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Iturralde E, Rubinsky AD, Nguyen KH, Anderson C, Lyles CR, Mangurian C. Serious Mental Illness, Glycemic Control, and Neighborhood Factors within an Urban Diabetes Cohort. Schizophr Bull 2024; 50:653-662. [PMID: 37597839 PMCID: PMC11059791 DOI: 10.1093/schbul/sbad122] [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: 08/21/2023]
Abstract
BACKGROUND AND HYPOTHESIS Serious mental illness (SMI) may compromise diabetes self-management. This study assessed the association between SMI and glycemic control, and explored sociodemographic predictors and geographic clustering of this outcome among patients with and without SMI. STUDY DESIGN We used electronic health record data for adult primary care patients with diabetes from 2 San Francisco health care delivery systems. The primary outcome was poor glycemic control (hemoglobin A1c >9.0%), which was modeled on SMI diagnosis status and sociodemographics. Geospatial analyses examined hotspots of poor glycemic control and neighborhood characteristics. STUDY RESULTS The study included 11 694 participants with diabetes, 21% with comorbid SMI, of whom 22% had a schizophrenia spectrum or bipolar disorder. Median age was 62 years; 52% were female and 79% were Asian, Black, or Hispanic. In adjusted models, having schizophrenia spectrum disorder or bipolar disorder was associated with greater risk for poor glycemic control (vs participants without SMI, adjusted relative risk [aRR] = 1.24; 95% confidence interval, 1.02, 1.49), but having broadly defined SMI was not. People with and without SMI had similar sociodemographic correlates of poor glycemic control including younger versus older age, Hispanic versus non-Hispanic White race/ethnicity, and English versus Chinese language preference. Hotspots for poor glycemic control were found in neighborhoods with more lower-income, Hispanic, and Black residents. CONCLUSIONS Poor diabetes control was significantly related to having a schizophrenia spectrum or bipolar disorder, and to sociodemographic factors and neighborhood. Community-based mental health clinics in hotspots could be targets for implementation of diabetes management services.
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Affiliation(s)
- Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Anna D Rubinsky
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, United States
- Academic Research Services, Information Technology, University of California San Francisco, San Francisco, CA, United States
| | - Kim H Nguyen
- Department of Medicine, Center for Vulnerable Populations at ZSFG, University of California San Francisco, San Francisco, CA, United States
| | - Chelsie Anderson
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Courtney R Lyles
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Center for Vulnerable Populations at ZSFG, University of California San Francisco, San Francisco, CA, United States
| | - Christina Mangurian
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Center for Vulnerable Populations at ZSFG, University of California San Francisco, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States
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2
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Evans M, Engberg S, Faurby M, Fernandes JDDR, Hudson P, Polonsky W. Adherence to and persistence with antidiabetic medications and associations with clinical and economic outcomes in people with type 2 diabetes mellitus: A systematic literature review. Diabetes Obes Metab 2022; 24:377-390. [PMID: 34779107 PMCID: PMC9299643 DOI: 10.1111/dom.14603] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/21/2021] [Accepted: 10/31/2021] [Indexed: 12/28/2022]
Abstract
We designed a systematic literature review to identify available evidence on adherence to and persistence with antidiabetic medication in people with type 2 diabetes (T2D). Electronic screening and congress searches identified real-world noninterventional studies (published between 2010 and October 2020) reporting estimates of adherence to and persistence with antidiabetic medication in adults with T2D, and associations with glycaemic control, microvascular and/or macrovascular complications, hospitalizations and healthcare costs. Ninety-two relevant studies were identified, the majority of which were retrospective and reported US data. The proportions of patients considered adherent (median [range] 51.2% [9.4%-84.3%]) or persistent (median [range] 47.7% [16.9%-94.0%]) varied widely across studies. Multiple studies reported an association between greater adherence/persistence and greater reductions in glycated haemoglobin levels. Better adherence/persistence was associated with fewer microvascular and/or macrovascular outcomes, although there was little consistency across studies in terms of which outcomes were improved. More adherent and more persistent patients were typically less likely to be hospitalized or to have emergency department visits/admissions and spent fewer days in hospital annually than less adherent/persistent patients. Greater adherence and persistence were generally associated with lower hospitalization costs, higher pharmacy costs and lower or budget-neutral total healthcare costs compared with lower adherence/persistence. In conclusion, better adherence and persistence in people with T2D is associated with lower rates of microvascular and/or macrovascular outcomes and inpatient hospitalization, and lower or budget-neutral total healthcare expenditure. Education and treatment strategies to address suboptimal adherence and persistence are needed to improve clinical and economic outcomes.
