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Le Bozec A, Korb-Savoldelli V, Boiteau C, Dechartres A, Al Kahf S, Sitbon O, Montani D, Jaïs X, Guignabert C, Humbert M, Savale L, Chaumais MC. Medication adherence, related factors and outcomes among patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension: a systematic review. Eur Respir Rev 2024; 33:240006. [PMID: 38960611 PMCID: PMC11220621 DOI: 10.1183/16000617.0006-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/04/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are life-threatening conditions that can progress to death without treatment. Although strong medication adherence (MA) is known to enhance outcomes in chronic illnesses, its association with PAH and CTEPH was sporadically explored. This study aims to examine the MA of patients with PAH or CTEPH, identify factors associated with low adherence and explore the resulting outcomes. METHODS A systematic review was conducted by searching multiple databases (Medline, Embase, Cochrane Central, ClinicalTrials.gov, Scopus, Web of Science and Google Scholar) from 6 March 1998 to 6 July 2023. We included studies reporting MA as primary or secondary end-points. Study selection, data extraction and methodological quality assessment were performed in duplicate. RESULTS 20 studies involving 22 675 patients met the inclusion criteria. Heterogeneity was observed, particularly in the methods employed. MA means ranged from 0.62 to 0.96, with the proportion of patients exhibiting high MA varying from 40% (95% CI 35-45%) to 94% (95% CI 88-97%). Factors associated with low adherence included increased treatment frequency, time since diagnosis and co-payment. High MA seems to be associated with reduced hospitalisation rates, inpatient stays, outpatient visits and healthcare costs. CONCLUSIONS This systematic review underscores the heterogeneity of MA across studies. Nevertheless, the findings suggest that high MA could improve patients' clinical outcomes and alleviate the economic burden. Identifying factors consistently associated with poor MA could strengthen educational efforts for these patients, ultimately contributing to improved outcomes.
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Affiliation(s)
- Antoine Le Bozec
- Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Saclay, Service de Pharmacie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, Inserm, Hypertension Pulmonaire: Physiopathologie et Innovation Thérapeutique (HPPIT), Le Kremlin-Bicêtre, France
- Université Paris Saclay, Faculté de Pharmacie, Département de Pharmacie Clinique, Université Paris Saclay, Orsay, France
| | - Virginie Korb-Savoldelli
- Université Paris Saclay, Faculté de Pharmacie, Département de Pharmacie Clinique, Université Paris Saclay, Orsay, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Cité, Service de Pharmacie, Hôpital Européen Georges Pompidou, Paris, France
| | - Claire Boiteau
- Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Saclay, Service de Pharmacie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP. Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1421, Paris, France
| | - Salma Al Kahf
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service de Pneumologie et soins intensifs, centre de référence de l'hypertension pulmonaire, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Olivier Sitbon
- Université Paris-Saclay, Inserm, Hypertension Pulmonaire: Physiopathologie et Innovation Thérapeutique (HPPIT), Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service de Pneumologie et soins intensifs, centre de référence de l'hypertension pulmonaire, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - David Montani
- Université Paris-Saclay, Inserm, Hypertension Pulmonaire: Physiopathologie et Innovation Thérapeutique (HPPIT), Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service de Pneumologie et soins intensifs, centre de référence de l'hypertension pulmonaire, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Xavier Jaïs
- Université Paris-Saclay, Inserm, Hypertension Pulmonaire: Physiopathologie et Innovation Thérapeutique (HPPIT), Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service de Pneumologie et soins intensifs, centre de référence de l'hypertension pulmonaire, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Christophe Guignabert
- Université Paris-Saclay, Inserm, Hypertension Pulmonaire: Physiopathologie et Innovation Thérapeutique (HPPIT), Le Kremlin-Bicêtre, France
| | - Marc Humbert
- Université Paris-Saclay, Inserm, Hypertension Pulmonaire: Physiopathologie et Innovation Thérapeutique (HPPIT), Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service de Pneumologie et soins intensifs, centre de référence de l'hypertension pulmonaire, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Laurent Savale
- Université Paris-Saclay, Inserm, Hypertension Pulmonaire: Physiopathologie et Innovation Thérapeutique (HPPIT), Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service de Pneumologie et soins intensifs, centre de référence de l'hypertension pulmonaire, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Marie-Camille Chaumais
- Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Saclay, Service de Pharmacie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, Inserm, Hypertension Pulmonaire: Physiopathologie et Innovation Thérapeutique (HPPIT), Le Kremlin-Bicêtre, France
- Université Paris Saclay, Faculté de Pharmacie, Département de Pharmacie Clinique, Université Paris Saclay, Orsay, France
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Houghton DC, Merritt CR, Miller SN, Mitchell JM, Parker D, Hommel JD, Cunningham KA, Wilkes DM. Electronic Real-Time Monitoring Reveals Limited Adherence to Long-Term Opioid Prescriptions in Pain Patients. J Pain Res 2024; 17:1815-1827. [PMID: 38799276 PMCID: PMC11127646 DOI: 10.2147/jpr.s436898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 04/15/2024] [Indexed: 05/29/2024] Open
Abstract
Background Pain management physicians are increasingly focused on limiting prescription opioid abuse, yet existing tools for monitoring adherence have limited accuracy. Medication event monitoring system (MEMS) is an emerging technology for tracking medication usage in real-time but has not been tested in chronic pain patients on long-term opioid regimens. Objective We conducted a pilot clinical trial to investigate the utility of MEMS for monitoring opioid adherence and compared to traditional methods including self-report diaries, urine drug screen (UDS), and physicians' opinions. Methods Opioid-maintained chronic pain patients were recruited from a pain management clinic. Participants (n=28) were randomly assigned to either receive MEMS bottles containing their opioid medication for a 90-day period or to continue using standard medication bottles. MEMS bottles were configured to record and timestamp all bottle openings and the number of pills that were removed from the bottle (via measurement of weight change). Results Participants who received MEMS demonstrated highly heterogenous dosing patterns, with a substantial number of patients rapidly removing excessive amounts of medication and/or "stockpiling" medication. By comparison, physicians rated all participants as either "totally compliant" or "mostly compliant". UDS results did not reveal any illicit drug use, but 25% of participants (n=7) tested negative for their prescribed opioid metabolite. MEMS data did not correlate with physician-rated adherence (P=0.24) and UDS results (P=0.77). MEMS data consistently revealed greater non-adherence than self-report data (P<0.001). Conclusion These results highlight the limits in our understanding of naturalistic patterns of daily opioid use in chronic pain patients as well as support the use of MEMS for detecting potential misuse as compared to routine adherence monitoring methods. Future research directions include the need to determine how MEMS could be used to improve patient outcomes, minimize harm, and aid in clinical decision-making. Trial Registration This study was preregistered on ClinicalTrials.gov (NCT03752411).
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Affiliation(s)
- David C Houghton
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Christina R Merritt
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, USA
| | - Sierra N Miller
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
| | - Jasmine M Mitchell
- Department of Family and Community Medicine, UT McGovern Medical School, Houston, TX, USA
| | - David Parker
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
| | - Jonathan D Hommel
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, USA
| | - Kathryn A Cunningham
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, USA
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, USA
| | - Denise M Wilkes
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA
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de Tantillo L, McCabe BE, Zdanowicz M, Ortega J, Gonzalez JM, Chaparro S. Implementing Strategies to Recruit and Retain a Diverse Sample of Heart Failure Patients. HISPANIC HEALTH CARE INTERNATIONAL 2024:15404153241248144. [PMID: 38646673 DOI: 10.1177/15404153241248144] [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: 04/23/2024]
Abstract
Introduction: The increased prevalence, severity, and mortality of heart disease and specifically heart failure among Hispanic and Black populations are a concern for clinicians and researchers. Additionally, patients of poor socioeconomic status also have worse outcomes for cardiovascular disease. To address disparities, it is necessary to address the persistent lack of representation in clinical research of diverse populations, including the Hispanic and Black populations and individuals who are of low socioeconomic status. Method: This study was a pilot randomized trial of a medication adherence intervention for heart failure patients conducted at a safety net hospital and affiliated pharmacy with a diverse patient population. Using an evidence-based multifactorial approach, this investigation implemented and adapted best practices to support the inclusion of Hispanic, Black, and socioeconomically diverse participants. Results: A total of 40 participants were recruited, 58% were Hispanic, 38% Black, and 5% White. A total of 40% reported the need for socioeconomic assistance. At 30 days after discharge, follow-up data were obtained for 37 of 40 (93%) of participants either by interview, electronic record, or both. Conclusion: Findings suggest that a combination of strategies used in this trial can be applied to recruit and retain ethnically and socioeconomically diverse participants.
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Affiliation(s)
- Lila de Tantillo
- Brooks Rehabilitation College of Healthcare Sciences, Keigwin School of Nursing, Jacksonville University, Jacksonville, FL, USA
| | - Brian E McCabe
- Department of Special Education, Rehabilitation, and Counseling (SERC), Auburn University, Auburn, AL, USA
| | | | - Johis Ortega
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Juan M Gonzalez
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Sandra Chaparro
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
- Herbert Wertheim School of Medicine, Florida International University, Miami, FL, USA
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Larsen RE, Hole K, Selle ML, Johannessen Landmark C, Krogstad T, Holm LB. Access to a tailored mobile application enhances medication adherence among young users of antidepressants. Front Pharmacol 2024; 15:1379700. [PMID: 38659579 PMCID: PMC11039783 DOI: 10.3389/fphar.2024.1379700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/20/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Patients' adherence to antidepressants is generally reported to be poor. This study examined whether users of selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) enhance medication adherence following access to a mobile application (app) tailored for this patient group. The study addresses the implementation phase of medication adherence. Methods The study was a single group pre-post intervention design. Data were collected using the validated OsloMet Adherence-to-medication Survey tool (OMAS-37) before and after app access. Pre-app access survey (Survey 1) was conducted via social media and online newspapers, encompassing 445 SSRI/SNRI users aged 18 years and above. Post-app access survey (Survey 2) was sent to 103 SSRI/SNRI users from Survey 1. Wilcoxon Signed Rank Test compared pre- and post-intervention adherence measurements. Pearson's chi-square tests and Fisher's exact tests compared study population categories. Results Forty-two SSRI/SNRI users, median age 26 (IQR 17), 93% identifying as female, used the app while using the same antidepressant during the 2-month period between gaining access to the app and Survey 2. There was a statistically significant reduction in non-adherence score post-app access (z = 3.57, n = 42, p < 0.001) with medium effect size (r = 0.39), indicating enhanced adherence. Total non-adherence score decreased by 39% from pre-to post-access, and there was a 12% decrease in users scoring equivalent with poor adherence (score <2) post-access. Twenty-nine of 37 non-adherence causes improved, with three showing statistical significance. Of 42 responders, 50% (n = 21) indicated using the app one to two times, while 50% (n = 21) more than three times. Approximately 69% (n = 28) found it useful, and 43% (n = 18) felt safer in their use of antidepressants after access to the app. No significant preference was observed for the app over alternative sources of information. Discussion Enhanced medication adherence was observed among antidepressant users following access to the tailored app. Further studies are warranted to evaluate the app applicability to a broader range of antidepressants users or other patient groups, encompassing those in the initiation phase of medication adherence. The app is intended as an easily accessible supplement to the information and advice provided by prescribing physicians and dispensing pharmacists.
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Affiliation(s)
| | - Kristine Hole
- Department of Pharmacy, Oslo Metropolitan University, Oslo, Norway
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
| | - Maria Lie Selle
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Cecilie Johannessen Landmark
- Department of Pharmacy, Oslo Metropolitan University, Oslo, Norway
- The National Centre for Epilepsy, Member of the ERN Network EpiCare, Oslo University Hospital, Oslo, Norway
- Section for Clinical Pharmacology, Department of Pharmacology, Oslo University Hospital, Oslo, Norway
| | - Tonje Krogstad
- Department of Pharmacy, Oslo Metropolitan University, Oslo, Norway
| | - Lene Berge Holm
- Department of Pharmacy, Oslo Metropolitan University, Oslo, Norway
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Mortelmans L, Goossens E, De Graef M, Van Dingenen J, De Cock AM, Petrovic M, van den Bemt P, Dilles T. Evaluation of methods measuring medication adherence in patients with polypharmacy: a longitudinal and patient perspective. Eur J Clin Pharmacol 2024:10.1007/s00228-024-03661-1. [PMID: 38427083 DOI: 10.1007/s00228-024-03661-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE To explore patients' willingness to have medication adherence measured using different methods and evaluate the feasibility and validity of their combination (i.e., pill counts, a medication diary and a questionnaire assessing adherence two months post-discharge). METHODS (1) A cross-sectional evaluation of the willingness of patients with polypharmacy to have their medication adherence measured post-discharge. (2) Medication adherence was monitored during two months using pill counts based on preserved medication packages and a diary in which patients registered their adherence-related problems. During a home visit, the Probabilistic Medication Adherence Scale (ProMAS) and a questionnaire on feasibility were administered. RESULTS A total of 144 participants completed the questionnaire at discharge. The majority was willing to communicate truthfully about their adherence (97%) and to share adherence-related information with healthcare providers (99%). More participants were willing to preserve medication packages (76%) than to complete a medication diary (67%) during two months. Most participants reported that preserving medication packages (91%), completing the diary (99%) and the ProMAS (99%) were no effort to them. According to the majority of participants (60%), pill counts most accurately reflected medication adherence, followed by the diary (39%) and ProMAS (1%). Medication adherence measured by pill counts correlated significantly with ProMAS scores, but not with the number of diary-reported problems. However, adherence measured by the medication diary and ProMAS correlated significantly. CONCLUSION Combining tools for measuring adherence seems feasible and can provide insight into the accordance of patients' actual medication use with their prescribed regimen, but also into problems contributing to non-adherence.
