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Li C, Lu K, Shi Q, Gong YQ. Predicting the individualized risk of nonadherence to zoledronic acid among osteoporosis patients receiving the first infusion of zoledronic acid: development and validation of new predictive nomograms. Ther Adv Chronic Dis 2022; 13:20406223221114214. [PMID: 35924011 PMCID: PMC9340933 DOI: 10.1177/20406223221114214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 06/30/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Achieving optimal adherence to zoledronic acid (ZOL) among osteoporosis (OP) patients is a challenging task. Here, we aimed to develop and validate a precise and efficient prediction tool for ZOL nonadherence risk in OP patients. Methods: We prospectively collected and analyzed survey data from a clinical registry. A total of 1010 OP patients treated for the first time with ZOL in two separate hospitals were selected for nonadherence analysis. The evaluation included a 16-item ZOL Nonadherence Questionnaire and potential risk factors for ZOL nonadherence were assessed via univariate and multivariate analyses. We next developed and validated two distinct-stage nomograms. Discrimination, calibration, and clinical usefulness of the predicting models were assessed using the area under the curve (AUC), calibration curves, and decision curve analysis (DCA). Results: The total nonadherence rate was 20.30% after the first ZOL infusion. To generate a model predicting ZOL nonadherence risk, six predictors of 16 items were retained. Model 2 (AUC, 0.8486; 95% confidence interval [CI], 0.8171–0.8801) exhibited considerably more discrimination in desirable functional outcomes, relative to Model 1 (AUC, 0.7644; 95% CI, 0.7265–0.8024). The calibration curves displayed good calibration. DCA revealed that a cutoff probability of 5–54% (Model 1) and 1–85% (Model 2) indicated that the models were clinically useful. External validation also exhibited good discrimination and calibration. Conclusions: This study developed and validated two novel, distinct-stage prediction nomograms that precisely estimate nonadherence risk among OP patients receiving the first infusion of ZOL. However, additional evaluation and external validation are necessary prior to widespread implementation.
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Affiliation(s)
- Chong Li
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, China
| | - Ke Lu
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, No. 91 West of Qianjin Road, Suzhou 215300, China
- Department of Orthopedics, Gusu School, Nanjing Medical University, Suzhou, China
| | - Qin Shi
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute of Soochow University, Suzhou, China
| | - Ya-qin Gong
- Department of Information, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, China
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Maximos M, Smith K, Harris V, McFarlane T, Blay J, Hahn K, Chang F. A randomized controlled trial to assess the influence of a picture-based antiemetic medication calendar on medication-taking behavior in adults receiving chemotherapy. J Oncol Pharm Pract 2021; 28:1763-1770. [PMID: 34569871 DOI: 10.1177/10781552211041680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE A prospective open-label randomized controlled trial to assess the role of a picture-based medication calendar on adherence to antiemetic regimens for adult patients receiving chemotherapy and assess the effect on other medication taking behaviors as well as patient satisfaction with the tool. METHODS Participants were randomly assigned 1:1 to routine care with or without calendar. RESULTS Adherence, stratified by education (university or postgraduate, p = 0.09; grade school, high school or college p = 0.32), was non-significantly different between study arms. At least 70% of intervention arm participants moderately or completely agreed that the calendar helped with medication taking behaviors. There was no statistical difference between study arms for perceived regimen complexity (p = 0.16). Medication Use and Self Efficacy score (adjusted for age) used to assess perceived self-efficacy with medication taking behaviors were not statistically significant between study arms (p = 0.09). CONCLUSION The picture-based medication calendar did not statistically affect adherence to scheduled antiemetics among outpatients receiving chemotherapy for solid organ tumor origins. However, participants indicated that the calendar was effective for keeping track of medications, had an easy-to-understand layout, and provided help around when and how to take medications related to the oncology regimen.
