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Schulz M, Laufs U. Not obtaining a medication the first time it is prescribed: primary non-adherence to cardiovascular pharmacotherapy. Clin Res Cardiol 2024; 113:1103-1116. [PMID: 37209148 PMCID: PMC11269373 DOI: 10.1007/s00392-023-02230-3] [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: 04/03/2023] [Accepted: 05/08/2023] [Indexed: 05/22/2023]
Abstract
Primary medication non-adherence describes the situation when a first prescription for a new medication is never filled. Primary non-adherence is an important, yet understudied aspect of reduced effectiveness of pharmacotherapy. This review summarizes the frequency, impact, reasons, predictors, and interventions regarding primary non-adherence to cardiovascular/cardiometabolic drugs. The current literature reveals a high prevalence of primary non-adherence. The individual risk of primary non-adherence is determined on multiple factors, e.g., primary non-adherence of lipid-lowering drugs is higher compared to antihypertensive medications. However, the overall rate of primary non-adherence is > 10%. Additionally, this review identifies specific areas for research to better understand why patients forgo evidence-based beneficial pharmacotherapy and to explore targeted interventions. At the same time, measures to reduce primary non-adherence-once proven to be effective-may represent an important new opportunity to reduce cardiovascular diseases.
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Affiliation(s)
- Martin Schulz
- Institute of Pharmacy, Freie Universität Berlin, Kelchstraße 31, 12169, Berlin, Germany.
- Drug Commission of German Pharmacists (AMK), Heidestraße 7, 10557, Berlin, Germany.
- German Institute for Drug Use Evaluation (DAPI), Heidestraße 7, 10557, Berlin, Germany.
| | - Ulrich Laufs
- Department of Cardiology, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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Tsang JY, Sperrin M, Blakeman T, Payne RA, Ashcroft DM. Protocol for the development and validation of a Polypharmacy Assessment Score. Diagn Progn Res 2024; 8:10. [PMID: 39010248 PMCID: PMC11251249 DOI: 10.1186/s41512-024-00171-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/30/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND An increasing number of people are using multiple medications each day, named polypharmacy. This is driven by an ageing population, increasing multimorbidity, and single disease-focussed guidelines. Medications carry obvious benefits, yet polypharmacy is also linked to adverse consequences including adverse drug events, drug-drug and drug-disease interactions, poor patient experience and wasted resources. Problematic polypharmacy is 'the prescribing of multiple medicines inappropriately, or where the intended benefits are not realised'. Identifying people with problematic polypharmacy is complex, as multiple medicines can be suitable for people with several chronic conditions requiring more treatment. Hence, polypharmacy is often potentially problematic, rather than always inappropriate, dependent on clinical context and individual benefit vs risk. There is a need to improve how we identify and evaluate these patients by extending beyond simple counts of medicines to include individual factors and long-term conditions. AIM To produce a Polypharmacy Assessment Score to identify a population with unusual levels of prescribing who may be at risk of potentially problematic polypharmacy. METHODS Analyses will be performed in three parts: 1. A prediction model will be constructed using observed medications count as the dependent variable, with age, gender and long-term conditions as independent variables. A 'Polypharmacy Assessment Score' will then be constructed through calculating the differences between the observed and expected count of prescribed medications, thereby highlighting people that have unexpected levels of prescribing. Parts 2 and 3 will examine different aspects of validity of the Polypharmacy Assessment Score: 2. To assess 'construct validity', cross-sectional analyses will evaluate high-risk prescribing within populations defined by a range of Polypharmacy Assessment Scores, using both explicit (STOPP/START criteria) and implicit (Medication Appropriateness Index) measures of inappropriate prescribing. 3. To assess 'predictive validity', a retrospective cohort study will explore differences in clinical outcomes (adverse drug reactions, unplanned hospitalisation and all-cause mortality) between differing scores. DISCUSSION Developing a cross-cutting measure of polypharmacy may allow healthcare professionals to prioritise and risk stratify patients with polypharmacy using unusual levels of prescribing. This would be an improvement from current approaches of either using simple cutoffs or narrow prescribing criteria.
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Affiliation(s)
- Jung Yin Tsang
- Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK.
- NIHR Greater Manchester Patient Safety Research Collaboration (GMPSRC), Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK.
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, University of Manchester, Manchester, UK.
| | - Matthew Sperrin
- NIHR Greater Manchester Patient Safety Research Collaboration (GMPSRC), Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, University of Manchester, Manchester, UK
| | - Thomas Blakeman
- Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK
- NIHR Greater Manchester Patient Safety Research Collaboration (GMPSRC), Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK
| | - Rupert A Payne
- Department of Health and Community Sciences, University of Exeter Medical School, Exeter, UK
| | - Darren M Ashcroft
- NIHR Greater Manchester Patient Safety Research Collaboration (GMPSRC), Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK
- Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK
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O'Conor R, Russell AM, Pack A, Oladejo D, Filec S, Rogalski E, Morhardt D, Lindquist LA, Wolf MS. Managing medications among individuals with mild cognitive impairment and dementia: Patient-caregiver perspectives. J Am Geriatr Soc 2024. [PMID: 39007450 DOI: 10.1111/jgs.19065] [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: 04/03/2024] [Revised: 06/05/2024] [Accepted: 06/13/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND With changing cognitive abilities, individuals with mild cognitive impairment (MCI) and dementia face challenges in successfully managing multidrug regimens. We sought to understand how individuals with MCI or dementia and their family caregivers manage multidrug regimens and better understand patient-to-caregiver transitions in medication management responsibilities. METHODS We conducted qualitative interviews among patient-caregiver dyads. Eligibility included: patients with a diagnosis of MCI, mild or moderate dementia, managing ≥3 chronic conditions, ≥5 prescription medications, who also had a family caregiver ≥18 years old. Semi-structured interview guides, informed by the Medication Self-Management model, ascertained roles and responsibilities for medication management and patient-to-caregiver transitions in medication responsibilities. RESULTS We interviewed 32 patient-caregiver dyads. Older adults and caregivers favored older adult autonomy in medication management, and individuals with MCI and mild dementia largely managed their medications independently using multiple strategies (e.g., establishing daily routines, using pillboxes). Among individuals with moderate dementia, caregivers assumed all medication-related responsibilities except when living separately. In those scenarios, caregivers set up organizers and made reminder calls, but did not observe family members taking medications. Patient-to-caregiver transitions in medication responsibilities frequently occurred after caregivers observed older adults making errors with medications. As caregivers sought to assume greater responsibilities with family members' medicines, they faced multiple barriers. Most barriers were dyadic; they affected both the older adult and the caregiver and/or the relationship. Some barriers were specific to caregivers; these included caregivers' competing responsibilities or inaccurate perceptions of dementia, while other barriers were related to the healthcare system. CONCLUSIONS To ease medication management transitions, balance must be sought between preservation of older adult autonomy and early family caregiver involvement. Clinicians should work to initiate conversations with family caregivers and individuals living with MCI or dementia about transitioning medication responsibilities as memory loss progresses, simplify regimens, and deprescribe, as appropriate.
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Affiliation(s)
- Rachel O'Conor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA
| | - Andrea M Russell
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA
| | - Allison Pack
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA
| | - Dianne Oladejo
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sarah Filec
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA
| | - Emily Rogalski
- Healthy Aging & Alzheimer's Research Care (HAARC) Center, The University of Chicago, Chicago, Illinois, USA
| | - Darby Morhardt
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University, Chicago, Illinois, USA
| | - Lee A Lindquist
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA
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Fukasawa T, Nakanishi E, Shimoda H, Shinoda K, Ito S, Asada S, Yoshida S, Tanaka-Mizuno S, Mizuno K, Takahashi R, Kawakami K. Adherence to istradefylline in patients with Parkinson's disease: A group-based trajectory analysis. J Neurol Sci 2024; 462:123092. [PMID: 38925070 DOI: 10.1016/j.jns.2024.123092] [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: 01/25/2024] [Revised: 05/29/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Understanding the different patterns of adherence to istradefylline treatment is essential to identifying Parkinson's disease (PD) patients who might benefit from targeted interventions. OBJECTIVES This descriptive study aimed to identify longitudinal istradefylline adherence patterns and to characterize factors associated with them. METHODS We identified PD patients aged 21-99 years who initiated istradefylline treatment in a Japanese hospital administrative database. Group-based trajectory modeling was used to model the monthly proportion of days covered over time to identify distinct 360-day adherence patterns. Factors associated with each adherence pattern were assessed using univariable multinomial logistic regression models. RESULTS Of 2088 eligible PD patients, 4 distinct adherence groups were identified: consistently high adherence (56.8%); rapidly declining adherence (25.8%); gradually declining adherence (8.5%); and gradually declining and then recovering adherence (9.0%). Compared to the consistently high adherence group, the other groups had the following characteristics associated with a likelihood of lower adherence: the rapidly declining adherence group received fewer dopamine agonists (63.8% vs. 69.4%), monoamine oxidase B (MAO-B) inhibitors (26.8% vs. 31.6%), and catechol-O-methyl transferase inhibitors (31.6% vs. 37.0%) and had a higher prevalence of anxiety/mood disorders (29.9% vs. 24.6%); the gradually declining adherence group received fewer MAO-B inhibitors (22.5% vs. 31.6%) and amantadine (8.4% vs. 16.1%) and had a higher prevalence of mild cognitive impairment/dementia (27.0% vs. 18.8%); and the declining and then recovering adherence group had a higher prevalence of anxiety/mood disorders (34.2% vs. 24.6%). CONCLUSIONS Clinicians should be aware of the heterogeneous patterns of adherence to istradefylline.
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Affiliation(s)
- Toshiki Fukasawa
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan; Department of Digital Health and Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Etsuro Nakanishi
- Department of Neurology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroo Shimoda
- Medical Affairs Department, Kyowa Kirin Co., Ltd., Tokyo, Japan
| | - Katsumi Shinoda
- Medical Affairs Department, Kyowa Kirin Co., Ltd., Tokyo, Japan
| | - Satoru Ito
- Medical Affairs Department, Kyowa Kirin Co., Ltd., Tokyo, Japan; Pharmacovigilance Division, Kyowa Kirin Co., Ltd., Tokyo, Japan
| | - Shinji Asada
- Medical Affairs Department, Kyowa Kirin Co., Ltd., Tokyo, Japan
| | - Satomi Yoshida
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Sachiko Tanaka-Mizuno
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan; Department of Digital Health and Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Kayoko Mizuno
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan; Department of Digital Health and Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
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Ghai I, Palimaru A, Ebinger JE, Barajas D, Vallejo R, Morales M, Linnemayr S. Barriers and facilitators of habit building for long-term adherence to antihypertensive therapy among people with hypertensive disorders in Los Angeles, California: a qualitative study. BMJ Open 2024; 14:e079401. [PMID: 38991671 PMCID: PMC11243207 DOI: 10.1136/bmjopen-2023-079401] [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] [Indexed: 07/13/2024] Open
Abstract
OBJECTIVES The aim of this study was to a) explore barriers and facilitators associated with medication-taking habit formation, and b) elicit feedback on the components of an intervention designed to help form strong habits for long-term medication adherence. DESIGN The study design was qualitative; we conducted semistructured interviews between September 2021 and February 2022. SETTING The interviews were conducted online, with 27 participants recruited at the Cedars-Sinai Medical Center in Los Angeles, California. PARTICIPANTS A purposive sample of 20 patients who were over 18 years of age, had been diagnosed with hypertensive disorder (or reported high blood pressure; >140/90 mm Hg) and who were prescribed antihypertensive therapy at the time of recruitment, along with seven providers were interviewed. RESULTS Contextual factors included frequent changes to prescription for regimen adjustment, and polypharmacy. Forgetfulness, perceived need for medication, and routine disruptions were identified as possible barriers to habit formation. Facilitators of habit formation included identification of stable routines for anchoring, planning, use of external reminders (including visual reminders) and pillboxes for prescription management, and extrinsic motivation for forming habits. Interestingly, experiencing medication side effects was identified as a possible barrier and a possible facilitator of habit formation. Feedback on study components included increasing text size, and visual appeal of the habit leaflet; and imparting variation in text message content and adjusting their frequency to once a day. Patients generally favoured the use of conditional financial incentives to support habit formation. CONCLUSION The study sheds light on some key considerations concerning the contextual factors for habit formation among people with hypertension. As such, future studies may evaluate the generalisability of our findings, consider the role of visual reminders in habit formation and sustenance, and explore possible disruptions to habits. TRIAL REGISTRATION NUMBER NCT04029883.
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Affiliation(s)
- Ishita Ghai
- Pardee RAND Graduate School, Santa Monica, California, USA
| | | | - Joseph E Ebinger
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Denisse Barajas
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Rocio Vallejo
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michelle Morales
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Safroneeva E, Thorne H, Gerstner O, Laoun R. Similar Efficacy of Mesalazine in Adult and Older Adult Ulcerative Colitis Patients: Post Hoc Analysis of a Randomized Noninferiority Trial of 1600 mg vs 400 mg Tablets. Inflamm Bowel Dis 2024:izae123. [PMID: 38902993 DOI: 10.1093/ibd/izae123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND The efficacy data on treatment in older adults are scarce, while the greatest increase in ulcerative colitis (UC) prevalence is observed in age groups of individuals 40 to 65 years of age and ≥65 years of age. AIM We assessed the difference in rates of clinical and endoscopic response and remission in UC adults (≤60 years) and older adults (>60 years) treated with mesalazine. METHODS We performed a post hoc analysis of data from a phase 3 noninferiority trial of 817 UC patients treated with mesalazine for 8 and additional 26 weeks in a double-blind and open-label study, respectively. We used Wilcoxon rank sum or chi-square test to analyze differences between groups and multivariable logistic regression to determine the associations between endoscopic remission as outcome (Mayo endoscopic subscore [MES] = 0 or ≤1) and independent variables including disease duration, baseline MES, age, sex, comedications, and comorbidities. RESULTS Older adults had a longer disease duration, a higher number of comorbidities, concomitant medications, and higher baseline MES (2.38 ± 0.486 in older adults vs 2.26 ± 0.439 in adults; P = .008) compared with adults. We observed no difference in rates of combined clinical and endoscopic remission, clinical remission and response, and endoscopic remission and response at week 8 and 38 post-treatment. In addition to other well-known predictors of worse outcome, patients with ≥3 comedications were less likely to achieve an MES = 0 at week 8 and 38 and an MES ≤1 at week 38. CONCLUSIONS We observed similar efficacy of mesalazine in adult and older adult UC patients. The increased comedication number rather than age may decrease effectiveness of UC medications, highlighting the importance of healthy aging.