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Affiliation(s)
- Marc Evans
- Department of Diabetes and EndocrinologyUniversity Hospital LlandoughPenarthUK
| | | | | | | | | | - William Polonsky
- Behavioral Diabetes InstituteSan DiegoCaliforniaUSA
- Department of MedicineUniversity of CaliforniaSan DiegoCaliforniaUSA
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3
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Khaton Taheri N, Torabizadeh C, Aflaki E, Mohammadi M, Khademian Z. Experiences of the Patients with Behcet's Syndrom from Adherence to Treatment: A Qualitative Content Analysis. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2021; 9:300-312. [PMID: 34604399 PMCID: PMC8479285 DOI: 10.30476/ijcbnm.2021.89726.1640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/23/2021] [Accepted: 06/01/2021] [Indexed: 11/19/2022]
Abstract
Background Adherence to treatment plays an important role in the effectiveness of treatment in patients with Behcet's Syndrome (BS). An in-depth understanding of the experiences of patients with BS will help to improve the patients' management. The present qualitative study aimed to explore the experiences of patients with BS from adherence to treatment. Methods This qualitative study was conducted during February-September 2019 at Shahid Motahari Behcet's Clinic in Shiraz, Iran. Data were collected through eight unstructured observations and 22 individual in-depth semi-structured interviews with 20 participants (15 patients with BS, three family members, and two rheumatologists). Data analysis was performed simultaneously with data collection, using the conventional content analysis as proposed by Graneheim and Lundman. Data were managed using MAXQDA 10 software. Results Data analysis resulted in 21 sub-categories, seven categories, and three themes. The themes included barriers to treatment adherence (inability to cope with treatment and challenges in access to health care), facilitators of treatment adherence (incentives, receiving support, and striving to adapt to illness), and missing aspects of the treatment program (inadequate patient education and the neglect of lifestyle modification). Conclusion The barriers to and facilitators of treatment adherence as well as the missing aspects of the treatment program of patients with BS were identified. Adherence to treatment is not only determined by the patients, but also affected by the support system and relies upon the existing context and the nature of the treatment plan. These parameters should be considered during patient management to effectively promote treatment adherence.
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Affiliation(s)
- Narjes Khaton Taheri
- Student Research Committee, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Camellia Torabizadeh
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elham Aflaki
- Autoimmune Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Mohammadi
- Department of Administration and Educational Planning, School of Education Sciences and Psychology, Shiraz University, Shiraz, Iran
| | - Zahra Khademian
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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4
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Foley L, Larkin J, Lombard-Vance R, Murphy AW, Hynes L, Galvin E, Molloy GJ. Prevalence and predictors of medication non-adherence among people living with multimorbidity: a systematic review and meta-analysis. BMJ Open 2021; 11:e044987. [PMID: 34475141 PMCID: PMC8413882 DOI: 10.1136/bmjopen-2020-044987] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This systematic review aimed to describe medication non-adherence among people living with multimorbidity according to the current literature, and synthesise predictors of non-adherence in this population. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. PubMed, EMBASE, CINAHL and PsycINFO were searched for relevant articles published in English language between January 2009 and April 2019. Quantitative studies reporting medication non-adherence and/or predictors of non-adherence among people with two or more chronic conditions were included in the review. A meta-analysis was conducted with a subgroup of studies that used an inclusive definition of multimorbidity to recruit participants, rather than seeking people with specific conditions. Remaining studies reporting prevalence and predictors of non-adherence were narratively synthesised. RESULTS The database search produced 10 998 records and a further 75 were identified through other sources. Following full-text screening, 178 studies were included in the review. The range of reported non-adherence differed by measurement method, at 76.5% for self-report, 69.4% for pharmacy data, and 44.1% for electronic monitoring. A meta-analysis was conducted with eight studies (n=8949) that used an inclusive definition of multimorbidity to recruit participants. The pooled prevalence of non-adherence was 42.6% (95% CI: 34.0 - 51.3%, k=8, I2=97%, p<0.01). The overall range of non-adherence was 7.0%-83.5%. Frequently reported correlates of non-adherence included previous non-adherence and treatment-related beliefs. CONCLUSIONS The review identified a heterogeneous literature in terms of conditions studied, and definitions and measures of non-adherence used. Results suggest that future attempts to improve adherence among people with multimorbidity should determine for which conditions individuals require most support. The variable levels of medication non-adherence highlight the need for more attention to be paid by healthcare providers to the impact of multimorbidity on chronic disease self-management. PROSPERO REGISTRATION NUMBER CRD42019133849.