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Affiliation(s)
- Mira Maximos
- 10033London Regional Cancer Centre & London Health Sciences Centre, London, ON, Canada.,8430University of Waterloo School of Pharmacy, Kitchener, ON, Canada.,8701Woodstock Hospital, Woodstock, ON, Canada
| | - Kelly Smith
- 10033London Regional Cancer Centre & London Health Sciences Centre, London, ON, Canada
| | - Venita Harris
- 10033London Regional Cancer Centre & London Health Sciences Centre, London, ON, Canada.,Department of Paediatrics, 6221Western University, London, ON, Canada
| | - Thomas McFarlane
- 8430University of Waterloo School of Pharmacy, Kitchener, ON, Canada
| | - Jonathan Blay
- 8430University of Waterloo School of Pharmacy, Kitchener, ON, Canada.,Department of Pathology, 3688Dalhousie University, Halifax, NS, Canada
| | - Karin Hahn
- 10033London Regional Cancer Centre & London Health Sciences Centre, London, ON, Canada
| | - Feng Chang
- 8430University of Waterloo School of Pharmacy, Kitchener, ON, Canada
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What are the risk factors of poor medication adherence in the target-to-treat era? Turk J Phys Med Rehabil 2019; 65:343-351. [PMID: 31893271 DOI: 10.5606/tftrd.2019.3071] [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: 04/20/2018] [Accepted: 10/30/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to identify adherence rate and risk factors of poor adherence in patients with tightly controlled rheumatoid arthritis (RA) based on the treat-to-target (TTT) strategy. Patients and methods In this cross-sectional, observational study, a total of 103 patients (22 males, 81 females; mean age 58.6±9.5 years; range, 35 to 76 years) with tightly controlled RA between November 2016 and May 2017 were included. The patients were evaluated in terms of sociodemographic features, smoking and alcohol drinking status, body mass index (BMI), Disease Activity Score 28 (DAS28), and clinical and medication data. They filled out a series of standardized questionnaires including the Morisky 8-item Medication Adherence Scale (MMAS-8), Beck Depression Inventory (BDI), Mini-Mental State Examination (MMSE), and Health Assessment Questionnaire-Disability Index (HAQ-DI). Multiple multivariate linear regression analysis was used to identify variables which were possibly associated with the MMAS-8. Results Of the patients, 53 (51.5%) were non-adherent and 50 (48.5%) were adherent to medication. The DAS28-erythrocyte sedimentation rate, mean DAS28, HAQ, BDI scores, and the number of visits were higher and the MMSE scores were lower in non-adherent patients than adherent patients. In the linear multivariate analysis, significant associations were found between the MMAS-8 and MMSE, BDI, DAS28, and mean DAS28 scores. Conclusion Our study results show that the medication adherence rate is significantly higher compared to previous studies and high disease activity, depression, and cognitive dysfunction significantly affect medication adherence in this patient population.
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Taibanguay N, Chaiamnuay S, Asavatanabodee P, Narongroeknawin P. Effect of patient education on medication adherence of patients with rheumatoid arthritis: a randomized controlled trial. Patient Prefer Adherence 2019; 13:119-129. [PMID: 30666095 PMCID: PMC6333161 DOI: 10.2147/ppa.s192008] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE There is a general understanding that patient educational interventions for enhancing medication adherence are important. However, their success at improving adherence is debatable. This study aimed to assess the influence of different modes of patient education on medication adherence in patients with rheumatoid arthritis (RA). MATERIALS AND METHODS One hundred and twenty RA patients with non-adherence, defined as pill count ≥80% or medication-taking behavior questionnaire for Thai patient ≥23, were randomized by block randomization and assigned in a 1:1 allocation ratio to two study arms: multi-component intervention group or single intervention group. The multi-component intervention group received 30-minute directed counseling and a disease information pamphlet. The single intervention group received only a disease information pamphlet. The primary outcomes were an improvement in an adherence rate measured by pill count after 12 weeks. The Thai Clinical Trial Registry number is TCTR20171207003. RESULTS After 12 weeks, the pill count adherence rate increased significantly from baseline in both study groups. In the multi-component intervention group, adherence rate increased from 92.21±14.05 to 97.59±10.07 (P=0.002) and in the single intervention group, it increased from 88.60±19.66 to 92.42±14.27 (P=0.044). However, the mean difference between the multi-component intervention group and the single intervention group was not significant (5.38±12.90 vs 3.18±14.23, P=0.531). Clinical outcomes, including disease activity score 28, EuroQoL-5D, EuroQol visual analog scale, pain score, and physician global assessment were unchanged from baseline in both groups. CONCLUSION Patient education significantly improved adherence. However, there were no differences between single education intervention and multi-component education intervention in improving medication adherence. Provision of a disease information pamphlet with or without directed counseling can equally enhance medication adherence of patients with RA.