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Affiliation(s)
- Ekaterina Safroneeva
- Tillotts Pharma AG, Rheinfelden, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Figueroa JF, Duggan C, Phelan J, Ang L, Ebem F, Chu J, Orav EJ, Hyle EP. Antiretroviral Therapy Use and Disparities Among Medicare Beneficiaries with HIV. J Gen Intern Med 2024:10.1007/s11606-024-08847-y. [PMID: 38865008 DOI: 10.1007/s11606-024-08847-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/24/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Antiretroviral therapy (ART) is recommended for all people with HIV. Understanding ART use among Medicare beneficiaries with HIV is therefore critically important for improving quality and equity of care among the growing population of older adults with HIV. However, a comprehensive national evaluation of filled ART prescriptions among Medicare beneficiaries is lacking. OBJECTIVE To examine trends in ART use among Medicare beneficiaries with HIV from 2013 to 2019 and to evaluate whether racial and ethnic disparities in ART use are narrowing over time. DESIGN Retrospective observational study. SUBJECTS Traditional Medicare beneficiaries with Part D living with HIV in 2013-2019. MAIN MEASURES Months of filled ART prescriptions each year. KEY RESULTS Compared with beneficiaries not on ART, beneficiaries on ART were younger, less likely to be Black (41.6% vs. 47.0%), and more likely to be Hispanic (13.1% vs. 9.7%). While the share of beneficiaries who filled ART prescriptions for 10 + months/year improved (+ 0.48 percentage points/year [p.p.y.], 95% CI 0.34-0.63, p < 0.001), 25.8% of beneficiaries did not fill ART for 10 + months in 2019. Between 2013 and 2019, the proportion of beneficiaries who filled ART for 10 + months improved for Black beneficiaries (65.8 to 70.3%, + 0.66 p.p.y., 95% CI 0.43-0.89, p < 0.001) and White beneficiaries (74.8 to 77.4%, + 0.38 p.p.y.; 95% CI 0.19-0.58, p < 0.001), while remaining stable for Hispanic beneficiaries (74.5 to 75.0%, + 0.12 p.p.y., 95% CI - 0.24-0.49, p = 0.51). Although Black-White disparities in ART use narrowed over time, the share of beneficiaries who filled ART prescriptions for 10 + months/year was significantly lower among Black beneficiaries relative to White beneficiaries each year. CONCLUSIONS ART use improved from 2013 to 2019 among Medicare beneficiaries with HIV. However, about 25% of beneficiaries did not consistently fill ART prescriptions within a given year. Despite declining differences between Black and White beneficiaries, concerning disparities in ART use persist.
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Affiliation(s)
- Jose F Figueroa
- Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA.
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Ciara Duggan
- Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA
| | - Jessica Phelan
- Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA
| | - Luke Ang
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Florence Ebem
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Jacqueline Chu
- Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - E John Orav
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Emily P Hyle
- Harvard Medical School, Boston, MA, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard University Center for AIDS Research (CFAR), Boston, MA, USA
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Afshari M, Karimi-Shahanjarini A, Tapak L, Hashemi S. Determinants of medication adherence among elderly with high blood pressure living in deprived areas. Chronic Illn 2024:17423953241241803. [PMID: 38866539 DOI: 10.1177/17423953241241803] [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] [Indexed: 06/14/2024]
Abstract
INTRODUCTION The current study was conducted to determine the impact of health literacy and factors related to adherence to drug treatment, using the model proposed by the World Health Organization, in older adults with hypertension residing in informal settlements in Hamadan. METHODS This cross-sectional study was conducted on 405 patients in Hamadan city, located in the western part of Iran. Data were collected using an interviewer-administered questionnaire that included the 5-dimensional model proposed by the World Health Organization, Health Literacy for Iranian Adults, and Morisky Medication Adherence Scale-8. A two-stage sampling procedure was used to select patients from 14 comprehensive health service centers and health bases. The data were analyzed using SPSS v.24. RESULTS The study found that medication adherence was suboptimal in 63% of the participants. Additionally, 87.5% of patients had inadequate or insufficient health literacy. Factors related to medication adherence included age (odds ratio (OR) = 1.07), annual income (OR = 0.17), duration of hypertension (OR = 7.33), health literacy (OR = 1.03), self-reported health status (P < 0.05), and regular medication use (P < 0.008). CONCLUSION The results of this study indicate that more than half of the older adults in the study had suboptimal medication adherence and insufficient health literacy. The study also found that various factors, such as socioeconomic status, disease and treatment-related factors, and patient-related factors, influence medication adherence among older adults.
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Affiliation(s)
- Maryam Afshari
- Department of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Akram Karimi-Shahanjarini
- Department of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Lili Tapak
- Department of Biostatistics, School of Public Health and Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Somayeh Hashemi
- Department of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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Tsang JY, Sperrin M, Blakeman T, Payne RA, Ashcroft D. Defining, identifying and addressing problematic polypharmacy within multimorbidity in primary care: a scoping review. BMJ Open 2024; 14:e081698. [PMID: 38803265 PMCID: PMC11129052 DOI: 10.1136/bmjopen-2023-081698] [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: 11/03/2023] [Accepted: 05/11/2024] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION Polypharmacy and multimorbidity pose escalating challenges. Despite numerous attempts, interventions have yet to show consistent improvements in health outcomes. A key factor may be varied approaches to targeting patients for intervention. OBJECTIVES To explore how patients are targeted for intervention by examining the literature with respect to: understanding how polypharmacy is defined; identifying problematic polypharmacy in practice; and addressing problematic polypharmacy through interventions. DESIGN We performed a scoping review as defined by the Joanna Briggs Institute. SETTING The focus was on primary care settings. DATA SOURCES Medline, Embase, Cumulative Index to Nursing and Allied Health Literature and Cochrane along with ClinicalTrials.gov, Science.gov and WorldCat.org were searched from January 2004 to February 2024. ELIGIBILITY CRITERIA We included all articles that had a focus on problematic polypharmacy in multimorbidity and primary care, incorporating multiple types of evidence, such as reviews, quantitative trials, qualitative studies and policy documents. Articles focussing on a single index disease or not written in English were excluded. EXTRACTION AND ANALYSIS We performed a narrative synthesis, comparing themes and findings across the collective evidence to draw contextualised insights and conclusions. RESULTS In total, 157 articles were included. Case-finding methods often rely on basic medication counts (often five or more) without considering medical history or whether individual medications are clinically appropriate. Other approaches highlight specific drug indicators and interactions as potentially inappropriate prescribing, failing to capture a proportion of patients not fitting criteria. Different potentially inappropriate prescribing criteria also show significant inconsistencies in determining the appropriateness of medications, often neglecting to consider multimorbidity and underprescribing. This may hinder the identification of the precise population requiring intervention. CONCLUSIONS Improved strategies are needed to target patients with polypharmacy, which should consider patient perspectives, individual factors and clinical appropriateness. The development of a cross-cutting measure of problematic polypharmacy that consistently incorporates adjustment for multimorbidity may be a valuable next step to address frequent confounding.
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Affiliation(s)
- Jung Yin Tsang
- Centre for Primary Care and Health Services Research, School of Health Sciences, The University of Manchester Division of Population Health Health Services Research and Primary Care, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration (GMPSRC), Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), The University of Manchester, Manchester, UK
| | - Matthew Sperrin
- NIHR Greater Manchester Patient Safety Research Collaboration (GMPSRC), Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), The University of Manchester, Manchester, UK
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Thomas Blakeman
- Centre for Primary Care and Health Services Research, School of Health Sciences, The University of Manchester Division of Population Health Health Services Research and Primary Care, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration (GMPSRC), Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), The University of Manchester, Manchester, UK
| | - Rupert A Payne
- Department of Health and Community Sciences, University of Exeter Medical School, Exeter, UK
| | - Darren Ashcroft
- NIHR Greater Manchester Patient Safety Research Collaboration (GMPSRC), Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), The University of Manchester, Manchester, UK
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
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Ichibayashi R, Togawa M. Coloration Phenomenon of Flunitrazepam on the Tongue of an Elderly Patient: A Case Report. Cureus 2024; 16:e60627. [PMID: 38903315 PMCID: PMC11187469 DOI: 10.7759/cureus.60627] [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: 05/19/2024] [Indexed: 06/22/2024] Open
Abstract
Patients with dementia may forget to take their oral medications or may accidentally take too much. Furthermore, there are cases where people lick the medicine without recognizing it as a medicine or accidentally ingest it. An 88-year-old woman with a history of insomnia presented to the hospital, complaining of her weakness and mild loss of consciousness. Although her blood tests, imaging studies, and neurological findings were unremarkable, we noticed that her tongue was blue and determined that she had mistakenly taken flunitrazepam. This accidental ingestion was diagnosed as the cause of the symptoms. Patients with dementia report that they may take medicine by licking it, and some oral medicines have a coloring effect.
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Affiliation(s)
- Ryo Ichibayashi
- Division of Emergency Medicine Department of Internal Medicine, Toho University Medical Center Sakura Hospital, Chiba, JPN
| | - Miwako Togawa
- Division of Emergency Medicine, Department of Internal Medicine, Toho University Medical Center Sakura Hospital, Chiba, JPN
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11
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Caballero J, Patel N, Waldrop D, Ownby RL. Patient activation and medication adherence in adults. J Am Pharm Assoc (2003) 2024; 64:102025. [PMID: 38320653 PMCID: PMC11081861 DOI: 10.1016/j.japh.2024.01.021] [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: 10/02/2023] [Revised: 01/02/2024] [Accepted: 01/30/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Patients' level of medication adherence provides conflicting results in its relationship to patient activation. Multiple factors may be contributing to these mixed results. OBJECTIVES The primary purpose was to assess the association of patient activation to medication adherence in adults with chronic health conditions and low health literacy (HL). Secondary objectives were to determine whether age, education, gender, and race were associated with activation. METHODS Participants completed self-report questionnaires regarding chronic disease self-management. Patient activation was measured using Hibbard's Patient Activation Measure (PAM). Self-report of medication adherence was determined using the Gonzalez-Lu adherence questionnaire. Block regressions first assessed the relation of demographic variables and education to adherence and then the added relation of patient activation in a second model. RESULTS The analyses included 301 participants (mean age 58 years; 53% female; mean chronic conditions of 6.6). Some of the most common chronic conditions included hypertension (60%), arthritis (51%), depression (49%), and hyperlipidemia (43%). The relation of older age to greater medication adherence was significant (P < 0.05) in both models. The addition of PAM was significantly related to better adherence (P < 0.001) and also increased the R squared value from 0.04 to 0.09. This change resulted in a moderate effect size (d = 0.50). CONCLUSION Evaluating patient activation at baseline may predict those more likely to be medication adherent in patients with low HL.
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Park S, Kim DW, Lee K, Park MW, Chang K, Jeong MH, Ahn YK, Chae SC, Ahn TH, Rha SW, Kim HS, Gwon HC, Seong IW, Hwang KK, Kim KB, Cha KS, Oh SK, Chae JK. Association between body mass index and three-year outcome of acute myocardial infarction. Sci Rep 2024; 14:365. [PMID: 38429290 PMCID: PMC10907694 DOI: 10.1038/s41598-023-43493-0] [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: 06/29/2023] [Accepted: 09/25/2023] [Indexed: 03/03/2024] Open
Abstract
Body mass index (BMI), as an important risk factor related to metabolic disease. However, in some studies higher BMI was emphasized as a beneficial factor in the clinical course of patients after acute myocardial infarction (AMI) in a concept known as the "BMI paradox." The purpose of this study was to investigate how clinical outcomes of patients treated for AMI differed according to BMI levels. A total of 10,566 patients in the Korea Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH) from May 2010 to June 2015 were divided into three BMI groups (group 1: BMI < 22 kg/m2, group 2: ≥ 22 and < 26 kg/m2, and group 3: ≥ 26 kg/m2). The primary outcome was major adverse cardiac and cerebrovascular event (MACCE) at 3 years of follow-up. At 1 year of follow-up, the incidence of MACCE in group 1 was 10.1% of that in group 3, with a hazard ratio (HR) of 2.27, and 6.5% in group 2, with an HR of 1.415. This tendency continued up to 3 years of follow-up. The study demonstrated that lower incidence of MACCE in the high BMI group of Asians during the 3-year follow-up period compared to the low BMI group. The results implied higher BMI could exert a positive effect on the long-term clinical outcomes of patients with AMI undergoing percutaneous coronary intervention (PCI).
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Affiliation(s)
- Soyoon Park
- Department of Internal Medicine, Division of Cardiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dae-Won Kim
- Department of Internal Medicine, Division of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
- Department of Internal Medicine, Division of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| | - Kyusup Lee
- Department of Internal Medicine, Division of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mahn-Won Park
- Department of Internal Medicine, Division of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kiyuk Chang
- Department of Internal Medicine, Division of Cardiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Myung Ho Jeong
- Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Young Keun Ahn
- Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Sung Chull Chae
- Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Tae Hoon Ahn
- Gil Medical Center, Gachon University, Incheon, Republic of Korea
| | - Seung Woon Rha
- Guro Hospital, Korea University, Seoul, Republic of Korea
| | - Hyo-Soo Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeon Cheol Gwon
- Samsung Medical Center, Sungkyunkwan Universtiy, Seoul, Republic of Korea
| | - In Whan Seong
- Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Kyung Kuk Hwang
- Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Kwon-Bae Kim
- Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Kwang Soo Cha
- Pusan National University Hospital, Busan, Republic of Korea
| | - Seok Kyu Oh
- Wonkwang University Hospital, Iksan, Republic of Korea
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Ruiz Ramos J, Alquézar-Arbé A, Juanes Borrego A, Burillo Putze G, Aguiló S, Jacob J, Fernández C, Llorens P, Quero Espinosa FDB, Gordo Remartinez S, Hernando González R, Moreno Martín M, Sánchez Aroca S, Sara Knabe A, González González R, Carrión Fernández M, Artieda Larrañaga A, Adroher Muñoz M, Hong Cho JU, Escolar Martínez Berganza MT, Gayoso Martín S, Sánchez Sindín G, Silva Penas M, Gómez y Gómez B, Arenos Sambro R, González del Castillo J, Miró Ò. Short-term prognosis of polypharmacy in elderly patients treated in emergency departments: results from the EDEN project. Ther Adv Drug Saf 2024; 15:20420986241228129. [PMID: 38323189 PMCID: PMC10846059 DOI: 10.1177/20420986241228129] [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: 09/24/2023] [Accepted: 01/06/2024] [Indexed: 02/08/2024] Open
Abstract
Background Polypharmacy is a growing phenomenon among elderly individuals. However, there is little information about the frequency of polypharmacy among the elderly population treated in emergency departments (EDs) and its prognostic effect. This study aims to determine the prevalence and short-term prognostic effect of polypharmacy in elderly patients treated in EDs. Methods A retrospective analysis of the Emergency Department Elderly in Needs (EDEN) project's cohort was performed. This registry included all elderly patients who attended 52 Spanish EDs for any condition. Mild and severe polypharmacy was defined as the use of 5-9 drugs and ⩾10 drugs, respectively. The assessed outcomes were ED revisits, hospital readmissions, and mortality 30 days after discharge. Crude and adjusted logistic regression analyses, including the patient's comorbidities, were performed. Results A total of 25,557 patients were evaluated [mean age: 78 (IQR: 71-84) years]; 10,534 (41.2%) and 5678 (22.2%) patients presented with mild and severe polypharmacy, respectively. In the adjusted analysis, mild polypharmacy and severe polypharmacy were associated with an increase in ED revisits [odds ratio (OR) 1.13 (95% confidence interval (CI): 1.04-1.23) and 1.38 (95% CI: 1.24-1.51)] and hospital readmissions [OR 1.18 (95% CI: 1.04-1.35) and 1.36 (95% CI: 1.16-1.60)], respectively, compared to non-polypharmacy. Mild and severe polypharmacy were not associated with increased 30-day mortality [OR 1.05 (95% CI: 0.89-2.26) and OR 0.89 (95% CI: 0.72-1.12)], respectively. Conclusion Polypharmacy was common among the elderly treated in EDs and associated with increased risks of ED revisits and hospital readmissions ⩽30 days but not with an increased risk of 30-day mortality. Patients with polypharmacy had a higher risk of ED revisits and hospital readmissions ⩽30 days after discharge.
