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Zanforlini BM, Sambo S, Devita M, Cignarella A, Vezzali F, Sturani S, Grandieri A, Noale M, Siviero P, Limongi F, Volpato S, Sergi G, Trevisan C. A multidisciplinary approach to improve adherence to medical recommendations in older adults at hospital discharge: The APPROACH study protocol. PLoS One 2024; 19:e0297238. [PMID: 38687693 PMCID: PMC11060519 DOI: 10.1371/journal.pone.0297238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 12/16/2023] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION Poor comprehension and medication adherence are common in older people, especially after hospitalizations, in case of changes or prescriptions of new therapeutic regimes. This randomized controlled trial aims to evaluate the effectiveness of an integrated approach in improving older individuals' adherence to medical recommendations after hospital discharge. METHODS Data from an expected sample of 360 older inpatients (and their caregivers) will be collected. Medical recommendations' understanding will be tested before and after the routine explanation received by in-charge physicians. Participants will be randomized in the control (usual care) and intervention group. The intervention consists of educational training by a multidisciplinary team (occupational therapist, dietician, and physician, in consultation with a pharmacologist) at hospital discharge and, after hospital discharge, receiving a phone recall checking for therapy adherence and having the possibility to contact the study team for potential related concerns. After 7 days, medication adherence will be assessed through structured phone interviews comparing ongoing and prescribed medications and by administering the 4-item validated Morisky, Green, Levine scale and the Medication adherence report scale (MARS-5). At 30 and 90 days from discharge, data on medication adherence, falls, rehospitalizations, and vital status will be collected through phone interviews and hospital records. TRIAL REGISTRATION Registration: NCT05719870 (clinicaltrial.gov). https://classic.clinicaltrials.gov/ct2/show/NCT05719870.
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Affiliation(s)
| | - Sara Sambo
- Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Maria Devita
- Department of Medicine (DIMED), University of Padua, Padua, Italy
- Department of General Psychology (DPG), University of Padua, Padua, Italy
| | | | - Federico Vezzali
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Silvia Sturani
- Department of General Psychology (DPG), University of Padua, Padua, Italy
| | - Andrea Grandieri
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Marianna Noale
- Institute of Neuroscience – Aging Branch, National Research Council (CNR), Padua, Italy
| | - Paola Siviero
- Institute of Neuroscience – Aging Branch, National Research Council (CNR), Padua, Italy
| | - Federica Limongi
- Institute of Neuroscience – Aging Branch, National Research Council (CNR), Padua, Italy
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Giuseppe Sergi
- Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Caterina Trevisan
- Department of Medicine (DIMED), University of Padua, Padua, Italy
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Aging Research Center, Karolinska Institutet, Stockholm, Sweden
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Kitaw TA, Haile RN. Prevalence of polypharmacy among older adults in Ethiopia: a systematic review and meta-analysis. Sci Rep 2023; 13:17641. [PMID: 37848565 PMCID: PMC10582100 DOI: 10.1038/s41598-023-45095-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 10/16/2023] [Indexed: 10/19/2023] Open
Abstract
Polypharmacy is a significant concern for older adults. Taking multiple medicines to prevent and treat comorbidities is very common in older adults, potentially leading to polypharmacy. Polypharmacy is associated with the development of geriatric syndromes, including cognitive impairment, delirium, falls, frailty, urinary incontinence, and weight loss. The prevalence of polypharmacy varies according to the literature. There is a paucity of data regarding the prevalence of polypharmacy among older adults. Therefore, this study aimed to estimate the pooled prevalence of polypharmacy among older adults in Ethiopia. A comprehensive search of databases, including PubMed, MEDLINE, EMBASE, Hinari, Cumulative Index to Nursing and Allied Health Literature, International Scientific Indexing, Cochrane library and Web of Science, and Google Scholar, was conducted. STATA statistical software (version 17) was used to analyze the data. Forest plot and I2 heterogeneity test were computed to examine the existence of heterogeneity. Subgroup analysis and sensitivity analysis were done to explore the source of heterogeneity. Publication bias was evaluated by using funnel plots and Egger's test. A random effect model was used to determine the pooled prevalence of polypharmacy. After reviewing 123 studies, 13 studies with a total of 3547 older adults fulfilled the inclusion criteria and were included in this meta-analysis. The result from 13 studies revealed that the pooled prevalence of polypharmacy among older adults in Ethiopia was 37.10% (95CI: 28.28-45.91). A Subgroup Meta-analysis showed that the heterogeneity level was slightly lower among studies done in Oromia region (I2 = 46.62, P-value = 0.154). Higher pooled polypharmacy prevalence was found among older adults with cardiovascular disorders (42.7%) and admitted patients (51.4%). In general, it was found that the pooled prevalence of polypharmacy among older adults in Ethiopia was high. More than one in three older adults take five or more medications at a time. Thus, intervention focusing on rational geriatric pharmacotherapy is significant to prevent unnecessary pill burden, adverse drug events, medical costs, geriatric morbidity, and mortality. Furthermore, enhancing pharmacist roles towards medication therapy management and safety monitoring in older adults is also indicated.
