytics. CONCLUSION Initiation of oral oncolytics may negatively impact adherence to oral therapies for chronic comorbid conditions, necessitating the need for medication management strategies to help patients adhere to their entire medication regimen.
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Affiliation(s)
- Ankur A Dashputre
- Institute for Health Outcomes and Policy, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Katie S Gatwood
- Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jillian Schmidt
- College of Pharmacy, University of Tennessee Health Science Center, TN, USA
| | - Justin Gatwood
- College of Pharmacy, University of Tennessee Health Science Center, TN, USA
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423
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Canfield SL, Zuckerman A, Anguiano RH, Jolly JA, DeClercq J, Wascher M, Choi L, Knox S, Mitchell DG. Navigating the Wild West of Medication Adherence Reporting in Specialty Pharmacy. J Manag Care Spec Pharm 2019; 25:1073-1077. [PMID: 31556829 PMCID: PMC10397888 DOI: 10.18553/jmcp.2019.25.10.1073] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Estimating medication adherence through the use of pharmacy claims-based adherence calculations such as medication possession ratio (MPR) and proportion of days covered (PDC) plays a significant role in specialty pharmacy practice. Although MPR and PDC are frequently used in clinical practice, calculation methodologies vary, making meaningful comparisons of adherence rates difficult. In addition, MPR and PDC are increasingly used by insurance companies, pharmacies, accrediting bodies, and drug manufacturers to demonstrate quality differences or clinical benefit across the specialty pharmacy industry. Therefore, recognizing the source and effect of calculation variability is necessary to fully understand reported adherence results. This article highlights the challenges in standardizing adherence methodologies, minimum methodology considerations that should be reported with MPR and PDC results, and key elements to consider when interpreting and applying adherence results. Further, recommendations are provided to promote a more consistent description of calculation methods and to aid pharmacies in adherence measure analysis, interpretation, and application to practice, with a focus on specialty pharmacy programs. A detailed description of methodology as outlined in this article must be provided to ensure reproducibility, external validation, and scientific rigor. In the absence of standardization, specialty pharmacies should be prudent in their use of adherence calculations as a clinical benchmarking tool or comparative quality indicator with outside organizations. Furthermore, specialty pharmacies should consider using current adherence measure calculations to identify and provide targeted interventions to patients with potential adherence problems and strive to better demonstrate ties between adherence measures and direct clinical and cost outcomes. DISCLOSURES: No outside funding supported the writing of this article. Anguiano is a speaker and research consultant for United Therapeutics. The other authors have nothing to disclose.
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Affiliation(s)
| | - Autumn Zuckerman
- Department of Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rebekah H. Anguiano
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, Illinois
| | - Jacob A. Jolly
- Department of Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Josh DeClercq
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Leena Choi
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stacy Knox
- Department of Pharmacy Services, UC Davis Health, Sacramento, California
| | - David G. Mitchell
- Department of Pharmacy Services, UC Davis Health, Sacramento, California
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424
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Zozaya N, Alcalá B, Galindo J. The offset effect of pharmaceutical innovation: A review study. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2019. [DOI: 10.1177/2284240319875108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
It is well known that pharmaceutical innovation has improved the health and quality of life of patients. It is however sometimes forgotten that new drugs also have the potential of improving the efficiency and the sustainability of the healthcare system. The objective of this review is to shed light on the magnitude of the offset effect that drugs may have in the realm of the healthcare system and for society as a whole. A narrative literature review was carried out. This review demonstrated that a growing body of literature has tried to measure the magnitude of the offset effect associated with pharmaceutical innovation, both at the aggregate level and for different diseases. There is evidence that the aggregate use of new drugs can generate net savings to the healthcare system and to society, as they may release both healthcare and non-healthcare resources for alternative uses. A high degree of heterogeneity in the magnitude of the effect has been found across different pathologies and different types of drugs.
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Affiliation(s)
- Néboa Zozaya
- Department of Health Economics, Weber, Madrid, Spain
- University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Bleric Alcalá
- Department of Health Economics, Weber, Madrid, Spain
| | - Jhon Galindo
- Department of Health Economics, Weber, Madrid, Spain
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425
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Wan B, Ball P, Jackson D, Maynard G. Self-rated health and medicine beliefs among older hospital outpatients in Hong Kong. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 27:451-458. [DOI: 10.1111/ijpp.12524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/16/2019] [Indexed: 11/26/2022]
Abstract
Abstract
Objectives
(1) To identify any demographic characteristics, which predict medicines adherence by reporting Necessity-Concern Differential (NCD) and Self-Reported Health (SRH) scores among Hong Kong hospital outpatients. (ii) To investigate any association between SRH and NCD in this cultural group.
Methods
A total of 709 outpatients completed a questionnaire consisting demographic information, SRH and Belief about Medicines Questionnaire. Findings were analysed statistically.
Key findings
Descriptive statistics suggested that older participants (mean age > 64 years) tended to report low SRH, but high NCD compared to younger respondents (mean age < 53 years). Males were more likely to return high SRH and NCD scores than females (56.9 versus 42.2% and 74.8 versus 64.6%, respectively). Chi-squared tests demonstrated that socio-economic status was not significantly associated with SRH and NCD reporting (P > 0.05). Logistic regressions indicated gender and age groups (young-old and old-old) were significant predictors of SRH reporting (P < 0.001). Moreover, patients with high SRH were more likely to report high NCD than those with low SRH (P = 0.02; OR = 1.53; 95%CI 1.07–2.20). This indicates that regular administration of the SRH item followed by specific questioning could enhance early identification of potential medicine non-believers and, subsequently, non-adherent patients who may require urgent interventions or monitoring.
Conclusions
Demographic characteristics and significant association between SRH and NCD reporting support our claim that SRH opens new opportunities for prompt identification of potentially non-adherent patients. However, further interviews to determine the cause(s) of non-adherence are necessary to validate such findings.
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Affiliation(s)
- Bosco Wan
- Charles Sturt University, Wagga Wagga, NSW, Australia
| | | | - David Jackson
- Charles Sturt University, Wagga Wagga, NSW, Australia
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426
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Gupta S, McColl MA, Guilcher SJT, Smith K. An Adapted Model of Cost-Related Nonadherence to Medications Among People With Disabilities. JOURNAL OF DISABILITY POLICY STUDIES 2019. [DOI: 10.1177/1044207319868779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite emerging evidence on cost-related nonadherence (CRNA) to prescription medications, there is little conceptualization and exploration of this phenomenon with respect to disability. Specifically, there is a gap in the literature that explores factors influencing medication cost–adherence relationship among individuals living with a disability. To advance research on and policy for CRNA to medications among people with disabilities, we need a framework that can contribute towards guiding solutions to this problem. We examined the applicability of Piette and colleagues’ existing model for CRNA to the context of people with disabilities and suggested an adapted model (CRNA to medications for persons with disability [CRNA-d]) that can provide a more specific conceptualization of CRNA with respect to disability. The adapted CRNA-d model depicts that CRNA to prescription medications with respect to disability is a dynamic and multifaceted phenomenon, determined by various socioeconomic, disability-related, medication-related, prescriber-related, and system-related factors. We discuss how higher susceptibility to health complications, barriers to income and employment, additional health care costs, the complexity of medical regimens, limited access to physician services, and other policy-related factors increase the risk of persons with disabilities to face cost-related barriers to fulfill their necessary medications.