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Affiliation(s)
- Nichapa Taibanguay
- Division of Rheumatology, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand,
| | - Sumapa Chaiamnuay
- Division of Rheumatology, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand,
| | - Paijit Asavatanabodee
- Division of Rheumatology, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand,
| | - Pongthorn Narongroeknawin
- Division of Rheumatology, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand,
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Wang H, Zhang L, Liu Z, Wang X, Geng S, Li J, Li T, Ye S. Predicting medication nonadherence risk in a Chinese inflammatory rheumatic disease population: development and assessment of a new predictive nomogram. Patient Prefer Adherence 2018; 12:1757-1765. [PMID: 30237698 PMCID: PMC6136915 DOI: 10.2147/ppa.s159293] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The aim of this study was to develop and internally validate a medication nonadherence risk nomogram in a Chinese population of patients with inflammatory rheumatic diseases. PATIENTS AND METHODS We developed a prediction model based on a training dataset of 244 IRD patients, and data were collected from March 2016 to May 2016. Adherence was evaluated using 19-item Compliance Questionnaire Rheumatology. The least absolute shrinkage and selection operator regression model was used to optimize feature selection for the medication nonadherence risk model. Multivariable logistic regression analysis was applied to build a predicting model incorporating the feature selected in the least absolute shrinkage and selection operator regression model. Discrimination, calibration, and clinical usefulness of the predicting model were assessed using the C-index, calibration plot, and decision curve analysis. Internal validation was assessed using the bootstrapping validation. RESULTS Predictors contained in the prediction nomogram included use of glucocorticoid (GC), use of nonsteroidal anti-inflammatory drugs, number of medicine-related questions, education level, and the distance to hospital. The model displayed good discrimination with a C-index of 0.857 (95% confidence interval: 0.807-0.907) and good calibration. High C-index value of 0.847 could still be reached in the interval validation. Decision curve analysis showed that the nonadherence nomogram was clinically useful when intervention was decided at the nonadherence possibility threshold of 14%. CONCLUSION This novel nonadherence nomogram incorporating the use of GC, the use of nonsteroidal anti-inflammatory drugs, the number of medicine-related questions, education level, and distance to hospital could be conveniently used to facilitate the individual medication nonadherence risk prediction in IRD patients.
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Affiliation(s)
- Huijing Wang
- Department of Rheumatology, South Campus, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,
| | - Le Zhang
- Department of Pharmacy, South Campus, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhe Liu
- Department of Rheumatology, South Campus, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,
| | - Xiaodong Wang
- Department of Rheumatology, South Campus, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,
| | - Shikai Geng
- Department of Rheumatology, South Campus, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,
| | - Jiaoyu Li
- Department of Rheumatology, South Campus, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,
| | - Ting Li
- Department of Rheumatology, South Campus, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,
| | - Shuang Ye
- Department of Rheumatology, South Campus, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,
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The Challenge of Assessing Adherence to Subcutaneous Biological Drugs in Immune-Mediated Inflammatory Diseases. Letter to the Editor Regarding Michetti P, Weinman J, Mrowietz U, et al. Adv Ther (2017);34:91-108. doi:10.1007/s12325-016-0441-3. Adv Ther 2017; 34:2173-2176. [PMID: 28819910 PMCID: PMC5599446 DOI: 10.1007/s12325-017-0602-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Indexed: 01/06/2023]
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The Challenge of Assessing Adherence to Subcutaneous Biological Drugs in Immune-Mediated Inflammatory Diseases. Letter to the Editor Regarding Michetti P, Weinman J, Mrowietz U, et al. Adv Ther (2017);34:91-108. doi:10.1007/s12325-016-0441-3. Adv Ther 2017. [PMID: 28819910 DOI: 10.1007/s12325-016-0441-3+10.1007/s12325-017-0602-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Goh H, Kwan YH, Seah Y, Low LL, Fong W, Thumboo J. A systematic review of the barriers affecting medication adherence in patients with rheumatic diseases. Rheumatol Int 2017; 37:1619-1628. [PMID: 28681249 DOI: 10.1007/s00296-017-3763-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/28/2017] [Indexed: 12/22/2022]
Abstract