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Affiliation(s)
- Laura Mortelmans
- Department of Nursing Science and Midwifery, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
- Research Foundation Flanders (FWO), Brussels, Belgium.
| | - Eva Goossens
- Department of Nursing Science and Midwifery, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Department of Patient Care, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Marjan De Graef
- Department of Nursing Science and Midwifery, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Jana Van Dingenen
- Department of Nursing Science and Midwifery, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Anne-Marie De Cock
- Department of Geriatrics, ZNA, Antwerp, Belgium
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Patricia van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Tinne Dilles
- Department of Nursing Science and Midwifery, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Robinson L, Arden MA, Dawson S, Walters SJ, Wildman MJ, Stevenson M. A machine-learning assisted review of the use of habit formation in medication adherence interventions for long-term conditions. Health Psychol Rev 2024; 18:1-23. [PMID: 35086431 DOI: 10.1080/17437199.2022.2034516] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/21/2022] [Indexed: 12/20/2022]
Abstract
Adherence to medication in long-term conditions is around 50%. The key components of successful interventions to improve medication adherence remain unclear, particularly when examined over prolonged follow-up periods. Behaviour change theories are increasingly interested in the utility of habit formation for the maintenance of health behaviour change, but there is no documentation on how habit has been conceptualised in the medication adherence intervention literature, or what effect the key technique identified in habit formation theory (context dependent repetition) has in these studies. To examine this, a machine-learning assisted review was conducted. Searches of MEDLINE, EMBASE and PSYCInfo and the reference list of a comprehensive systematic review of medication adherence interventions yielded 5973 articles. Machine learning-assisted title and abstract screening identified 15 independent RCTs published between 1976 and 2021, including 18 intervention comparisons of interest. Key findings indicate that conceptualisations of habit in the medication adherence literature are varied and behaviour change technique coding identified only six studies which explicitly described using habit formation. Future work should aim to develop this evidence base, drawing on contemporary habit theory and with explicit demonstration of what techniques have been used to promote habit formation.
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Affiliation(s)
- L Robinson
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - M A Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, UK
| | - S Dawson
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, UK
| | - S J Walters
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - M J Wildman
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | - M Stevenson
- Department of Computer Science, The University of Sheffield, Sheffield, UK
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Dietrich F, Polymeris AA, Albert V, Engelter ST, Hersberger KE, Schaedelin S, Lyrer PA, Arnet I. Intake reminders are effective in enhancing adherence to direct oral anticoagulants in stroke patients: a randomised cross-over trial (MAAESTRO study). J Neurol 2024; 271:841-851. [PMID: 37831125 PMCID: PMC10827905 DOI: 10.1007/s00415-023-12035-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Direct oral anticoagulants (DOAC) effectively prevent recurrent ischaemic events in atrial fibrillation (AF) patients with recent stroke. However, excellent adherence to DOAC is mandatory to guarantee sufficient anticoagulation as the effect quickly subsides. AIM To investigate the effect of intake reminders on adherence to DOAC. METHODS MAAESTRO was a randomised, cross-over study in DOAC-treated AF patients hospitalised for ischaemic stroke. Adherence was measured by electronic monitoring for 12 months. After an observational phase, patients were randomised to obtain an intake reminder either in the first or the second half of the subsequent 6-month interventional phase. The primary outcome was 100%-timing adherence. Secondary outcomes were 100%-taking adherence, and overall timing and taking adherence. We analysed adherence outcomes using McNemar's test or mixed-effects logistic models. RESULTS Between January 2018 and March 2022, 130 stroke patients were included, of whom 42 dropped out before randomisation. Analysis was performed with 84 patients (mean age: 76.5 years, 39.3% women). A 100%-timing adherence was observed in 10 patients who were using the reminder, and in zero patients without reminder (p = 0.002). The reminder significantly improved adherence to DOAC, with study participants having 2.7-fold increased odds to achieve an alternative threshold of 90%-timing adherence (OR 2.65; 95% CI 1.05-6.69; p = 0.039). A similar effect was observed for 90%-taking adherence (OR 3.06; 95% CI 1.20-7.80; p = 0.019). Overall timing and taking adherence increased significantly when using the reminder (OR 1.70; 95% CI 1.55-1.86, p < 0.01; and OR 1.67; 95% CI 1.52-1.84; p < 0.01). CONCLUSION Intake reminders increased adherence to DOAC in patients with stroke attributable to atrial fibrillation. TRIAL REGISTRATION ClinicalTrials.gov: NCT03344146.
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Affiliation(s)
- Fine Dietrich
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Klingelbergstrasse 50, 4056, Basel, Switzerland.
| | - Alexandros A Polymeris
- Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Petersgraben 4, 4051, Basel, Switzerland
| | - Valerie Albert
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Klingelbergstrasse 50, 4056, Basel, Switzerland
| | - Stefan T Engelter
- Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Petersgraben 4, 4051, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Burgfelderstrasse 101, 4055, Basel, Switzerland
| | - Kurt E Hersberger
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Klingelbergstrasse 50, 4056, Basel, Switzerland
| | - Sabine Schaedelin
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel and University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland
| | - Philippe A Lyrer
- Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Petersgraben 4, 4051, Basel, Switzerland
| | - Isabelle Arnet
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Klingelbergstrasse 50, 4056, Basel, Switzerland
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Artignan J, Capmas P, Panjo H, Constantinou P, Pelletier-Fleury N. Are breast cancer patients with suboptimal adherence to cardiovascular treatment more likely to discontinue adjuvant endocrine therapy? Competing risk survival analysis in a nationwide cohort of postmenopausal women. BMC Med 2023; 21:463. [PMID: 38001491 PMCID: PMC10675896 DOI: 10.1186/s12916-023-03156-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND High rates of discontinuation undermine the effectiveness of adjuvant endocrine therapy (AET) among hormone-receptive breast cancer patients. Patient prognosis also relies on the successful management of cardiovascular risk, which affects a high proportion of postmenopausal women. As with AET, adherence with cardiovascular drugs is suboptimal. We examined whether patient adherence with cardiovascular drugs was associated with the rate of AET discontinuation in a French nationwide claims database linked with hospitalisation data. METHODS We identified postmenopausal women starting AET between 01/01/2016 and 31/12/2020 and taking at least two drugs for the primary prevention of cardiovascular disease (antihypertensive drugs, lipid-lowering drugs and platelet aggregation inhibitors) before AET initiation. Adherence was assessed for each drug class by computing the proportion of days covered. Women were categorised as fully adherent, partially adherent or fully non-adherent with their cardiovascular drug regimen based on whether they adhered with all, part or none of their drugs. AET discontinuation was defined as a 90-day gap in AET availability. Time to AET discontinuation according to levels of cardiovascular drug adherence was estimated using cumulative incidence curves, accounting for the competing risks of death and cancer recurrence. Multivariate cause-specific Cox regressions and Fine-and-Gray regressions were used to assess the relative hazards of AET discontinuation. RESULTS In total, 32,075 women fit the inclusion criteria. Women who were fully adherent with their cardiovascular drugs had the lowest cumulative incidence of AET discontinuation at any point over the 5-year follow-up period. At 5 years, 40.2% of fully non-adherent women had discontinued AET compared with 33.5% of partially adherent women and 28.8% of fully adherent women. Both partial adherence and full non-adherence with cardiovascular drugs were predictors of AET discontinuation in the two models (cause-specific hazard ratios 1.16 [95% CI 1.10-1.22] and 1.49 [95% CI 1.39-1.58]; subdistribution hazard ratios 1.15 [95% CI 1.10-1.21] and 1.47 [95% CI 1.38-1.57]). CONCLUSION Clinicians should be aware that patients who do not adhere with their entire cardiovascular drug regimen are also more likely to discontinue AET. This stresses the importance of integrated care, as suboptimal adherence with both treatment components poses a threat to achieving ideal patient outcomes.
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Affiliation(s)
- Juliette Artignan
- Centre for Research in Epidemiology and Population Health (Inserm U1018), Villejuif, France.
- Paris-Saclay University, UVSQ, Inserm, CESP, Villejuif, France.
| | - Perrine Capmas
- Centre for Research in Epidemiology and Population Health (Inserm U1018), Villejuif, France
- Paris-Saclay University, UVSQ, Inserm, CESP, Villejuif, France
- Department of Gynecology and Obstetrics, Kremlin-Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Henri Panjo
- Centre for Research in Epidemiology and Population Health (Inserm U1018), Villejuif, France
- Paris-Saclay University, UVSQ, Inserm, CESP, Villejuif, France
| | - Panayotis Constantinou
- Direction of Strategy, Studies and Statistics, French National Health Insurance (CNAM), Paris, France
| | - Nathalie Pelletier-Fleury
- Centre for Research in Epidemiology and Population Health (Inserm U1018), Villejuif, France
- Paris-Saclay University, UVSQ, Inserm, CESP, Villejuif, France
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Onwusah DO, Ojewole EB, Manyangadze T, Chimbari MJ. Barriers and Facilitators of Adherence to Oral Anticancer Medications Among Women with Breast Cancer: A Qualitative Study. Patient Prefer Adherence 2023; 17:2821-2839. [PMID: 37953981 PMCID: PMC10637192 DOI: 10.2147/ppa.s416843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/29/2023] [Indexed: 11/14/2023] Open
Abstract
Purpose Despite the life-saving benefits of oral anticancer medications (OAMs) to women with breast cancer (BC), adherence remains suboptimal and, in many cases, not well documented. The study examined barriers and facilitators of adherence to OAMs among women receiving BC treatment in Nigeria. Patients and Methods The study was framed within the World Health Organization (WHO) Multidimensional Model of Adherence. We conducted qualitative in-depth interviews of 16 purposively sampled women in two tertiary hospitals in Southern Nigeria. The interviews were audio-recorded and transcribed verbatim. The interview data were analyzed using the Framework Method. Results The key barriers to OAM adherence mentioned were socioeconomic factors (high cost of medication) and therapy-related factors (medication side effects). The key facilitating mechanisms for adherence to OAMs mentioned included; (i) patient-related psychosocial factors such as self-encouragement and self-discipline in sticking to the prescription, taking the medication at a particular time each day, receiving practical support from family members; and (ii) healthcare team/system factors such as obtaining an adequate supply of the medication at the pharmacy. Conclusion Barriers and facilitators to OAM adherence are multidimensional. The study findings highlight the potential benefit of a multifaceted intervention (such as patient education and monitoring or strategies promoting cost-containment and side effects management) to optimize adherence. Therefore, our findings may inform the designing and evaluating of context-specific adherence measures and multifaceted intervention strategies targeting key barriers and approaches that enable adherence to enhance patient outcomes.
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Affiliation(s)
- Deborah Obehi Onwusah
- Discipline of Pharmaceutical Sciences, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Elizabeth Bolanle Ojewole
- Discipline of Pharmaceutical Sciences, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Tawanda Manyangadze
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Geosciences, School of Geosciences, Disasters and Sustainable Development, Faculty of Science and Engineering, Bindura University of Science Education, Bindura, Mashonaland Central, Zimbabwe
| | - Moses John Chimbari
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Department of Public Health, School of Medical and Health Sciences, Great Zimbabwe University, Masvingo, Zimbabwe
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10
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Alamer S, Robinson-Barella A, Nazar H, Husband A. Influence of ethnicity on adherence to nonsurgical interventions for COPD: a scoping review. ERJ Open Res 2023; 9:00421-2023. [PMID: 37965227 PMCID: PMC10641584 DOI: 10.1183/23120541.00421-2023] [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: 07/02/2023] [Accepted: 09/08/2023] [Indexed: 11/16/2023] Open
Abstract
Objective Poor therapeutic adherence and the contributing factors have been extensively researched in several chronic diseases, including COPD. However, the influence of ethnicity on adherence to nonsurgical treatment interventions for COPD (e.g. smoking cessation and pulmonary rehabilitation) is not well understood. This scoping review was performed to better understand variations in adherence among people from minority ethnic communities diagnosed with COPD. Method This scoping review was designed based on the refined frameworks of Arksey and O'Malley, developed by JBI (Joanna Briggs Institute). Systematic searches were performed across three databases: CINHAL (EBSCO), MEDLINE (Ovid) and Embase (Ovid). Results Out of 3654 identified records, 37 studies were deemed eligible for inclusion; these were conducted in various countries and involved populations of diverse ethnic groups diagnosed with COPD. The included studies considered provision and/or adherence to medication (n=8, 21.6%), smoking cessation (n=11, 29.7%), influenza vaccinations (n=7, 18.9%), pulmonary rehabilitation (n=11, 29.7%) and oxygen therapy (n=2, 5.4%). Outcomes varied widely between studies within a single intervention (e.g. initiation, adherence and completion of pulmonary rehabilitation programme). However, most of the included studies suggested the presence of inequalities linked to ethnicity across interventions. Conclusion This review indicated the presence of poor adherence to nonsurgical interventions among people from minority ethnic backgrounds living with COPD. However, due to the heterogeneity in population groups considered and compared within the individual studies, it is challenging to identify and understand the key inequalities influencing adherence to nonsurgical interventions. Further research is needed to better explore this.