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Affiliation(s)
| | | | | | - Karen Smith
- Queen’s University, Kingston, Ontario, Canada
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427
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Zullig LL, Jazowski SA, Wang TY, Hellkamp A, Wojdyla D, Thomas L, Egbuonu-Davis L, Beal A, Bosworth HB. Novel application of approaches to predicting medication adherence using medical claims data. Health Serv Res 2019; 54:1255-1262. [PMID: 31429471 DOI: 10.1111/1475-6773.13200] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To compare predictive analytic approaches to characterize medication nonadherence and determine under which circumstances each method may be best applied. DATA SOURCES/STUDY SETTING Medicare Parts A, B, and D claims from 2007 to 2013. STUDY DESIGN We evaluated three statistical techniques to predict statin adherence (proportion of days covered [PDC ≥ 80 percent]) in the year following discharge: standard logistic regression with backward selection of covariates, least absolute shrinkage and selection operator (LASSO), and random forest. We used the C-index to assess model discrimination and decile plots comparing predicted values to observed event rates to evaluate model performance. DATA EXTRACTION We identified 11 969 beneficiaries with an acute myocardial infarction (MI)-related admission from 2007 to 2012, who filled a statin prescription at, or shortly after, discharge. PRINCIPAL FINDINGS In all models, prior statin use was the most important predictor of future adherence (OR = 3.65, 95% CI: 3.34-3.98; OR = 3.55). Although the LASSO regression model selected nearly 90 percent of all candidate predictors, all three analytic approaches had moderate discrimination (C-index ranging from 0.664 to 0.673). CONCLUSIONS Although none of the models emerged as clearly superior, predictive analytics could proactively determine which patients are at risk of nonadherence, thus allowing for timely engagement in adherence-improving interventions.
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Affiliation(s)
- Leah L Zullig
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina.,Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Shelley A Jazowski
- Department of Population Health Sciences, Duke University, Durham, North Carolina.,Department of Health Policy and Management, University of North Carolina, Chapel Hill, North Carolina
| | - Tracy Y Wang
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Anne Hellkamp
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Daniel Wojdyla
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Laine Thomas
- Duke Clinical Research Institute, Duke University, Durham, North Carolina.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Lisa Egbuonu-Davis
- Global Patient Centered Outcomes and Solutions, Sanofi, New York, New York
| | - Anne Beal
- Global Patient Centered Outcomes and Solutions, Sanofi, New York, New York
| | - Hayden B Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina.,Department of Population Health Sciences, Duke University, Durham, North Carolina.,School of Nursing, Duke University, Durham, North Carolina.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina.,Department of Medicine, Duke University, Durham, North Carolina
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428
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Desai R, Thakkar S, Fong HK, Varma Y, Ali Khan MZ, Itare VB, Raina JS, Savani S, Damarlapally N, Doshi RP, Gangani K, Sitammagari K. Rising Trends in Medication Non-compliance and Associated Worsening Cardiovascular and Cerebrovascular Outcomes Among Hospitalized Adults Across the United States. Cureus 2019; 11:e5389. [PMID: 31482043 PMCID: PMC6701890 DOI: 10.7759/cureus.5389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction Small-scale studies have described concerning rates of non-compliance/nonadherence towards groups of medications for primary and secondary prevention. Trends in cardiovascular and cerebrovascular events (CCE) among hospitalized patients with a non-compliant behavior towards medication, on the whole, remains unexplored on a large scale. Methods Using the National Inpatient Sample databases (2007-2014), we sought to assess the prevalence and trends in all-cause mortality and CCE in adult patients hospitalized with medication non-compliance. We compared baseline characteristics and comorbidities in the non-compliant patients with and without concomitant in-hospital CCE. Results We identified 7,453,831 adult hospitalizations with medication non-compliance from 2007 to 2014, of which 867,997 (11.6%) patients demonstrated in-hospital CCE. Non-compliant patients with CCE consisted of a higher number of older, white, male patients having greater comorbid risk factors. Non-compliant patients with CCE had higher all-cause in-hospital mortality (3% vs. 0.7%), frequent transfers [4.4% vs. 1.8% transfers to short-term hospitals, and 17.6% vs. 11.6% other transfers (skilled nursing or intermediate care facilities)], lower routine discharges (59.4% vs. 71.1%), and higher mean hospital charges ($52,740 vs. $30,748) compared to non-compliant patients without CCE. Remarkably, this study demonstrates the rising trend in medication non-compliance across all age, sex, and race groups, and related in-hospital mortality, CCE, transfers to other facilities, and the health care cost from 2007 to 2014. Conclusions We observed rising trends in the prevalence of medication non-compliance and subsequent in-hospital mortality in hospitalizations among adults from 2007 to 2014. Non-compliant patients with inpatient CCE demonstrated rising trends in all-cause mortality, complications, health care utilization, and cost from 2007 to 2014.
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Affiliation(s)
- Rupak Desai
- Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, USA
| | | | - Hee Kong Fong
- Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, USA
| | - Yash Varma
- Internal Medicine, Government Medical College, Bhavnagar, IND
| | - Mir Z Ali Khan
- Internal Medicine, Saint Peters University Hospital, New Brunswick, USA
| | - Vikram B Itare
- Internal Medicine, Smolensk State Medical University, Smolensk, RUS
| | - Jilmil S Raina
- Internal Medicine, Smolensk State Medical University, Smolensk, RUS
| | - Sejal Savani
- Public Health, New York University, New York, USA
| | | | - Rajkumar P Doshi
- Internal Medicine, University of Nevada, Reno School of Medicine, Reno, USA
| | - Kishorbhai Gangani
- Internal Medicine, Texas Health Arlington Memorial Hospital, Arlington, USA
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429
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Onakpoya IJ, Aronson JK. Lorcaserin in obesity: minimal benefits and ill-defined harms. BMJ Evid Based Med 2019; 24:145-146. [PMID: 30700436 DOI: 10.1136/bmjebm-2018-111128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2018] [Indexed: 01/20/2023]
Affiliation(s)
- Igho J Onakpoya
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jeffrey K Aronson
- Centre for Evidence Based Medicine, University of Oxford, Oxford, UK
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430
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Improving mental health pathways and care for adolescents in transition to adult services (IMPACT): a retrospective case note review of social and clinical determinants of transition. Soc Psychiatry Psychiatr Epidemiol 2019; 54:955-963. [PMID: 30843086 DOI: 10.1007/s00127-019-01684-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Poor transitions to adult care from child and adolescent mental health services may increase the risk of disengagement and long-term negative outcomes. However, studies of transitions in mental health care are commonly difficult to administer and little is known about the determinants of successful transition. The persistence of health inequalities related to access, care, and outcome is now well accepted including the inverse care law which suggests that those most in need of services may be the least likely to obtain them. We sought to examine the pathways and determinants of transition, including the role of social class. METHOD A retrospective systematic examination of electronic records and case notes of young people eligible to transition to adult care over a 4-year period across five Health and Social Care NHS Trusts in Northern Ireland. RESULTS We identified 373 service users eligible for transition. While a high proportion of eligible patients made the transition to adult services, very few received an optimal transition process and many dropped out of services or subsequently disengaged. Clinical factors, rather than social class, appear to be more influential in the transition pathway. However, those not in employment, education or training (NEET) were more likely (OR 3.04: 95% CI 1.34, 6.91) to have been referred to Adult Mental Health Services (AMHS), as were those with a risk assessment or diagnosis (OR 4.89: 2.45, 9.80 and OR 3.36: 1.78, 6.34), respectively. CONCLUSIONS Despite the importance of a smoother transition to adult services, surprisingly, few patients experience this. There is a need for stronger standardised policies and guidelines to ensure optimal transitional care to AMHS. The barriers between different arms of psychiatry appear to persist. Joint working and shared arrangements between child and adolescent and adult mental health services should be fostered.