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Affiliation(s)
- Louise Foley
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - James Larkin
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Richard Lombard-Vance
- Department of Psychology, National University of Ireland Maynooth, Maynooth, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
- HRB Primary Care Clinical Trials Network Ireland, National University of Ireland Galway, Galway, Ireland
| | - Lisa Hynes
- Health Programmes, Croí Heart & Stroke Centre, Galway, Ireland
| | - Emer Galvin
- School of Pharmacy & Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gerard J Molloy
- School of Psychology, National University of Ireland Galway, Galway, Ireland
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5
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Keogh B, Murphy E, Doyle L, Sheaf G, Watts M, Higgins A. Mental health service users experiences of medication discontinuation: a systematic review of qualitative studies. J Ment Health 2021; 31:227-238. [PMID: 34126035 DOI: 10.1080/09638237.2021.1922644] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The use of psychotropic medication is often the first line of treatment for people with mental distress. However, many service users discontinue their prescribed medication, and little is known about their experiences or the reasons why they choose to stop taking medication. AIM The aim of this review is to synthesize research literature focused on the experiences of people who decided to discontinue taking medication for their mental health problem. METHODS A systematic review of qualitative studies was conducted. Data bases were searched for qualitative research which explored participants' motivations for discontinuing medication and their experiences of the process. RESULTS Six themes were identified: (1) Taking medications: a loss of autonomy, (2) Discontinuing medication: a thought-out process, (3) Factors influencing the decision to discontinue medication, (4) Discontinuing medication: experiences of the process, (5) Outcomes of discontinuing medication, (6) Managing mental distress in the absence of medication. CONCLUSION Service providers need to be aware that for some service user's psychotropic medication is not deemed a suitable treatment approach. Those who wish to discontinue medication need to be supported in the context of positive, therapeutic risk where their mental and physical health can be monitored and the likelihood of success increased.
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Affiliation(s)
- Brian Keogh
- Trinity College Dublin, the University of Dublin, School of Nursing and Midwifery, Dublin, Ireland
| | - Esther Murphy
- Trinity College Dublin, the University of Dublin, School of Nursing and Midwifery, Dublin, Ireland
| | - Louise Doyle
- Trinity College Dublin, the University of Dublin, School of Nursing and Midwifery, Dublin, Ireland
| | - Greg Sheaf
- The Library of Trinity College, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Mike Watts
- Grow, Mental Health Organisation, Dublin, Ireland
| | - Agnes Higgins
- Trinity College Dublin, the University of Dublin, School of Nursing and Midwifery, Dublin, Ireland
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6
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Coventry PA, Young B, Balogun-Katang A, Taylor J, Brown JVE, Kitchen C, Kellar I, Peckham E, Bellass S, Wright J, Alderson S, Lister J, Holt RIG, Doherty P, Carswell C, Hewitt C, Jacobs R, Osborn D, Boehnke J, Siddiqi N. Determinants of Physical Health Self-Management Behaviours in Adults With Serious Mental Illness: A Systematic Review. Front Psychiatry 2021; 12:723962. [PMID: 34489764 PMCID: PMC8417946 DOI: 10.3389/fpsyt.2021.723962] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/23/2021] [Indexed: 01/27/2023] Open
Abstract
Behavioural interventions can support the adoption of healthier lifestyles and improve physical health outcomes, but it is unclear what factors might drive success of such interventions in people with serious mental illness (SMI). We systematically identified and reviewed evidence of the association between determinants of physical health self-management behaviours in adults with SMI. Data about American Association of Diabetes Educator's Self-Care Behaviours (AADE-7) were mapped against the novel Mechanisms of Action (MoA) framework. Twenty-eight studies were included in the review, reporting evidence on 104 determinant-behaviour links. Beliefs about capabilities and beliefs about consequences were the most important determinants of behaviour, especially for being physically active and healthy eating. There was some evidence that emotion and environmental context and resources played a role in determining reducing risks, being active, and taking medications. We found very limited evidence associated with problem solving, and no study assessed links between MoAs and healthy coping. Although the review predominantly identified evidence about associations from cross-sectional studies that lacked validated and objective measures of self-management behaviours, these findings can facilitate the identification of behaviour change techniques with hypothesised links to determinants to support self-management in people with SMI. Systematic Review Registration: PROSPERO, registration CRD42018099553.