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Affiliation(s)
- Sarah Alamer
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
- College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Anna Robinson-Barella
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hamde Nazar
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
| | - Andy Husband
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
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11
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Tibble H, Sheikh A, Tsanas A. Estimating medication adherence from Electronic Health Records: comparing methods for mining and processing asthma treatment prescriptions. BMC Med Res Methodol 2023; 23:167. [PMID: 37438684 PMCID: PMC10337150 DOI: 10.1186/s12874-023-01935-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 04/26/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Medication adherence is usually defined as the extent of the agreement between the medication regimen agreed to by patients with their healthcare provider and the real-world implementation. Proactive identification of those with poor adherence may be useful to identify those with poor disease control and offers the opportunity for ameliorative action. Adherence can be estimated from Electronic Health Records (EHRs) by comparing medication dispensing records to the prescribed regimen. Several methods have been developed in the literature to infer adherence from EHRs, however there is no clear consensus on what should be considered the gold standard in each use case. Our objectives were to critically evaluate different measures of medication adherence in a large longitudinal Scottish EHR dataset. We used asthma, a chronic condition with high prevalence and high rates of non-adherence, as a case study. METHODS Over 1.6 million asthma controllers were prescribed for our cohort of 91,334 individuals, between January 2009 and March 2017. Eight adherence measures were calculated, and different approaches to estimating the amount of medication supply available at any time were compared. RESULTS Estimates from different measures of adherence varied substantially. Three of the main drivers of the differences between adherence measures were the expected duration (if taken as in accordance with the dose directions), whether there was overlapping supply between prescriptions, and whether treatment had been discontinued. However, there are also wider, study-related, factors which are crucial to consider when comparing the adherence measures. CONCLUSIONS We evaluated the limitations of various medication adherence measures, and highlight key considerations about the underlying data, condition, and population to guide researchers choose appropriate adherence measures. This guidance will enable researchers to make more informed decisions about the methodology they employ, ensuring that adherence is captured in the most meaningful way for their particular application needs.
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Affiliation(s)
- Holly Tibble
- Usher Institute, University of Edinburgh, Edinburgh, Scotland.
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, Scotland.
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, Scotland
| | - Athanasios Tsanas
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, Scotland
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12
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Kuchyn I, Horoshko V. Chronic pain in patients with gunshot wounds. BMC Anesthesiol 2023; 23:47. [PMID: 36750768 PMCID: PMC9903440 DOI: 10.1186/s12871-023-02005-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND In civilian life, from 11 to 40% of patients suffer from chronic pain after receiving injuries. There are almost no data on chronic pain in patients with gunshot wounds, isolated clinical cases have been published. The purpose of our study is to determine the factors that can potentially affect the results of treatment of such patients, namely the frequency of development of chronic pain, acute stress reactions, satisfaction with the results of treatment and the number of wound localizations. METHODS The treatment of 769 patients was analyzed. Pain intensity was diagnosed using a visual analog scale (VAS). To detect neuropathic pain, the Douleur Neuropathique 4 questions (DN4). The presence of an acute stress reaction (ASR) was diagnosed using The hospital anxiety and depression scale (HADS) and medical history, the diagnosis was established by a psychiatrist. Satisfaction with treatment results was studied using the Chaban quality of life scale (CQLS). Group comparisons were made using the Mann-Whitney test and the chi-square test, taking into account continuity correction. RESULTS Chronic pain was observed in 538 (70% 95% CI 66.7%-73.1%) patients with gunshot wounds: of them, 439 patients had wounds in 1, 2 anatomical parts of the body, here the frequency of pain chronicity is 69.7% (95% CI 66.0%-78.5%), and 99 patients had wounds in 3 or more anatomical parts of the body - 71.2% (95%CI 63.4%-78.5%). DN4 data suggest the presence of a neuropathic pain component in these patients. Also, all patients were diagnosed with ASR upon admission: the number of HADS points ranged from 9 to 25 points. CQLS data indicate that satisfaction with treatment outcomes was high (76 points) before hospital discharge, but subsequently decreased to a low level (64 points). CONCLUSIONS Patients with gunshot wounds have a high risk of chronic pain, averaging 45% higher than the general population in civilian trauma patients. A greater frequency of the neuropathic component of pain and acute stress reactions is the reason for such chronicity. A decrease in the level of satisfaction with the results of treatment, in the remote period of observation, compared to the level at the time of discharge from the hospital, is probably a consequence of the formation of chronic pain. TRIAL REGISTRATION ClinicalTrials.gov: Retrospectively registered on August 1, 2022, NCT05489029.
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Affiliation(s)
- Iurii Kuchyn
- grid.412081.eNational Medical University Named After O. O. Bogomolets, Kiev, Ukraine
| | - Vasyl’ Horoshko
- grid.412081.eNational Medical University Named After O. O. Bogomolets, Kiev, Ukraine
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13
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Association between health literacy and medication adherence in chronic diseases: a recent systematic review. Int J Clin Pharm 2023; 45:38-51. [PMID: 36369411 DOI: 10.1007/s11096-022-01470-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Poor medication adherence is a serious barrier to successful chronic disease management. Previous reviews reported that low health literacy could be associated with medication non-adherence but conclusions were uncertain. AIM The aim of this systematic review was to clarify the relationship between health literacy and medication adherence in adults with chronic diseases. A secondary objective was to identify the factors that influence medication adherence. METHOD Publications analyzing the relationship between health literacy and adherence in adults with chronic diseases were identified through 6 databases between 2015 and 2020. A quality assessment was conducted in order to improve the interpretation of the relationship between health literacy and medication adherence. A narrative synthesis was then performed to describe the relationship between health literacy and medication adherence. The factors influencing medication adherence were then analyzed as a secondary outcome. RESULTS Among the 27 studies, 17 and 10 were considered to be of good and medium methodological quality, respectively. Concerning the relationship between health literacy and adherence, 14 reported a positive relationship, 1 study suggested a negative relationship, 3 found mixed results, and 9 reported not finding a relationship. Patient-related factors such as medication beliefs, self-efficacy, or medication knowledge, as well as demographic factors such as ethnic minority and incomes influence medication adherence. CONCLUSION The present review confirms an unclear relationship between health literacy and medication adherence. Although health literacy plays a substantial role in medication adherence, other factors must be taken into account when addressing non-adherence.
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14
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Penner LS, Armitage CJ, Thornley T, Whelan P, Chuter A, Allen T, Elliott RA. What affected UK adults' adherence to medicines during the COVID-19 pandemic? Cross-sectional survey in a representative sample of people with long-term conditions. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2023; 32:1-14. [PMID: 36691578 PMCID: PMC9849112 DOI: 10.1007/s10389-022-01813-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/19/2022] [Indexed: 01/20/2023]
Abstract
Aim Medicines non-adherence is associated with poorer outcomes and higher costs. COVID-19 affected access to healthcare, with increased reliance on remote methods, including medicines supply. This study aimed to identify what affected people's adherence to medicines for long-term conditions (LTCs) during the pandemic. Subject and methods Cross-sectional online survey of UK adults prescribed medicines for LTCs assessing self-reported medicines adherence, reasons for non-adherence (using the capability, opportunity and motivation model of behaviour [COM-B]), medicines access and COVID-19-related behaviours. Results The 1746 respondents reported a mean (SD) of 2.5 (1.9) LTCs, for which they were taking 2.4 (1.9) prescribed medicines, 525 (30.1%) reported using digital tools to support ordering or taking medicines and 22.6% reported medicines non-adherence. No access to at least one medicine was reported by 182 (10.4%) respondents; 1048 (60.0%) reported taking at least one non-prescription medicine as a substitute; 409 (23.4%) requested emergency supply from pharmacy for at least one medicine. Problems accessing medicines, being younger, male, in the highest socioeconomic group and working were linked to poorer adherence. Access problems were mostly directly or indirectly related to the COVID-19 pandemic. Respondents were generally lacking in capabilities and opportunities, but disruptions to habits (automatic motivation) was the major reason for non-adherence. Conclusion Navigating changes in how medicines were accessed, and disruption of habits during the COVID-19 pandemic, was associated with suboptimal adherence. People were resourceful in overcoming barriers to access. Solutions to support medicines-taking need to take account of the multiple ways that medicines are prescribed and supplied remotely. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-022-01813-0.
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Affiliation(s)
- L. S. Penner
- Janssen-Cilag GmbH, Johnson & Johnson Platz 1, 41470 Neuss, Germany
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 4th Floor, Jean McFarlane Building, Manchester, M13 9PL UK
| | - C. J. Armitage
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Coupland Building 1, Manchester, M13 9PL; Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, M13 9PT; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Coupland Building 1, Manchester, M13 9PL UK
| | - T. Thornley
- School of Pharmacy, University of Nottingham, University Park, Nottingham, NG7 2RD UK
| | - P. Whelan
- Digital Health Technical Lead, Centre for Health Informatics, Division of Informatics, Imaging and Data Science| School of Health Sciences | Faculty of Biology, Medicine and Health, University of Manchester, Vaughan House, Manchester, M13 9PL UK
| | - A. Chuter
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 4th Floor, Jean McFarlane Building, Manchester, M13 9PL UK
| | - T. Allen
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 4th Floor, Jean McFarlane Building, Manchester, M13 9PL UK
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - R. A. Elliott
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 4th Floor, Jean McFarlane Building, Manchester, M13 9PL UK
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15
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Wang QC, Yuan H, Chen ZM, Wang J, Xue H, Zhang XY. Barriers and Facilitators of Adherence to Oral Nutritional Supplements Among People Living With Cancer: A Systematic Review. Clin Nurs Res 2023; 32:209-220. [PMID: 35707872 DOI: 10.1177/10547738221104216] [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: 12/24/2022]
Abstract
This study aims to synthesize the barriers and facilitators of oral nutritional supplement adherence in people with cancer and assess levels of adherence. Databases including Embase, PubMed, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Database, and Chinese Scientific Journal Database, were used to search articles before January 4, 2021. Eighteen studies with 1,267 participants met the inclusion criteria. All studies reported rates of adherence, ranging from 6.0% to 96.9%. Gastrointestinal intolerances and disliked tastes were considered common barriers to cancer patients' adherence, whereas the ONS management strategy was considered the most crucial facilitator of adherence. Health professionals can improve adherence through regular monitoring and guidance and incentive strategies, and paying attention to the management and prevention of adverse reactions when prescribing nutritional products.
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Affiliation(s)
| | - Hua Yuan
- Jilin University, Changchun, P.R. China
| | | | - Jia Wang
- Jilin University, Changchun, P.R. China
| | - Hui Xue
- Jilin University, Changchun, P.R. China
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16
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Kanyongo W, Ezugwu AE. Machine learning approaches to medication adherence amongst NCD patients: A systematic literature review. INFORMATICS IN MEDICINE UNLOCKED 2023. [DOI: 10.1016/j.imu.2023.101210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
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17
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Saukkosalmi P, Kankaanranta H, Vähätalo I, Sillanmäki L, Sumanen M. Defined daily dose definition in medication adherence assessment in asthma. Eur Clin Respir J 2023; 10:2207335. [PMID: 37139181 PMCID: PMC10150619 DOI: 10.1080/20018525.2023.2207335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Adherence to inhaled corticosteroids (ICS) has been described as poor. In adherence studies, if the actual prescribed dosing is not available, generic defined daily doses (DDD) are applied instead when assessing adherence. We evaluated asthma patients' adherence in a large prospective follow-up survey. We also analysed whether World Health Organization (WHO) and Global Initiative for Asthma (GINA) reference doses give different results. The current study was cross-sectional and included respondents attending to HeSSup follow-up questionnaire in 2012. Altogether 1,141 of 12,854 adult participants answered positively to the question about having asthma. According to the Finnish Social Insurance Institutions' medication register, 686 of them had purchased ICS medication during 2011. DDDs for ICS by WHO as well as medium doses from GINA report were used as reference doses to evaluate adherence. To estimate adherence to ICS, the proportion of days covered (PDC) over one year was calculated for every patient. If the lower limit of GINA medium ICS dose was used as a reference, 65% of the patients were adherent (PDC ≥ 80%). Use of WHO's DDD as reference halved the proportion of adherent patients. Adherence was higher among those using a combination inhaler of corticosteroid and long-acting β2-agonist compared to those using steroid only inhalers. Use of WHO's daily defined doses as reference values may lead to underestimation of adherence to inhaled corticosteroids. Thus, attention should be paid when choosing the reference doses for the evaluation of adherence to inhaled corticosteroids in asthma.
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Affiliation(s)
- Päivi Saukkosalmi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Regional State Administrative Agency for Southern Finland, Hämeenlinna, Finland
| | - Hannu Kankaanranta
- Faculty of Medicine and Health Technology, Tampere University Respiratory Research Group, Tampere, Finland
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
- Department of Internal Medicine, Krefting Research Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Iida Vähätalo
- Faculty of Medicine and Health Technology, Tampere University Respiratory Research Group, Tampere, Finland
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Lauri Sillanmäki
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Markku Sumanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- CONTACT Markku Sumanen Faculty of Medicine and Health Technology, Tampere University, TampereFIN-33014, Finland
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18
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Onwusah DO, Ojewole EB, Chimbari MJ. Adherence to Oral Anticancer Medications Among Women With Breast Cancer in Africa: A Scoping Review. JCO Glob Oncol 2023; 9:e2100289. [PMID: 36689700 PMCID: PMC10166491 DOI: 10.1200/go.21.00289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Oral anticancer medications (OAMs) improve treatment outcomes and survival in women with breast cancer (BC). However, adherence to OAM therapy remains suboptimal. This scoping review provides evidence of adherence to OAMs among African women with BC. METHODS We searched four databases and gray literature, using guidance from the Joanna Briggs Institute. Thirteen studies on adherence rates, determinants, and interventions were included. NVivo 12 software was used to perform thematic analysis of the included studies. The determinants (barriers and facilitators) associated with adherence were analyzed according to the five dimensions of the WHO multidimensional adherence model. RESULTS Most studies (n = 11, 85%) focused on endocrine medication. Depending on the definition, measurements, and assessment period, the nonadherence rates ranged from 4.3% to 65.4% for endocrine medications, 80.9% for cytotoxic chemotherapies, and 32.7% for combined medications. The significant barriers associated with adherence include Islamic religion, concurrent comorbidities, mastectomy, anastrozole treatment, side effects, unawareness of treatment insurance coverage, and seeking treatment from traditional healers. Thorough therapeutic communication regarding treatment, neoadjuvant chemotherapy, and adequate social support significantly facilitate adherence. A randomized controlled trial of breast nursing interventions reported improved patient adherence. CONCLUSION The evidence mapped from studies that evaluated OAM adherence in women with BC indicates that nonadherence to OAMs is common. Applying context-specific standardized measures to assess adherence and facilitators or strategies targeting the identified barriers can optimize adherence and treatment outcomes. Effective interventions to improve adherence are limited. Therefore, further empirical and interventional studies in Africa are required to enhance the evidence.