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431
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Association between person and disease related factors and the planned diabetes care in people who receive person-centered type 2 diabetes care: An implementation study. PLoS One 2019; 14:e0219702. [PMID: 31339929 PMCID: PMC6655662 DOI: 10.1371/journal.pone.0219702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/29/2019] [Indexed: 11/20/2022] Open
Abstract
AIMS To assess the planned diabetes care for the coming year and its associated factors in patients with Type 2 diabetes who have a person-centered annual consultation. METHODS Implementation study of a new consultation model in 47 general practices (primary care) and 6 outpatient clinics (secondary care); 1200 patients from primary and 166 from secondary care participated. Data collection took place between November 2015 and February 2017. Outcomes: preferred monitoring frequency; referral to other health care provider(s); medication change. One measurement at the end of the consultation. We performed logistic regression analyses. Differences between primary and secondary care were analyzed. RESULTS Many patients arranged a monitoring frequency <4 times per year (general practices 19.5%, outpatient clinics 40%, p < .001). Type of provider (physician/nurse, OR 3.83, p < .001), baseline HbA1c (OR 1.02, p = .017), glucose lowering medication; and setting treatment goals (OR .65, p = .048) were associated with the chosen frequency. Independently associated with a referral were age (OR .99, p = .039), baseline glucose lowering medication and patients' goal setting (OR 1.52, p = .016). Medication change was associated with type of provider, baseline HbA1c, blood glucose lowering medication, quality of life (OR .80, p = .037) and setting treatment goals (OR 2.64, p = .001). CONCLUSIONS Not only disease but also person related factors, especially setting treatment goals, are independently associated with planned care use in person-centered diabetes care.
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432
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Baldoni S, Amenta F, Ricci G. Telepharmacy Services: Present Status and Future Perspectives: A Review. ACTA ACUST UNITED AC 2019; 55:medicina55070327. [PMID: 31266263 PMCID: PMC6681067 DOI: 10.3390/medicina55070327] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 11/22/2022]
Abstract
Background and Objectives: The term “telepharmacy” indicates a form of pharmaceutical care in which pharmacists and patients are not in the same place and can interact using information and communication technology (ICT) facilities. Telepharmacy has been adopted to provide pharmaceutical services to underserved areas and to address the problem of pharmacist shortage. This paper has reviewed the multi-faceted phenomenon of telepharmacy, summarizing different experiences in the area. Advantages and limitations of telepharmacy are discussed as well. Materials and Methods: A literature analysis was carried out on PubMed, using as entry term “telepharmacy” and including articles on the topic published between 2012 and 2018. Results: The studies reviewed were divided into three categories of pharmacy practice, namely (1) support to clinical services, (2) remote education and handling of “special pharmacies”, and (3) prescription and reconciliation of drug therapies. In general, different telepharmacy services were effective and accompanied by a satisfaction of their targets. Conclusions: Nowadays, the shortage of health personnel, and in particular pharmacists, is a challenging issue that the health systems have to face. The use of a new technology such as telepharmacy can represent a possible option to solve these problems. However, there are unsolved limitations (e.g., legal implications) that make greater diffusion of telepharmacy difficult. Stronger data on the effectiveness of this area of pharmacy care, together with a critical evaluation of its limits, can make actors involved aware about the potentialities of it and could contribute to a larger diffusion of telepharmacy services in the interest of communities and citizens.
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Affiliation(s)
- Simone Baldoni
- Telemedicine and Telepharmacy Center, School of Pharmaceutical Sciences and Health Products, University of Camerino, 62032 Camerino, Italy
| | - Francesco Amenta
- Telemedicine and Telepharmacy Center, School of Pharmaceutical Sciences and Health Products, University of Camerino, 62032 Camerino, Italy
| | - Giovanna Ricci
- Section of Forensic Medicine, School of Law, University of Camerino, 62032 Camerino, Italy.
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433
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Fowler JC, Cope N, Knights J, Phiri P, Makin A, Peters-Strickland T, Rathod S. Hummingbird Study: a study protocol for a multicentre exploratory trial to assess the acceptance and performance of a digital medicine system in adults with schizophrenia, schizoaffective disorder or first-episode psychosis. BMJ Open 2019; 9:e025952. [PMID: 31253613 PMCID: PMC6609081 DOI: 10.1136/bmjopen-2018-025952] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION In patients with schizophrenia, medication adherence is important for relapse prevention, and effective adherence monitoring is essential for treatment planning. A digital medicine system (DMS) has been developed to objectively monitor patient adherence and support clinical decision making regarding treatment choices. This study assesses the acceptance and performance of the DMS in adults with schizophrenia, schizoaffective disorder or first-episode psychosis and in healthcare professionals (HCPs). METHODS/ANALYSIS This is a multicentre, 8-week, single-arm, open-label pragmatic trial designed using coproduction methodology. The study will be conducted at five National Health Service Foundation Trusts in the UK. Patients 18-65 years old with a diagnosis of schizophrenia, schizoaffective disorder or first-episode psychosis will be eligible. HCPs (psychiatrists, care coordinators, nurses, pharmacists), researchers, information governance personnel, clinical commissioning groups and patients participated in the study design and coproduction. Intervention employed will be the DMS, an integrated system comprising an oral sensor tablet coencapsulated with an antipsychotic, non-medicated wearable patch, mobile application (app) and web-based dashboard. The coencapsulation product contains aripiprazole, olanzapine, quetiapine or risperidone, as prescribed by the HCP, with a miniature ingestible event marker (IEM) in tablet. On ingestion, the IEM transmits a signal to the patch, which collects ingestion and physical activity data for processing on the patient's smartphone or tablet before transmission to a cloud-based server for viewing by patients, caregivers and HCPs on secure web portals or mobile apps. ETHICS AND DISSEMINATION Approval was granted by London - City and East Research Ethics Committee (REC ref no 18/LO/0128), and clinical trial authorisation was provided by the Medicines and Healthcare products Regulatory Agency. Written informed consent will be obtained from every participant. The trial will be compliant with the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use guidelines and the Declaration of Helsinki. TRIAL REGISTRATION NUMBER NCT03568500; EudraCT2017-004602-17; Pre-results.