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Affiliation(s)
- Tegene Atamenta Kitaw
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia.
| | - Ribka Nigatu Haile
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
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Ye L, Yang-Huang J, Franse CB, Rukavina T, Vasiljev V, Mattace-Raso F, Verma A, Borrás TA, Rentoumis T, Raat H. Factors associated with polypharmacy and the high risk of medication-related problems among older community-dwelling adults in European countries: a longitudinal study. BMC Geriatr 2022; 22:841. [PMID: 36344918 PMCID: PMC9641844 DOI: 10.1186/s12877-022-03536-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/11/2022] [Indexed: 11/09/2022] Open
Abstract
Background Polypharmacy can be defined as using five or more medications simultaneously. “Medication-related problems”, an extension of polypharmacy, includes inappropriate prescribing, poor adherence, overdosage, underdosage, inappropriate drug selection, inadequate monitoring, adverse drug effects, and drug interactions. Polypharmacy and the high risk of medication-related problems among older people are associated with adverse health consequences due to drug-drug interactions, drug-disease interactions, and adverse drug effects. This study aims to assess the factors associated with polypharmacy and the high risk of medication-related problems among community-dwelling older people in the Netherlands, Greece, Croatia, Spain, United Kingdom. Method This longitudinal study used baseline and follow-up data from 1791 participants of the Urban Health Center European project. Polypharmacy and the risk of medication-related problems were evaluated at baseline and follow-up using the Medication Risk Questionnaire. We studied factors in the domains (a) sociodemographic characteristics, (b) lifestyle and nutrition, and (c) health and health care use. Hierarchical logistic regression analyses were used to examine the factors associated with polypharmacy and the high risk of medication-related problems. Results Mean age was 79.6 years (SD ± 5.6 years); 60.8% were women; 45.2% had polypharmacy, and 41.8% had a high risk of medication-related problems. Women participants had lower odds of polypharmacy (OR = 0.55;95%CI:0.42–0.72) and a high risk of medication-related problems (OR = 0.50; 95%CI:0.39–0.65). Participants with a migration background (OR = 1.67;95%CI:1.08–2.59), overweight (OR = 1.37; 95%CI:1.04–1.79) and obesity (OR = 1.78;95%CI:1.26–2.51) compared to ‘normal weight’, with lower physical HRQoL (OR = 0.96, 95%CI:0.95–0.98), multi-morbidity (OR = 3.73, 95%CI:2.18–6.37), frailty (OR = 1.69, 95%CI:1.24–2.30), visited outpatient services (OR = 1.77, 95%CI: 1.09–2.88) had higher odds of polypharmacy. The associations with the high risk of medication-related problems were similar. Conclusions Multiple factors in demography, lifestyle, nutrition, and health care use are associated with polypharmacy and the high risk of medication-related problems. Polypharmacy is a single element that may reflect the number of medications taken. The broader content of medication-related problems should be considered to assess the context of medication use among older people comprehensively. These provide starting points to improve interventions to reduce polypharmacy and high risk of medication-related problems. In the meantime, health professionals can apply these insights to identify subgroups of patients at a high risk of polypharmacy and medication-related problems. Trial registration The intervention of the UHCE project was registered in the ISRCTN registry as ISRCTN52788952. The date of registration is 13/03/2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03536-z.