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Affiliation(s)
- Peter A Coventry
- Department of Health Sciences, University of York, York, United Kingdom
| | - Ben Young
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | | | - Johanna Taylor
- Department of Health Sciences, University of York, York, United Kingdom
| | | | - Charlotte Kitchen
- Department of Health Sciences, University of York, York, United Kingdom
| | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Emily Peckham
- Department of Health Sciences, University of York, York, United Kingdom
| | - Sue Bellass
- Department of Health Sciences, University of York, York, United Kingdom.,School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Judy Wright
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Sarah Alderson
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Jennie Lister
- Department of Health Sciences, University of York, York, United Kingdom
| | - Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Patrick Doherty
- Department of Health Sciences, University of York, York, United Kingdom
| | - Claire Carswell
- Department of Health Sciences, University of York, York, United Kingdom
| | - Catherine Hewitt
- Department of Health Sciences, University of York, York, United Kingdom
| | - Rowena Jacobs
- Centre for Health Economics, University of York, York, United Kingdom
| | - David Osborn
- Division of Psychiatry, University College London, London, United Kingdom
| | - Jan Boehnke
- Department of Health Sciences, University of York, York, United Kingdom.,School of Health Sciences, University of Dundee, Dundee, United Kingdom
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom.,Hull York Medical School, University of York, York, United Kingdom
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7
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Rønne ST, Zabell V, Joensen LE, Jørgensen R, Gaede PH, Hemmingsen Arnfred SM. Perceptions and experiences of living with coexisting type 2 diabetes and severe mental illness: a scoping review. Diabet Med 2020; 37:1627-1639. [PMID: 32421884 DOI: 10.1111/dme.14322] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2020] [Indexed: 12/21/2022]
Abstract
AIMS To map existing research-based knowledge of everyday life and illness management among people with coexisting type 2 diabetes and severe mental illness, and to identify study designs, aims, populations and themes. METHODS A systematic literature search was performed on 16 April 2019 using Medline, Embase, PsycINFO, Cinahl, the Cochrane Library, and the Web of Science to conduct a scoping review. Included studies were summarized with regard to the quantity of research, the study designs, aims, populations and themes RESULTS: From 3406 records, we included 23 studies about everyday life and illness management among people with coexisting type 2 diabetes and severe mental illness. Four studies were qualitative (observations, interviews and focus groups), and 19 were quantitative (observational and interventions) and used questionnaires. Five themes emerged in the findings: (1) diet and exercise, but not other diabetes self-care activities, are consistently compromised in the target group; (2) psychiatric exacerbation diminishes diabetes self-care; (3) social support and high self-efficacy improve diabetes self-care; (4) use of healthcare services is compromised; and (5) quality of life and well-being is poor. CONCLUSIONS The limited research into the studied population's experiences with coexisting type 2 diabetes and severe mental illness is characterized by its heterogeneity in aims and methods and a strong focus on diabetes management and treatment. Further research focusing on the management of both conditions in everyday life is needed to improve specialized and integrated care targeting the population.
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Affiliation(s)
- S T Rønne
- Psychiatric Research Unit West, Slagelse, Region Zealand, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - V Zabell
- Psychiatric Research Unit West, Slagelse, Region Zealand, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - L E Joensen
- Health Promotion, Steno Diabetes Centre Copenhagen, Copenhagen, Denmark
| | - R Jørgensen
- Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark
| | - P H Gaede
- Department of Internal Medicine Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Region Zealand, Denmark
- Faculty of Public Health, University of Southern Denmark, Odense, Denmark
| | - S M Hemmingsen Arnfred
- Psychiatric Research Unit West, Slagelse, Region Zealand, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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8
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Mangurian C, Schillinger D, Newcomer JW, Vittinghoff E, Essock S, Zhu Z, Dyer W, Young-Wolff KC, Schmittdiel J. Comorbid Diabetes and Severe Mental Illness: Outcomes in an Integrated Health Care Delivery System. J Gen Intern Med 2020; 35:160-166. [PMID: 31705468 PMCID: PMC6957587 DOI: 10.1007/s11606-019-05489-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 05/02/2019] [Accepted: 09/25/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Diabetes prevalence is twice as high among people with severe mental illness (SMI) when compared to the general population. Despite high prevalence, care outcomes are not well understood. OBJECTIVE To compare diabetes health outcomes received by people with and without comorbid SMI, and to understand demographic factors associated with poor diabetes control among those with SMI. DESIGN Retrospective cohort study PARTICIPANTS: 269,243 adults with diabetes MAIN MEASURES: Primary outcomes included optimal glycemic control (A1c < 7) or poor diabetes control (A1c > 9) in 2014. Secondary outcomes included control of other cardiometabolic risk factors (hypertension, dyslipidemia, smoking) and recommended diabetes monitoring. KEY RESULTS Among this cohort, people with SMI (N = 4,399), compared to those without SMI (N = 264,844), were more likely to have optimal glycemic control, adjusting for various covariates (adjusted relative risk (aRR) 1.25, 95% CI 1.21-1.28, p < .001) and less likely to have poor control (aRR 0.92, 95% CI 0.87-0.98, p = 0.012). Better blood pressure and lipid control was more prevalent among people with SMI when compared to those without SMI (aRR 1.03; 95% CI 1.02-1.05, p < .001; aRR 1.02; 95% CI 1.00-1.05, p = 0.044, respectively). No differences were observed in recommended A1c or LDL testing, but people with SMI were more likely to have blood pressure checked (aRR 1.02, 95% CI 1.02-1.03, p < .001) and less likely to receive retinopathy screening (aRR 0.80, 95% CI 0.71-0.91, p < .001) than those without SMI. Among people with diabetes and comorbid SMI, younger adults and Hispanics were more likely to have poor diabetes control. CONCLUSIONS Adults with diabetes and comorbid SMI had better cardiometabolic control than people with diabetes who did not have SMI, despite lower rates of retinopathy screening. Among those with comorbid SMI, younger adults and Hispanics were more vulnerable to poor A1c control.