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Affiliation(s)
- Deborah O Onwusah
- Discipline of Pharmaceutical Sciences, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Elizabeth B Ojewole
- Discipline of Pharmaceutical Sciences, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Moses J Chimbari
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.,Department of Public Health, School of Medical and Health Sciences, Great Zimbabwe University, Masvingo, Zimbabwe
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Báez P, Tiburcio A, Alba N, Mateo F, Grullon E, Cordero S, Fernández A, Reinoso J, Cruz D, Gómez K, Vargas N, Saint-Hilaire C, Abreu O, Acosta G, Halpern M, Stonbraker S. Medición de adherencia a antirretrovirales con métodos múltiples en La Romana, República Dominicana. Rev Panam Salud Publica 2022; 46:e207. [PMCID: PMC9733707 DOI: 10.26633/rpsp.2022.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/15/2022] [Indexed: 12/13/2022] Open
Abstract
RESUMEN
Objetivo.
El objetivo fue desarrollar una herramienta para medir los niveles de adherencia al tratamiento antirretroviral (la TARV) en un entorno de escasos recursos, a partir de la combinación de cuatro métodos de medición de adherencia.
Métodos.
Revisión retrospectiva de 500 expedientes médicos de personas que viven con VIH, elegidos de manera aleatoria desde octubre del 2017 hasta enero del 2020. Se midió la adherencia a la TARV combinando cuatro métodos de medición (porcentaje de cobertura de la TARV recetada, recogida de la TARV en farmacia, nivel de carga viral y autoinforme de adherencia). Se realizaron pruebas de chi al cuadrado con P <0,05 para diferencias estadísticamente significativas y regresión binaria logística para identificar probabilidades de adherencia óptima y subóptima. Realizamos pruebas de Spearman para correlación de categorías y alfa de Cronbach para medir la consistencia interna de la herramienta.
Resultados.
Obtuvimos 497 calificaciones de adherencia. De estas, 307 (61,8%) usuarios se calificaron como adherentes, 141(28,4%) como semiadherentes y 49 (9,8%) como no adherentes. Se encontró una mayor probabilidad de adherencia óptima en grupos de 60 años o más (odds ratio [OR]: 1,6; IC95%: 0,8-3,5) sin diferencia entre hombres y mujeres (OR: 0,9; IC95%: 0,7-1,4). La prueba de Spearman informó una relación (r = 0,8) entre los niveles de carga viral y la calificación final, y la prueba alfa de Cronbach arrojó una modesta consistencia interna (α = 0,7).
Conclusiones.
Se desarrolló una herramienta para medir adherencia en un entorno de escasos recursos. La herramienta presenta niveles modestos de consistencia interna y una correlación fuerte en la categoría de carga viral y adherencia.
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Affiliation(s)
- Pamela Báez
- Clínica de Familia La Romana, La Romana, República Dominicana. Pamela Báez
| | - Adriana Tiburcio
- Clínica de Familia La Romana, La Romana, República Dominicana. Pamela Báez
| | - Nicole Alba
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
| | - Fernando Mateo
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
| | - Estefani Grullon
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
| | - Sheyla Cordero
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
| | - Ana Fernández
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
| | - Janetly Reinoso
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
| | - Desireé Cruz
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
| | - Karina Gómez
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
| | - Natacha Vargas
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
| | - Camila Saint-Hilaire
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
| | - Olga Abreu
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
| | - Grace Acosta
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
| | - Mina Halpern
- Clínica de Familia La Romana, La Romana, República Dominicana. Pamela Báez
| | - Samantha Stonbraker
- Escuela de Enfermería, Universidad de Colorado, Colorado, Estados Unidos de América
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20
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Yousif A, Lemière C, Forget A, Beauchesne MF, Blais L. Feasibility of implementing a web-based tool built from pharmacy claims data (e-MEDRESP) to monitor adherence to respiratory medications in primary care. Curr Med Res Opin 2022; 38:2055-2067. [PMID: 36239574 DOI: 10.1080/03007995.2022.2135835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE e-MEDRESP is a novel web-based tool that provides easily interpretable information on patient adherence to asthma/chronic obstructive pulmonary disease (COPD) medications, using pharmacy claims data. This study investigated the feasibility of implementing e-MEDRESP in primary care. MATERIAL AND METHODS In this 16-month prospective cohort study, e-MEDRESP was integrated into electronic medical records. Nineteen family physicians and 346 of their patients were enrolled. Counters embedded in the tool tracked physician use during the follow-up. Patient/physician satisfaction with e-MEDRESP was evaluated though telephone interviews and online questionnaires. The capacity of e-MEDRESP to improve adherence was explored using a pre-post analysis. RESULTS Overall, 245 patients had at least one medical visit during follow-up. e-MEDRESP was consulted by 15 (79%) physicians for 85 (35%) patients during clinic visits. Seventy-three patients participated in telephone interviews; 84% reported discussing their medication use with their physician; 33% viewed their e-MEDRESP report and indicated that it was easy to interpret. The physicians reported that the tool facilitated their evaluation of their patients' medication adherence (mean ± standard deviation rating: 4.8 ± 0.7, on a 5-point Likert scale). Although the pre-post analysis did not reveal improved adherence in the overall cohort, adherence improved significantly in patients whose adherence level was <80% and who were prescribed inhaled corticosteroids (26.9% [95% CI 14.3-39.3%]) or long-acting muscarinic agents (26.4% [95% CI 12.4-40.2%]). CONCLUSIONS e-MEDRESP was successfully integrated in clinical practice. It could serve as a useful tool to help physicians monitor their patients' medication adherence.
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Affiliation(s)
- Alia Yousif
- Faculty of Pharmacy, Université de Montréal, Montreal, Canada
- Research Centre, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montreal, Canada
| | - Catherine Lemière
- Research Centre, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montreal, Canada
- Faculty of Medicine, Université de Montreal, Montreal, Canada
| | - Amélie Forget
- Faculty of Pharmacy, Université de Montréal, Montreal, Canada
- Research Centre, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montreal, Canada
| | - Marie-France Beauchesne
- Faculty of Pharmacy, Université de Montréal, Montreal, Canada
- Research Centre, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montreal, Canada
- Research Centre, Centre Intégré Universitaire de santé et de services sociaux de l'Estrie-CHUS, Sherbrooke, Canada
| | - Lucie Blais
- Faculty of Pharmacy, Université de Montréal, Montreal, Canada
- Research Centre, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montreal, Canada
- Endowment Pharmaceutical Chair, Astra-Zeneca in Respiratory Health, Montreal, Canada
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21
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Hsu W, Warren JR, Riddle PJ. Medication adherence prediction through temporal modelling in cardiovascular disease management. BMC Med Inform Decis Mak 2022; 22:313. [DOI: 10.1186/s12911-022-02052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 11/16/2022] [Indexed: 11/30/2022] Open
Abstract
Abstract
Background
Chronic conditions place a considerable burden on modern healthcare systems. Within New Zealand and worldwide cardiovascular disease (CVD) affects a significant proportion of the population and it is the leading cause of death. Like other chronic diseases, the course of cardiovascular disease is usually prolonged and its management necessarily long-term. Despite being highly effective in reducing CVD risk, non-adherence to long-term medication continues to be a longstanding challenge in healthcare delivery. The study investigates the benefits of integrating patient history and assesses the contribution of explicitly temporal models to medication adherence prediction in the context of lipid-lowering therapy.
Methods
Data from a CVD risk assessment tool is linked to routinely collected national and regional data sets including pharmaceutical dispensing, hospitalisation, lab test results and deaths. The study extracts a sub-cohort from 564,180 patients who had primary CVD risk assessment for analysis. Based on community pharmaceutical dispensing record, proportion of days covered (PDC) $$\ge$$
≥
80 is used as the threshold for adherence. Two years (8 quarters) of patient history before their CVD risk assessment is used as the observation window to predict patient adherence in the subsequent 5 years (20 quarters). The predictive performance of temporal deep learning models long short-term memory (LSTM) and simple recurrent neural networks (Simple RNN) are compared against non-temporal models multilayer perceptron (MLP), ridge classifier (RC) and logistic regression (LR). Further, the study investigates the effect of lengthening the observation window on the task of adherence prediction.
Results
Temporal models that use sequential data outperform non-temporal models, with LSTM producing the best predictive performance achieving a ROC AUC of 0.805. A performance gap is observed between models that can discover non-linear interactions between predictor variables and their linear counter parts, with neural network (NN) based models significantly outperforming linear models. Additionally, the predictive advantage of temporal models become more pronounced when the length of the observation window is increased.
Conclusion
The findings of the study provide evidence that using deep temporal models to integrate patient history in adherence prediction is advantageous. In particular, the RNN architecture LSTM significantly outperforms all other model comparators.
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22
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Grzyb K, Meresińska M, Religioni U, Juszczyk G, Płaczek J, Neumann-Podczaska A, Szymański FM, Chełstowska B, Wieczorowska-Tobis K, Cofta S, Tobis S, Staszewski R, Vaillancourt R, Majewski R, Hernik J, Fehir Sola K, Blicharska E, Kaźmierczak J, Rutkowska E, Prygiel E, Skierska M, Nawara M, Korbiewska I, Krysiński J, Merks P. Implementation of the Patient Counselling Service at the Cancer Hospital in Radom, Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13642. [PMID: 36294222 PMCID: PMC9602852 DOI: 10.3390/ijerph192013642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
Background: Non-adherence occurs in various groups of patients, including those with chronic diseases. One strategy to increase adherence among oncological patients is to individualise treatment and expand pharmaceutical care. Pharmaceutical labels that remind patients how they should take their medications are of great importance in this respect. Objective: The main objective of this study was to evaluate medication adherence in oncological patients, and to gather their opinions on the individual medication labelling system as an element of effective treatment. Methods: The study was conducted in 2021 among 82 patients of the oncological department of the Centre of Oncology in Radom. The research tool was a questionnaire consisting of personal data and two parts relating to the patient's disease and the medication labelling system. Results: Nearly half of the respondents reported that they forget to take medications and how they should take them. These problems increased with the age of the patient and the number of administered medications. Of the respondents, 89% stated that the labels with dosing information are helpful. Over 67% agreed that these labels should be affixed to all medications. Nearly 90% of the respondents believed the labels should be available in all pharmacies. Conclusions: Non-adherence is a common phenomenon among oncological patients. Pharmacists providing a labelling service for medicinal products can play a significant role in reducing this phenomenon.
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Affiliation(s)
- Katarzyna Grzyb
- Radom Oncology Center im, Bohaterów Radomskiego Czerwca 76′, 26-600 Radom, Poland
| | - Martyna Meresińska
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, 85-089 Bydgoszcz, Poland
| | - Urszula Religioni
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, Kleczewska 61/63, 01-826 Warsaw, Poland
| | - Grzegorz Juszczyk
- Department of Public Health, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Jakub Płaczek
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, 85-089 Bydgoszcz, Poland
| | | | - Filip M. Szymański
- Department of Civilization Diseases, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland
| | - Beata Chełstowska
- Department of Biochemistry and Laboratory Diagnostics, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland
| | - Katarzyna Wieczorowska-Tobis
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland
- Heliodor Swiecicki Clinical Hospital in Poznan, 60-355 Poznan, Poland
| | - Szczepan Cofta
- Heliodor Swiecicki Clinical Hospital in Poznan, 60-355 Poznan, Poland
- Department of Pulmonology, Allergology and Respiratory Oncology, Poznan University of Medical Sciences, 60-569 Poznan, Poland
| | - Sławomir Tobis
- Department of Pulmonology, Allergology and Respiratory Oncology, Poznan University of Medical Sciences, 60-569 Poznan, Poland
- Department of Occupational Therapy, Poznan University of Medical Sciences, 60-781 Poznan, Poland
| | - Rafał Staszewski
- Department of Hypertension, Angiology and Internal Medicine, Poznan University of Medical Sciences, 61-848 Poznań, Poland
| | - Regis Vaillancourt
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warszawa, Poland
| | - Rafał Majewski
- Radom Oncology Center im, Bohaterów Radomskiego Czerwca 76′, 26-600 Radom, Poland
| | - Justyna Hernik
- Radom Oncology Center im, Bohaterów Radomskiego Czerwca 76′, 26-600 Radom, Poland
| | | | - Eliza Blicharska
- Department of Analytical Chemistry, Medical University of Lublin, Chodźki 4a, 20-093 Lublin, Poland
| | | | - Ewa Rutkowska
- Radom Oncology Center im, Bohaterów Radomskiego Czerwca 76′, 26-600 Radom, Poland
| | - Elżbieta Prygiel
- Radom Oncology Center im, Bohaterów Radomskiego Czerwca 76′, 26-600 Radom, Poland
| | - Monika Skierska
- Radom Oncology Center im, Bohaterów Radomskiego Czerwca 76′, 26-600 Radom, Poland
| | - Monika Nawara
- Radom Oncology Center im, Bohaterów Radomskiego Czerwca 76′, 26-600 Radom, Poland
| | - Izabela Korbiewska
- Rehabilitation Faculty of Medical Sciences, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland
| | - Jerzy Krysiński
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, 85-089 Bydgoszcz, Poland
| | - Piotr Merks
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warszawa, Poland
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23
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Syafhan NF, Donnelly R, Harper R, Harding J, Mulligan C, Hogg A, Scott M, Fleming G, Scullin C, Hawwa AF, Chen G, Parsons C, McElnay JC. Adherence to metformin in adults with type 2 diabetes: a combined method approach. J Pharm Policy Pract 2022; 15:61. [PMID: 36224634 PMCID: PMC9554867 DOI: 10.1186/s40545-022-00457-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background Medication adherence, one of the most important aspects in the process of optimal medicines use, is unfortunately still a major challenge in modern healthcare, and further research is required into how adherence can be assessed and optimised. The aim of this study was to use a combined method approach of self-report and dried blood spot (DBS) sampling coupled with population pharmacokinetic (PopPK) modelling, to assess adherence to metformin in adult patients with type 2 diabetes. Further aims were to assess metformin exposure levels in patients, determine factors associated with non-adherence with prescribed metformin, and to explore the relationship between adherence and therapeutic outcomes. Methods A combined method approach was used to evaluate metformin adherence in patients with type 2 diabetes who had been prescribed metformin for a minimum period of 6 months. Patients were recruited from consultant-led diabetic outpatient clinics at three hospitals in Northern Ireland, UK. Data collection involved self-reported questionnaires [Medication Adherence Report Scale (MARS), Beliefs about Medicines Questionnaire and Centre for Epidemiologic Studies Depression Scale], direct measurement of metformin concentration in DBS samples, and researcher-led patient interviews. The DBS sampling approach was coupled with population pharmacokinetic (PopPK) modelling, which took account of patient characteristics, metformin dosage and type of formulation prescribed (immediate or sustained release). Results The proportion of patients considered to be adherent to their prescribed metformin, derived from self-reported MARS scores and metformin concentration in DBS samples, was 61.2% (74 out of 121 patients). The majority (n = 103, 85.1%) of recruited patients had metformin exposure levels that fell within the therapeutic range. However, 17 patients (14.1%) had low exposure to metformin and one patient (0.8%) had undetectable metformin level in their blood sample (non-exposure). Metformin self-administration and use of a purchased adherence pill box significantly increased the probability of a patient being classified as adherent based on logistic regression analysis. Both HbA1c and random glucose levels (representing poor glycaemic control) in the present research were, however, not statistically linked to non-adherence to metformin (P > 0.05). Conclusions A significant proportion of participating patients were not fully adherent with their therapy. DBS sampling together with the use of a published PopPK model was a useful, novel, direct, objective approach to estimate levels of adherence in adult patients with type 2 diabetes (61.2%). Supplementary Information The online version contains supplementary material available at 10.1186/s40545-022-00457-5.