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Gil-Guillen VF, Balsa A, Bernárdez B, Valdés y Llorca C, Márquez-Contreras E, de la Haba-Rodríguez J, Castellano JM, Gómez-Martínez J. Medication Non-Adherence in Rheumatology, Oncology and Cardiology: A Review of the Literature of Risk Factors and Potential Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12036. [PMID: 36231341 PMCID: PMC9564665 DOI: 10.3390/ijerph191912036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
Medication adherence is directly associated with health outcomes. Adherence has been reviewed extensively; however, most studies provide a narrow scope of the problem, covering a specific disease or treatment. This project's objective was to identify risk factors for non-adherence in the fields of rheumatology, oncology, and cardiology as well as potential interventions to improve adherence and their association with the risk factors. The project was developed in three phases and carried out by a Steering Committee made up of experts from the fields of rheumatology, oncology, cardiology, general medicine, and hospital and community pharmacy. In phase 1, a bibliographic review was performed, and the articles/reviews were classified according to the authors' level of confidence in the results and their clinical relevance. In phase 2, 20 risk factors for non-adherence were identified from these articles/reviews and agreed upon in Steering Committee meetings. In phase 3, potential interventions for improving adherence were also identified and agreed upon. The results obtained show that adherence is a dynamic concept that can change throughout the course of the disease, the treatments, and other factors. Educational interventions are the most studied ones and have the highest level of confidence in the authors' opinion. Information and education are essential to improve adherence in all patients.
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Affiliation(s)
- Vicente F. Gil-Guillen
- Department of Clinical Medicine, Miguel Hernandez University, 03550 San Juan, Spain
- Research Unit, Hospital General Universitario de Elda, 30600 Elda, Spain
| | - Alejandro Balsa
- Rheumatology Department, La Paz University Hospital, 28046 Madrid, Spain
- Institute for Health Research Hospital La Paz (IdiPaz), 28046 Madrid, Spain
| | - Beatriz Bernárdez
- Department of Oncologic Pharmacy, Santiago de Compostela University Hospital, 15706 Santiago de Compostela, Spain
- Medicine Department, Santiago de Compostela University, 15706 Santiago de Compostela, Spain
- Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15782 Santiago de Compostela, Spain
- Adherence Group of the Sociedad Española de Farmacia Hospitalaria (ADHEFAR-SEFH), 28001 Madrid, Spain
| | - Carmen Valdés y Llorca
- Fuencarral Health Center, 28034 Madrid, Spain
- Observatorio de Adherencia al Tratamiento (OAT), 28231 Madrid, Spain
- Treatment Adherence Chair, San Juan de Alicante University, 03550 Alicante, Spain
| | | | | | - Jose M. Castellano
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
- Centro Integral de Enfermedades Cardiovasculares, Monteprincipe University Hospital, 28660 Madrid, Spain
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González-Bueno J, Sevilla-Sánchez D, Puigoriol-Juvanteny E, Molist-Brunet N, Codina-Jané C, Espaulella-Panicot J. Improving medication adherence and effective prescribing through a patient-centered prescription model in patients with multimorbidity. Eur J Clin Pharmacol 2021; 78:127-137. [PMID: 34448906 DOI: 10.1007/s00228-021-03207-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/16/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to assess the impact of the patient-centered prescription (PCP) model in medication adherence and effective prescribing in patients with multimorbidity. METHODS Uncontrolled before-after study in an intermediate care facility in a mixed urban-rural district. Inpatients aged ≥ 65 years with multimorbidity exposed to polypharmacy before hospital admission were consecutively enrolled. Every patient's treatment plan was analyzed through the PCP model, which includes interventions aimed at improving medication adherence. The primary endpoint was the change in the proportion of adherent patients between pre-admission and after discharge for all regularly scheduled long-term medications, using the proportion of days covered (PDC). Secondary endpoints included the change on mean PDC for all long-term medications, number of long-term medications, proportion of patients with hyperpolypharmacy, medication regimen complexity index (MRCI) score, drug burden index (DBI) score, number of potential inappropriate prescribing (PIP), and proportion of patients with ≥ 2 PIPs. RESULTS Ninety-three non-institutionalized patients were included (mean age 83.0 ± SD 6.1 years). The proportion of adherent patients increased from 22.1 to 51.9% (P < 0.001). Intervention also improved mean PDC [mean difference (95% CI) 10.6 (7.7, 13.5)] and effective prescribing through a reduction on the number of long-term medications [- 1.3 (- 1.7, - 0.9)], proportion of patients exposed to hyperpolypharmacy (- 16.1%, P < 0.001), MRCI score [- 2.2 (- 3.4, - 1.0)], DBI score [- 0.16 (- 1.8, - 1.3)], number of PIPs [- 1.6 (- 1.8, - 1.3)], and proportion of patients with ≥ 2 PIPs (- 53.7%, P < 0.001). CONCLUSION Studied intervention provides significant effective prescribing and medication adherence enhancements in non-institutionalized older patients with multimorbidity and polypharmacy.