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Affiliation(s)
- J Corey Fowler
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA
| | | | - Jonathan Knights
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA
| | - Peter Phiri
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Andrew Makin
- Otsuka Europe Development and Commercialisation, Wexham, UK
| | - Tim Peters-Strickland
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA
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434
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Citrome L. Adherence: A challenge for all. Int J Clin Pract 2019; 73:e13379. [PMID: 31145832 DOI: 10.1111/ijcp.13379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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435
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Roseleur J, Harvey G, Stocks N, Karnon J. Behavioral economic insights to improve medication adherence in adults with chronic conditions: a scoping review protocol. ACTA ACUST UNITED AC 2019; 17:1915-1923. [PMID: 31145189 DOI: 10.11124/jbisrir-2017-003971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objective of this review is to map the evidence on the use of behavioral economic insights to improve medication adherence in adults with chronic conditions. INTRODUCTION Medication non-adherence is a barrier to effectively managing chronic conditions, leading to poorer patient outcomes and placing an additional financial burden on healthcare systems. As the population ages and the prevalence of chronic disease increases, new ways to influence patient behavior are needed. Approaches that use insights from behavioral economics may help improve medication adherence, thus reducing morbidity, mortality and financial costs of unmanaged chronic diseases. INCLUSION CRITERIA Eligible studies will include adults taking medication for a chronic condition. All interventions relevant to high-income settings using insights from behavioral economics to improve medication adherence in adults will be considered. Contexts may include, but are not limited to, primary health care, corporate wellness programs and health insurance schemes. Any study design published in English will be considered. Studies in facilities where medication is administered to patients will be excluded. METHODS PubMed, Embase, Scopus, PsycINFO, EconLit and CINAHL will be searched from database inception to present. Gray literature will be searched using Google Scholar, OpenGrey and the Grey Literature Report. One reviewer will review titles, and then two reviewers will independently review abstracts to identify eligible studies. One reviewer will extract data on study characteristics, study design and study outcomes. A second reviewer will validate 25% of the extracted information. The results of the data extraction will be presented in a table, and a narrative summary will be presented.
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Affiliation(s)
- Jacqueline Roseleur
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Gillian Harvey
- Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, The University of Adelaide, Adelaide, Australia
| | - Jonathan Karnon
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
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436
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Cutler RL, der Linden NV, Charlie Benrimoj SI, Fernandez-Llimos F, Garcia-Cardenas V. An evidence-based model to consolidate medication adherence cost estimation: the medication adherence cost estimation framework. J Comp Eff Res 2019; 8:555-567. [PMID: 31116029 DOI: 10.2217/cer-2018-0099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Aim: To develop a standardized framework determining the economic impact of medication nonadherence. Materials & methods: Secondary analysis of existing literature reported cost data, aggregating cost outcome indicators. Weighted-average cost analysis performed, determining the proportional contribution to total cost. Results: Direct costs were reported in 92% of studies and indirect costs in 4% of studies. Three most utilized cost categories were hospital (68%), primary care (18%) and pharmacy costs (72%). Average unadjusted direct costs ranged from $625 to $154,203 contributing to 88% of the total cost; adjusted medical costs ranged from $565 to $56,313 representing 96% of the total cost. Conclusion: The medication adherence cost estimation framework enables the comparison of costing studies, facilitating informed health policy decision-making based on consistent evidence and terminology.
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Affiliation(s)
- Rachelle L Cutler
- Graduate School of Health, University of Technology Sydney, Sydney, Australia, 2007
| | - Naomi Van der Linden
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, Sydney, Australia, 2000
| | | | - Fernando Fernandez-Llimos
- Department of Social Pharmacy, Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal, 1649-003
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437
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Pons-Faudoa FP, Ballerini A, Sakamoto J, Grattoni A. Advanced implantable drug delivery technologies: transforming the clinical landscape of therapeutics for chronic diseases. Biomed Microdevices 2019; 21:47. [PMID: 31104136 PMCID: PMC7161312 DOI: 10.1007/s10544-019-0389-6] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Chronic diseases account for the majority of all deaths worldwide, and their prevalence is expected to escalate in the next 10 years. Because chronic disorders require long-term therapy, the healthcare system must address the needs of an increasing number of patients. The use of new drug administration routes, specifically implantable drug delivery devices, has the potential to reduce treatment-monitoring clinical visits and follow-ups with healthcare providers. Also, implantable drug delivery devices can be designed to maintain drug concentrations in the therapeutic window to achieve controlled, continuous release of therapeutics over extended periods, eliminating the risk of patient non-compliance to oral treatment. A higher local drug concentration can be achieved if the device is implanted in the affected tissue, reducing systemic adverse side effects and decreasing the challenges and discomfort of parenteral treatment. Although implantable drug delivery devices have existed for some time, interest in their therapeutic potential is growing, with a global market expected to reach over $12 billion USD by 2018. This review discusses implantable drug delivery technologies in an advanced stage of development or in clinical use and focuses on the state-of-the-art of reservoir-based implants including pumps, electromechanical systems, and polymers, sites of implantation and side effects, and deployment in developing countries.
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Affiliation(s)
- Fernanda P Pons-Faudoa
- Department of Nanomedicine, Houston Methodist Research Institute, 6670 Bertner Avenue, Houston, TX, 77030, USA
- School of Medicine and Health Sciences, Tecnologico de Monterrey, Avenida Eugenio Garza Sada 2501, 64849, Monterrey, NL, Mexico
| | - Andrea Ballerini
- Department of Nanomedicine, Houston Methodist Research Institute, 6670 Bertner Avenue, Houston, TX, 77030, USA
- Department of Oncology and Onco-Hematology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Jason Sakamoto
- Department of Nanomedicine, Houston Methodist Research Institute, 6670 Bertner Avenue, Houston, TX, 77030, USA
| | - Alessandro Grattoni
- Department of Nanomedicine, Houston Methodist Research Institute, 6670 Bertner Avenue, Houston, TX, 77030, USA.
- Department of Surgery, Houston Methodist Hospital, 6550 Fannin Street, Houston, TX, 77030, USA.
- Department of Radiation Oncology, Houston Methodist Hospital, 6550 Fannin Street, Houston, TX, 77030, USA.
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438
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Johnson R, Harmon R, Klammer C, Kumar A, Greer C, Beasley K, Wigstadt S, Ambrose L, VanDePol E, Jones J. Cost-related medication nonadherence among elderly emergency department patients. Am J Emerg Med 2019; 37:2255-2256. [PMID: 31076213 DOI: 10.1016/j.ajem.2019.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/03/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Riley Johnson
- Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States
| | - Rochelle Harmon
- Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States
| | - Catherine Klammer
- Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States
| | - Anjana Kumar
- Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States
| | - Conner Greer
- Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States
| | - Kyle Beasley
- Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States
| | - Stephanie Wigstadt
- Department of Emergency Medicine, Spectrum Health Hospitals, Grand Rapids, MI, United States
| | - Lisa Ambrose
- Department of Emergency Medicine, Spectrum Health Hospitals, Grand Rapids, MI, United States
| | - Eric VanDePol
- Department of Emergency Medicine, Spectrum Health Hospitals, Grand Rapids, MI, United States
| | - Jeffrey Jones
- Department of Emergency Medicine, Spectrum Health Hospitals, Grand Rapids, MI, United States.
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439
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Gast A, Mathes T. Medication adherence influencing factors-an (updated) overview of systematic reviews. Syst Rev 2019; 8:112. [PMID: 31077247 PMCID: PMC6511120 DOI: 10.1186/s13643-019-1014-8] [Citation(s) in RCA: 193] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 04/01/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Non-adherence negatively affects the efficacy, safety and costs of therapies. Non-adherence is a multifactorial problem. This systematic review (SR) of SRs (overview) aims to identify factors that can influence the adherence of adult patients with chronic physical diseases. METHODS We performed a systematic literature search in MEDLINE and Embase on June 13, 2018. We included SRs on the factors that can influence adherence in adult patients taking oral medications for treating physical chronic diseases. Two reviewers independently selected studies according to pre-defined inclusion criteria. Two reviewers independently assessed the risk of bias with the ROBIS tool. Data were extracted in standardized tables previously piloted by one reviewer and verified by a second reviewer. We synthesized data in tables in a structured narrative manner. RESULTS We included 21 SRs on eight different conditions. We rated eight SRs to be at low risk of bias and 13 to be at high risk of bias. Although higher education, employment, higher financial status and marriage/partnership mostly showed a positive effect on adherence, the impact was unclear because of the high uncertainty of the underlying evidence. The evidence indicates that socioeconomic status and social support might have a positive impact on adherence and that belonging to an ethnic minority might have a negative impact on adherence. Therapy-related factors (e.g., intake regime) and disease-related factors (e.g., duration) mostly showed no impact on adherence. Analysis of gender showed inconsistent results. Age might have a concave relation to adherence, i.e., adherence is lowest in very young and very old people. Depression has a negative impact on adherence. Impacts of other mental and physical comorbidities were uncertain. Co-payments (any or higher) have a negative impact on adherence. In contrast, the impacts of medication costs and insurance status were uncertain. CONCLUSION This overview analyses factors that might impact adherence to oral therapies in adult patients with physical chronic diseases. Our overview suggests that there is a social gradient in adherence. However, for most factors, the evidence was not conclusive due to the risk of bias, inconsistency or imprecision.