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Affiliation(s)
- Nadia Farhanah Syafhan
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK.,Department of Clinical Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok, Indonesia
| | - Rosemary Donnelly
- Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, UK
| | - Roy Harper
- Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, UK
| | - Janet Harding
- Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, UK
| | - Ciara Mulligan
- Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, UK
| | - Anita Hogg
- Medicines Optimisation Innovation Centre, Northern Health Social Care Trust, Antrim, Northern Ireland, UK
| | - Michael Scott
- Medicines Optimisation Innovation Centre, Northern Health Social Care Trust, Antrim, Northern Ireland, UK
| | - Glenda Fleming
- Medicines Optimisation Innovation Centre, Northern Health Social Care Trust, Antrim, Northern Ireland, UK
| | - Claire Scullin
- Medicines Optimisation Innovation Centre, Northern Health Social Care Trust, Antrim, Northern Ireland, UK
| | - Ahmed F Hawwa
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK.,School of Biological Sciences. Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Gaoyun Chen
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Carole Parsons
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - James C McElnay
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK.
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24
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Lim GN, Allen JC, Tiew PY, Chen W, Koh MS. Healthcare utilisation and health-related quality of life of severe asthma patients in Singapore. J Asthma 2022; 60:969-980. [PMID: 35972821 DOI: 10.1080/02770903.2022.2114086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BackgroundNotwithstanding unequivocal consensus on the disproportionate effect of severe asthma (SA) on asthma morbidity, healthcare utilisation, quality of life, work impairment and socioeconomic burden, the burden of SA patients in Singapore has not been appraised.ObjectivesTo determine the burden of disease and extent of quality of life impairment in SA patients in Singapore.MethodsA cross-sectional analysis of SA patients seen in Singapore General Hospital (2020-2021) to investigate emergency healthcare utilization, oral corticosteroid (OCS) burden and health-related quality of life (HRQoL) with primary endpoint EuroQoL-5 Dimension three-level (EQ-5D-3L) scores. The empirical measurement properties of the EQ-5D utility index in SA were comprehensively assessed through multivariate regression analyses.ResultsA total of 336 SA patients were recruited, 51.2% of SA patients had at least one acute healthcare resource utilization during the previous year, with 25.6% of patients having an emergency healthcare visit to the hospital. Overall mean (SD) EQ-5D-3L and EQ-5D-3L utility scores in SA patients were 6.22 (1.51) and 0.77 (0.30), respectively. EQ-5D utility scores were 0.14 lower in uncontrolled vs controlled asthma and 0.09 lower in the presence of severe exacerbation, whereas barely changed by maintenance OCS dose and airflow limitation.ConclusionSA patients were found to have high disease burden, high healthcare resource utilization and OCS use, low biologics usage, poor HRQoL and utility in comparison with other chronic diseases.
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Affiliation(s)
| | | | - Pei Yee Tiew
- Duke-NUS Medical School, Singapore.,Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Wenjia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Mariko Siyue Koh
- Duke-NUS Medical School, Singapore.,Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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25
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Alosaimi K, Alwafi H, Alhindi Y, Falemban A, Alshanberi A, Ayoub N, Alsanosi S. Medication Adherence among Patients with Chronic Diseases in Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610053. [PMID: 36011690 PMCID: PMC9408114 DOI: 10.3390/ijerph191610053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/06/2022] [Accepted: 08/11/2022] [Indexed: 05/28/2023]
Abstract
Introduction: The management of chronic illnesses commonly includes a long-term pharmacological approach. Although these medications effectively control disease, their full benefits are often not realized because approximately 50% of patients do not take their medications as prescribed. Medication adherence has become a big concern to clinicians and healthcare systems in Saudi Arabia and worldwide because of growing evidence associating nonadherence with adverse outcomes and higher costs of care. Despite it being a well-recognized problem, few studies have investigated medication adherence in Saudi Arabia. Therefore, this study aims to gain a better perspective on medication adherence among patients with chronic diseases in Saudi Arabia. Method: A questionnaire-based cross-sectional study was conducted among patients with chronic diseases in the Makkah region, Saudi Arabia, from 1 May to 31 July 2021. Patients aged 18 years and above who were taking prescribed or over-the-counter medications were included. Descriptive statistics were used to describe the participants’ characteristics, and categorical variables were reported as frequencies and percentages. A Chi-square test was used to test the relations between variables. Results: In total, 239 participants were included in the study. Females represented 62% of the participants. In terms of the history of chronic diseases, 44% had hypertension, 40% had diabetes mellitus, 21% had heart diseases and 9% had asthma. Nearly half (49%) of participants did not follow up regularly with a primary healthcare center and 42% said that they had forgotten to take their medications in the past. However, most of the participants (78%) stated that they took their medicine as instructed by their doctor or pharmacist, and 61% took their medications on time. The majority of participants (85%) said that the pharmacist explained the method of using the medications and the instructions for use, while 30% thought that the medications they took were too much. In regard to the reasons for medication nonadherence, having no specific reasons for medication nonadherence was the most common cause for nonadherence in our study. The relationship between patients taking medications as instructed by a healthcare provider (the doctor or pharmacist) and the healthcare provider giving clear instructions to patients about medication use was significant (p < 0.001). Conclusions: Failure to adhere is a significant problem that not only affects the patient but also the healthcare system. Additional research is needed to monitor medication adherence and identify factors contributing to this problem to provide successful strategies to improve medication adherence in Saudi Arabia.
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Affiliation(s)
- Khulud Alosaimi
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
- Pharmacy Department, King Faisal Medical Complex, Taif 26514, Saudi Arabia
| | - Hassan Alwafi
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Yosra Alhindi
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Alaa Falemban
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
- Saudi Toxicology Society, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Asim Alshanberi
- Department of Community Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Nahla Ayoub
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
- Saudi Toxicology Society, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Safaa Alsanosi
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK
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26
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Tibble H, Sheikh A, Tsanas A. Estimating Medication Adherence from Electronic Health Records Using Rolling Averages of Single Refill-based Estimates. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:3554-3557. [PMID: 36086002 DOI: 10.1109/embc48229.2022.9871486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Medication adherence is usually defined as the manner in which a patient takes their medication, in relation to the regimen agreed to with their healthcare provider. Electronic Health Records (EHRs) can be used to estimate adherence in a cost-effective and non-invasive manner across large-scale populations, although there is no universally agreed optimal approach to doing so. We sought to explore patterns of asthma ICS prescription refills in a large EHR dataset, and to evaluate the use of rolling-average based measures towards short-term adherence estimation. Over 1.6 million asthma controllers were prescribed for our cohort of 91,332 individuals, between January 2009 and March 2017. The Continuous Single interval measures of medication Availability (CSA) and Gaps (CSG) were calculated for individual prescriptions, as well as rolling-average adherence measures of the CSA over 3, 5, or 10 past prescription intervals. 16.7% of the study population had only a single prescription during their follow-up (a median duration of 7.1 years). 51% of prescriptions were refilled before (or on the day that) supply was exhausted, and for 19% of prescription refills, the amount of medication dispensed should have lasted at least twice as long as the duration before the next refill was filled. The rolling average measures had statistically strong associations (Spearman |R|>0.7) with the estimate for the subsequent prescription refill. Rolling averages of multiple individual refill-level adherence estimates provide a novel and simple way to crudely smoothen estimates from individual prescription refills, which are strongly influenced by common (and adherent) real-world behaviors, for more meaningful and effective trend detection. Clinical Relevance- This demonstrates a novel methodology for estimating medication adherence which can detect recent changes in trends.
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27
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Effects of a nurse-led medication self-management intervention on medication adherence and health outcomes in older people with multimorbidity: A randomised controlled trial. Int J Nurs Stud 2022; 134:104314. [DOI: 10.1016/j.ijnurstu.2022.104314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/27/2022]
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28
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Serhal S, Armour C, Billot L, Krass I, Emmerton L, Saini B, Bosnic-Anticevich S, Bereznicki B, Bereznicki L, Shan S, Campain A. Integrating Pharmacy and Registry Data Strengthens Clinical Assessments of Patient Adherence. Front Pharmacol 2022; 13:869162. [PMID: 35401235 PMCID: PMC8990834 DOI: 10.3389/fphar.2022.869162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Accurate clinical assessment of patient adherence using reliable and valid measures is essential in establishing the presence of adherence issues and support practices for pharmacists.Objective: This investigation aims to conduct a novel assessment of patient adherence to asthma controller therapy by combining 1) patient-specific dosage data found in pharmacy dispensing data with 2) centrally collected administrative claims records, to determine the added value of using both sources of data.Methods: A total of 381 clinically uncontrolled asthma patients, from 95 community pharmacies across three Australian States were recruited and provided consent for the retrieval of their claims records and pharmacy dispensing data. Patients were stratified as multiple or single pharmacy users and adherence scores were calculated via the proportion of days covered (PDC) method using 1) patient claims records, 2) patient pharmacy dispensing data, and 3) combined claims records and pharmacy dispensing data. Cohort and subgroup adherence estimates were then compared.Results: Low levels of adherence were evident amongst the cohort irrespective of the data source used. PDC estimates based on claims records alone or combined claims records and pharmacy dispensing data were significantly higher than estimates based on pharmacy dispensing data for the total cohort (56%, 52%, 42% respectively, p < 0.001) and more noticeably for multiple pharmacy users (67%, 64%, 35% respectively, p < 0.001). PDC estimates based on combined claims records and pharmacy dispensing data were significantly lower than estimates based on claims records alone, indicating that perhaps standard daily dose is not a robust proxy for prescribed dosage to inhaled respiratory devices in adherence approximations. Poorer adherence was found amongst single pharmacy users than multiple pharmacy users when combined claims records and pharmacy dispensing data (46% compared to 64% respectively, p < 0.001) or claims records alone (51% compared to 67% respectively, p < 0.001) were compared.Conclusion: Access to routine collected data increases clinical acuity over patient adherence to asthma controller medications and is a valuable resource for health care professionals. A policy of secure accessibility of such data at the patient-pharmacist or patient-GP interface may allow real-time intervention and assist in decision making across numerous therapeutic areas.