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Affiliation(s)
- J González-Bueno
- Pharmacy Department, Consorci Hospitalari de Vic, Vic, Barcelona, Spain. .,Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.
| | - D Sevilla-Sánchez
- Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.,Pharmacy Department, Parc Sanitari Pere Virgili, Barcelona, Spain
| | - E Puigoriol-Juvanteny
- Epidemiology Unit, Consorci Hospitalari de Vic, Vic, Barcelona, Spain.,Tissue Repair and Regeneration Laboratory (TR2Lab) Group, Faculty of Sciences and Technology & Faculty of Medicine, University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain
| | - N Molist-Brunet
- Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.,Department of Geriatrics, Consorci Hospitalari de Vic & Fundació Hospital de La Santa Creu de Vic, Vic, Barcelona, Spain
| | - C Codina-Jané
- Pharmacy Department, Consorci Hospitalari de Vic, Vic, Barcelona, Spain.,Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain
| | - J Espaulella-Panicot
- Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.,Department of Geriatrics, Consorci Hospitalari de Vic & Fundació Hospital de La Santa Creu de Vic, Vic, Barcelona, Spain
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Vahedparast H, Nazarian R, Bagherzadeh R, Farhadi A. The Predictor Role of Perceived Social Support and Aging Perception in Treatment Adherence of Older Adults with Chronic Diseases. ADVANCES IN GERONTOLOGY 2021. [DOI: 10.1134/s2079057021020168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Xu Z, Sun W, Zhang D, Chung VCH, Sit RWS, Wong SYS. Comparative Effectiveness of Interventions for Global Cognition in Patients With Mild Cognitive Impairment: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Front Aging Neurosci 2021; 13:653340. [PMID: 34220484 PMCID: PMC8249717 DOI: 10.3389/fnagi.2021.653340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/17/2021] [Indexed: 12/13/2022] Open
Abstract
Background: There is a lack of study comprehensively comparing the effects of all existing types of interventions on global cognition among patients with mild cognitive impairment (MCI). Aims: To conduct a network meta-analysis to evaluate the effectiveness of different types of interventions in improving global cognition among MCI patients. Methods: Randomized controlled trials (RCTs) assessing the effects of pharmacological or non-pharmacological interventions on the Mini-Mental State Examination (MMSE) in MCI patients were included. Two authors independently screened the studies and extracted the data. Random-effects network meta-analysis was used to synthesize the data. Results were summarized as mean difference (MD) and corresponding 95% CIs of MMSE in forest plots. Results: Fifty RCTs with 5,944 MCI patients met the inclusion criteria and 49 were included in the network meta-analysis. Compared with the control group, cognition-based intervention (MD = 0.80, 95% CI 0.04–1.57), physical exercise (MD = 1.92, 95% CI 1.19–2.64), combined physical exercise and cognition-based intervention (MD = 1.86, 95% CI 0.60–3.12), and antioxidants (MD = 0.94, 95% CI 0.04–1.83) had positive effects on MMSE in participants with MCI. There was no significant difference between all other interventions included and the control group. Conclusions: This study suggested that cognition-based intervention, physical exercise, combined physical exercise and cognition-based intervention, and antioxidants could be among the most effective interventions on global cognition in older adults with MCI. The availability, acceptability, and cost-effectiveness of interventions should also be taken into consideration when selecting interventions. Registration: PROSPERO CRD42020171985.
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Affiliation(s)
- Zijun Xu
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Wen Sun
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Dexing Zhang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent Chi-Ho Chung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Regina Wing-Shan Sit
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Samuel Yeung-Shan Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
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Implementation of a Real-Time Medication Intake Monitoring Technology Intervention in Community Pharmacy Settings: A Mixed-Method Pilot Study. PHARMACY 2021; 9:pharmacy9020105. [PMID: 34070544 PMCID: PMC8162977 DOI: 10.3390/pharmacy9020105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/10/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022] Open
Abstract
Innovative dispensing products offering real-time medication intake monitoring are being developed to address medication non-adherence. However, implementation of these interventions within the workflow of a community pharmacy is unknown. The purpose of this study was to explore factors affecting implementation of a real-time adherence-monitoring, multidose-dispensing system in community pharmacies. A mixed-method study was conducted with pharmacy staff, who packaged and dispensed medications in smart multidose packages and monitored real-time medication intake via web-portal. Pharmacy staff participated in semi-structured interviews. The Technology Acceptance Model, Theory of Planned Behaviour and Capability, Opportunity, Motivation, Behaviour Model informed the interview guide. Interview transcripts were analyzed thematically and findings were mapped back to the frameworks. The usability was assessed by the System Usability Scale (SUS). Three pharmacists and one pharmacy assistant with a mean of 19 years of practice were interviewed. Three themes and 12 subthemes were generated. Themes included: pharmacy workflow factors, integration factors, and pharmacist-perceived patient factors. The mean SUS was found to be 80.63. Products with real-time adherence monitoring capabilities are valued by pharmacists. A careful assessment of infrastructure—including pharmacy workload, manpower and financial resources—is imperative for successful implementation of such interventions in a community pharmacy setting.