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Affiliation(s)
- Alina Gast
- Institute for Research in Operative Medicine (Witten/Herdecke University), Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Tim Mathes
- Institute for Health Economics and Clinical Epidemiology of the University of Cologne, Gleueler Str. 176-178, 50935, Cologne, Germany.
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440
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Hall AM, Scurrey SR, Pike AE, Albury C, Richmond HL, Matthews J, Toomey E, Hayden JA, Etchegary H. Physician-reported barriers to using evidence-based recommendations for low back pain in clinical practice: a systematic review and synthesis of qualitative studies using the Theoretical Domains Framework. Implement Sci 2019; 14:49. [PMID: 31064375 PMCID: PMC6505266 DOI: 10.1186/s13012-019-0884-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/27/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Adoption of low back pain guidelines is a well-documented problem. Information to guide the development of behaviour change interventions is needed. The review is the first to synthesise the evidence regarding physicians' barriers to providing evidence-based care for LBP using the Theoretical Domains Framework (TDF). Using the TDF allowed us to map specific physician-reported barriers to individual guideline recommendations. Therefore, the results can provide direction to future interventions to increase physician compliance with evidence-based care for LBP. METHODS We searched the literature for qualitative studies from inception to July 2018. Two authors independently screened titles, abstracts, and full texts for eligibility and extracted data on study characteristics, reporting quality, and methodological rigour. Guided by a TDF coding manual, two reviewers independently coded the individual study themes using NVivo. After coding, we assessed confidence in the findings using the GRADE-CERQual approach. RESULTS Fourteen studies (n = 318 physicians) from 9 countries reported barriers to adopting one of the 5 guideline-recommended behaviours regarding in-clinic diagnostic assessments (9 studies, n = 198), advice on activity (7 studies, n = 194), medication prescription (2 studies, n = 39), imaging referrals (11 studies, n = 270), and treatment/specialist referrals (8 studies, n = 193). Imaging behaviour is influenced by (1) social influence-from patients requesting an image or wanting a diagnosis (n = 252, 9 studies), (2) beliefs about consequence-physicians believe that providing a scan will reassure patients (n = 175, 6 studies), and (3) environmental context and resources-physicians report a lack of time to have a conversation with patients about diagnosis and why a scan is not needed (n = 179, 6 studies). Referrals to conservative care is influenced by environmental context and resources-long wait-times or a complete lack of access to adjunct services prevented physicians from referring to these services (n = 82, 5 studies). CONCLUSIONS Physicians face numerous barriers to providing evidence-based LBP care which we have mapped onto 7 TDF domains. Two to five TDF domains are involved in determining physician behaviour, confirming the complexity of this problem. This is important as interventions often target a single domain where multiple domains are involved. Interventions designed to address all the domains involved while considering context-specific factors may prove most successful in increasing guideline adoption. REGISTRATION PROSPERO 2017, CRD42017070703.
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Affiliation(s)
- Amanda M Hall
- Primary Healthcare Research Unit (PHRU), Faculty of Medicine, Memorial University, Room 417
- Janeway Hostel, Health Sciences Centre, 300 Prince Philip Parkway, St. John's, NL, A1B 3V6, Canada.
| | - Samantha R Scurrey
- Primary Healthcare Research Unit (PHRU), Faculty of Medicine, Memorial University, Room 417
- Janeway Hostel, Health Sciences Centre, 300 Prince Philip Parkway, St. John's, NL, A1B 3V6, Canada
| | - Andrea E Pike
- Primary Healthcare Research Unit (PHRU), Faculty of Medicine, Memorial University, Room 417
- Janeway Hostel, Health Sciences Centre, 300 Prince Philip Parkway, St. John's, NL, A1B 3V6, Canada
| | - Charlotte Albury
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Helen L Richmond
- Centre for Rehabilitation Research in Oxford, University of Oxford, Oxford, UK
| | - James Matthews
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Elaine Toomey
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Jill A Hayden
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Holly Etchegary
- Clinical Epidemiology, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
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441
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Mangin D, Risdon C, Lamarche L, Langevin J, Ali A, Parascandalo J, Stephen G, Trimble J. 'I think this medicine actually killed my wife': patient and family perspectives on shared decision-making to optimize medications and safety. Ther Adv Drug Saf 2019; 10:2042098619838796. [PMID: 31057788 PMCID: PMC6452573 DOI: 10.1177/2042098619838796] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 02/01/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND This study explored the perspectives and experiences from patients and families around how patient/family preferences and priorities are considered in medication-related discussions and decisions within the healthcare system. METHODS We conducted a qualitative study using focus groups with residents of Southern Ontario and British Columbia (N = 16). Three focus groups were conducted using a semi-structured focus group guide. The audiotaped focus group discussions were transcribed verbatim. A thematic analysis, using inductive coding, was completed. RESULTS A total of three main themes [and several sub-themes (and sub-sub-themes)] emerged from the data: patient and family expertise [lived experience, information expert, and perceived expert roles (patient/family, healthcare provider)], perceived patient-centredness (relationship qualities of healthcare provider and assumptions about patients), and system (time, coordination and communication, and culture). Stories told by participants helped to clarify the relationships between the themes and sub-themes, leading to, what we understand as shared decision-making around medications and subsequent health outcomes. CONCLUSIONS Our findings showed that shared decision-making resulted from both recognition and integration of the personal expertise of the patient and family in medications, and perceived patient-centredness. This is broadly consistent with the current conceptualization of evidence-based medicine. The stories told highlight the complex, dynamic, and nonlinear nature of shared decision-making for medications, and that patient priorities are not as integrated into shared decision-making about medications as we would hope. This suggests the need for developing a systematic process to elicit, record, and integrate patient preferences and priorities about medications to create space for a more patient-centred conversation.