Medication adherence is a crucial part in the management of rheumatic diseases, especially with many such patients requiring long-term medications. In this paper, we aim to systematically review the literature for the factors associated with medication adherence in the rheumatic patient population. We carried out a systematic literature search using PubMed®, PsychInfo® and Embase ® with relevant keywords and employed the PRISMA® criteria. We included English peer-reviewed articles that studied the factors affecting medication adherence in patients with rheumatic diseases, which were assessed by two independent reviewers. Hand searches were conducted and relevant factors were extracted and classified using the World Health Organization (WHO)'s five dimensions of medication adherence. A simple diagram was drawn to summarise the factors extracted. 1977 articles were identified and reviewed and 90 articles were found to be relevant. A total of 17 factors and 38 sub-factors were identified and categorized based on the WHO's five dimensions of medication adherence. A hand model for medication adherence was developed to succinctly summarise these dimension to remind clinicians the importance of medication adherence in daily practice. We conducted a systematic review on the various factors including patient, therapy, condition, health system and socioeconomic-related factors that affected medication adherence in rheumatic patients. We found 17 factors and 38 sub-factors that affected medication adherence in this population. This systematic review can facilitate future focused research in unexplored dimensions.
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Affiliation(s)
- Hendra Goh
- Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
- Department of Pharmacy, Khoo Teck Puat Hospital, Singapore, Singapore.
- Singapore Heart Foundation, Singapore, Singapore.
| | - Yi Seah
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Lian Leng Low
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Julian Thumboo
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Zhang L, Lu GH, Ye S, Wu B, Shen Y, Li T. Treatment adherence and disease burden of individuals with rheumatic diseases admitted as outpatients to a large rheumatology center in Shanghai, China. Patient Prefer Adherence 2017; 11:1591-1601. [PMID: 29075106 PMCID: PMC5609799 DOI: 10.2147/ppa.s144624] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE The purpose of this study was to determine treatment adherence and disease burden, analyze detailed medication problems experienced by patients, and identify factors associated with adherence in patients with rheumatic diseases in China. PATIENTS AND METHODS Patients with confirmed diagnoses of ankylosing spondylitis (AS), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE) were recruited, regardless of demographics, disease severity, and treatment characteristics. Adherence was assessed using the Compliance Questionnaire for Rheumatology and interview-based self-reports. A backwards-stepwise multivariate regression analysis was used to identify factors associated with adherence. RESULTS We collected data on 252 patients who had a rheumatic disease and visited our outpatient clinic in January or February of 2017. There were 121 patients with SLE, 70 with RA, and 61 with AS. The overall adherence rate was 41.7%, with 48.7% for SLE patients, 38.6% for RA patients, and 31.1% for AS patients. The overall EuroQol (EQ)-index was 0.761; AS patients had the best EQ-index (0.792), followed by those with SLE (0.780) and RA (0.700). SLE patients also had greater annual direct costs (US$5,103.58) than RA or AS patients. CONCLUSION Overall, 41.7% of our rheumatic disease patients were adherent to treatment, lower than in many other parts of the world. This indicates that it is important to identify methods that improve adherence in this population. It is particularly important to improve the health status and reduce the disease burden of patients with SLE, the most common of the three rheumatic diseases we analyzed. Our results suggest that reminder tools may improve adherence. Further prospective research is needed to confirm whether reminder tools and other measures can improve patient compliance.
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Affiliation(s)
- Le Zhang
- Department of Pharmacy, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Guo Hong Lu
- Department of Pharmacy, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shuang Ye
- Department of Rheumatology, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Bin Wu
- Department of Pharmacy, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yi Shen
- Department of Mathematics, Applied Statistics, Shanghai Jiaotong University, Shanghai, China
| | - Ting Li
- Department of Rheumatology, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- Correspondence: Ting Li, Department of Rheumatology, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 2000 Jiangyue Road, Shanghai 201112, China, Tel +86 139 1692 7066, Fax +86 21 3450 6151, Email
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