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Monaco A, Palmer K, Holm Ravn Faber N, Kohler I, Silva M, Vatland A, van Griensven J, Votta M, Walsh D, Clay V, Yazicioglu MC, Ducinskiene D, Donde S. Digital Health Tools for Managing Noncommunicable Diseases During and After the COVID-19 Pandemic: Perspectives of Patients and Caregivers. J Med Internet Res 2021; 23:e25652. [PMID: 33464206 PMCID: PMC7850778 DOI: 10.2196/25652] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/24/2020] [Accepted: 01/13/2021] [Indexed: 02/07/2023] Open
Abstract
Background A reduction in the number of face-to-face medical examinations conducted for patients with noncommunicable diseases (NCDs) during the first wave of the COVID-19 pandemic has led to health care professionals quickly adopting different strategies to communicate with and monitor their patients. Such strategies include the increased use of digital health tools. However, patient preferences, privacy concerns, a lack of regulations, overregulation, and insufficient evidence on the efficacy of digital health tools may have hampered the potential positive benefits of using such tools to manage NCDs. Objective This viewpoint aims to discuss the views of an advisory board of patient and caregiver association members. Specifically, we aim to present this advisory board’s view on the role of digital health tools in managing patients with NCDs during and after the COVID-19 pandemic, and to identify future directions based on patients’ perspectives. Methods As an initiative under the NCD Partnership (PARTners in Ncds Engage foR building Strategies to improve Healthy ageing In Patients) model of Upjohn, a web-based advisory board of patient and caregiver advocates was held on July 28, 2020, to bring together key stakeholders from public and private sectors. Results The following key themes emerged: (1) technology developers should understand that the goals of patients may differ from those of health care professionals and other stakeholders; (2) patients, health care professionals, caregivers, and other end users need to be involved in the development of digital health tools at the earliest phase possible, to guarantee usability, efficacy, and adoption; (3) digital health tools must be better tailored to people with complex conditions, such as multimorbidity, older age, and cognitive or sensory impairment; and (4) some patients do not want or are unable to use digital health care tools, so adequate alternatives should always be available. Conclusions There was consensus that public-private partnership models, such as the Upjohn NCD Partnership, can be effective models that foster innovation by integrating multiple perspectives (eg, patients’ perspectives) into the design, development, and implementation of digital and nondigital health tools, with the main overall objective of improving the life of patients with NCDs.
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Affiliation(s)
- Alessandro Monaco
- École des hautes études commerciales de Paris (HEC Paris), Jouy-en-Josas, France
| | | | | | - Irene Kohler
- Healthwatch Wiltshire, Trowbridge, United Kingdom
| | | | | | | | - Mariano Votta
- Cittadinanzattiva/Active Citizenship Network, Rome, Italy
| | - Donna Walsh
- European Federation of Neurological Associations, Brussels, Belgium
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Jafarimanesh H, Matourypour P, Sadrnia S, Ranjbaran M. Patient adherence and health management issues: A case study on the effect of medication reminder box. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2018.1498200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Hadi Jafarimanesh
- School of Nursing & Midwifery, Arak University of Medical Sciences, Arak, Iran
| | - Pegah Matourypour
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Sadrnia
- Cardiology Department, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Mehdi Ranjbaran
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Xu Z, Sun W, Zhang D, Wong SY. Recruitment and adherence of randomized controlled trials for mild cognitive impairment: A systematic review and meta-analysis. Int J Geriatr Psychiatry 2020; 35:1141-1150. [PMID: 32420630 DOI: 10.1002/gps.5336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/02/2020] [Accepted: 05/10/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The recruitment and adherence status of randomized controlled trials (RCTs) for population with mild cognitive impairment (MCI) are little known. We aimed to explore the RCT recruitment and adherence status and factors associated with these among MCI patients. METHODS We searched MEDLINE, EMBASE, Cochrane Library, CINAHL, PsycINFO, and PsycARTICLES from inception to 8th July 2019. Included studies were RCTs conducted among MCI patients with available data of invitation rate, eligibility rate, randomization rate, recruitment rate, adherence rate, satisfaction rate, or potential barrier for recruitment and compliance. Two authors screened the studies and extracted the data independently. We calculated pooled proportions of each rate and their 95% confidence intervals (CIs) using random-effects meta-analysis. Meta-regression and subgroup analysis was conducted. RESULTS Hundred and ten articles were judged to meet the study inclusion criteria from 10 387 articles. The invitation rates ranged from 9% to96% but were not pooled together due to high heterogeneity. The pooled overall eligibility, randomization, recruitment, intervention adherence, and follow-up adherence rates were 55% (95% CI: 48%-62%), 86% (95% CI: 81%-91%), 44% (95% CI: 37%-50%), 88% (95% CI: 86%-90%), and 85% (95% CI: 83%-87%), respectively. Non-MCI (47.5%), disease or medical problems (13.8%), and loss of interest (8.5%) were the most frequent reasons for screen failure. Refusal without reason (36.6%), adverse events (30.9%), and health issues (7.7%) were the most frequent reasons for drop-out. CONCLUSIONS This study provided important information for future RCTs targeting at MCI patients. Strategies designed to improve participant recruitment and RCT adherence should be developed among this population.