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Affiliation(s)
- Dee Mangin
- Department of Family Medicine, McMaster University, 100 Main Street W, 5th Floor, Hamilton, ON L8P 1H6, Canada
| | | | | | | | - Abbas Ali
- McMaster University, Hamilton, ON, Canada
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442
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Haas K, Ben Miled Z, Mahoui M. Medication Adherence Prediction Through Online Social Forums: A Case Study of Fibromyalgia. JMIR Med Inform 2019; 7:e12561. [PMID: 30946020 PMCID: PMC6470459 DOI: 10.2196/12561] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 01/20/2019] [Accepted: 01/21/2019] [Indexed: 11/21/2022] Open
Abstract
Background Medication nonadherence can compound into severe medical problems for patients. Identifying patients who are likely to become nonadherent may help reduce these problems. Data-driven machine learning models can predict medication adherence by using selected indicators from patients’ past health records. Sources of data for these models traditionally fall under two main categories: (1) proprietary data from insurance claims, pharmacy prescriptions, or electronic medical records and (2) survey data collected from representative groups of patients. Models developed using these data sources often are limited because they are proprietary, subject to high cost, have limited scalability, or lack timely accessibility. These limitations suggest that social health forums might be an alternate source of data for adherence prediction. Indeed, these data are accessible, affordable, timely, and available at scale. However, they can be inaccurate. Objective This paper proposes a medication adherence machine learning model for fibromyalgia therapies that can mitigate the inaccuracy of social health forum data. Methods Transfer learning is a machine learning technique that allows knowledge acquired from one dataset to be transferred to another dataset. In this study, predictive adherence models for the target disease were first developed by using accurate but limited survey data. These models were then used to predict medication adherence from health social forum data. Random forest, an ensemble machine learning technique, was used to develop the predictive models. This transfer learning methodology is demonstrated in this study by examining data from the Medical Expenditure Panel Survey and the PatientsLikeMe social health forum. Results When the models are carefully designed, less than a 5% difference in accuracy is observed between the Medical Expenditure Panel Survey and the PatientsLikeMe medication adherence predictions for fibromyalgia treatments. This design must take into consideration the mapping between the predictors and the outcomes in the two datasets. Conclusions This study exemplifies the potential and limitations of transfer learning in medication adherence–predictive models based on survey data and social health forum data. The proposed approach can make timely medication adherence monitoring cost-effective and widely accessible. Additional investigation is needed to improve the robustness of the approach and extend its applicability to other therapies and other sources of data.
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Affiliation(s)
- Kyle Haas
- Department of Electrical and Computer Engineering, School of Engineering and Technology, Indiana University Purdue University, Indianapolis, IN, United States
| | - Zina Ben Miled
- Department of Electrical and Computer Engineering, School of Engineering and Technology, Indiana University Purdue University, Indianapolis, IN, United States
| | - Malika Mahoui
- Eli Lilly and Company, Indianapolis, IN, United States
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443
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Appalasamy JR, Joseph JP, Seeta Ramaiah S, Quek KF, Md Zain AZ, Tha KK. An Intervention to Promote Medication Understanding and Use Self-Efficacy: Design of Video Narratives for Aging Patients at Risk of Recurrent Stroke. JMIR Aging 2019; 2:e11539. [PMID: 31518260 PMCID: PMC6715007 DOI: 10.2196/11539] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 01/11/2019] [Accepted: 01/23/2019] [Indexed: 12/16/2022] Open
Abstract
Background The debilitating effects of recurrent stroke among aging patients have urged researchers to explore medication adherence among these patients. Video narratives built upon Health Belief Model (HBM) constructs have displayed potential impact on medication adherence, adding an advantage to patient education efforts. However, its effect on medication understanding and use self-efficacy have not been tested. Objective The researchers believed that culturally sensitive video narratives, which catered to a specific niche, would reveal a personalized impact on medication adherence. Therefore, this study aimed to develop and validate video narratives for this purpose. Methods This study adapted the Delphi method to develop a consensus on the video scripts’ contents based on learning outcomes and HBM constructs. The panel of experts comprised 8 members representing professional stroke disease experts and experienced poststroke patients in Malaysia. The Delphi method involved 3 rounds of discussions. Once the consensus among members was achieved, the researchers drafted the initial scripts in English, which were then back translated to the Malay language. A total of 10 bilingual patients, within the study’s inclusion criteria, screened the scripts for comprehension. Subsequently, a neurologist and poststroke patient narrated the scripts in both languages as they were filmed, to add to the realism of the narratives. Then, the video narratives underwent a few cycles of editing after some feedback on video engagement by the bilingual patients. Few statistical analyses were applied to confirm the validity and reliability of the video narratives. Results Initially, the researchers proposed 8 learning outcomes and 9 questions based on HBM constructs for the video scripts’ content. However, following Delphi rounds 1 to 3, a few statements were omitted and rephrased. The Kendall coefficient of concordance, W, was about 0.7 (P<.001) for both learning outcomes and questions which indicated good agreement between members. Each statement’s Cronbach alpha was above .8 with SD values within a range below 1.5 that confirmed satisfactory content and construct validity. Approximately 75% (6/8) of members agreed that all chosen statements were relevant and suitable for video script content development. Similarly, more than 80% (8/10) of patients scored video engagement above average, intraclass correlation coefficient was above 0.7, whereas its Kendall W was about 0.7 with significance (P<.001), which indicated average agreement that the video narratives perceived realism. Conclusions The Delphi method was proven to be helpful in conducting discussions systematically and providing precise content for the development of video narratives, whereas the Video Engagement Scale was an appropriate measurement of video realism and emotions, which the researchers believed could positively impact medication understanding and use self-efficacy among patients with stroke. A feasibility and acceptability study in an actual stroke care center is needed. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12618000174280; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=373554&isReview=true
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Affiliation(s)
- Jamuna Rani Appalasamy
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Joyce Pauline Joseph
- Department of Neurology, Hospital Kuala Lumpur, Ministry of Health, Kuala Lumpur, Malaysia
| | | | - Kia Fatt Quek
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Anuar Zaini Md Zain
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Kyi Kyi Tha
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
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444
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Torres-Robles A, Wiecek E, Cutler R, Drake B, Benrimoj SI, Fernandez-Llimos F, Garcia-Cardenas V. Using Dispensing Data to Evaluate Adherence Implementation Rates in Community Pharmacy. Front Pharmacol 2019; 10:130. [PMID: 30863308 PMCID: PMC6399119 DOI: 10.3389/fphar.2019.00130] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 02/05/2019] [Indexed: 01/11/2023] Open
Abstract
Background: Medication non-adherence remains a significant problem for the health care system with clinical, humanistic and economic impact. Dispensing data is a valuable and commonly utilized measure due accessibility in electronic health data. The purpose of this study was to analyze the changes on adherence implementation rates before and after a community pharmacist intervention integrated in usual real life practice, incorporating big data analysis techniques to evaluate Proportion of Days Covered (PDC) from pharmacy dispensing data. Methods: Retrospective observational study. A de-identified database of dispensing data from 20,335 patients (n = 11,257 on rosuvastatin, n = 6,797 on irbesartan, and n = 2,281 on desvenlafaxine) was analyzed. Included patients received a pharmacist-led medication adherence intervention and had dispensing records before and after the intervention. As a measure of adherence implementation, PDC was utilized. Analysis of the database was performed using SQL and Python. Results: Three months after the pharmacist intervention there was an increase on average PDC from 50.2% (SD: 30.1) to 66.9% (SD: 29.9) for rosuvastatin, from 50.8% (SD: 30.3) to 68% (SD: 29.3) for irbesartan and from 47.3% (SD: 28.4) to 66.3% (SD: 27.3) for desvenlafaxine. These rates declined over 12 months to 62.1% (SD: 32.0) for rosuvastatin, to 62.4% (SD: 32.5) for irbesartan and to 58.1% (SD: 31.1) for desvenlafaxine. In terms of the proportion of adherent patients (PDC >= 80.0%) the trend was similar, increasing after the pharmacist intervention from overall 17.4 to 41.2% and decreasing after one year of analysis to 35.3%. Conclusion: Big database analysis techniques provided results on adherence implementation over 2 years of analysis. An increase in adherence rates was observed after the pharmacist intervention, followed by a gradual decrease over time. Enhancing the current intervention using an evidence-based approach and integrating big database analysis techniques to a real-time measurement of adherence could help community pharmacies improve and sustain medication adherence.