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Affiliation(s)
- Jesus Ruiz Ramos
- Pharmacy Department, Hospital de la Santa Creu I Sant Pau, Institut de Recerca Sant Pau (IR SANT PAU), C/San Quintin 56-58, Barcelona 08025, Spain
| | - Aitor Alquézar-Arbé
- Emergency Department, Hospital de la Santa Creu I Sant Pau, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Ana Juanes Borrego
- Pharmacy Department, Hospital de la Santa Creu I Sant Pau, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Guillermo Burillo Putze
- Facultad de Ciencias de la Salud, Universidad Europea de Canarias, Santa Cruz de Tenerife, Spain
| | - Sira Aguiló
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, l’Hospitalet de Llobregat, Spain
| | - Cesáreo Fernández
- Emergency Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
| | - Pere Llorens
- Emergency Department, Hospital Doctor Balmis, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | | | | | | | | | - Sara Sánchez Aroca
- Emergency Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | | | | | | | | | | | | | | | - Sara Gayoso Martín
- Emergency Department, Hospital Comarcal El Escorial, San Lorenzo de El Escorial, Spain
| | | | | | | | | | | | - Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
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Lipton JH. Maximizing the Value of Chronic Myeloid Leukemia Management Using Tyrosine Kinase Inhibitors in the USA: Potential Determinants and Consequences of Healthcare Resource Utilization and Costs, with Proposed Optimization Approaches. Clin Drug Investig 2024; 44:91-108. [PMID: 38182963 DOI: 10.1007/s40261-023-01329-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND AND OBJECTIVES The introduction and widespread use of effective and well-tolerated tyrosine kinase inhibitors for chronic myeloid leukemia have been associated with marked increments in life expectancy and disease prevalence. These changes have been accompanied by elevations in costs of tyrosine kinase inhibitors, which typically must be taken ad vitam after diagnosis and tend to be more expensive than medical therapies for many other hematologic malignancies. The aims of this review included evaluating the potential associations and consequences of healthcare resource utilization and costs of tyrosine kinase inhibitors and possible clinical management approaches to mitigate them. METHODS A PubMed search of English-language US study reports was conducted that covered the interval of 2001 (US approval of imatinib) through 17 April, 2023 augmented by manual reviews of published bibliographies from the referenced articles and searches of other databases: Google Scholar and Scopus. RESULTS On the basis of this analysis of chiefly real-world evidence (administrative claims database studies), healthcare resource utilization and costs can be considered indicators of ineffective chronic myeloid leukemia management, including potentially mutation-driven treatment resistance and costly tyrosine kinase inhibitor switches, non-adherence, and suboptimal tolerability, which may culminate in the progression of disease from the chronic to an accelerated or blast phase, with additional excess costs. Costs of tyrosine kinase inhibitors are also associated with reduced treatment adherence. At a willingness-to-pay threshold of $50,000-$200,000 per quality-adjusted life-year, tyrosine kinase inhibitors can be considered cost effective from a US payer perspective. Potential clinical approaches to mitigate costs include regular molecular monitoring with proactive assessments of BCR::ABL1 gene mutations to avoid costly treatment switches, as well as interventions to enhance treatment adherence and tyrosine kinase inhibitor tolerability. CONCLUSIONS Healthcare resource utilization and costs of chronic myeloid leukemia care may be considered barometers of ineffective management, including mutation-driven tyrosine kinase inhibitor resistance and switching as well as non-adherence and intolerance. Future prospective research is warranted to help determine whether costs can be reduced and other treatment outcomes optimized via more proactive and effective diagnostic interventions (i.e., regular molecular monitoring and proactive mutational testing) and treatment approaches. The strengths and limitations of this review include its emphasis on observational research, which, on one hand, offers a naturalistic "real-world" perspective on current chronic myeloid leukemia management, but, on the other hand, is associational in nature and cannot be used to determine causality and/or its direction.
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Affiliation(s)
- Jeffrey H Lipton
- Princess Margaret Cancer Centre and University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
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Dahal P, Kahana E. Following Physician's Advice in Late Life: The Roles of Health Beliefs and Health Status. Patient Prefer Adherence 2024; 18:217-226. [PMID: 38269209 PMCID: PMC10807281 DOI: 10.2147/ppa.s409023] [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: 12/08/2023] [Accepted: 01/17/2024] [Indexed: 01/26/2024] Open
Abstract
Objective This study aims to explore the influence of health-related locus of control beliefs such as belief in the role of health professionals in influencing patient health, cognitive functioning, and multimorbidity on adherence to physician's recommendations among older adults. Methods A cross-sectional study involving older adults (N=684, age range = 71-100 years) living in Clearwater, Florida, reported their adherence to physician's recommendations, cognitive functioning, physical health, and health-related locus of control beliefs. Ordered Logistic regression was used. Results Older adults who believed that health professionals influence health and a person is likely to recover from illness because other people take good care of him/her had higher adherence to physician's recommendations. Older adults who believed that their own action affects their health had lower odds of reporting adherence by 27%. Additionally, those with cognitive impairment had lower odds of reporting adherence by 38%. Functional limitations, multimorbidity, and self-image of health were not associated with adherence. Conclusion This is one of the first studies to consider the influence of locus of control beliefs on adherence of physician's recommendations among community dwelling older adults. With the exception of one item "My good health is largely a matter of good fortune", generally individuals with external locus of control had higher adherence. Our findings also underscore the policy and clinical significance of different health-related beliefs held by older adults.
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Affiliation(s)
- Poshan Dahal
- Department of Sociology, Case Western Reserve University, Cleveland, OH, USA
| | - Eva Kahana
- Department of Sociology, Case Western Reserve University, Cleveland, OH, USA
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Peñalva-Arigita A, Lecha M, Sansano A, Prats R, Vásquez A, Bascuñana H, Vila L. Adherence to commercial food thickener in patients with oropharyngeal dysphagia. BMC Geriatr 2024; 24:67. [PMID: 38229009 DOI: 10.1186/s12877-023-04589-4] [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: 07/17/2022] [Accepted: 12/11/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Oropharyngeal dysphagia (OD), a common symptom in the elderly, uses commercial thickener (CT) as part of its treatment. This is often accompanied of dislike and poor compliance. AIM Describe adherence to CT and possible differences according to dwelling location in an area of influence of approximately 400.0000 inhabitants. METHODS Cohort prospective observational study. Randomized patients from Nutrition and Dietetic (NDU)-database (4 calls-interviews/year). VARIABLES Age, diagnostic, gender, dwelling/location: Home (H) / Nursing Home (NH), viscosity (nectar, honey, pudding), days with CT. Adherence measured with a questionnaire, considering implementation of treatment by combining CT use and consumption data, categorised in three groups good, moderate and poor. Change in patterns (improvement, maintenance, worsening) and non-adherence reasons. RESULTS One hundred sixty-eight patients recruited with indicated viscosity: Nectar 39.7%, honey 29.3% and pudding 30.8%. Average age of 82.6 ± 11.1 years; 57.8% women (46.4% at H vs. 67% at NH, p < 0.01). Dwelling/location: 80 (47.6%) live at H and 88 (52.4%) at NH. Days with CT prior study were 509 ± 475.28. Implementation found in first call: good in 50%, moderate in 20.2% and poor in 29.8%. At first call, adherence parameters were more favourable in NH compared to H. However these parameters were reversed during the study period as there was an improvement at H vs. NH. Also in terms of change in patterns a significant improvement of implementation was found in patients living at H, 31.1% vs. those living at NH, 15.7%, p < 0.05. CT persistence throughout study was 89.7%. CONCLUSIONS Low adherence to CT found in our community. Telephone follow-up resulted in improved adherence, especially in the H population. Our data provides valuable insights into the variability and changes in CT adherence among patients with OD. Adherence is complex and subject to many factors and dwelling/location is one of them. This study reveals the need to approach CT treatment for OD differently in NH.
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Affiliation(s)
- Amaya Peñalva-Arigita
- Nutritional & Dietetics Unit, Hospital Moisès Broggi, Oriol, C. d'Oriol Martorell, 12, Sant Joan Despí, Barcelona, 08970, Spain.
| | - Maria Lecha
- Nutritional & Dietetics Unit, Hospital Moisès Broggi, Oriol, C. d'Oriol Martorell, 12, Sant Joan Despí, Barcelona, 08970, Spain
| | - Anna Sansano
- Nutritional & Dietetics Unit, Hospital Moisès Broggi, Oriol, C. d'Oriol Martorell, 12, Sant Joan Despí, Barcelona, 08970, Spain
| | - Rosa Prats
- Nutritional & Dietetics Unit, Hospital Moisès Broggi, C. d'Oriol Martorell 12., Sant Joan Despí, Barcelona, 08970, Spain
| | - Aida Vásquez
- Nutritional & Dietetics Unit, Hospital Moisès Broggi, Oriol, C. d'Oriol Martorell, 12, Sant Joan Despí, Barcelona, 08970, Spain
| | - Helena Bascuñana
- Nutritional & Dietetics Unit, Hospital Moisès Broggi, Oriol, C. d'Oriol Martorell, 12, Sant Joan Despí, Barcelona, 08970, Spain
- Physical Medicine and Rehabilitation Department Sant Pau University Hospital, Sant Quintí, 89, Barcelona, 08041, Spain
| | - Lluis Vila
- Endocrinology and Nutrition Department, Hospital Moisès Broggi, C. d'Oriol Martorell, 12, Sant Joan Despí, Barcelona, 08970, Spain
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O'Conor R, Bonham M, Magnuson G, Opsasnick L, Hurtado J, Yoshino Benavente J, Curtis LM, Wolf MS. Caregiver health literacy and health task performance: Findings from the LitCog caregiver cohort study. PEC INNOVATION 2023; 3:100240. [PMID: 38161686 PMCID: PMC10757034 DOI: 10.1016/j.pecinn.2023.100240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/20/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024]
Abstract
Objective Many older adults receive assistance in managing their chronic conditions. Yet complicating the utility of caregiver support is whether caregivers have sufficient skills to aid in older adults' health management at home. We examined associations between caregiver health literacy and performance on health tasks. Methods Caregivers to older adults enrolled in a cognitive aging cohort were recruited to participate in a supplemental interview (n = 97). Caregivers completed one structured interview that included assessments of health literacy and health task performance. Results Caregivers demonstrated a range of health literacy skills (44% adequate, 36% marginal, 20% low health literacy). In adjusted analyses, caregivers with marginal and low health literacy demonstrated worse overall performance on the health tasks, and poorer interpretation of health information presented on print documents and recall of spoken communication (p's < 0.05). Conclusion Caregivers with marginal or low health literacy demonstrated poorer performance on everyday health tasks that they commonly assist older adults with. The application of health literacy best-practices to support better training and capacity-building for caregivers is warranted. Innovation Few studies have considered the health literacy skills of caregivers and its application to caregivers' abilities to carry out common supportive tasks.
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Affiliation(s)
- Rachel O'Conor
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Morgan Bonham
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Grace Magnuson
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lauren Opsasnick
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jeimmy Hurtado
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Julia Yoshino Benavente
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Laura M. Curtis
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael S. Wolf
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Betts AC, Murphy CC, Shay LA, Balasubramanian BA, Markham C, Roth ME, Allicock M. Polypharmacy and medication fill nonadherence in a population-based sample of adolescent and young adult cancer survivors, 2008-2017. J Cancer Surviv 2023; 17:1688-1697. [PMID: 36346577 PMCID: PMC10164839 DOI: 10.1007/s11764-022-01274-0] [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: 06/15/2022] [Accepted: 10/11/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE We examined the association between polypharmacy-an established risk factor for nonadherence in the elderly-and medication fill nonadherence in a large national sample of adolescent and young adult cancer survivors (AYAs) in the USA. METHODS We pooled data (2008-2017) from the Medical Expenditure Panel Survey. We defined polypharmacy as ≥ 3 unique medications prescribed, based on self-report and pharmacy data, and medication fill nonadherence as self-reported delay or inability to obtain a necessary medication. We estimated prevalence of medication fill nonadherence among AYAs (age 18-39 years with a cancer history). We used logistic regression to estimate the association between (1) polypharmacy and medication fill nonadherence in AYAs, and (2) total number of medications prescribed and medication fill nonadherence, controlling for sex, number of chronic conditions, disability, and survey year. RESULTS AYAs (n = 598) were predominantly female (76.2%), age 30-39 years (64.9%), and non-Hispanic White (72.1%). Nearly half were poor (19.0%) or near-poor/low income (21.6%). One in ten AYAs reported medication fill nonadherence (9.75%). Of these, more than 70% cited cost-related barriers as the reason. AYAs with polypharmacy had 2.49 times higher odds of medication fill nonadherence (95%CI 1.11-5.59), compared to those without polypharmacy. Odds of medication fill nonadherence increased by 16% with each additional medication prescribed (AOR 1.16, 95% CI 1.07-1.25). CONCLUSIONS Polypharmacy may be an important risk factor for medication fill nonadherence in AYAs in the USA. IMPLICATIONS FOR CANCER SURVIVORS Improving AYAs' medication adherence requires eliminating cost-related barriers, particularly for those with polypharmacy.