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Affiliation(s)
- Zijun Xu
- Division of Family Medicine and Primary Health Care, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Wen Sun
- Division of Family Medicine and Primary Health Care, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Dexing Zhang
- Division of Family Medicine and Primary Health Care, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Samuel Yeungshan Wong
- Division of Family Medicine and Primary Health Care, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
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Zucchelli A, Vetrano DL, Bianchini E, Lombardo FP, Piraino A, Zibellini M, Ricci A, Marengoni A, Lapi F, Cricelli C. Adherence to COPD free triple inhaled therapy in the real world: a primary care based study. THE CLINICAL RESPIRATORY JOURNAL 2020; 14:732-739. [PMID: 32216053 DOI: 10.1111/crj.13190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 02/25/2020] [Accepted: 03/17/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The development of new pharmacological treatments for chronic obstructive pulmonary disease (COPD) has improved health-related quality of life of patients. However, suboptimal adherence may limit its potential. OBJECTIVE The aim of the present study was to assess the adherence to free triple inhaled therapy and to investigate poor adherence determinants among primary care patients. METHODS Data were derived from a primary care database in Italy. Patients aged 40+ affected by COPD and prescribed with inhaled corticosteroids, long-acting beta agonists and long-acting muscarinic antagonists (N = 3177) were enrolled. Low adherence was defined as a proportion of days covered (PDC) by medications prescription lower than 80%. Predictors of low adherence were tested using logistic regression models. RESULTS AND CONCLUSIONS The 85% of enrolled patients showed poor adherence to free triple inhaled therapy. Comorbidities, such as heart failure (OR 1.78, 95%CI 1.19-2.75), depression (OR 1.41, 95%CI 1.06-1.88) and peripheral vascular disease (OR 1.32, 95%CI 1.01-1.74) were associated with poor adherence. Former (OR 0.52, 95%CI 0.34-0.78) or current smokers (OR 0.61, 95%CI 0.41-0.93) and patients with more severe airways obstruction or history of severe exacerbations (OR 0.64, 95%CI 0.52-0.79) were less likely to exhibit poor adherence. Real-world adherence to triple inhaled therapy with different inhalers is generally low. Higher GOLD airways obstruction stage and current or former smoking status are associated with increased adherence to treatment. Reduced perceived benefit on symptoms control is probably linked to poorer adherence to free triple therapy.
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Affiliation(s)
- Alberto Zucchelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Davide L Vetrano
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Geriatrics, Catholic University of Rome and IRCCS Fondazione Policlinico "A. Gemelli", Rome, Italy
| | - Elisa Bianchini
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | | | | | | | - Alberto Ricci
- Department of Clinical and Molecular Medicine, S. Andrea Hospital-Sapienza University, Rome, Italy
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
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Dillon P, Smith SM, Gallagher P, Cousins G. The association between pharmacy refill-adherence metrics and healthcare utilisation: a prospective cohort study of older hypertensive adults. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 27:459-467. [PMID: 30968988 DOI: 10.1111/ijpp.12539] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/26/2019] [Indexed: 11/26/2022]
Abstract
AIMS Methods that enable targeting and tailoring of adherence interventions may facilitate implementation in clinical settings. We aimed to determine whether community pharmacy refill-adherence metrics are useful to identify patients at higher risk of healthcare utilisation due to low antihypertensive adherence, who may benefit from an adherence intervention. METHODS We conducted a prospective cohort study, recruiting participants (n = 905) from 106 community pharmacies across the Republic of Ireland. Participants completed a structured interview at baseline and 12 months. Antihypertensive medication adherence was evaluated from linked pharmacy records using group-based trajectory modelling (GBTM) and proportion of days covered (PDC). Healthcare utilisation included self-reported number of hospital visits (emergency department visits and inpatient admissions) and general practitioner (GP) visits, over a 6-month period. Separate regression models were used to estimate the association between adherence and number of hospital/GP visits. The relative statistical fit of each model using different adherence metrics was determined using the Bayesian information criterion (BIC). RESULTS For the number of hospital visits, significant associations were observed only for PDC but not for GBTM. Each 10% increase in refill-adherence by PDC was significantly associated with a 16% lower rate of hospital visits (adjusted incidence rate ratio 0.84, 95% CI 0.72-0.98, P = 0.036). Poorer adherence using both measures was associated with higher GP visits. Improvements in BIC favoured models using PDC. CONCLUSIONS Medication refill-adherence, measured using PDC in community pharmacy settings, could be used to recognise poor antihypertensive adherence to enable effective targeting of clinical interventions to improve hypertension management and outcomes.