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Affiliation(s)
- Sarah Serhal
- Woolcock Institute of Medical Research, Sydney, NSW, Australia
- School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
- *Correspondence: Sarah Serhal,
| | - Carol Armour
- Woolcock Institute of Medical Research, Sydney, NSW, Australia
- Central Sydney Area Health Service, Sydney, NSW, Australia
| | - Laurent Billot
- The George Institute, Newtown, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Ines Krass
- School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Lynne Emmerton
- Curtin Medical School, Curtin University, Perth, WA, Australia
| | - Bandana Saini
- Woolcock Institute of Medical Research, Sydney, NSW, Australia
- School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, Sydney, NSW, Australia
- Central Sydney Area Health Service, Sydney, NSW, Australia
| | | | - Luke Bereznicki
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
| | - Sana Shan
- The George Institute, Newtown, NSW, Australia
| | - Anna Campain
- The George Institute, Newtown, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Zaeh SE, Ramsey R, Bender B, Hommel K, Mosnaim G, Rand C. The Impact of Adherence and Health Literacy on Difficult-to-Control Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:386-394. [PMID: 34788658 DOI: 10.1016/j.jaip.2021.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/25/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022]
Abstract
Medication nonadherence and health literacy are key factors that influence the management of difficult-to-control asthma. Adherence, or the extent to which a patient follows a treatment plan, extends beyond asthma medication use and includes an appropriate inhaler technique. Assessment of adherence is critical before making a diagnosis of severe asthma and stepping up asthma therapy but is challenging in the clinical context. Health literacy, or the degree to which individuals can obtain, process, and understand health information and services needed to make health care decisions, is additionally important for asthma management and has been shown to impact medication adherence. Initiatives aiming to improve difficult-to-control asthma should address medication adherence and health literacy. Universal health literacy precautions are recommended while communicating with patients, in addition to the creation of low health literacy asthma action plans. To improve adherence, a comprehensive assessment of adherence should be conducted. Additional evidence-based interventions aiming to improve adherence focus on appropriate inhaler use, improved access to medications, the use of digital platforms, school-based asthma interventions, and the implementation of culturally tailored interventions. Data are limited regarding the use of these initiatives in patients with severe or difficult-to-control asthma.
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Affiliation(s)
- Sandra E Zaeh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Conn.
| | - Rachelle Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Bruce Bender
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | - Kevin Hommel
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Giselle Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University Health System, Evanston, Ill
| | - Cynthia Rand
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Md
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Backes C, Moyano C, Rimaud C, Bienvenu C, Schneider MP. Digital Medication Adherence Support: Could Healthcare Providers Recommend Mobile Health Apps? FRONTIERS IN MEDICAL TECHNOLOGY 2022; 2:616242. [PMID: 35047896 PMCID: PMC8757821 DOI: 10.3389/fmedt.2020.616242] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/29/2020] [Indexed: 11/13/2022] Open
Abstract
Adherence to prescribed medication is suboptimal in 50% of the chronic population, resulting in negative medical and economic outcomes. With the widespread use of mobile phones worldwide, medication adherence apps for mobile phones become promising medication adherence aids thanks to simplicity, user-friendliness, and accessibility for the public. Yet, until today, there is insufficient evidence in favor of using mobile health (mHealth) apps to increase medication adherence. This study aims to develop a methodology for scientific and end-user (patient) mHealth evaluation (a) to identify medication adherence apps search terms, (b) to evaluate identified apps based on scientific criteria, and (c) to report best smartphone apps evaluated by patients. Search terms were identified via literature review and expertise. Firstly, an online questionnaire was developed to identify frequently used search terms by recruited patients. Related medication adherence apps were identified and selected using predefined inclusion criteria. Secondly, identified apps were evaluated thanks to a scientific evaluation method and a created online questionnaire for patient feedback. Recruited patients were invited to test and evaluate the selected apps. Out of 1,833 free-of-charge and 307 paid apps identified, only four free-of-charge and three paid apps remained included in the study after eligibility criteria. None of the selected app reached a high score. Looking at the overall scores, Medisafe (59%), MyTherapy (56%), and Meds on time (44%) received the highest scores in the scientific app evaluation. In the patient evaluation, Dosecast (3.83 out of five points), Medisafe (3.62), and SwissMeds (3.50) received the highest scores. None of the apps in this research has undergone a process for certification, for example, CE marking, through a notified body. Security and data protection aspects of existing apps highly contribute to these low evaluation scores through little information on patient's data processing and storage. This might be corrected through the introduction of General Data Protection Regulation (GDPR) in the European Economic Area (EEA) and more scrutiny through regulatory bodies in the EU/EEA and the USA. None of the applications should be recommended by healthcare providers. In addition, clinical studies with chronic patients are necessary to measure long-term app impacts.
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Affiliation(s)
- Claudine Backes
- Lab of Medication Adherence and Interprofessionality, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Carla Moyano
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Camille Rimaud
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Christine Bienvenu
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Marie P Schneider
- Lab of Medication Adherence and Interprofessionality, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.,Pharma24, An Academic Community Pharmacy and Living Lab Located at the Exit of the Geneva University Hospitals, Geneva, Switzerland
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Delta T, a Useful Indicator for Pharmacy Dispensing Data to Monitor Medication Adherence. Pharmaceutics 2022; 14:pharmaceutics14010103. [PMID: 35056999 PMCID: PMC8778707 DOI: 10.3390/pharmaceutics14010103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Calculating patients' medication availability from dispensing or refill data is a common method to estimate adherence. The most often used measures, such as the medication possession ratio (MPR), average medication supplies over an arbitrary period. Averaging masks the variability of refill behavior over time. GOAL To derive a new absolute adherence estimate from dispensing data. METHOD Dispensing histories of patients with 19 refills of direct oral anticoagulants (DOAC) between 1 January 2008 and 31 December 2017 were extracted from 39 community pharmacies in Switzerland. The difference between the calculated and effective refill day (ΔT) was determined for each refill event. We graphed ΔT and its dichotomized version (dΔT) against the MPR, calculated mean ΔT and mean dΔT per refill, and applied cluster analysis. RESULTS We characterized 2204 refill events from 116 DOAC patients. MPR was high (0.975 ± 0.129) and showed a positive correlation with mean ΔT. Refills occurred on average 17.8 ± 27.9 days "too early", with a mean of 75.8 ± 20.2 refills being "on time". Four refill behavior patterns were identified including constant gaps within or at the end of the observation period, which were critical. CONCLUSION We introduce a new absolute adherence estimate ΔT that characterizes every refill event and shows that the refill behavior of DOAC patients is dynamic.
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Medeiros GCD, Silva GAD, Asano NMJ, Coriolano MDGWDS. Antiparkinson drugs use and adherence in older adults and associated factors: an integrative review. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2022. [DOI: 10.1590/1981-22562022025.220131.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Abstract Objectives To identify factors associated with antiparkinson drugs use and adherence in older adults with Parkinson's disease (PD) through an integrative literature review. Method An integrative literature review involving a search for relevant publications in Portuguese, English, and Spanish on the electronic databases LILACS, MEDLINE - via PubMed, Web of Science and Scopus, without restriction regarding date or study design, was carried out during the period August-September 2021. The selection of studies was performed independently by two reviewers and the final validation conducted by a third reviewer. Results After applying the eligibility criteria, 5 of the 460 studies found were included in the review. Results showed moderate adherence rates (range 35.3-66.8%) and the main factors associated with lower adherence to antiparkinson therapy were older age, cognitive deficit, greater motor impairment, multimorbidities, change in therapy regimens, depression, polypharmacy, lower education, non-white ethnicity and male gender. Factors associated with greater adherence were younger age, white ethnicity, no change in therapy regimen, higher level of knowledge about PD, good clinical control, higher educational level, married status, higher income and greater level of awareness. Conclusions Non-adherence to antiparkinsonian therapy was frequent and multifactorial., Understanding this behavior is important to help inform the scientific community and devise public policies and strategic planning in health services for improving the quality of life of the older population.
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Forma F, Chiu K, Shafrin J, Boskovic DH, Veeranki SP. Are caregivers ready for digital? Caregiver preferences for health technology tools to monitor medication adherence among patients with serious mental illness. Digit Health 2022; 8:20552076221084472. [PMID: 35295765 PMCID: PMC8918958 DOI: 10.1177/20552076221084472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/14/2022] [Indexed: 01/23/2023] Open
Abstract
Background Adherence to antipsychotic medication is critical for bipolar disorder (BPD), major depression (MDD) and schizophrenia (SCZ) patients. Digital tools have emerged to monitor medication adherence along with tracking general health. Evidence on physician or patient preferences for such tools exists but is limited among caregivers. The study objective was to assess preferences and willingness-to-pay (WTP) for medication adherence monitoring tools among caregivers of SMI patients. Methods A web-based survey was administered to caregivers of adult SMI patients. Twelve discrete choice questions comparing adherence monitoring tools that varied across two attribute bundles: (1) tool attributes including source of medication adherence information, frequency of information updates, access to adherence information, and physical activity, mood, and rest tracking, and (2) caregiver monthly out-of-pocket cost attribute were administered to caregiver respondents. Attributes were parameterized for both digital and non-digital tools. Random utility models were used to estimate caregivers’ preferences and WTP. Results Among 184 study-eligible caregivers, 57, 61 and 66 participants cared for BPD, MDD, and SCZ patients, respectively. Caregivers highly preferred (odds ratio (OR): 7.34, 95% confidence interval (CI): 5.00–10.79) a tool that tracked medication ingestion using a pill embedded with an ingestible event market (IEM) sensor and tracked patients’ physical activity, mood, and rest than a non-digital pill organizer. Additionally, caregivers were willing to pay $255 per month (95% CI: $123–$387) more for this tool compared to a pill organizer. Conclusion Caregivers of SMI patients highly preferred and were willing to pay more for digital tools that not only measures medication ingestion but also tracks general health.
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Medeiros GCD, Silva GAD, Asano NMJ, Coriolano MDGWDS. Adesão terapêutica ao uso de antiparkinsonianos em pessoas idosas e seus fatores associados: revisão integrativa. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2022. [DOI: 10.1590/1981-22562022025.220131.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Resumo Objetivos Identificar os fatores associados à adesão terapêutica ao uso de antiparkinsonianos em idosos com Doença de Parkinson (DP) por meio de uma revisão integrativa da literatura. Método Trata-se de uma revisão integrativa de literatura nos idiomas português, inglês, espanhol, nas bases de dados eletrônicas LILACS, MEDLINE - via PubMed, Web of Science e Scopus, sem restrição quanto ao tempo e desenho de estudo, realizada no período de agosto a setembro de 2021. A seleção dos estudos foi realizada de maneira independente por dois revisores e a validação final por um terceiro revisor. Resultados Após a aplicação dos critérios de elegibilidade, dos 460 estudos encontrados, foram incluídos cinco estudos que evidenciam taxas moderadas de adesão, variando de 35,3% a 66,8%, e apontam como principais fatores associados à menor adesão à terapia antiparkinsoniana: idade mais avançada, deficit cognitivo, maior comprometimento motor, multimorbidades, alteração nos regimes terapêuticos, depressão, polifarmácia, menor escolaridade, não brancos e sexo masculino. Foram fatores descritos para maior adesão: idade mais jovem, cor branca, sem modificação de regime terapêutico, maior nível de conhecimento sobre a DP, bom controle clínico, educação, ser casado, maior renda e nível de consciência. Conclusões A não adesão à terapêutica antiparkinsoniana é frequente e de dimensão multifatorial, sua compreensão torna-se relevante para subsidiar dados para a comunidade científica, objetivando a criação de políticas públicas e planejamento estratégico em serviços de saúde com o propósito de melhorar a qualidade de vida da pessoa idosa.
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Pill Counting as an Intervention to Enhance Compliance and Reduce Adverse Outcomes with Analgesics Prescribed for Chronic Pain Conditions: A Systematic Review. Curr Pain Headache Rep 2022; 26:883-887. [PMID: 36459370 PMCID: PMC9716148 DOI: 10.1007/s11916-022-01091-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE OF REVIEW Appropriate use of opioid analgesics is a key concern within the field of pain medicine. Several methods exist to discourage abuse and facilitate effective treatment regimens. Pill counting is often cited as one such method and frequently employed in varying fashions within clinical practice. However, to date, there is no published review of the evidence to support this practice. This was a comprehensive review of the available literature that was conducted with analysis of the efficacy and practical application of pill counting during treatment of chronic pain conditions. RECENT FINDINGS There is paucity in data regarding pill count importance in pain management. Pill count is a very important tool to monitor compliance of opioids use which in turn can prevent several complications associated with opioid misuse. Pill counting may be used in conjunction with other abuse deterrents, although increased support for this practice requires standardized methods of pill counting and further analysis of its effectiveness.
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Estimating proportion of days covered (PDC) using real-world online medicine suppliers' datasets. J Pharm Policy Pract 2021; 14:113. [PMID: 34965882 PMCID: PMC8715592 DOI: 10.1186/s40545-021-00385-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The proportion of days covered (PDC) is used to estimate medication adherence by looking at the proportion of days in which a person has access to the medication, over a given period of interest. This study aimed to adapt the PDC algorithm to allow for plausible assumptions about prescription refill behaviour when applied to data from online pharmacy suppliers. METHODS Three PDC algorithms, the conventional approach (PDC1) and two alternative approaches (PDC2 and PDC3), were used to estimate adherence in a real-world dataset from an online pharmacy. Each algorithm has different denominators and increasing levels of complexity. PDC1, the conventional approach, is the total number of days between first dispensation and a defined end date. PDC2 counts the days until the end of supply date. PDC3 removes from the denominator specifically defined large gaps between refills, which could indicate legitimate reasons for treatment discontinuation. The distribution of the three PDCs across four different follow-up lengths was compared. RESULTS The dataset included people taking ACE inhibitors (n = 65,905), statins (n = 100,362), and/or thyroid hormones (n = 30,637). The proportion of people taking ACE inhibitors with PDC ≥ 0.8 was 50-74% for PDC1, 81-91% for PDC2, and 86-100% for PDC3 with values depending on drug and length of follow-up. Similar ranges were identified in people taking statins and thyroid hormones. CONCLUSION These algorithms enable researchers and healthcare providers to assess pharmacy services and individual levels of adherence in real-world databases, particularly in settings where people may switch between different suppliers of medicines, meaning an individual supplier's data may show temporary but legitimate gaps in access to medication. Accurately identifying problems with adherence provides the foundation for opportunities to improve experience, adherence and outcomes and to reduce medicines wastage. Research with people taking medications and prescribers is required to validate the algorithms' assumptions.