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Affiliation(s)
- Andrea C Betts
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA.
| | - Caitlin C Murphy
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Houston, TX, USA
| | - L Aubree Shay
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, San Antonio, TX, USA
| | - Bijal A Balasubramanian
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Dallas, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Dallas, TX, USA
| | - Christine Markham
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Houston, TX, USA
| | - Michael E Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marlyn Allicock
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Dallas, TX, USA
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Lopez JL, Duarte G, Taylor CN, Ibrahim NE. Achieving Health Equity in the Care of Patients with Heart Failure. Curr Cardiol Rep 2023; 25:1769-1781. [PMID: 37975970 DOI: 10.1007/s11886-023-01994-4] [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] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW To discuss the prevailing racial and ethnic disparities in heart failure (HF) care by identifying barriers to equitable care and proposing solutions for achieving equitable outcomes. RECENT FINDINGS Throughout the entire spectrum of HF care, from prevention to implementation of guideline-directed medical therapy and advanced interventions, racial and ethnic disparities exist. Factors such as differential distribution of risk factors, poor access to care, inadequate representation in clinical trials, and discrimination from healthcare clinicians, among others, contribute to these disparities. Recent data suggests that despite improvements, disparities prevail in several aspects of HF care, hindering our progress towards equity in HF care. This review highlights the urgent need to address racial and ethnic disparities in HF care, emphasizing the importance of a multifaceted approach involving policy changes, quality improvement strategies, targeted interventions, and intentional community engagement. Our proposed framework was derived from existing research and emphasizes integrating equity into routine quality improvement efforts, tailoring interventions to specific populations, and advocating for policy transformation. By acknowledging these disparities, implementing evidence-based strategies, and fostering collaborative efforts, the HF community can strive to reduce disparities and achieve equity in HF care.
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Affiliation(s)
- Jose L Lopez
- Division of Cardiovascular Disease, JFK Hospital, University of Miami Miller School of Medicine, Atlantis, FL, USA
| | - Gustavo Duarte
- Division of Cardiology, Cleveland Clinic Florida, Weston, FL, USA
| | - Christy N Taylor
- Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York City, NY, USA
| | - Nasrien E Ibrahim
- Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA.
- The Equity in Heart Transplant Project, Inc, Boston, MA, USA.
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Lauffenburger JC, Tesfaye H, Solomon DH, Antman EM, Glynn RJ, Lee SB, Tong A, Choudhry NK. Investigating the ability to adhere to cardiometabolic medications with different properties: a retrospective cohort study of >500 000 patients in the USA. BMJ Open 2023; 13:e075840. [PMID: 37949625 PMCID: PMC10649612 DOI: 10.1136/bmjopen-2023-075840] [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: 05/19/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE Poor medication adherence remains highly prevalent and adversely affects health outcomes. Patients frequently describe properties of the pills themselves, like size and shape, as barriers, but this has not been evaluated objectively. We sought to determine the extent to which oral medication properties thought to be influential translate into lower objectively-measured adherence. DESIGN Retrospective cohort study. SETTING US nationwide commercial claims database, 2016-2019. PARTICIPANTS Among patients initiating first-line hypertension, diabetes or hyperlipidaemia treatment based on clinical guidelines, we measured pill size, shape, colour and flavouring, number of pills/day and fixed-dose combination status as properties. OUTCOME MEASURES Outcomes included discontinuation after the first fill (ie, never filling again over a minimum of 1-year follow-up) and long-term non-adherence (1-year proportion of days covered <0.80). We estimated associations between each property and outcomes, by therapeutic class (eg, statins), with multivariable logistic regression. RESULTS Across 604 323 patients, 14.6% discontinued after filling once (ie, were non-persistent), and 54.0% were non-adherent over 1-year follow-up. Large pill size was associated with non-adherence, except for thiazides (eg, metformin adjusted OR (aOR): 1.12, 95% CI: 1.06 to 1.18). Greater pill burden was associated with a higher risk of non-adherence across all classes (eg, metformin aOR: 1.58, 95% CI: 1.53 to 1.64 for two pills/day). Taking less than one pill/day was also associated with higher risk of non-adherence and non-persistence (eg, non-persistence statin aOR: 1.29, 95% CI: 1.20 to 1.38). Pill shape, colour, flavouring and combination status were associated with mixed effects across classes. CONCLUSIONS Pill burden and pill size are key properties affecting adherence for almost all classes; others, like size and combination, could modestly affect medication adherence. Clinical interventions could screen patients for potential intolerance to medication and potentially implement more convenient dosing schedules.
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Affiliation(s)
- Julie C Lauffenburger
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Center for Healthcare Delivery Sciences, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Helen Tesfaye
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel H Solomon
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Elliott M Antman
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Robert J Glynn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Angela Tong
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Niteesh K Choudhry
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Center for Healthcare Delivery Sciences, Brigham and Women's Hospital, Boston, Massachusetts, USA
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21
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Lovett R, Filec S, Bonham M, Yoshino Benavente J, O'Conor R, Russell A, Zheng P, Wismer G, Yoon E, Weiner-Light S, Vogeley A, Morrissey Kwasny M, Lowe S, Curtis LM, Federman A, Bailey SC, Wolf M. Long-term impact of the COVID-19 pandemic on self-management of chronic conditions among high-risk adults in the USA: protocol for the C3 observational cohort study. BMJ Open 2023; 13:e077911. [PMID: 37899164 PMCID: PMC10618985 DOI: 10.1136/bmjopen-2023-077911] [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: 07/20/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION COVID-19 is an unprecedented public health threat in modern times, especially for older adults or those with chronic illness. Beyond the threat of infection, the pandemic may also have longer-term impacts on mental and physical health. The COVID-19 & Chronic Conditions ('C3') study offers a unique opportunity to assess psychosocial and health/healthcare trajectories over 5 years among a diverse cohort of adults with comorbidities well-characterised from before the pandemic, at its onset, through multiple surges, vaccine rollouts and through the gradual easing of restrictions as society slowly returns to 'normal'. METHODS AND ANALYSIS The C3 study is an extension of an ongoing longitudinal cohort study of 'high-risk' adults (aged 23-88 at baseline) with one or more chronic medical conditions during the COVID-19 pandemic. Five active studies with uniform data collection prior to COVID-19 were leveraged to establish the C3 cohort; 673 adults in Chicago were interviewed during the first week of the outbreak. The C3 cohort has since expanded to include 1044 participants across eight survey waves (T1-T8). Four additional survey waves (T9-T12) will be conducted via telephone interviews spaced 1 year apart and supplemented by electronic health record and pharmacy fill data, for a total of 5 years of data post pandemic onset. Measurement will include COVID-19-related attitudes/behaviours, mental health, social behaviour, lifestyle/health behaviours, healthcare use, chronic disease self-management and health outcomes. Mental health trajectories and associations with health behaviours/outcomes will be examined in a series of latent group and mixed effects modelling, while also examining mediating and moderating factors. ETHICS AND DISSEMINATION This study was approved by Northwestern University's Feinberg School of Medicine Institutional Review Board (STU00215360). Results will be published in international peer-reviewed journals and summaries will be provided to the funders of the study.
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Affiliation(s)
- Rebecca Lovett
- Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarah Filec
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Morgan Bonham
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Julia Yoshino Benavente
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rachel O'Conor
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrea Russell
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Pauline Zheng
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Guisselle Wismer
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Esther Yoon
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sophia Weiner-Light
- Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Abigail Vogeley
- Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mary Morrissey Kwasny
- Preventive Medicine (Biostatistics), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarah Lowe
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Laura M Curtis
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alex Federman
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Stacy C Bailey
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Wolf
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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22
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O'Conor R, Bonham M, Opsasnick L, Magnuson G, Yoshino Benavente J, Curtis LM, Morrissey Kwasny M, Wolf M. LitCog Caregiver Cohort: a prospective, observational cohort study investigating US caregivers' health literacy, self-care skills and cognitive function. BMJ Open 2023; 13:e075921. [PMID: 37857547 PMCID: PMC10603521 DOI: 10.1136/bmjopen-2023-075921] [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: 05/22/2023] [Accepted: 09/28/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Many older adults receive assistance in managing chronic conditions. Yet complicating the utility of caregiver support is whether caregivers have sufficient skills to aid in a patient's self-care. Health literacy and cognition are important determinants of older adults' health outcomes, but few studies have examined caregiver health literacy, cognition and self-care skills and their relations to patient outcomes. METHODS AND ANALYSIS We will expand an ongoing cognitive ageing cohort study (LitCog) to enroll a parallel caregiver cohort. Caregivers are eligible if they are (1) ≥18 years of age, (2) provided care for ≥6 months and (3) assisted with at least one activity of daily living, instrumental activity of daily living or health management task. Caregivers will complete interviews at time points corresponding with the LitCog participant interviews. Caregivers will complete assessments of health literacy, self-care skills, cognitive function, caregiver healthcare task difficulty, caregiver burden, caregiver self-efficacy, activation, technology use, busyness and routine and relationship quality. Caregivers will self-report the nature and intensity of care provided, and their own health status. Associations between caregiver presence and caregiver capacity with patient outcomes will be examined in a series of regression models, and mediating and moderating factors will be tested. ETHICS AND DISSEMINATION The Institutional Review Board at Northwestern University has approved the study protocol (STU00026255). Results will be published in peer-reviewed journals and summaries will be provided to the funders of the study as well as patients and caregivers.
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Affiliation(s)
- Rachel O'Conor
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Morgan Bonham
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lauren Opsasnick
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Grace Magnuson
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Julia Yoshino Benavente
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laura M Curtis
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mary Morrissey Kwasny
- Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Wolf
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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23
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Kumar T, Dutta RR, Thakre S, Singh A, Velagala VR, Shinde RK. Resistance to Resilience: Understanding Post-surgical Hormone Therapy in Breast Cancer Care. Cureus 2023; 15:e47869. [PMID: 38021507 PMCID: PMC10681032 DOI: 10.7759/cureus.47869] [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: 10/11/2023] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
Breast cancer is one of the most common types of cancer affecting women worldwide. Over the years, breast cancer has become a major public health concern, and its incidence is rising globally. The treatment of breast cancer does not stop with surgical intervention, but adjuvant therapies are administered to improve patient outcomes post-surgery based on the type of breast cancer diagnosed. This review focuses on the value of hormone therapy (HT) in improving the prognosis of breast cancer patients and why adhering to adjuvant treatment post-surgery is difficult for patients. HT aims to reduce the chances of breast cancer recurrence after surgical treatment. Even though HT is life-saving, patients tend to not adhere to the therapy due to various factors such as side effects, age-related issues, and socioeconomic status. Most patients stop adhering to the therapy as the duration can be as long as 5-10 years, and the quality of life is greatly impacted due to the side effects of the treatment. This review examines the possible factors leading to non-adherence to HT and tries to propose possible interventions that might improve patient compliance with the treatment. This article not only focuses on the impact of side effects of HT on patients' quality of life but also tries to understand the problems faced by breast cancer patients in adhering to HT.
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Affiliation(s)
- Tanishq Kumar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rajoshee R Dutta
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swedaj Thakre
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Arihant Singh
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vivek R Velagala
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raju K Shinde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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24
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Kan H, Bae JP, Dunn JP, Buysman EK, Gronroos NN, Swindle JP, Bengtson LG, Ahmad N. Real-world primary nonadherence to antiobesity medications. J Manag Care Spec Pharm 2023; 29:1099-1108. [PMID: 37594848 PMCID: PMC10586463 DOI: 10.18553/jmcp.2023.23083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
BACKGROUND: Primary nonadherence (PNA), when a medication is newly prescribed but not filled, has been identified as a major research gap potentially impacting the optimal treatment of patients with overweight and obesity who are newly prescribed antiobesity medications (AOMs). OBJECTIVES: To assess PNA among patients with newly prescribed AOMs and to examine factors associated with PNA to AOMs. METHODS: This was a retrospective study that used the Optum Integrated Clinical plus Claims database to identify individuals who had at least 1 prescription order for an AOM the US Food and Drug Administration approved for long-term use. Individuals with prescription orders between January 1, 2012, and February 28, 2019, were identified, and patient demographics, clinical characteristics, medication prescribed, baseline health care utilization, and obesity-related complications were described by PNA status. PNA was defined as no pharmacy claim for the AOM within 60 days of the date of the new prescription order as identified in electronic health record data. A multivariable logistic regression model was used to examine factors associated with PNA. RESULTS: The study sample included a total of 1,563 patients. The mean body mass index was 38.4 kg/m2; 10.7% were prescribed liraglutide 3.0 mg, 26.0% were prescribed lorcaserin, 36.3% of patients were prescribed naltrexone-bupropion, 5.4% were prescribed orlistat, and 21.6% were prescribed phentermine-topiramate. Most patients (91.1%) exhibited PNA, with only 8.9% filling their newly prescribed AOM within 60 days. Both the adherent and nonadherent groups were predominately female sex, White, and covered by commercial insurance. The mean age was similar between the 2 groups. Most obesity-related complications were less prevalent in the adherent group, although the Charlson comorbidity index score was similar between the 2 groups. After adjustment for patient demographics and clinical characteristics, there was not a statistically significant association between the specific AOM and PNA (P = 0.299). Patients with depression or living in the Midwest or South regions were at significantly increased risk of PNA. CONCLUSIONS: The rate of PNA to AOMs was very high, suggesting barriers in effective medical management of patients with overweight and obesity. Future research is warranted to understand reasons for PNA to AOMs and how to address these barriers. DISCLOSURES: Dr Kan, Dr Bae, Dr Dunn, and Dr Ahmad are employees of Eli Lilly and Company. Ms Buysman and Dr Gronroos are employees of Optum. Dr Swindle was an employee of Optum at the time the study was conducted and is currently employed at Evidera. Dr Bengtson is employed at Boehringer Ingelheim Pharmaceuticals, Inc. (Boehringer Ingelheim has no connection to this study), and during the conduct of this study was employed at Optum.
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25
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Amonoo HL, Deary EC, Wang A, Newcomb RA, Daskalakis E, Weber D, Holmbeck KE, Choe JJ, Nabily A, Cutler C, Traeger LN, El-Jawahri A. Medication Adherence in Patients with Hematologic Malignancies Who Are Hematopoietic Stem Cell Transplantation Survivors: A Qualitative Study. Transplant Cell Ther 2023; 29:620.e1-620.e11. [PMID: 37516379 PMCID: PMC10592303 DOI: 10.1016/j.jtct.2023.07.019] [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: 05/26/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Abstract
Medication adherence is critical for optimal health outcomes in patients with hematologic malignancies who have undergone allogeneic hematopoietic stem cell transplants (HSCT). However, this population struggles with medication nonadherence. Research that comprehensively describes the complex patient- and medication-related factors which impact medication adherence in this population is lacking. Hence, we used semistructured qualitative interviews to explore the diverse and complex factors contributing to medication adherence in HSCT recipients. We conducted 30 in-depth interviews with patients who were more than 180 days post-allogeneic HSCT at the Dana-Farber Cancer Institute. The interviews explored the physical, social, psychological, and sociodemographic factors that facilitate or discourage adherence to the post-transplantation medication regimen. Interviews were audio-recorded, transcribed, and coded using NVivo software. Two themes emerged that characterized the barriers patients face with their medication regimen. Patients reported factors outside of their control, such as managing multiple pharmacies, health insurance difficulties, and dosage timing, as significant barriers to medication adherence. Patients also reported barriers within their control, such as familial responsibilities. Important facilitators for medication adherence included caregiver and clinician support, previous experience managing a medication regimen, and tools that aid pill organization and timing. Furthermore, patients reported that although medication side effects and quantity of pills did not directly impact medication adherence, it increased their psychological distress. Facilitators and barriers to medication adherence can be physical, psychological, organizational, and social. There are many aspects of medication regimens that significantly increase patient distress. Hence, supportive interventions to improve medication adherence in patients undergoing HSCT may need to incorporate strategies to manage medication side effects and skills to improve psychological well-being and social support.