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Affiliation(s)
| | - Susan M Smith
- Department of General Practice, HRB Centre for Primary Care Research, RCSI, Dublin 2, Ireland
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Midão L, Giardini A, Menditto E, Kardas P, Costa E. Adherence to Medication in Older Adults as a Way to Improve Health Outcomes and Reduce Healthcare System Spending. Gerontology 2018. [DOI: 10.5772/intechopen.72070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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15
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Polypharmacy prevalence among older adults based on the survey of health, ageing and retirement in Europe. Arch Gerontol Geriatr 2018; 78:213-220. [PMID: 30015057 DOI: 10.1016/j.archger.2018.06.018] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/28/2018] [Accepted: 06/28/2018] [Indexed: 01/10/2023]
Abstract
Polypharmacy, a common condition among the elderly, is associated with adverse outcomes, including increased healthcare costs, due to higher mortality, falls and hospitalizations rates, adverse drug reactions, drug-drug reactions and medication nonadherence. This study aims to evaluate the prevalence and factors related to polypharmacy in older adults across 17 European countries, plus Israel. In this cross-sectional analysis, we used data from participants aged 65 or more years from Wave 6 of the Survey of Health, Ageing, and Retirement in Europe (SHARE) database. Polypharmacy was defined as the concurrent use of five or more medications. Age, gender, education, physical inactivity, number of limitations with activities of daily living, network satisfaction, quality of life, depression, number of chronic diseases and difficulty taking medication variables were found to be associated with polypharmacy. Our results showed a prevalence of polypharmacy ranging from 26.3 to 39.9%. Switzerland, Croatia and Slovenia were the countries with the lowest prevalence, whereas Portugal, Israel and the Czech Republic were the countries where the prevalence of polypharmacy was the highest. Age, gender, number of limitations with activities of daily living, number of chronic diseases, quality of life, depression, physical inactivity, network satisfaction, difficulty in taking medications, years of education and shortage of money were significant variables associated with polypharmacy. Polypharmacy is a highly prevalent condition in the elderly population. Identification of variables associated with polypharmacy, such as those identified in this study, is important to identify and monitor elderly groups, which are most vulnerable to polypharmacy.
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Dillon P, Stewart D, Smith SM, Gallagher P, Cousins G. Group-Based Trajectory Models: Assessing Adherence to Antihypertensive Medication in Older Adults in a Community Pharmacy Setting. Clin Pharmacol Ther 2017; 103:1052-1060. [PMID: 28875569 PMCID: PMC6001422 DOI: 10.1002/cpt.865] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/31/2017] [Accepted: 08/27/2017] [Indexed: 12/31/2022]
Abstract
Antihypertensive medication nonadherence is highly prevalent, leading to uncontrolled blood pressure. Methods that facilitate the targeting and tailoring of adherence interventions in clinical settings are required. Group‐Based Trajectory Modeling (GBTM) is a newer method to evaluate adherence using pharmacy dispensing (refill) data that has advantages over traditional refill adherence metrics (e.g. Proportion of Days Covered) by identifying groups of patients who may benefit from adherence interventions, and identifying patterns of adherence behavior over time that may facilitate tailoring of an adherence intervention. We evaluated adherence to antihypertensive medication in 905 patients over a 12‐month period in a community pharmacy setting using GBTM, identifying three subgroups of adherence patterns: 52.8%, 40.7%, and 6.5% had very high, high, and low adherence, respectively. However, GBTM failed to demonstrate predictive validity with blood pressure at 12 months. Further research on the validity of adherence measures that facilitate interventions in clinical settings is required.