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Clinical trial considerations in sickle cell disease: patient-reported outcomes, data elements, and the stakeholder engagement framework. Hematology 2021; 2021:196-205. [DOI: 10.1182/hematology.2021000252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Patients with sickle cell disease (SCD) have significant impairment in their quality of life across the life span as a consequence of serious disease burden with several SCD-related complications. A number of disease-modifying therapies are currently available, yet long-term clinical benefits in real-world settings remain unclear. Over the past few years, a number of important initiatives have been launched to optimize clinical trials in SCD in different ways, including: (1) established panels through a partnership between the American Society of Hematology (ASH) and the US Food and Drug Administration; (2) the ASH Research Collaborative SCD Clinical Trials Network; (3) the PhenX Toolkit (consensus measures for Phenotypes and eXposures) in SCD; and (4) the Cure Sickle Cell Initiative, led by the National Heart, Lung, and Blood Institute. Electronic patient-reported outcomes assessment is highly recommended, and patient-reported outcomes (PROs) should be evaluated in all SCD trials and reported using Standard Protocol Items Recommendations for Interventional Trials guidelines. Patient-centered outcomes research (PCOR) approaches and meaningful stakeholder engagement throughout the process have the potential to optimize the execution and success of clinical trials in SCD with considerable financial value. This article reviews several clinical trial considerations in SCD related to study design and outcomes assessment as informed by recent initiatives as well as patient-centered research approaches and stakeholder engagement. A proposed hematology stakeholder-engagement framework for clinical trials is also discussed.
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Wuyts J, Maesschalck J, Hamelinck W, De Wulf I, Foulon V. Does a pharmacist-led medication use review improve medication adherence in polymedicated aged patients? Methodological choices matter! J Eval Clin Pract 2021; 27:1343-1352. [PMID: 33760376 DOI: 10.1111/jep.13567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The rise in chronic diseases urges for an identification of interventions that improve adherence. However, no golden standard exists for evaluating adherence in polymedicated patients. The objectives were to investigate the impact of a pharmacist-led medication use review (MUR) service on adherence implementation rates for chronic medication, and to evaluate the appropriateness of two adherence calculation approaches in this regard. METHOD Before-after study (SIMENON study) including ambulatory, aged, polymedicated patients. Refill data were used to calculate the proportion of days covered (PDC) per medication before and after the MUR. Adherence was assessed for chronic, solid, oral medication using a prescription-based and interval-based approach, and the performance of both approaches was compared. RESULTS Adherence was evaluated for 1483 medications from 316 patients. The median baseline PDC per medication was 0.95 (prescription-based method) and 0.91 (interval-based approach). Pearson correlation between both approaches was 0.616 (P < .0001). The prescription-based approach found less medication below the adherence threshold of 0.80 (319 medications; 21.5% vs 481 medications; 32.4%). Using the prescription-based approach, the proportion of non-adherent patients at baseline was 61.7% (195/316 patients), of which 54.9% (107/195 patients) was only non-adherent for one medication. Median PDC scores increased significantly from 0.95 to 0.99 and 0.91 to 0.99 with the prescription-based and interval-based approach respectively (both P < .0001). Only considering the 319 medications with baseline PDC scores <0.8 using the prescription-based approach, the median PDC scores significantly increased from 0.67 to 0.84 (P < .0001), with a median score improvement of 18.3%. CONCLUSIONS Although baseline adherence was high in this population of polymedicated aged patients, both calculation methods showed the MUR significantly improved adherence. The prescription-based approach was considered the most appropriate method. Based on these findings and literature evidence, it is recommended to implement the MUR service in Belgium and target non-adherent patients for maximal effect.
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Affiliation(s)
- Joke Wuyts
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | | | | | | | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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Lasala R, Santoleri F. Association between adherence to oral therapies in cancer patients and clinical outcome: A systematic review of the literature. Br J Clin Pharmacol 2021; 88:1999-2018. [PMID: 34784654 DOI: 10.1111/bcp.15147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 01/23/2023] Open
Abstract
AIMS Adherence to therapy is a key factor in successful treatment. The aim of this systematic review is to assess the extent to which patients with better adherence to oral therapy have better clinical outcomes among cancer patients. METHODS All studies published in PubMed up to 20 October 2020, which considered the use of oral anticancer drugs for cancer patients and which correlated treatment adherence with a clinical outcome, were considered. RESULTS From the 42 studies considered in the systematic review, 14 were for oncological indications and 28 for haematological indications. There was considerable variance in calculation methods, outcomes considered, and in the definitions of adherence. However, it emerged that most studies reported a significant correlation between adherence to therapy and clinical outcome. CONCLUSION As adherence to therapy is a key factor in achieving a better clinical outcome, future studies with large samples, robust endpoints and the use of at least two methods of assessing adherence would be desirable in order to produce more robust evidence.
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DeMatteo CA, Lin CYA, Foster G, Giglia L, Thabane L, Claridge E, Noseworthy MD, Hall GB, Connolly JF. Evaluating Adherence to Return to School and Activity Protocols in Children After Concussion. Clin J Sport Med 2021; 31:e406-e413. [PMID: 31876794 DOI: 10.1097/jsm.0000000000000800] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 02/13/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The need to have a pediatric-specific concussion management protocol on Return to School (RTS) and Return to Activity (RTA) after concussion has been recognized internationally. The first step to evaluate the protocol effectiveness is to establish whether children and youth are adhering to these recommendations. The objective of this study was to explore the prevalence and predictors of adherence to RTS and RTA concussion management protocols for children/youth. DESIGN A prospective cohort of children/youth with concussion. SETTING Childhood Disability Research Centre. PARTICIPANTS One hundred thirty-nine children/youth aged 5 to 18 years, diagnosed with concussion and symptomatic upon enrollment, were followed for up to 6 months. Primary recruitment occurred from a Children's Hospital Emergency Department. INTERVENTION Provision of RTS/RTA guidelines. MAIN OUTCOME MEASURES Measurement of adherence came from multiple sources, including the child's and parent's knowledge of protocols, research personnel evaluations, and self-reported stages of RTS/RTA and Post-Concussion Symptom Scale (PCSS) scores. RESULTS Spearman correlations and logistic regression were used, investigating the relationship between PCSS and progression of protocols and determining predictors of adherence. Significant negative associations between total PCSS score and stage of RTS/RTA protocols were found. Fifty-three percent and 56% of the participants adhered to the RTS and RTA protocols, respectively. CONCLUSIONS Children's knowledge of protocols and total PCSS scores significantly predicted adherence to RTS/RTA and may be the most important factors in predicting adherence during recovery from concussion.
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Affiliation(s)
- Carol A DeMatteo
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Chia-Yu A Lin
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
- ARiEAL, Centre for Advanced Research in Experimental and Applied Linguistics, McMaster University, Hamilton, Ontario, Canada
| | - Gary Foster
- Biostatistics Unit, The Research Institute, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada; and
| | - Lucia Giglia
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Biostatistics Unit, The Research Institute, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada; and
| | - Everett Claridge
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Michael D Noseworthy
- McMaster School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
- Imaging Research Centre, St. Joseph's Healthcare, Hamilton, ON, Canada
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON, Canada
| | - Geoffrey B Hall
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada; and
| | - John F Connolly
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
- ARiEAL, Centre for Advanced Research in Experimental and Applied Linguistics, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada; and
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Babel A, Taneja R, Mondello Malvestiti F, Monaco A, Donde S. Artificial Intelligence Solutions to Increase Medication Adherence in Patients With Non-communicable Diseases. Front Digit Health 2021; 3:669869. [PMID: 34713142 PMCID: PMC8521858 DOI: 10.3389/fdgth.2021.669869] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/04/2021] [Indexed: 11/30/2022] Open
Abstract
Artificial intelligence (AI) tools are increasingly being used within healthcare for various purposes, including helping patients to adhere to drug regimens. The aim of this narrative review was to describe: (1) studies on AI tools that can be used to measure and increase medication adherence in patients with non-communicable diseases (NCDs); (2) the benefits of using AI for these purposes; (3) challenges of the use of AI in healthcare; and (4) priorities for future research. We discuss the current AI technologies, including mobile phone applications, reminder systems, tools for patient empowerment, instruments that can be used in integrated care, and machine learning. The use of AI may be key to understanding the complex interplay of factors that underly medication non-adherence in NCD patients. AI-assisted interventions aiming to improve communication between patients and physicians, monitor drug consumption, empower patients, and ultimately, increase adherence levels may lead to better clinical outcomes and increase the quality of life of NCD patients. However, the use of AI in healthcare is challenged by numerous factors; the characteristics of users can impact the effectiveness of an AI tool, which may lead to further inequalities in healthcare, and there may be concerns that it could depersonalize medicine. The success and widespread use of AI technologies will depend on data storage capacity, processing power, and other infrastructure capacities within healthcare systems. Research is needed to evaluate the effectiveness of AI solutions in different patient groups and establish the barriers to widespread adoption, especially in light of the COVID-19 pandemic, which has led to a rapid increase in the use and development of digital health technologies.
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Affiliation(s)
- Aditi Babel
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Richi Taneja
- Medical Product Evaluation, Pfizer Ltd, Mumbai, India
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Psychometric evaluation of the Medication Adherence Scale in older Chinese patients with coronary heart disease. Geriatr Nurs 2021; 42:1482-1487. [PMID: 34687991 DOI: 10.1016/j.gerinurse.2021.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/03/2021] [Accepted: 10/06/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To translate the Medication Adherence Scale (MAS) into Chinese and evaluate the psychometric properties of the Chinese version of MAS (C-MAS). METHODS The study used a cross-sectional design. The performance of C-MAS was assessed among 170 older patients with coronary heart disease (CHD). The psychometric properties of C-MAS, including content validity, factor structure, hypothesized validity, and internal consistency, were tested. RESULTS The content validity index of the C-MAS was 0.90. Three factors were identified using the principal component analysis. The Cronbach's α was 0.868 for the total scale and ranged from 0.703 to 0.941 for the three subscales of C-MAS. In addition, the construct validity of the C-MAS was confirmed to test the hypothesis. CONCLUSIONS The three-factor C-MAS has good validity and internal consistency in older Chinese patients with CHD. The C-MAS can be used to assess the knowledge, attitudes, and barriers related to medication adherence among this population.
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Dietrich F, Zeller A, Haag M, Hersberger KE, Arnet I. Communicating Electronic Adherence Data to Physicians-Consensus-Based Development of a Compact Reporting Form. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910264. [PMID: 34639562 PMCID: PMC8507897 DOI: 10.3390/ijerph181910264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/17/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022]
Abstract
Information on medication adherence is missing in patient files, although it might be helpful to optimize treatment. An adherence report that presents data from electronic adherence monitoring and provides recommendations regarding pharmacological treatment could close this gap. We aimed to develop an adherence reporting form that combines suitable calculations and graphical representations to facilitate the physicians’ interpretation of (non-)adherence. Two consensus development panels were conducted. First, pharmacists with expertise in adherence monitoring debated the items needed to calculate and illustrate electronic adherence data. Second, physicians discussed the items they would need for an adherence report and were encouraged to propose new items. Preference was indicated by raising a green or red card. Voting was repeated until consensus was obtained. Third, first drafts of the adherence reporting form were created by two pharmacists. Seven pharmacists agreed on four metrics to express medication adherence and three graphical representations. Five physicians approved the four metrics and rated the dot chart as the most useful illustration for judging the patient’s adherence patterns. Additionally, they required a clinical–pharmaceutical evaluation of the adherence estimates considering drug-related properties. We developed an adherence reporting form for the first time in a compact format and based on the recommendations of experts. In addition, we considered the preferences of physicians, who appreciated the clarity of the reporting form.
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Affiliation(s)
- Fine Dietrich
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Petersplatz 14, P.O. Box 2148, 4001 Basel, Switzerland; (M.H.); (K.E.H.); (I.A.)
- Correspondence: ; Tel.: +41-61-207-15-29
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Rheinstrasse 26, 4410 Liestal, Switzerland;
| | - Melanie Haag
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Petersplatz 14, P.O. Box 2148, 4001 Basel, Switzerland; (M.H.); (K.E.H.); (I.A.)
| | - Kurt E. Hersberger
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Petersplatz 14, P.O. Box 2148, 4001 Basel, Switzerland; (M.H.); (K.E.H.); (I.A.)
| | - Isabelle Arnet
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Petersplatz 14, P.O. Box 2148, 4001 Basel, Switzerland; (M.H.); (K.E.H.); (I.A.)
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Exploring Barriers and Facilitators of Adherence to Artemisinin-Based Combination Therapies for the Treatment of Uncomplicated Malaria in Children in Freetown, Sierra Leone. Healthcare (Basel) 2021; 9:healthcare9091233. [PMID: 34575007 PMCID: PMC8471195 DOI: 10.3390/healthcare9091233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/06/2021] [Accepted: 09/09/2021] [Indexed: 12/01/2022] Open
Abstract
Medication adherence is an essential step in the malaria treatment cascade. We conducted a qualitative study embedded within a randomized controlled trial comparing the adherence to the recommended dosing of two artemisinin-based combination therapies (ACT) to treat uncomplicated malaria in Freetown, Sierra Leone. This study explored the circumstances and factors that influenced caregiver adherence to the ACT prescribed for their child in the trial. In-depth interviews were conducted with 49 caregivers; all interviews were recorded, transcribed, and translated. Transcripts were coded and aggregated into themes, applying a thematic content approach. We identified four key factors that influenced optimal treatment adherence: (1) health system influences, (2) health services, (3) caregivers' experiences with malaria illness and treatment, and (4) medication characteristics. Specifically, caregivers reported confidence in the health system as facilities were well maintained and care was free. They also felt that health workers provided quality care, leading them to trust the health workers and believe the test results. Ease of medication administration and perceived risk of side effects coupled with caregivers' prior experience treating malaria influenced how medications were administered. To ensure ACTs achieve maximum effectiveness, consideration of these contextual factors and further development of child-friendly antimalarials are needed.