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Affiliation(s)
- Hermioni L Amonoo
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Emma C Deary
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Annie Wang
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Richard A Newcomb
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Daniel Weber
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Katherine E Holmbeck
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Joanna J Choe
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Anisa Nabily
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Corey Cutler
- Harvard Medical School, Boston, Massachusetts; Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lara N Traeger
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychology, University of Miami, Coral Gables, Florida
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts; Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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26
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Allahverdipour H, Badri M, Shaghaghi A, Mahmoodi H, Heizomi H, Shirzadi S, Asghari-Jafarabadi M. Medications Non-adherence Reasoning Scale (MedNARS): Development and psychometric properties appraisal. Health Promot Perspect 2023; 13:212-218. [PMID: 37808946 PMCID: PMC10558970 DOI: 10.34172/hpp.2023.26] [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: 05/06/2023] [Accepted: 06/21/2023] [Indexed: 10/10/2023] Open
Abstract
Background Proper elucidation of medication non-adherence reasoning especially in older adults might pave the way for an auspicious therapeutic outcome. The main aim of this study was to develop and psychometrically test the Medications Non-adherence Reasoning (MedNARS) questionnaire for application in research and probably practice settings. Methods A mixed methods design was utilized to develop the MedNARS. The item pool was mainly generated based on a qualitative query and literature review. The expert panel approved version of the MedNARS was psychometrically assessed on a convenience sample of 220 older patients with chronic disease. The internal consistency, test-retest reliability, content and face validity of the scale were appraised and its construct validity was assed using exploratory and confirmatory factor analyses. Results A nine-item version of the MedNARS was drafted based on the classical item analysis procedures and its estimated internal consistency measure of the Cronbach's alpha (0.85) and test-retest reliability (0.96) were in the vicinity of acceptable range. The exploratory factor analysis (EFA) output revealed a unidimensional structure for the MedNARS and the conducted confirmatory factor analysis (CFA) indicated an acceptable data fit for the extracted one-factor model. The goodness of fit indices were as the followings: χ2 /df=1.63(90% CI: 0.02 to 0.11), root mean squared error of approximation (RMSEA)=(0.07), comparative fit index (CFI)=0.95, Tucker-Lewis index (TLI)=0.93 and standardized root mean squared residual (SRMSR)=(0.05). Conclusion The study findings were indicative of MedNARS's applicability and feasibility for use in assessment of medication non-adherence reasoning among the elderly patients with chronic diseases. The MedNARS as a brief and elder-friendly instrument can be applied both in research and practice settings to enhance efficiency, safety, and health outcomes of the therapeutic recommendations.
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Affiliation(s)
- Hamid Allahverdipour
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Health Education & Promotion Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid Badri
- Health Education & Promotion Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdolreza Shaghaghi
- Health Education & Promotion Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hassan Mahmoodi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Haleh Heizomi
- Health Education & Promotion Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shayesteh Shirzadi
- Department of Public Health, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Mohammad Asghari-Jafarabadi
- Cabrini Research, Cabrini Health, Malvern, VIC, 3144, Australia
- School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, 3004, Australia
- Department of Psychiatry, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, 3168, Australia
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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27
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Xu Y, Zheng X, Li Y, Ye X, Cheng H, Wang H, Lyu J. Exploring patient medication adherence and data mining methods in clinical big data: A contemporary review. J Evid Based Med 2023; 16:342-375. [PMID: 37718729 DOI: 10.1111/jebm.12548] [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: 07/04/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Increasingly, patient medication adherence data are being consolidated from claims databases and electronic health records (EHRs). Such databases offer an indirect avenue to gauge medication adherence in our data-rich healthcare milieu. The surge in data accessibility, coupled with the pressing need for its conversion to actionable insights, has spotlighted data mining, with machine learning (ML) emerging as a pivotal technique. Nonadherence poses heightened health risks and escalates medical costs. This paper elucidates the synergistic interaction between medical database mining for medication adherence and the role of ML in fostering knowledge discovery. METHODS We conducted a comprehensive review of EHR applications in the realm of medication adherence, leveraging ML techniques. We expounded on the evolution and structure of medical databases pertinent to medication adherence and harnessed both supervised and unsupervised ML paradigms to delve into adherence and its ramifications. RESULTS Our study underscores the applications of medical databases and ML, encompassing both supervised and unsupervised learning, for medication adherence in clinical big data. Databases like SEER and NHANES, often underutilized due to their intricacies, have gained prominence. Employing ML to excavate patient medication logs from these databases facilitates adherence analysis. Such findings are pivotal for clinical decision-making, risk stratification, and scholarly pursuits, aiming to elevate healthcare quality. CONCLUSION Advanced data mining in the era of big data has revolutionized medication adherence research, thereby enhancing patient care. Emphasizing bespoke interventions and research could herald transformative shifts in therapeutic modalities.
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Affiliation(s)
- Yixian Xu
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xinkai Zheng
- Department of Dermatology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yuanjie Li
- Planning & Discipline Construction Office, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xinmiao Ye
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Hongtao Cheng
- School of Nursing, Jinan University, Guangzhou, China
| | - Hao Wang
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, China
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28
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Camejo N, Castillo C, Tambasco C, Strazzarino N, Requena N, Peraza S, Boronat A, Herrera G, Esperon P, Cuello M, Krygier G. Assessing Adherence to Adjuvant Hormone Therapy in Breast Cancer Patients in Routine Clinical Practice. World J Oncol 2023; 14:300-308. [PMID: 37560342 PMCID: PMC10409554 DOI: 10.14740/wjon1647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/24/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Adjuvant hormone therapy (HT) in patients with hormone receptor-positive breast cancer (BC) increases overall survival (OS). A lack of adherence to adjuvant endocrine therapy is common, 31.0-73.0% of women discontinue endocrine treatment before 5 years. The aim of the study was to assess adherence to HT in routine clinical practice in patients assisted at the Clinical Oncology Department of the Hospital de Clinicas - Universidad de la Republica, Uruguay. METHODS Patients treated with HT for stage 0-III BC between 2017 and 2019 were included. The medication possession (MPR) rate was calculated using pharmacy records, and the Morisky-Green Scale was applied to assess adherence. Adherent patients were those with MPR ≥ 0.80 and who correctly answered the Morisky-Green treatment adherence questionnaire. The association of adherence with polypharmacy, treatment, and patient characteristics was assessed using simple logistic models. The associations between qualitative variables and adherence were assessed using simple logistic regression model or Fisher's exact test. The association between quantitative variables and adherence was assessed using the Student's t-test. The odds ratio (OR) for non-adherence to treatment and its 95% confidence interval were estimated. RESULTS Totally, 118 patients were included; 65.2% were treated with aromatase inhibitors (AIs), 36.0% presenting polypharmacy. The adherence rate at the end of 2 years was 81.0 %; and it was associated with age (P = 0.03, OR = 0.96 for non-adherence), with adherent and non-adherent patients having a mean age of 65.0 and 60.3 years, respectively; however, adherence was not associated with polypharmacy, territory of origin, marital status, living alone, level of education, occupation, or stage. The adherence profile was similar for both drugs, but homemakers and retired women showed greater adherence to AI. CONCLUSIONS Adherence to HT was assessed in real life, with 19.0% of the patients not adhering to the treatment, despite the known benefit for OS, being a well-tolerated treatment, and being provided free of charge. Older patients were associated with being more adherent. The results show the need of the Pharmacy Service and Department of Clinical Oncology Medical Oncology combining efforts to develop coordinated strategies and interventions to increase adherence, given the impact that this may have on patients' OS.
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Affiliation(s)
- Natalia Camejo
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Cecilia Castillo
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Clara Tambasco
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Noelia Strazzarino
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Nicolas Requena
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Silvina Peraza
- Pharmacy Service, Hospital de Clinicas Dr. Manuel Quintela, Montevideo, Uruguay
| | - Anna Boronat
- Pharmacy Service, Hospital de Clinicas Dr. Manuel Quintela, Montevideo, Uruguay
| | - Guadalupe Herrera
- Department of Quantitative Methods, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Patricia Esperon
- Molecular Genetics Laboratory Clinical Biochemistry Department, School of Chemistry, Universidad de la Republica, Montevideo, Uruguay
| | - Mauricio Cuello
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Gabriel Krygier
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
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Di Fusco SA, Aquilani S, Spinelli A, Alonzo A, Matteucci A, Castello L, Imperoli G, Colivicchi F. The polypill strategy in cardiovascular disease prevention: It's time for its implementation. Prog Cardiovasc Dis 2023; 79:37-40. [PMID: 36931543 DOI: 10.1016/j.pcad.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
A polypill strategy has been demonstrated to improve treatment adherence in several cardiovascular disease (CVD) settings. However, data on the prognostic impact in the secondary prevention setting have been scarce. The Secondary Prevention of Cardiovascular Disease in the Elderly trial, the results of which have been recently published, has demonstrated a benefit in terms of major adverse CVD event reduction. This finding, in addition to previous evidence, should lead to a broader polypill implementation in CVD prevention.
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Affiliation(s)
- Stefania Angela Di Fusco
- Clinical and Rehabilitation Cardiology Unit, Emergency Department, San Filippo Neri Hospital, ASL Rome 1, Rome, Italy.
| | - Stefano Aquilani
- Clinical and Rehabilitation Cardiology Unit, Emergency Department, San Filippo Neri Hospital, ASL Rome 1, Rome, Italy
| | - Antonella Spinelli
- Clinical and Rehabilitation Cardiology Unit, Emergency Department, San Filippo Neri Hospital, ASL Rome 1, Rome, Italy
| | - Alessandro Alonzo
- Clinical and Rehabilitation Cardiology Unit, Emergency Department, San Filippo Neri Hospital, ASL Rome 1, Rome, Italy
| | - Andrea Matteucci
- Clinical and Rehabilitation Cardiology Unit, Emergency Department, San Filippo Neri Hospital, ASL Rome 1, Rome, Italy
| | - Lorenzo Castello
- Clinical and Rehabilitation Cardiology Unit, Emergency Department, San Filippo Neri Hospital, ASL Rome 1, Rome, Italy
| | - Giuseppe Imperoli
- Internal Medicine Unit, Emergency Department, San Filippo Neri Hospital, ASL Rome 1, Rome, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Unit, Emergency Department, San Filippo Neri Hospital, ASL Rome 1, Rome, Italy
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Smith ML, Steinman LE, Montoya CN, Thompson M, Zhong L, Merianos AL. Effectiveness of the Program to Encourage Active, Rewarding Lives (PEARLS) to reduce depression: a multi-state evaluation. Front Public Health 2023; 11:1169257. [PMID: 37361168 PMCID: PMC10289834 DOI: 10.3389/fpubh.2023.1169257] [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: 02/19/2023] [Accepted: 05/15/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction An estimated 15% of community-dwelling older adults have depressive symptoms in the U.S. The Program to Encourage Active, Rewarding Lives (PEARLS) is an evidence-based program for managing late-life depression. PEARLS is a home/community-based collaborative care model delivered by community-based organizations to improve access to quality depression care. Trained staff actively screen for depression to improve recognition, teach problem-solving and activity planning skills for self-management, and connect participants to other supports and services as needed. Methods This study examined 2015-2021 data from 1,155 PEARLS participants across four states to assess PEARLS effectiveness to reduce depressive symptoms. The clinical outcomes were measured by the self-reported PHQ-9 instrument to assess changes in depressive symptoms scored as depression-related severity, clinical remission, and clinical response. A generalized estimating equation (GEE) model was fitted to examine changes in composite PHQ-9 scores from baseline to the final session. The model adjusted for participants' age, gender, race/ethnicity, education level, income level, marital status, number of chronic conditions, and number of PEARLS sessions attended. Cox proportional hazards regression models were conducted to estimate the hazard ratio for improvement of depressive symptoms (i.e., remission or response), while adjusting for the covariates. Results PHQ-9 scale scores significantly improved from baseline to their final sessions (mean difference = -5.67, SEM = 0.16, p < 0.001). About 35% of participants achieved remission with PHQ-9 score < 5. Compared to participants with mild depression, patients with moderate depression (HR = 0.43, 95%CI = 0.35-0.55), moderately severe depression (HR = 0.28, 95%CI = 0.21-0.38), and severe depression (HR = 0.22 95%CI = 0.14-0.34) were less likely to experience clinical remission with PHQ-9 score < 5, while adjusting for the covariates. About 73% achieved remission based on no longer having one or both cardinal symptoms. Compared to participants with mild depression, patients with moderate depression (HR = 0.66, 95%CI = 0.56-0.78), moderately severe depression (HR = 0.46, 95%CI = 0.38-0.56), and severe depression (HR = 0.38, 95%CI = 0.29-0.51) were less likely to experience clinical remission, while adjusting for the covariates. Nearly 49% of participants had a clinical response or a ≥ 50% decrease in PHQ-9 scores over time. There were no differences between the severity of depression groups based on the time to clinical response. Discussion Findings confirm that PEARLS is an effective program to improve depressive symptoms among older adults in diverse real-world community settings and can be a more accessible option for depressive older adults who are traditionally underserved by clinical care.