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Affiliation(s)
- Andrea Torres-Robles
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Elyssa Wiecek
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Rachelle Cutler
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Barry Drake
- Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW, Australia
| | - Shalom I Benrimoj
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
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445
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Morgan M, Anderson R, Walburn J, Weinman J, Sarkany R. The influence of perceived medical risks and psychosocial concerns on photoprotection behaviours among adults with xeroderma pigmentosum: a qualitative interview study in the UK. BMJ Open 2019; 9:e024445. [PMID: 30782905 PMCID: PMC6377541 DOI: 10.1136/bmjopen-2018-024445] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND A high level of photoprotection is required by people with xeroderma pigmentosum (XP), a rare skin disease, to reduce skin cancer and other risks. However poor photoprotection is thought to be widespread. PURPOSE This study examines the influences on photoprotection behaviours in adults with XP. DESIGN Inductive qualitative study with semistructured interviews. Analysis employed a framework approach. SETTING National sample recruited through a specialist XP centre in London. METHODS Semistructured interviews at patients' homes. All transcripts were coded and themes charted for each participant. Comparisons within and across cases identified common themes and differing motivations and approaches to photoprotection. Credibility of interpretations assessed through patient/carer input and clinic adherence scores. PARTICIPANTS 25 adults (17 male, eight female) aged 16-63 years with diagnosed XP attending a specialist centre. 18 lived outside London. RESULTS Awareness of risks of ultraviolet radiation (UVR) and photoprotection was high. However, photoprotection behaviours varied according to perceived necessity and concerns. Three behavioural responses were identified: (1) 'dominated' by planning and routines to achieve a high level of photoprotection with significant activity restrictions and psychosocial impacts. (2) 'resistant' to photoprotection with priority given to avoiding an illness identity and enjoying a normal life. (3) Photoprotection' integrated' with an individual's life with little psychosocial impact. These responses were influenced by illness, personal and contextual factors including age, life stage and social support. Only the 'integrated' group achieved an equilibrium between perceived 'necessity' and 'concerns'. CONCLUSIONS The personal balance between perceived risks of UVR and social/psychological 'concerns' led to differing behavioural responses and contributes to an understanding of adaptation and normalisation in chronic illness. The study will also inform a series of individualised behavioural interventions to reduce measured UVR exposure among people with XP that are potentially applicable to other conditions with high risks of skin cancer.
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Affiliation(s)
- Myfanwy Morgan
- School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - Rebecca Anderson
- School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - Jessica Walburn
- School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - John Weinman
- School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - Robert Sarkany
- National Xeroderma Pigmentosum Service, Guy’s and St Thomas' NHS Foundation Trust, London, UK
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446
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Mann K, Möcker M, Grosser J. Adherence to long-term prophylactic treatment: microeconomic analysis of patients' behavior and the impact of financial incentives. HEALTH ECONOMICS REVIEW 2019; 9:5. [PMID: 30758683 PMCID: PMC6734257 DOI: 10.1186/s13561-019-0222-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/31/2019] [Indexed: 06/09/2023]
Abstract
The effectiveness of medical therapies depends crucially on patients' adherence. To gain deeper insight into the behavioral mechanisms underlying adherence, we present a microeconomic model of the decision-making process of an individual who is initially in an asymptomatic clinical state and to whom a prophylactic therapy is offered with the aim of preventing damage to health in the future. The focus of modeling is the optimization of an intertemporal utility function, where time-inconsistent preferences are incorporated by a quasi-hyperbolic discount function. The predictions of the model concur with experience in clinical practice. Moreover, the introduction of time-inconsistency reveals a self-control problem of the individuals where resolutions made before may be given up at a later time. A more pronounced present bias leads to a decrease in adherence and, consequently, the gain in societal welfare resulting from the prophylactic therapy declines. Developing effective strategies to improve adherence is a major challenge in health care. As an example, the impact of financial incentives offered to the patients on adherence and welfare are investigated on the basis of the model. The results are consistent with empirical findings. The approach presented contributes to a better understanding of the complex interaction of the relevant determinants for adherence, particularly regarding the individuals' self-control problem.
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Affiliation(s)
- Klaus Mann
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, D-55131 Mainz, Germany
| | - Michael Möcker
- Chair of Economic Policy, University of Hagen, D-58084 Hagen, Germany
| | - Joachim Grosser
- Chair of Economic Policy, University of Hagen, D-58084 Hagen, Germany
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447
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Ali EE, Chan SSL, Poh HY, Susanto YA, Suganya T, Leow JL, Pang CK, Chew L, Yap KYL. Design Considerations in the Development of App-Based Oral Anticancer Medication Management Systems: a Qualitative Evaluation of Pharmacists' and Patients' Perspectives. J Med Syst 2019; 43:63. [PMID: 30726518 DOI: 10.1007/s10916-019-1168-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 01/15/2019] [Indexed: 12/23/2022]
Abstract
Smartphone apps can potentially help in enhancing oral anticancer medication (OAM) adherence. Patient adoption and efficacy of such apps depends on inclusion of user-centred and evidence-based features. The objective of this study was to identify important design considerations from the perspectives of patients taking OAMs, caregivers and oncology pharmacists. The study employed a qualitative study design. Data were collected using in-depth interviews with patients (n = 15), caregivers (n = 3) and pharmacists (n = 16). Interviews were audio-recorded, transcribed verbatim and inductive thematic analysis approach was used in data analysis. Monitoring medication-related problems, medication information, replacement of or integration with current systems and accessibility of app content on devices other than smartphones were the key themes identified in the analysis. Flexible input methods for monitored data, glanceability of monitored reports/information, near real-time adherence enhancing and symptom management interventions and customisable reminder options were design considerations identified under the monitoring medication-related problems theme. Participants suggested the provision of focused and easily understandable medication information with a potential for personalisation. Integration of app-based adherence systems with patients' electronic medical records with added mechanisms for alerts in the dispensing system was also suggested as a key design requirement to improve quality of patient care and facilitate adoption by clinicians. Finally, smartphones were the most favoured platform with optional accessibility of app content on other devices. In conclusion, important design considerations were identified through a user-centred design approach. The findings will help developers and clinicians in the design of new app-based systems and evaluation of existing ones.
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Affiliation(s)
- Eskinder Eshetu Ali
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Sharlene Si Ling Chan
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Huan Yu Poh
- Department of Electrical and Computer Engineering, Faculty of Engineering, National University of Singapore, Block E4, Level 5, 4 Engineering Drive 3, Singapore, 117583, Singapore
| | - Yosua Amadeus Susanto
- Department of Electrical and Computer Engineering, Faculty of Engineering, National University of Singapore, Block E4, Level 5, 4 Engineering Drive 3, Singapore, 117583, Singapore
| | - Thendral Suganya
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Jo Lene Leow
- Department of Pharmacy, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Chee Khiang Pang
- Department of Electrical and Computer Engineering, Faculty of Engineering, National University of Singapore, Block E4, Level 5, 4 Engineering Drive 3, Singapore, 117583, Singapore
- Engineering Cluster, Singapore Institute of Technology, 10 Dover Drive, Singapore, 138683, Singapore
| | - Lita Chew
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, Singapore, 117543, Singapore
- Department of Pharmacy, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Kevin Yi-Lwern Yap
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, 3086, Victoria, Australia.