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Kim SJ, Kwon OD, Choi HC, Lee EJ, Cho B, Yoon DH. Prevalence and associated factors of premature discontinuation of antiplatelet therapy after ischemic stroke: a nationwide population-based study. BMC Neurol 2021; 21:349. [PMID: 34507550 PMCID: PMC8431917 DOI: 10.1186/s12883-021-02384-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/24/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND We tried to evaluate the prevalence of premature discontinuation of antiplatelets and its affecting factors after ischemic stroke using large-sized representative national claims data. METHODS Patients aged 20 years or older with newly confirmed ischemic stroke who started aspirin or clopidogrel for the first time were selected from 2003 to 2010 National Health Insurance Service-National Sample Cohort (NHIS-NSC) of South Korea (n = 4621), a randomly collected sample which accounts for 2.2% (n = 1,017,468) of total population (n = 46,605,433). The prevalence of discontinuation of antiplatelets was measured every 6 months until the 24 months since the first prescription. Then we classified the participants into 2 groups according to the discontinuation status at 12 months and assessed the factors influencing premature discontinuation of antiplatelets within 12 months. RESULTS Among total participants, 35.5% (n = 1640) discontinued antiplatelets within 12 months and 58.5% (n = 2704) discontinued them within 24 months. The remaining 41.5% (n = 1917) continued them for 24 months or more. In the multivariate logistic regression analysis, initiating treatment with aspirin monotherapy [adjusted OR (aOR), 2.66, 95% CI 2.17-3.25] was the most prominent determinant of premature discontinuation within 12 months followed by CCI score ≥ 6 (aOR 1.50, 95% CI 1.31-1.98), and beginning treatment with clopidogrel monotherapy (aOR 1.41, 95% CI 1.15-1.72). Rural residency (aOR 1.36, 95% CI 1.14-1.62), < 4 total prescribed drugs (aOR 1.24, 95% CI 1.05-1.47), lower income (aOR 1.20, 95% CI 1.03-1.40 for middle income class and OR 1.21, 95% CI 1.02-1.45 for low income class), and ages ≥70 years (aOR 1.15, 95% CI 1.00-1.31) were also significantly associated with premature discontinuation of antiplatelets within 12 months. CONCLUSIONS The prevalence of premature discontinuation of antiplatelets after ischemic stroke was quite high. Thus, by understanding factors associated with premature discontinuation, a more strategic approach is required for the physicians to improve persistence with antiplatelets.
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Affiliation(s)
- Seung Jae Kim
- International Healthcare Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | | | - Ho Chun Choi
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, 06236, Republic of Korea.
- Nuvizen, Palo Alto, California, 94303, USA.
| | - Eung-Joon Lee
- Institute of Public Health and Medical Care, Seoul National University Hospital, Seoul, 03080, Republic of Korea.
- Department of Neurology, Seoul National University Hospital, Seoul, 03080, Republic of Korea.
| | - BeLong Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Dae Hyun Yoon
- Department of Psychiatry, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, 06236, Republic of Korea
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Raijada D, Wac K, Greisen E, Rantanen J, Genina N. Integration of personalized drug delivery systems into digital health. Adv Drug Deliv Rev 2021; 176:113857. [PMID: 34389172 DOI: 10.1016/j.addr.2021.113857] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/09/2021] [Accepted: 07/01/2021] [Indexed: 12/11/2022]
Abstract
Personalized drug delivery systems (PDDS), implying the patient-tailored dose, dosage form, frequency of administration and drug release kinetics, and digital health platforms for diagnosis and treatment monitoring, patient adherence, and traceability of drug products, are emerging scientific areas. Both fields are advancing at a fast pace. However, despite the strong complementary nature of these disciplines, there are only a few successful examples of merging these areas. Therefore, it is important and timely to combine PDDS with an increasing number of high-end digital health solutions to create an interactive feedback loop between the actual needs of each patient and the drug products. This review provides an overview of advanced design solutions for new products such as interactive personalized treatment that would interconnect the pharmaceutical and digital worlds. Furthermore, we discuss the recent advancements in the pharmaceutical supply chain (PSC) management and related limitations of the current mass production model. We summarize the current state of the art and envision future directions and potential development areas.
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Affiliation(s)
- Dhara Raijada
- Department of Pharmacy, University of Copenhagen, Denmark
| | - Katarzyna Wac
- Department of Computer Science, University of Copenhagen, Denmark; Quality of Life Technologies Lab, Center for Informatics, University of Geneva, Switzerland
| | | | - Jukka Rantanen
- Department of Pharmacy, University of Copenhagen, Denmark
| | - Natalja Genina
- Department of Pharmacy, University of Copenhagen, Denmark.
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Federman AD, O’Conor R, Wolf MS, Wisnivesky JP. Associations of Medication Regimen Complexity with COPD Medication Adherence and Control. Int J Chron Obstruct Pulmon Dis 2021; 16:2385-2392. [PMID: 34434045 PMCID: PMC8382307 DOI: 10.2147/copd.s310630] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/04/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction Medication adherence is often low among people with chronic obstructive pulmonary disease (COPD) and medication regimen complexity may be a contributing factor. In this study, we sought to examine the role of medication regimen complexity in COPD medication adherence among patients with multimorbidity. Methods We performed cross-sectional analysis of data on COPD patients in primary care and pulmonary practices in New York City and Chicago (n=400). Regimen complexity was represented by the medication regimen complexity index (MRCI) and simple medication count. Adherence was measured by self-report and inhaler dose counts. Disease control measures included the COPD severity score (COPDSS) and the Medical Research Council (MRC) severity index. Results Mean age of study participants was 69 years, 66% had MRC grades 4 or 5, and 45% had low medication adherence. MRCI scores did not differ significantly between those with and without adequate medication adherence. Patients with higher MRCI scores were more likely to have severe COPD (OR 5.00, 95% CI 1.46-17.1, p=0.01) and dyspnea grades 3 or 4 (OR 2.27, 95% CI 1.03-5.03, p=0.04). Significant associations of medication count with COPD severity were also observed. Discussion These findings demonstrate that among patients with COPD and comorbid hypertension and diabetes, higher medication regimen complexity is associated with worse COPD control but not with COPD medication adherence.
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Affiliation(s)
- Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel O’Conor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Bekker CL, Aslani P, Chen TF. The use of medication adherence guidelines in medication taking behaviour research. Res Social Adm Pharm 2021; 18:2325-2330. [PMID: 34393079 DOI: 10.1016/j.sapharm.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 08/10/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
Medication nonadherence continues to be a serious issue in a range of long-term medical conditions and has been studied extensively over the past few decades. However, despite the plethora of research studies on medication adherence, poor methodological rigour in many studies has contributed to limited generalisability of the positive findings, limited impact on patients' medication adherence, and inability to compare between studies. This paper focuses on current guidelines designed specifically for research on medication adherence. It discusses key elements to consider during study design, selection of adherence measurements, and reporting on medication adherence research, to ensure a higher quality of research in medication adherence. Overall, there appears to be variations in adherence terminology reported in the literature despite improvements in defining medication taking behaviour and the availability of taxonomies. In addition, limited guidance exists on how best to measure adherence. Recommendations are provided on appropriate adherence measures for the adherence behaviour being investigated, including careful consideration of adherence concepts, validity of adherence instruments, appropriate instrument selection, definition of nonadherence threshold, and how to report medication adherence. Improving adherence research requires greater clarity and standardisation of descriptions of nonadherence behaviour, increased methodological rigour in study designs, better selection of adherence measurements, and comprehensive reporting.
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Affiliation(s)
- Charlotte L Bekker
- Radboud University Medical Center, Research Institute for Health Sciences, Department of Pharmacy, Nijmegen, the Netherlands.
| | - Parisa Aslani
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Timothy F Chen
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
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Eshtehardi SS, Taylor AA, Chen TA, de Dios MA, Correa-Fernández V, Kendzor DE, Businelle MS, Reitzel LR. Sociodemographic Determinants of Nonadherence to Depression and Anxiety Medication among Individuals Experiencing Homelessness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157958. [PMID: 34360251 PMCID: PMC8345659 DOI: 10.3390/ijerph18157958] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/11/2021] [Accepted: 07/27/2021] [Indexed: 12/03/2022]
Abstract
Psychiatric medication nonadherence continues to be a leading cause of poor health outcomes for individuals experiencing homelessness. Identifying the sociodemographic factors that contribute to medication nonadherence may help guide strategies to care for and support this group. This study examined 200 adults with depression diagnoses and active anti-depressant prescriptions (Mage = 43.98 ± 12.08, 59.4% Caucasian, 58.5% male, 70% uninsured, 89.5% unemployed) and 181 adults with anxiety diagnoses and active anti-anxiety prescriptions (Mage = 43.45 ± 11.02, 54.4% Caucasian, 57.5% male, 66.3% uninsured, 88.9% unemployed) recruited from six homeless-serving agencies in Oklahoma City. Self-reported sociodemographic variables included: age, sex, race/ethnicity, education, monthly income, employment status, and health insurance status. Adjusted logistic regression analyses revealed that employed (OR = 4.022, CI0.95: 1.244–13.004) and insured (OR = 2.923, CI0.95: 1.225–6.973) participants had greater odds of depression medication nonadherence. For anxiety, being employed (OR = 3.573, CI0.95: 1.160–11.010) was associated with greater odds of anxiety medication nonadherence, whereas having depression and anxiety diagnostic comorbidity (OR = 0.333, CI0.95: 0.137–0.810) was associated with lower odds of anxiety medication nonadherence. Interventions aimed at facilitating accessible prescription acquisition or otherwise reducing barriers to prescription medications for employed adults, including those with health insurance, may benefit adherence, but more research is needed. Future studies would benefit from using a qualitative approach to better delineate nuanced barriers to psychiatric medication adherence.
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Affiliation(s)
- Sahar S. Eshtehardi
- Department of Psychological, Health, & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (S.S.E.); (A.A.T.); (T.A.C.); (M.A.d.D.); (V.C.-F.)
| | - Ashley A. Taylor
- Department of Psychological, Health, & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (S.S.E.); (A.A.T.); (T.A.C.); (M.A.d.D.); (V.C.-F.)
| | - Tzuan A. Chen
- Department of Psychological, Health, & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (S.S.E.); (A.A.T.); (T.A.C.); (M.A.d.D.); (V.C.-F.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Marcel A. de Dios
- Department of Psychological, Health, & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (S.S.E.); (A.A.T.); (T.A.C.); (M.A.d.D.); (V.C.-F.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Virmarie Correa-Fernández
- Department of Psychological, Health, & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (S.S.E.); (A.A.T.); (T.A.C.); (M.A.d.D.); (V.C.-F.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Darla E. Kendzor
- TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma, OK 73104, USA; (D.E.K.); (M.S.B.)
| | - Michael S. Businelle
- TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma, OK 73104, USA; (D.E.K.); (M.S.B.)
| | - Lorraine R. Reitzel
- Department of Psychological, Health, & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (S.S.E.); (A.A.T.); (T.A.C.); (M.A.d.D.); (V.C.-F.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
- Correspondence: ; Tel.: +1-713-743-6679
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Delage C, Lelong H, Brion F, Blacher J. Effect of a pharmacist-led educational intervention on clinical outcomes: a randomised controlled study in patients with hypertension, type 2 diabetes and hypercholesterolaemia. Eur J Hosp Pharm 2021; 28:e197-e202. [PMID: 34183458 DOI: 10.1136/ejhpharm-2021-002787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/15/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES In recent years, hospital pharmacists have gained more importance in the clinical support of patients. However, most of the studies evaluating the impact of clinical pharmacy have only studied patients' adherence or satisfaction. The aim of this study was to evaluate the direct clinical outcomes of a pharmacist-led educational intervention in patients with chronic disease. METHODS We conducted a randomised, controlled, parallel, physician-blinded study in a day hospital and a consultation unit of a French teaching hospital over a 1-year period. Patients with hypertension, type 2 diabetes or hypercholesterolaemia who did not reach their therapeutic goals despite drug therapy were eligible. Patients in the intervention group received an intervention from a hospital pharmacist who provided patient education on pathology and drug management. The primary outcome was the proportion of patients reaching their therapeutic goals for blood pressure, glycated haemoglobin level or low-density lipoprotein cholesterol level at the 3-month follow-up consultation. RESULTS From January to December 2015, 89 patients were included and 73 completed the study. In the intervention group, 61.7% (21/34) of the patients reached their therapeutic goals compared with 33.3% (13/39) in the control group (p=0.015). The intervention was significantly more effective in polypharmacy patients (60.0% (12/20) vs 16.7% (4/24); p=0.005), in those aged >60 years (57.9% (11/19) vs 26.1% (6/23); p=0.037) and in patients with a high education level (68.8% (11/16) vs 29.4% (5/17); p=0.024). CONCLUSION A single pharmacist-led educational intervention has a clinical impact, doubling the proportion of patients reaching their therapeutic goals at 3 months, especially in polypharmacy patients and those aged >60 years. This study confirms the value of clinical involvement of hospital pharmacists in patient care in a consultation unit and day hospital.
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Affiliation(s)
- Clement Delage
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, Île-de-France, France .,Université de Paris, Faculté de Pharmacie, Paris, Île-de-France, France
| | - Hélène Lelong
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, Île-de-France, France.,Université de Paris, Faculté de Médecine, Paris, Île-de-France, France
| | - Francoise Brion
- Université de Paris, Faculté de Pharmacie, Paris, Île-de-France, France
| | - Jacques Blacher
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, Île-de-France, France.,Université de Paris, Faculté de Médecine, Paris, Île-de-France, France
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