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Affiliation(s)
- Matthew Lee Smith
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, United States
- Center for Community Health and Aging, Texas A&M University, College Station, TX, United States
- Center for Health Equity and Evaluation Research, Texas A&M University, College Station, TX, United States
| | - Lesley E. Steinman
- Department of Health Systems and Population Health, Health Promotion Research Center, School of Public Health, University of Washington, Seattle, WA, United States
| | | | | | - Lixian Zhong
- School of Pharmacy, Texas A&M University, College Station, TX, United States
| | - Ashley L. Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, United States
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Babateen O, Aldharman SS, Mogharbel G, Badawi AS, Aljohani SA, Alsharif MM, Al-Jallal MS, Samkari JA. Medication Adherence Status and Its Association With Quality of Life Among Individuals With Neurological Conditions in Saudi Arabia. Cureus 2023; 15:e40508. [PMID: 37461796 PMCID: PMC10350288 DOI: 10.7759/cureus.40508] [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: 06/15/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION Chronic disorders commonly require long-term therapies. Medication non-adherence can cause major morbidity and mortality in chronic illness individuals, as well as increase the financial burden on the healthcare system. It is considered that patients who adhere to their treatment may improve their quality of life (QoL). There is a scarcity of updated comprehensive data on medication adherence among Saudi patients with neurological disorders. Therefore, this study aimed to assess the medication adherence status among individuals with neurological conditions and its association with QoL. METHOD A cross-sectional questionnaire-based study was conducted. The study included subjects individuals who have neurological conditions aged at least 18 from different regions of Saudi Arabia. The questionnaire measured medication adherence by using the 10-item version of the Medication Adherence Report Scale (MARS-10, ©Professor Rob Horne). The QoL was measured by employing validated Euro Quality of Life 5-dimension scale (EQ-5D). RESULTS A total of 370 participants were included. Respondents aged 18 to 35 years represented 62.4% of the sample. More than half of the participants were females (65.7%). The most frequently reported chronic conditions were migraine (29.2%), epilepsy (20.8%), and multiple sclerosis (20.5%). The reliability of the EQ-5D questionnaire was acceptable (Cronbach's alpha = 0.764). In general, more than half of the participants indicated that had problems due to pain/discomfort (60.3%) and anxiety/depression (62.2%). The most common pattern of non-adherence was taking the medication only when a patient needed it followed by avoiding taking the medication as possible. Non-adherence to medications was less prevalent among participants with epilepsy (68.8%) and multiple sclerosis (65.8%). On the other hand, medication adherence was higher among respondents with migraine compared to participants without the condition (86.1% vs 73.7%, p = 0.009). A significantly lower proportion of participants who had some or extreme problems with self-care were non-adherent to medications compared to those who had no problems (68.1% vs 80.3%, respectively, p = 0.016). Results of the regression analysis showed that participants with epilepsy and multiple sclerosis were less likely to be non-adherence to medications. Furthermore, respondents with moderate and severe problems in self-care were less likely to be non-adherent. CONCLUSION It was found that more than half of the participants had problems regarding their QoL due to pain/discomfort and anxiety/depression. The most prevalent pattern of non-adherence was taking the medication only when needed. Participants with epilepsy and multiple sclerosis were less likely to be non-adherent to medications. Furthermore, respondents with moderate and severe problems in self-care were less likely to be non-adherent. We recommend serial studies on the issue should be conducted to gather more evidence regarding this topic.
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Affiliation(s)
- Omar Babateen
- Department of Physiology, Umm Al-Qura University, Makkah, SAU
| | - Sarah S Aldharman
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | | | | | | | | | - Jamil A Samkari
- Department of Family and Community Medicine, King Abdul Aziz University, Jeddah, SAU
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Alenazi F, Peddle M, Bressington D, Mahzari M, Gray R. Adherence therapy for adults with type 2 diabetes: a feasibility study of a randomized controlled trial. Pilot Feasibility Stud 2023; 9:71. [PMID: 37106431 PMCID: PMC10134646 DOI: 10.1186/s40814-023-01294-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Adherence Therapy is a candidate intervention to promote consistent medication taking in people with type 2 diabetes. The aim of this study was to establish the feasibility of conducting a randomized controlled trial of adherence therapy in people with type 2 diabetes who were non-adherent with medication. METHODS The design is an open-label, single-center, randomized controlled feasibility trial. Participants were randomly allocated to receive either eight sessions of telephone-delivered adherence therapy or treatment as usual. Recruitment occurred during the COVID-19 pandemic. Outcome measures-adherence, beliefs about medication, and average blood glucose (sugar) levels (HbA1c)-were administered at baseline and after 8 weeks (TAU group) or at the completion of the treatment (AT group). Feasibility outcomes included the number of people approached to participate in the trial and the numbers that consented, completed study measures, finished treatment with adherence therapy, and dropped out of the trial. Fieldwork for this trial was conducted in the National Guard Hospital, a tertiary care provider, in the Kingdom of Saudi Arabia. RESULTS Seventy-eight people were screened, of which 47 met eligibility criteria and were invited to take part in the trial. Thirty-four people were excluded for various reasons. The remaining thirteen who consented to participate were enrolled in the trial and were randomized (AT, n = 7) (TAU, n = 6). Five (71%) of the seven participants in the adherence therapy arm completed treatment. Baseline measures were completed by all participants. Week 8 (post-treatment) measures were completed by eight (62%) participants. Dropout may have been linked to a poor understanding of what was involved in taking part in the trial. CONCLUSIONS It may be feasible to conduct a full RCT of adherence therapy, but careful consideration should be given to developing effective recruitment strategies, consent procedures, rigorous field testing, and clear support materials. TRIAL REGISTRATION The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12619000827134, on the 7th of June 2019.
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Affiliation(s)
- Fatimah Alenazi
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, 3086, Australia.
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, AlBukayriyah, Kingdom of Saudi Arabia.
| | - Monica Peddle
- School of Nursing and Midwifery, Deakin University, Melbourne, Australia
| | - Daniel Bressington
- Faculty of Nursing, Chiang Mai University, 110/406 Inthawaroros Road, Sri Phum District, Chiang Mai, 50200, Thailand
- Faculty of Health, Charles Darwin University, Ellengowan Drive, Darwin, Northern Territory, 0810, Australia
| | - Moeber Mahzari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- Department of Medicine, Division of Endocrinology, Ministry of National Guard, Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, 3086, Australia
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Pinto FJ, Piepoli MF, Ferrari R, Tsioufis K, Rosano GMC, Nedoshivin A, Kaski JC. Single-pill combination in the management of chronic coronary syndromes: A strategy to improve treatment adherence and patient outcomes? Int J Cardiol 2023:S0167-5273(23)00600-9. [PMID: 37116759 DOI: 10.1016/j.ijcard.2023.04.046] [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: 04/15/2023] [Accepted: 04/24/2023] [Indexed: 04/30/2023]
Abstract
Chronic coronary syndrome (CCS) represents a major challenge for physicians, particularly in the context of an increasing aging population. Additionally, CCS is often underestimated and under-recognised, particularly in female patients. As patients are frequently affected by several chronic comorbidities requiring polypharmacy, this can have a negative impact on patients' adherence to treatment. To overcome this barrier, single-pill combination (SPC), or fixed-dose combination, therapies are already widely used in the management of conditions such as hypertension, dyslipidaemia, and diabetes mellitus. The use of SPC anti-anginal therapy deserves careful consideration, as it has the potential to substantially improve treatment adherence and clinical outcomes, along with reducing the failure of pharmacological treatment before considering other interventions in patients with CCS.
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Affiliation(s)
- Fausto J Pinto
- Centro Academico de Medicina de Lisboa, CCUL, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Massimo F Piepoli
- Clinical Cardiology, IRCCS Policlinico San Donato, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Roberto Ferrari
- Cardiology Center, University of Ferrara, Viale Aldo Moro 8, 44024 Cona, Ferrara, Italy; Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Greece
| | | | | | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George's, University of London, UK.
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Faletsky A, Kassamali B, Han JJ, Zhao B, LaChance A, Mostaghimi A. Variation in Medicare Part D topical steroid prescription costs. J Am Acad Dermatol 2023; 88:928-930. [PMID: 36356705 DOI: 10.1016/j.jaad.2022.09.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Adam Faletsky
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts
| | - Bina Kassamali
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Jane J Han
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Loyola Stritch School of Medicine, Maywood, Illinois
| | - Bruce Zhao
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Avery LaChance
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.
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Somerville E, Bollinger R, Keleman A, Haxton M, Sarrami B, Chen SW, Holden B, Yan Y, Stark S. Tailored medication management intervention delivered by occupational therapists for older adults: A study protocol. Br J Occup Ther 2023. [DOI: 10.1177/03080226221135366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Introduction: Medication management is an essential instrumental activity of daily living for older adults; however, 40–70% of older adults fail to take their medications correctly. Addressing medication management falls under the scope of occupational therapy, but there is a lack of evidence supporting occupational therapy interventions to improving medication management. This study’s primary aims are to examine the feasibility, acceptability, and preliminary efficacy of a Tailored Intervention for Medication Management delivered by occupational therapists to improve medication management. Method/Design: Single-blind, parallel-group randomized controlled equivalency trial, with two phases. Thirty community-dwelling older adults will be enrolled in this study. In Phase 1, participants in the treatment group will receive Tailored Intervention for Medication Management delivered remotely; those in the waitlist control will receive attention visits. In Phase 2, waitlist control participants will receive Tailored Intervention for Medication Management in person. The primary outcomes are feasibility and acceptability; secondary outcomes include preliminary efficacy of the intervention delivered by an occupational therapist remotely and in person. Additionally, the remote and in-person delivery methods will be compared to each other for equivalency. Discussion: Inability to manage medication and inappropriate polypharmacy are significant and prevalent problems that must be addressed so older adults can safely perform this essential instrumental activity of daily living. Trial Registration: ClinicalTrials.gov identifier NCT04717297.
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Affiliation(s)
- Emily Somerville
- School of Medicine, Program in Occupational Therapy, Washington University in St. Louis, Saint Louis, MO, USA
| | - Rebecca Bollinger
- School of Medicine, Program in Occupational Therapy, Washington University in St. Louis, Saint Louis, MO, USA
| | - Audrey Keleman
- School of Medicine, Program in Occupational Therapy, Washington University in St. Louis, Saint Louis, MO, USA
| | - Meghan Haxton
- School of Medicine, Program in Occupational Therapy, Washington University in St. Louis, Saint Louis, MO, USA
| | - Behnaz Sarrami
- Missouri Pharmacogenomics Consulting, LLC, St. Louis, MO, USA
| | - Szu-Wei Chen
- School of Medicine, Program in Occupational Therapy, Washington University in St. Louis, Saint Louis, MO, USA
| | - Brianna Holden
- School of Medicine, Program in Occupational Therapy, Washington University in St. Louis, Saint Louis, MO, USA
| | - Yan Yan
- School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Susan Stark
- School of Medicine, Program in Occupational Therapy, Washington University in St. Louis, Saint Louis, MO, USA
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Elston Lafata J, Nguyen B, Staresinic C, Johnson M, Gratie D, Muluneh B. Interpersonal communication-, education- and counselling-based interventions to support adherence to oral anticancer therapy: a systematic review. J Oncol Pharm Pract 2023; 29:358-369. [PMID: 35048768 DOI: 10.1177/10781552211073576] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background. Many factors contribute to oral anti-cancer therapy adherence, including counselling and educational support. Objective. We systematically review the literature evaluating the effectiveness of interpersonal communication-, counselling- and education-based interventions on patient adherence to oral anticancer therapy. Methods. Using search terms pertaining to medication adherence, oral anticancer therapy, and communication, education, and counselling, we conducted a systematic search for full-text, original research articles prior to 3/13/20. Two reviewers independently reviewed each paper for inclusion and charted study information. Results. Twenty-four articles were included. All considered the use of oral anticancer therapy between two defined time points. Four studies also considered the length of time a patient persisted on therapy. Half (n = 12) of the studies reported a statistically significant relationship between the intervention and medication adherence, with no consistent pattern among intervention structure/content and effectiveness. Programmes offering in-person counselling and those targeting patients with chronic myeloid leukemia (CML), tended to report positive findings. Most studies faced substantial risk of bias, and only two reported using a behavioural theory to guide interventional content. Conclusions. Findings highlight the infancy of evidence base and need for rigorous and large-scale studies grounded in established behavioural theories to advance patient-targeted educational and counselling practices supporting adherence to oral anti-cancer therapy.
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Vargas F, Ringel JB, Yum B, Levitan EB, Mangal S, Steinman MA, Safford MM, Goyal P. Implications of Under-Reporting Medication Side Effects: Beta-Blockers in Heart Failure as a Case Example. Drugs Aging 2023; 40:285-291. [PMID: 36800060 PMCID: PMC10900534 DOI: 10.1007/s40266-023-01007-7] [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] [Accepted: 01/24/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Perceiving medication side effects but not reporting them to a clinician is common. Patterns of "under-reporting" and their implications are not well described. We aimed to address this gap by examining patterns of under-reporting perceived side effects of beta-blockers among patients with heart failure. METHODS In 2016, a survey that evaluated medication-taking behavior was administered to 1114 participants (46.5% response rate) from The Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort with prior adjudicated heart failure hospitalization or a heart failure Medicare claim. We examined the results of survey respondents who reported taking a beta-blocker to understand patterns of under-reporting perceived beta-blocker side effects. We defined an under-reporter as a participant who perceived experiencing a side effect from their beta-blocker but did not share it with their clinician (according to survey responses). We conducted a multivariable logistic regression analysis to identify determinants of being an under-reporter. Co-variates included age, sex, race, income, level of education, geographical location, and pill burden. We also examined whether under-reporters differed in self-reported medication adherence and willingness to take additional medication to prevent a future healthcare encounter compared to participants who reported perceived side effects to their clinicians and those who did not experience side effects. RESULTS Among 310 respondents, 28% (n = 87) were under-reporters. Black race (odds ratio 2.11, confidence interval 1.21-3.67) and education less than college (odds ratio 2.00, confidence interval 1.09-3.67) were associated with being an under-reporter. Self-reported medication adherence was similar between groups (under-reporters: 46.3%; those who reported perceived side effects: 49.4%; those who did not experience side effects: 45.0%); under-reporters were more frequently unwilling to take additional medication to prevent a doctor's visit (18.9% vs 12.1% vs 10.8%), emergency room visit (21.6% vs 13.3% vs 9.9%), and hospitalization (17.6% vs 10.8% vs 9.0%) compared with the other groups. CONCLUSION We conclude that under-reporting perceived side effects of beta-blockers among adults with heart failure is common, is associated with Black race and low education, and may contribute to patient willingness to take additional medication to prevent future medical encounters.
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Affiliation(s)
- Fabian Vargas
- Divisions of Cardiology and General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street LH-365, New York, NY, 10021, USA
| | - Joanna Bryan Ringel
- Divisions of Cardiology and General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street LH-365, New York, NY, 10021, USA
| | - Brian Yum
- Divisions of Cardiology and General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street LH-365, New York, NY, 10021, USA
| | - Emily B Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sabrina Mangal
- Divisions of Cardiology and General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street LH-365, New York, NY, 10021, USA
| | - Michael A Steinman
- Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA
| | - Monika M Safford
- Divisions of Cardiology and General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street LH-365, New York, NY, 10021, USA
| | - Parag Goyal
- Divisions of Cardiology and General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street LH-365, New York, NY, 10021, USA.