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448
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Cutler RL, Torres-Robles A, Wiecek E, Drake B, Van der Linden N, Benrimoj SI(C, Garcia-Cardenas V. Pharmacist-led medication non-adherence intervention: reducing the economic burden placed on the Australian health care system. Patient Prefer Adherence 2019; 13:853-862. [PMID: 31213779 PMCID: PMC6537038 DOI: 10.2147/ppa.s191482] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/27/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Scarcity of prospective medication non-adherence cost measurements for the Australian population with no directly measured estimates makes determining the burden medication non-adherence places on the Australian health care system difficult. This study aims to indirectly estimate the national cost of medication non-adherence in Australia comparing the cost prior to and following a community pharmacy-led intervention. Methods: Retrospective observational study. A de-identified database of dispensing data from 20,335 patients (n=11,257 on rosuvastatin, n=6,797 on irbesartan and n=2,281 on desvenlafaxine) was analyzed and average adherence rate determined through calculation of PDC. Included patients received a pharmacist-led medication adherence intervention and had twelve months dispensing records; six months before and six months after the intervention. The national cost estimate of medication non-adherence in hypertension, dyslipidemia and depression pre- and post-intervention was determined through utilization of disease prevalence and comorbidity, non-adherence rates and per patient disease-specific adherence-related costs. Results: The total national cost of medication non-adherence across three prevalent conditions, hypertension, dyslipidemia and depression was $10.4 billion equating to $517 per adult. Following enrollment in the pharmacist-led intervention medication non-adherence costs per adult decreased $95 saving the Australian health care system and patients $1.9 billion annually. Conclusion: In the absence of a directly measured national cost of medication non-adherence, this estimate demonstrates that pharmacists are ideally placed to improve patient adherence and reduce financial burden placed on the health care system due to non-adherence. Funding of medication adherence programs should be considered by policy and decision makers to ease the current burden and improve patient health outcomes moving forward.
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Affiliation(s)
- Rachelle Louise Cutler
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
- Correspondence: Rachelle Louise CutlerGraduate School of Health, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW2007, AustraliaTel +61 29 514 7187Email
| | - Andrea Torres-Robles
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Elyssa Wiecek
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Barry Drake
- Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW, Australia
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449
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Alsubeeh NA, Alsharafi AA, Ahamed SS, Alajlan A. Treatment Adherence Among Patients with Five Dermatological Diseases and Four Treatment Types - a Cross-Sectional Study. Patient Prefer Adherence 2019; 13:2029-2038. [PMID: 31819384 PMCID: PMC6899063 DOI: 10.2147/ppa.s230921] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/05/2019] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Treatment non-adherence leads to negative therapeutic outcomes and financial burdens on the healthcare system. This study aims to compare the mean adherence scores among patients with five dermatological diseases and four treatment types and to identify the associated patient-related factors. PATIENTS AND METHODS This is a cross-sectional study conducted from January 2019 to August 2019. The questionnaire was distributed among patients attending the outpatient dermatology clinic at King Khalid University Hospital, Riyadh, Saudi Arabia. It included 2330 patients who were over 16 years old and diagnosed with any of the five dermatological diseases (psoriasis, chronic dermatitis, acne vulgaris, hair growth disorders, and vitiligo). The 12-item Medication Adherence Scale was used to quantify the mean adherence score. RESULTS Patients with psoriasis or chronic dermatitis were less adherent to treatments than patients with acne vulgaris, hair growth disorder, or vitiligo. Oral treatment and phototherapy had higher mean adherence scores than injection or topical treatment. High adherence was found in female, single patients; those who did not feel stigmatized from using treatment; those who did not have bad experience with the treatment; those who did not suffer from forgetfulness; those who connected receiving treatment with a habit; those who did not lack treatment responsiveness; those who had an excellent relationship with a dermatologist; and patients with a lesion in an exposed area. Stepwise multiple linear regression was also used to identify the independent variables related to adherence score. CONCLUSION Psoriasis and chronic dermatitis patients had the lowest mean adherence scores. Patient who were on oral medication had the highest adherence score, while those on topical medication had the lowest score. The thoughtful consideration of factors associated with high adherence is important for optimal therapeutic outcomes.
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Affiliation(s)
| | | | - Shaik Shaffi Ahamed
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulmajeed Alajlan
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Correspondence: Abdulmajeed Alajlan King Saud University, Riyadh, Saudi ArabiaTel +966 502223030 Email
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450
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Raparelli V, Proietti M, Romiti GF, Lenzi A, Basili S. The Sex-Specific Detrimental Effect of Diabetes and Gender-Related Factors on Pre-admission Medication Adherence Among Patients Hospitalized for Ischemic Heart Disease: Insights From EVA Study. Front Endocrinol (Lausanne) 2019; 10:107. [PMID: 30858826 PMCID: PMC6397889 DOI: 10.3389/fendo.2019.00107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/05/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Sex and gender-related factors have been under-investigated as relevant determinants of health outcomes across non-communicable chronic diseases. Poor medication adherence results in adverse clinical outcomes and sex differences have been reported among patients at high cardiovascular risk, such as diabetics. The effect of diabetes and gender-related factors on medication adherence among women and men at high risk for ischemic heart disease (IHD) has not yet been fully investigated. Aim: To explore the role of sex, gender-related factors, and diabetes in pre-admission medication adherence among patients hospitalized for IHD. Materials and Methods: Data were obtained from the Endocrine Vascular disease Approach (EVA) (ClinicalTrials.gov Identifier: NCT02737982), a prospective cohort of patients admitted for IHD. We selected patients with baseline information regarding the presence of diabetes, cardiovascular risk factors, and gender-related variables (i.e., gender identity, gender role, gender relations, institutionalized gender). Our primary outcome was the proportion of pre-admission medication adherence defined through a self-reported questionnaire. We performed a sex-stratified analysis of clinical and gender-related factors associated with pre-admission medication adherence. Results: Two-hundred eighty patients admitted for IHD (35% women, mean age 70), were included. Around one-fourth of the patients were low-adherent to therapy before hospitalization, regardless of sex. Low-adherent patients were more likely diabetic (40%) and employed (40%). Sex-stratified analysis showed that low-adherent men were more likely to be employed (58 vs. 33%) and not primary earners (73 vs. 54%), with more masculine traits of personality, as compared with medium-high adherent men. Interestingly, women reporting medication low-adherence were similar for clinical and gender-related factors to those with medium-high adherence, except for diabetes (42 vs. 20%, p = 0.004). In a multivariate adjusted model only employed status was associated with poor medication adherence (OR 0.55, 95%CI 0.31-0.97). However, in the sex-stratified analysis, diabetes was independently associated with medication adherence only in women (OR 0.36; 95%CI 0.13-0.96), whereas a higher masculine BSRI was the only factor associated with medication adherence in men (OR 0.59, 95%CI 0.35-0.99). Conclusion: Pre-admission medication adherence is common in patients hospitalized for IHD, regardless of sex. However, patient-related factors such as diabetes, employment, and personality traits are associated with adherence in a sex-specific manner.
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Affiliation(s)
- Valeria Raparelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC, Canada
- *Correspondence: Valeria Raparelli ;
| | - Marco Proietti
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
- Department of Neuroscience, Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, Milan, Italy
| | - Giulio Francesco Romiti
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Stefania Basili
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
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