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Affiliation(s)
| | - Derek Stewart
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, Scotland, UK
| | - Susan M Smith
- Department of General Practice and HRB Centre for Primary Care Research, Dublin, Ireland
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Espaulella-Panicot J, Molist-Brunet N, Sevilla-Sánchez D, González-Bueno J, Amblàs-Novellas J, Solà-Bonada N, Codina-Jané C. [Patient-centred prescription model to improve adequate prescription and therapeutic adherence in patients with multiple disorders]. Rev Esp Geriatr Gerontol 2017; 52:278-281. [PMID: 28476211 DOI: 10.1016/j.regg.2017.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/16/2017] [Accepted: 03/20/2017] [Indexed: 06/07/2023]
Abstract
Patients with multiple disorders and on multiple medication are often associated with clinical complexity, defined as a situation of uncertainty conditioned by difficulties in establishing a situational diagnosis and decision-making. The patient-centred care approach in this population group seems to be one of the best therapeutic options. In this context, the preparation of an individualised therapeutic plan is the most relevant practical element, where the pharmacological plan maintains an important role. There has recently been a significant increase in knowledge in the area of adequacy of prescription and adherence. In this context, we must find a model must be found that incorporates this knowledge into clinical practice by the professionals. Person-centred prescription is a medication review model that includes different strategies in a single intervention. It is performed by a multidisciplinary team, and allows them to adapt the pharmacological plan of patients with clinical complexity.
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Affiliation(s)
- Joan Espaulella-Panicot
- Hospital Universitari de la Santa Creu, Vic, Barcelona, España; Hospital Universitari de Vic, Vic, Barcelona, España.
| | - Núria Molist-Brunet
- Hospital Universitari de la Santa Creu, Vic, Barcelona, España; Hospital Universitari de Vic, Vic, Barcelona, España
| | - Daniel Sevilla-Sánchez
- Hospital Universitari de la Santa Creu, Vic, Barcelona, España; Hospital Universitari de Vic, Vic, Barcelona, España
| | | | - Jordi Amblàs-Novellas
- Hospital Universitari de la Santa Creu, Vic, Barcelona, España; Hospital Universitari de Vic, Vic, Barcelona, España
| | | | - Carles Codina-Jané
- Hospital Universitari de Vic, Vic, Barcelona, España; Hospital Clínic de Barcelona, Barcelona, España
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Marcum ZA, Hanlon JT, Murray MD. Improving Medication Adherence and Health Outcomes in Older Adults: An Evidence-Based Review of Randomized Controlled Trials. Drugs Aging 2017; 34:191-201. [PMID: 28074410 DOI: 10.1007/s40266-016-0433-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Poor medication adherence is a major public health problem in older adults often resulting in negative health outcomes. OBJECTIVE The objective of this review was to provide an updated summary of evidence from randomized controlled studies to determine whether interventions aimed at improving medication adherence also improve the health outcomes of older adults residing in community-based settings. METHODS Articles that assessed medication adherence interventions and related health outcomes in elderly individuals were identified through searches of MEDLINE (1970-June 2016), the Cochrane Database of Systematic Reviews (through to June 2016), and Google Scholar. Across the 12 included studies, interventions were grouped into three main categories: behavioral/educational (n = 3), pharmacist-led (n = 7), and reminder/simplification (n = 2). RESULTS Among the behavioral/educational intervention studies, two showed improvements in both adherence and related health outcomes, whereas one found no changes in adherence or health outcomes. Among the pharmacist-led studies, three showed improvements in both adherence and related health outcomes, while three reported no changes in adherence or health outcomes. One found an improvement in adherence but not health outcomes. Among the reminder/simplification studies, both studies reported improvements in adherence without a significant impact on related health outcomes. CONCLUSION This evidence-based review of medication adherence interventions in older adults revealed promising strategies in the larger context of a largely mixed body of literature. Future patient-centered and multidisciplinary interventions should be developed and tested using evidence-based principles to improve medication adherence and health outcomes in older adults.
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Affiliation(s)
| | - Joseph T Hanlon
- Schools of Medicine (Geriatrics), Pharmacy, and Public Health, University of Pittsburgh, 3471 Fifth Avenue, Suite #500, Pittsburgh, PA, 15213, USA. .,Center for Health Equity Research and Promotion and Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.
| | - Michael D Murray
- Purdue University College of Pharmacy and Regenstrief Institute, Indianapolis, IN, USA
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