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Christopher CM, Blebil AQ, Kc B, Alex D, Mohamed Ibrahim MI, Rajakumar S, Ismail N. Medication Use Questionnaire for Older Adults in Malaysia: Translation, Cultural Adaptation, and Reliability. Value Health Reg Issues 2023; 35:34-41. [PMID: 36842337 DOI: 10.1016/j.vhri.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/28/2022] [Accepted: 01/20/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVES This study aimed to translate the Medication Use Questionnaire into a Malay version, adapt it to Malaysia's culture, and verify its reliability among Malaysia's older adults. METHODS Methodological approaches were used to translate, validate, and modify the questionnaire. The subjects were older adults aged ≥ 60 years in primary care settings in Penang, Malaysia. Two forward translations (English to Malay) were developed, reviewed, and back translated to English. The reconciliation phase was conducted to compare the translated and original questionnaires. Five older adults were then interviewed for the cognitive debriefing of the reconciled questionnaire to assess the linguistic and cultural equivalence. Two experts assessed content validity, and the translated questionnaire was proofread and finalized. After that, pilot test was done to examine the internal consistency among 20 older adults. RESULTS Translation of the questionnaire was done with no major disagreements. The main issues identified in cognitive debriefing and content validity were terms, number of questions, and phrases used in the questionnaire. Most participants reported that the questionnaires were not difficult to complete during the cognitive debriefing phase. The issues were then judged and revised accordingly. Further pilot testing on 20 older adults demonstrated good internal consistency reliability, Cronbach α (0.902). CONCLUSIONS This study findings suggest promising data supporting the use of translated version of the Medication Use Questionnaire that can be used to identify medication use problems among older adults in Malaysia.
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Affiliation(s)
| | - Ali Qais Blebil
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Subang Jaya, Selangor, Malaysia; Department of Pharmacy, Al Rafidain University College, Baghdad, Iraq.
| | - Bhuvan Kc
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Deepa Alex
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Subang Jaya, Selangor, Malaysia
| | | | - Sutha Rajakumar
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Subang Jaya, Selangor, Malaysia
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Severe Periodontitis Increases the Risk of Oral Frailty: A Six-Year Follow-Up Study from Kashiwa Cohort Study. Geriatrics (Basel) 2023; 8:geriatrics8010025. [PMID: 36826367 PMCID: PMC9956982 DOI: 10.3390/geriatrics8010025] [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: 12/03/2022] [Revised: 01/18/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
Oral frailty, overlapping a decline in multi-faceted oral functions and often seen in older adults, increases risks of adverse health outcomes, thereby necessitating earlier measures. Tooth loss, a major element of oral frailty, is mainly caused by periodontal disease and is an irreversible event. Therefore, this study aimed to clarify whether advanced periodontal disease increases the risks of "new-onset" oral frailty through a longitudinal analysis based on the 2012 baseline survey of the Kashiwa cohort and the follow-up assessments conducted in 2013, 2014, 2016, and 2018. The participants were disability-free, non-orally frail older adults living in Kashiwa City. Of the 1234 participants (72.2 ± 5.1 years old; 50.8% men) analyzed in this study, oral frailty occurred in 23.1% within the six-year period. The group with Community Periodontal Index (CPI) ≥ 3 at baseline had no significant difference in the risk of oral frailty compared with CPI ≤ 2; however, CPI4 at baseline was related to the increased risk of oral frailty compared with CPI ≤ 3 (an adjusted hazard ratio (95% confidence interval): 1.42 (1.12-1.81). Conclusively, severe periodontitis (CPI4) might be associated with new-onset oral frailty, suggesting that prevention of periodontal disease could contribute to oral frailty prevention.
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Richmond LL, Kearley J, Schwartz ST, Hargis MB. Take a load off: examining partial and complete cognitive offloading of medication information. Cogn Res Princ Implic 2023; 8:12. [PMID: 36750483 PMCID: PMC9905397 DOI: 10.1186/s41235-023-00468-z] [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: 04/03/2021] [Accepted: 01/17/2023] [Indexed: 02/09/2023] Open
Abstract
Although cognitive offloading, or the use of physical action to reduce internal cognitive demands, is a commonly used strategy in everyday life, relatively little is known about the conditions that encourage offloading and the memorial consequences of different offloading strategies for performance. Much of the extant work in this domain has focused on laboratory-based tasks consisting of word lists, letter strings, or numerical stimuli and thus makes little contact with real-world scenarios under which engaging in cognitive offloading might be likely. Accordingly, the current work examines offloading choice behavior and potential benefits afforded by offloading health-related information. Experiment 1 tests for internal memory performance for different pieces of missing medication interaction information. Experiment 2 tests internal memory and offloading under full offloading and partial offloading instructions for interaction outcomes that are relatively low severity (e.g., sweating). Experiment 3 extends Experiment 2 by testing offloading behavior and benefit in low-severity, medium-severity (e.g., backache), and high-severity interaction outcomes (e.g., heart attack). Here, we aimed to elucidate the potential benefits afforded by partial offloading and to examine whether there appears to be a preference for choosing to offload (i) difficult-to-remember information across outcomes that vary in severity, as well as (ii) information from more severe interaction outcomes. Results suggest that partial offloading benefits performance compared to relying on internal memory alone, but full offloading is more beneficial to performance than partial offloading.
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Affiliation(s)
- Lauren L. Richmond
- grid.36425.360000 0001 2216 9681Department of Psychology, Stony Brook University, Psychology B Building, Stony Brook, NY 11794 USA
| | - Julia Kearley
- grid.36425.360000 0001 2216 9681Department of Psychology, Stony Brook University, Psychology B Building, Stony Brook, NY 11794 USA ,grid.14709.3b0000 0004 1936 8649Department of Psychology, McGill University, Montreal, Canada
| | - Shawn T. Schwartz
- grid.168010.e0000000419368956Department of Psychology, Stanford University, Stanford, USA
| | - Mary B. Hargis
- grid.264766.70000 0001 2289 1930Department of Psychology, Texas Christian University, Fort Worth, USA
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Dixe MDA, Pinho J, Pereira F, Verloo H, Meyer-Massetti C, Pereira SG. Patterns of Medication Management and Associated Medical and Clinical Features among Home-Dwelling Older Adults: A Cross-Sectional Study in Central Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1701. [PMID: 36767067 PMCID: PMC9914088 DOI: 10.3390/ijerph20031701] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 06/18/2023]
Abstract
Ageing is frequently associated with multimorbidity and polypharmacy. The present study aimed to identify the current medication management patterns and the profiles of home-dwelling older adults and to find any association with their conditions, including frailty and cognitive impairment. Within the scope of this cross-sectional study, 112 older adults living in the community were assessed via face-to-face structured interviews. Frailty, cognitive status, medication management and clinical and sociodemographic variables were evaluated. Descriptive and inferential statistics were calculated. The mean participant age was 76.6 ± 7.1 years, 53.6% of participants were women, and 40.2% of participants lived alone. More than half were classified as having frailty (58.9%), almost one-fifth (19.6%) presented with a moderate cognitive impairment had more than one disease, and 60.7% were polymedicated. No associations were found between polymedication and medication self-management, the use of over-the-counter medications, living alone, having a poor understanding of pharmacological therapy and/or pathology, or having more than one prescriber. Self-management was associated with age, the number of medications, frailty and cognitive status. Binary logistic regressions showed that cognitive impairment had statistically significant differences with medication management, having a poor understanding of pharmacological therapy and/or pathology, having one prescriber and the use of medications not prescribed by physicians. Interventions to prevent medication-related problems in home-dwelling older adults are recommended.
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Affiliation(s)
- Maria dos Anjos Dixe
- Center for Innovative Care and Health Technology, Polytechnic of Leiria, 2411-901 Leiria, Portugal
- School of Health Sciences, Polytechnic of Leiria, 2411-901 Leiria, Portugal
| | - Joana Pinho
- Center for Innovative Care and Health Technology, Polytechnic of Leiria, 2411-901 Leiria, Portugal
- School of Health Sciences, Polytechnic of Leiria, 2411-901 Leiria, Portugal
| | - Filipa Pereira
- School of Health Sciences, HES-SO Valais-Wallis, 2800 Sion, Switzerland
- Institute of Biomedical Sciences Abel Salazar, University of Porto, 4099-002 Porto, Portugal
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais-Wallis, 2800 Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology and Toxicology Unit, General Internal Medicine Clinic, University Hospital of Bern (Inselspital), 3010 Bern, Switzerland
- Institute for Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
| | - Sónia Gonçalves Pereira
- Center for Innovative Care and Health Technology, Polytechnic of Leiria, 2411-901 Leiria, Portugal
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Lauffenburger JC, Khatib R, Siddiqi A, Albert MA, Keller PA, Samal L, Glowacki N, Everett ME, Hanken K, Lee SG, Bhatkhande G, Haff N, Sears ES, Choudhry NK. Reducing ethnic and racial disparities by improving undertreatment, control, and engagement in blood pressure management with health information technology (REDUCE-BP) hybrid effectiveness-implementation pragmatic trial: Rationale and design. Am Heart J 2023; 255:12-21. [PMID: 36220355 PMCID: PMC9742137 DOI: 10.1016/j.ahj.2022.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND While racial/ethnic disparities in blood pressure control are documented, few interventions have successfully reduced these gaps. Under-prescribing, lack of treatment intensification, and suboptimal follow-up care are thought to be central contributors. Electronic health record (EHR) tools may help address these barriers and may be enhanced with behavioral science techniques. OBJECTIVE To evaluate the impact of a multicomponent behaviorally-informed EHR-based intervention on blood pressure control. TRIAL DESIGN Reducing Ethnic and racial Disparities by improving Undertreatment, Control, and Engagement in Blood Pressure management with health information technology (REDUCE-BP) (NCT05030467) is a two-arm cluster-randomized hybrid type 1 pragmatic trial in a large multi-ethnic health care system. Twenty-four clinics (>350 primary care providers [PCPs] and >10,000 eligible patients) are assigned to either multi-component EHR-based intervention or usual care. Intervention clinic PCPs will receive several EHR tools designed to reduce disparities delivered at different points, including a: (1) dashboard of all patients visible upon logging on to the EHR displaying blood pressure control by race/ethnicity compared to their PCP peers and (2) set of tools in an individual patient's chart containing decision support to encourage treatment intensification, ordering home blood pressure measurement, interventions to address health-related social needs, default text for note documentation, and enhanced patient education materials. The primary outcome is patient-level change in systolic blood pressure over 12 months between arms; secondary outcomes include changes in disparities and other clinical outcomes. CONCLUSION REDUCE-BP will provide important insights into whether an EHR-based intervention designed using behavioral science can improve hypertension control and reduce disparities.
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Affiliation(s)
- Julie C Lauffenburger
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
| | - Rasha Khatib
- Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, IL
| | - Alvia Siddiqi
- Enterprise Population Health, Advocate Aurora Health, Downers Grove, IL
| | - Michelle A Albert
- Center for the Study of Adversity and Cardiovascular Disease (NURTURE Center), Division of Cardiology of Medicine (Cardiology), University of California, San Francisco, San Francisco, CA
| | | | - Lipika Samal
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Nicole Glowacki
- Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, IL
| | | | - Kaitlin Hanken
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Simin G Lee
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Gauri Bhatkhande
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Nancy Haff
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Ellen S Sears
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Niteesh K Choudhry
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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Luegering A, Langner R, Wilm S, Doeppner TR, Hermann DM, Frohnhofen H, Gronewold J. Developing a novel tool to assess the ability to self-administer medication - A systematic evaluation of patients' video recordings in the ABLYMED study. Front Med (Lausanne) 2023; 10:1040528. [PMID: 36873894 PMCID: PMC9978218 DOI: 10.3389/fmed.2023.1040528] [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: 09/11/2022] [Accepted: 01/24/2023] [Indexed: 02/18/2023] Open
Abstract
BackgroundOlder people often experience medication management problems due to multimorbidity, polypharmacy and medication complexity. There is often a large gap between patients’ self-reported and actual abilities to handle the self-administration of their medication. Here we report on the development and evaluation of a new tool to assess the ability of non-demented hospitalized patients to self-administer medication in different dosage forms. To this end, we video-recorded the patients’ medication management performance and implemented a novel assessment scheme, which was applied by several independent raters.MethodsSixty-seven in-patients ≥70 years of age and regularly taking ≥5 different drugs autonomously of the ABLYMED study agreed to the video recording of their medication management performance with five different dosage forms. All raters underwent a training and applied a standardized assessment form and written guide with rating rules for evaluation. In a pilot phase, video recordings of three patients were rated by 19 raters (15 medical students, two expert raters to determine a reference standard, and two main raters who later rated the total sample). In the rating phase, based on the ratings obtained from the two main raters, we determined interrater (assessed every section of 20 patients as agreement between the raters at one point of time) and intrarater (assessed as consistency within each rater across three points of time) agreement by intraclass correlation analysis.ResultsIn the pilot phase we obtained an overall sufficient agreement pattern, with an adjustment of the rating rules for patches. In the rating phase we achieved satisfactory agreement between the two raters (interrater reliability) and across different points of time (intrarater reliability). For two dosage forms (eye-drops and pen), rater training needed to be repeated to reach satisfactory levels.DiscussionOur novel rating procedure was found to be objective, valid and reproducible, given appropriate training of the raters. Our findings are an important part of a larger research project to implement a novel assessment for the ability to self-administer medication in different dosage forms. Further, they can support the development of patient trainings to improve medication management and secure independent living.
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Affiliation(s)
- Anneke Luegering
- Hospital Pharmacy, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Robert Langner
- Institute of Systems Neuroscience, University Hospital Düsseldorf, Düsseldorf, Germany.,Institute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Research Centre Jülich, Jülich, Germany
| | - Stefan Wilm
- Institute of General Practice, Centre for Health and Society (chs), University Hospital Düsseldorf, Düsseldorf, Germany
| | - Thorsten R Doeppner
- Department of Neurology, University Hospital Giessen, Giessen, Germany.,Research Institute for Health Sciences and Technologies (SABITA), Istanbul Medipol University, Istanbul, Türkiye.,Department of Anatomy and Cell Biology, Medical University of Varna, Varna, Bulgaria.,Department of Neurology, University of Göttingen, Göttingen, Germany
| | - Dirk M Hermann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Helmut Frohnhofen
- Department of Orthopedics and Trauma Surgery, University Hospital Düsseldorf, Düsseldorf, Germany.,Department of Medicine, Geriatrics, Faculty of Health, University Witten-Herdecke, Witten, Germany
| | - Janine Gronewold
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Adherence and Discontinuation of Disease-Specific Therapies for Pulmonary Arterial Hypertension: A Systematic Review and Meta-Analysis. Am J Cardiovasc Drugs 2023; 23:19-33. [PMID: 36434365 DOI: 10.1007/s40256-022-00553-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND In patients with pulmonary arterial hypertension (PAH), the use of disease-specific therapies (i.e., endothelin receptor antagonists, phosphodiesterase type-5 inhibitors, soluble guanylate cyclase stimulators, prostacyclins, and prostanoids) has been associated with disease improvement and decreased mortality risk. We aimed to quantify the adherence and discontinuation rates for patients prescribed PAH-specific therapies. METHODS We performed a systematic review via searching MEDLINE, EMBASE, and the Cochrane Library from their inception to 4 March 2022 for observational studies published in English that reported data on adherence to and persistence with PAH-targeted therapies. Random-effects meta-analysis was performed to explore average adherence and discontinuation rates. RESULTS In all, 14 studies involving 14,861 individuals prescribed PAH-targeted therapies were included. The overall pooled proportion of patients adherent to their PAH-targeted medications was 60.9% (95% confidence interval [CI] 52.3-69.1%). The pooled proportions of patients adherent in questionnaire-based studies and in studies using prescription/dispensing data were 52.9% (95% CI 48.9-56.9%) and 62.9% (95% CI 53.1-72.2%), respectively. The pooled proportion of patients who discontinued their PAH-targeted medications was 42.3% (95% CI 31.6-53.3). Factors reported to impact adherence included administration frequency, length of time on treatment, co-payment, and occurrence of adverse events. CONCLUSIONS In the real world, a considerable proportion of patients prescribed PAH-specific therapies were non-adherent or discontinued. As diverse factors may influence treatment adherence, multifaceted interventions are needed to address this trend in order to improve patient outcomes. REGISTRATION The systematic review protocol was registered in the PROSPERO database (CRD42022316638).
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Manuzak JA, Granche J, Tassiopoulos K, Rower JE, Knox JR, Williams DW, Ellis RJ, Goodkin K, Sharma A, Erlandson KM. Cannabis Use Is Associated With Decreased Antiretroviral Therapy Adherence Among Older Adults With HIV. Open Forum Infect Dis 2023; 10:ofac699. [PMID: 36726540 PMCID: PMC9879711 DOI: 10.1093/ofid/ofac699] [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: 10/25/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
Background Conflicting evidence exists on the impact of cannabis use on antiretroviral therapy (ART) adherence among people with human immunodeficiency virus (PWH). We leveraged data collected among older PWH to characterize longitudinal associations between cannabis use and ART adherence. Methods AIDS Clinical Trials Group (ACTG) A5322 study participants were categorized as <100% (≥1 missed dose in past 7 days) or 100% (no missed doses) ART adherent. Participants self-reported current (past month), intermittent (past year but not past month), and no cannabis (in past year) use at each study visit. Generalized linear models using generalized estimating equations were fit and inverse probability weighting was used to adjust for time-varying confounders and loss to follow-up. Results Among 1011 participants (median age, 51 years), 18% reported current, 6% intermittent, and 76% no cannabis use at baseline; 88% reported 100% ART adherence. Current cannabis users were more likely to be <100% adherent than nonusers (adjusted risk ratio [aRR], 1.53 [95% CI, 1.11-2.10]). There was no association between ART adherence and current versus intermittent (aRR, 1.39 [95% CI, .85-2.28]) or intermittent versus no cannabis use (aRR, 1.04 [95% CI, .62-1.73]). Conclusions Among a cohort of older PWH, current cannabis users had a higher risk of <100% ART adherence compared to nonusers. These findings have important clinical implications as suboptimal ART adherence is associated with ART drug resistance, virologic failure, and elevated risk for mortality. Further research is needed to elucidate the mechanisms by which cannabis use decreases ART adherence in older PWH and to advance the development of more efficacious methods to mitigate nonadherence in this vulnerable population.
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Affiliation(s)
- Jennifer A Manuzak
- Division of Immunology, Tulane National Primate Research Center, Covington, Louisiana, USA
| | - Janeway Granche
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Katherine Tassiopoulos
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Joseph E Rower
- Center for Human Toxicology, Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, Utah, USA
| | - Justin R Knox
- Department of Psychiatry, Columbia University, Irving Medical Center, New York, New York, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, New York, USA
- Department of Sociomedical Science, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Dionna W Williams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ronald J Ellis
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Karl Goodkin
- Consultant, AIDS Clinical Trials Group, Los Angeles, California, USA
- Consultant, Chronic HIV Infection in Aging and NeuroAIDS Center, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kristine M Erlandson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Pratiwi H, Kristina SA, Widayanti AW, Prabandari YS, Kusuma IY. A Systematic Review of Compensation and Technology-Mediated Strategies to Maintain Older Adults' Medication Adherence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:803. [PMID: 36613130 PMCID: PMC9819645 DOI: 10.3390/ijerph20010803] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 06/16/2023]
Abstract
Elderly medication adherence is a challenge in health care. The elderly are often at higher risk for non-adherence, and more likely to be on multiple prescription medications for many comorbidities. This systematic review aimed to explore the current strategies for maintaining older adults' medication adherence with compensation and technology-mediated strategies. We conducted a systematic review to examine related articles published in the PubMed, Web of Science, and Scopus databases, as well as Google Scholar for additional reference sources by cross-reference review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to guide this review. A total of 217 articles were screened, and 27 studies fulfilled the inclusion criteria. Older adults applied a variety of methods to maintain or enhance their medication adherence. Three studies indicated compensation strategies, 19 studies reported technological assistance, two studies used other strategies (community-offered help or caregivers help), and three studies used a combination of compensation with another strategy or technology. Studies identified various compensation- and technology-based strategies carried out by older adults to help remind them to take medication. This review identified potential benefits of technology and compensation strategy implementation in older adults to increase medication adherence. Although we are conscious of the heterogeneity of the included studies, it remains challenging to determine which elements underpin the most effective approaches.
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Affiliation(s)
- Hening Pratiwi
- Doctoral Program in Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
- Department of Pharmacy, Faculty of Health Sciences, Jenderal Soedirman University, Purwokerto 53122, Indonesia
| | - Susi Ari Kristina
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Anna Wahyuni Widayanti
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Yayi Suryo Prabandari
- Department of Health Behavior, Environment, and Social Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Ikhwan Yuda Kusuma
- Pharmacy Study Program, Faculty of Health, Universitas Harapan Bangsa, Purwokerto 53182, Indonesia
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Wang M, Swinton M, Troyan S, Ho J, M Siegal D, Mbuagbaw L, Thabane L, M Holbrook A. Perceptions of patients and healthcare providers on patient education to improve oral anticoagulant management. J Eval Clin Pract 2022; 28:1027-1036. [PMID: 35142014 DOI: 10.1111/jep.13665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 12/31/2022]
Abstract
RATIONALE AND OBJECTIVES Education of patients is thought to be key to high-quality oral anticoagulant (OAC) medication management. Theoretically, improving patients' knowledge should improve their self-management skills and adherence. The study's objective was to explore the opinions of healthcare providers and patients on the desired content and format of patient education on OACs, in addition to perceived barriers to high-quality patient education. METHODS We applied qualitative descriptive methods in a focus group study on OAC management. Five focus group discussions were conducted in two health regions in Southwestern Ontario from 2017 to 2018 with 19 patients, 7 caregivers and 16 healthcare providers (physicians, nurses and pharmacists). During the focus groups, participants discussed their experiences with OAC education and made suggestions about the content and format for patient education on OACs. Transcripts were analysed using conventional content analysis. RESULTS We identified the five themes of patient education on OAC management: content of OAC education (rationale, risk and appropriate drug administration methods), the best times for providing OAC education (time of OACs initiation along with continuing education), preferred education delivery strategies (case management targeted patient information summaries from authoritative sources such as Thrombosis Canada and video education), patient and community pharmacist engagement in OAC education, and perceived barriers to optimal patient education (patients depending too much on their healthcare providers for advice, the limited time patients spend with healthcare providers, gaps in clear communication between providers and the lack of a nationally or provincially coordinated OAC management programme). CONCLUSION Our findings suggest that patients, caregivers and healthcare providers support the need for education on OACs, including for patients taking DOACs. Specific important content and proper education format are needed. The optimal combination of content, format, duration, timing and sources for OAC education requires further research.
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Affiliation(s)
- Mei Wang
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada.,Clinical Pharmacology & Toxicology Research, The Research Institute of St. Joseph's Hamilton, Hamilton, Ontario, Canada
| | - Marilyn Swinton
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sue Troyan
- Clinical Pharmacology & Toxicology Research, The Research Institute of St. Joseph's Hamilton, Hamilton, Ontario, Canada
| | - Joanne Ho
- Division of Clinical Pharmacology & Toxicology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Schlegel Research Institute for Aging, Waterloo, Ontario, Canada
| | - Deborah M Siegal
- Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada.,Biostatistics Unit, St Joseph's Healthcare-Hamilton, Hamilton, Ontario, Canada.,School of Public Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Anne M Holbrook
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada.,Clinical Pharmacology & Toxicology Research, The Research Institute of St. Joseph's Hamilton, Hamilton, Ontario, Canada.,Division of Clinical Pharmacology & Toxicology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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48
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A Study on Types of Medication Adherence in Hypertension among Older Patients and Influencing Factors. Healthcare (Basel) 2022; 10:healthcare10112322. [DOI: 10.3390/healthcare10112322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Hypertension has the characteristic that the risk of complications can be reduced through appropriate medication in daily life. Hence, it is important to consider practical measures to increase medication adherence, particularly among older patients. Methods: This study used the Korea Health Panel 2020 data (Version 2.0.1), jointly conducted by Korea Institute for Health and Social Affairs and National Health Insurance. A total of 2300 patients with high blood pressure over 65 years of age were selected. In order to identify types of medication adherence in older hypertensive patients, and examine factors that influence the types, the Latent Profile Analysis (LPA) and logistic regression were performed. Results: The types of adherence groups were classified into two groups: an ‘adherence group’ (87.1%) and a ‘non-adherence group’ (12.9%). Furthermore, age, living alone, and depressive symptoms were identified as determinants of medication adherence type among older hypertensive patients. Conclusion: The significant impact of sociodemographic status (age, living alone, and depressive symptoms) on medication adherence among older hypertensive patients indicates the need to establish more specific empirical interventions based on each type’s characteristics. It is expected that this study will provide an in-depth understanding of factors associated with medication adherence among older patients with hypertension, which can support interventions tailored to the specific needs of those who are non-adherent.
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Ali K, Mensah EA, McDermott EA, Kirkham FA, Stevenson J, Hamer V, Parekh N, Schiff R, Van Der Cammen T, Nyangoma S, Fowler-Davis S, Davies G, Gage H, Rajkumar C. Implementation of a medicine management plan (MMP) to reduce medication-related harm (MRH) in older people post-hospital discharge: a randomised controlled trial. BMC Geriatr 2022; 22:850. [DOI: 10.1186/s12877-022-03555-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Medication-related harm (MRH) is an escalating global challenge especially among older adults. The period following hospital discharge carries high-risk for MRH due to medication discrepancies, limited patient/carer education and support, and poor communication between hospital and community professionals. Discharge Medical Service (DMS), a newly introduced NHS scheme, aims to reduce post-discharge MRH through an electronic communication between hospital and community pharmacists. Our study team has previously developed a risk-prediction tool (RPT) for MRH in the 8-weeks period post discharge from a UK hospital cohort of 1280 patients. In this study, we aim to find out if a Medicines Management Plan (MMP) linked to the DMS is more effective than the DMS alone in reducing rates of MRH.
Method
Using a randomized control trial design, 682 older adults ≥ 65 years due to be discharged from hospital will be recruited from 4 sites. Participants will be randomized to an intervention arm (individualised medicine management plan (MMP) plus DMS) or a control arm (DMS only) using a 1:1 ratio stratification. Baseline data will include patients’ clinical and social demographics, and admission and discharge medications. At 8-weeks post-discharge, a telephone interview and review of GP records by the study pharmacist will verify MRH in both arms. An economic and process evaluation will assess the cost and acceptability of the study methods.
Data analysis
Univariate analysis will be done for baseline variables comparing the intervention and control arms. A multivariate logistic regression will be done incorporating these variables. Economic evaluation will compare the cost-of-service use among the study arms and modelled to provide national estimates. Qualitative data from focus-group interviews will explore practitioners’ understanding, and acceptance of the MMP, DMS and the RPT.
Conclusion
This study will inform the use of an objective, validated RPT for MRH among older adults after hospital discharge, and provide a clinical, economic, and service evaluation of a specific medicines management plan alongside the DMS in the National Health Service (UK).
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50
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Payne RA, Blair PS, Caddick B, Chew-Graham CA, Dreischulte T, Duncan LJ, Guthrie B, Mann C, Parslow RM, Round J, Salisbury C, Turner KM, Turner NL, McCahon D. Improving Medicines use in People with Polypharmacy in Primary Care (IMPPP): Protocol for a multicentre cluster randomised trial comparing a complex intervention for medication optimization against usual care. NIHR OPEN RESEARCH 2022; 2:54. [PMID: 37881305 PMCID: PMC10593356 DOI: 10.3310/nihropenres.13285.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 10/27/2023]
Abstract
Introduction Polypharmacy is increasingly common, and associated with undesirable consequences. Polypharmacy management necessitates balancing therapeutic benefits and risks, and varying clinical and patient priorities. Current guidance for managing polypharmacy is not supported by high quality evidence. The aim of the Improving Medicines use in People with Polypharmacy in Primary Care (IMPPP) trial is to evaluate the effectiveness of an intervention to optimise medication use for patients with polypharmacy in a general practice setting. Methods This trial will use a multicentre, open-label, cluster-randomised controlled approach, with two parallel groups. Practices will be randomised to a complex intervention comprising structured medication review (including interprofessional GP/pharmacist treatment planning and patient-facing review) supported by performance feedback, financial incentivisation, clinician training and clinical informatics (intervention), or usual care (control). Patients with polypharmacy and triggering potentially inappropriate prescribing (PIP) indicators will be recruited in each practice using a computerised search of health records. 37 practices will recruit 50 patients, and review them over a 26-week intervention delivery period. The primary outcome is the mean number of PIP indicators triggered per patient at 26 weeks follow-up, determined objectively from coded GP electronic health records. Secondary outcomes will include patient reported outcome measures, and health and care service use. The main intention-to-treat analysis will use linear mixed effects regression to compare number of PIP indicators triggered at 26 weeks post-review between groups, adjusted for baseline (pre-randomisation) values. A nested process evaluation will explore implementation of the intervention in primary care. Ethics and dissemination The protocol and associated study materials have been approved by the Wales REC 6, NHS Research Ethics Committee (REC reference 19/WA/0090), host institution and Health Research Authority. Research outputs will be published in peer-reviewed journals and relevant conferences, and additionally disseminated to patients and the public, clinicians, commissioners and policy makers. ISRCTN Registration 90146150 (28/03/2019).
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Affiliation(s)
- Rupert A. Payne
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Peter S. Blair
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Barbara Caddick
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | | | - Tobias Dreischulte
- Institute of General Practice and Family Medicine, Medical Center of the Ludwig-Maximilians-University, Munich, Germany
| | - Lorna J. Duncan
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, University of Edinburgh, Edinburgh, UK
| | - Cindy Mann
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | | | - Jeff Round
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Chris Salisbury
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Katrina M. Turner
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | | | - Deborah McCahon
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
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