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Affiliation(s)
- Christina Mangurian
- Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
| | - Dean Schillinger
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - John W Newcomer
- Thriving Mind South Florida and Washington University School of Medicine, St Louis, CA, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Susan Essock
- Department of Psychiatry, Columbia University, New York City, NY, USA
| | - Zheng Zhu
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Wendy Dyer
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Kelly C Young-Wolff
- Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Julie Schmittdiel
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
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9
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A pharmacist-managed cardiovascular risk-reduction clinic for individuals experiencing serious mental illness. J Am Pharm Assoc (2003) 2019; 59:698-703. [DOI: 10.1016/j.japh.2019.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 05/31/2019] [Accepted: 06/03/2019] [Indexed: 11/18/2022]
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10
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Rezaei M, Valiee S, Tahan M, Ebtekar F, Ghanei Gheshlagh R. Barriers of medication adherence in patients with type-2 diabetes: a pilot qualitative study. Diabetes Metab Syndr Obes 2019; 12:589-599. [PMID: 31118722 PMCID: PMC6507070 DOI: 10.2147/dmso.s197159] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/21/2019] [Indexed: 01/04/2023] Open
Abstract
Background: Patients with type-2 diabetes have poor adherence to the therapeutic regime. It can result in various complications in body systems associated with undesirable metabolic control. Purpose: The present study aimed to explore the inhibitors of medication adherence in patients with type-2 diabetes. Patients and methods: This was a qualitative study using a conventional content analysis method. Participants were 12 patients with type-2 diabetes referred to the diabetes unit in Saghez, Kurdistan Province in 2015. The purposive sampling method was used with a maximum variation in sampling, and data collection was continued until data saturation was achieved. Semi-structured interviews were used for data collection. Interviews were recorded and immediately transcribed verbatim. Results: Data analysis led to the development of four main categories including disbelief in medical explanatory/prescriptive knowledge, lived experiences of the disease, challenges of everyday life, and interactive/economic challenges. The main inhibitors were the patient's understanding of his/her own physical status and strategies used for maintaining the internal balance. Healthcare providers need to take patients' perceptions into account when they are prescribing medicinal diets. Another inhibitor was the incidents of everyday life, including economic and social challenges, and interactions to receive education and skills for living with the disease. Conclusion: Beliefs of the medical team and patients should be brought closer to each other, and patients' trust in the medical team should be increased. Nurses should consider the unique experience of every patient when giving healthcare recommendations, and try to limit the existing challenges as much as possible.
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Affiliation(s)
- Mehdi Rezaei
- Department of Social Sciences, Payame Noor University (PNU), Tehran, Iran
| | - Sina Valiee
- Clinical Care Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mohammad Tahan
- Young Researchers and Elite Club, Birjand Branch, Islamic Azad University, Birjand, Iran
| | - Fariba Ebtekar
- Department of Midwifery, School of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Reza Ghanei Gheshlagh
- Clinical Care Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Correspondence: Reza Ghanei GheshlaghClinical Care Research Center, Kurdistan University of Medical Sciences, Pasdaran Ave, Sanandaj6618634683, IranTel +98 914 405 0284Email
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11
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Xing S, Calip GS, Leow AD, Kim S, Schumock GT, Touchette DR, Lee TA. The impact of depression medications on oral antidiabetic drug adherence in patients with diabetes and depression. J Diabetes Complications 2018; 32:492-500. [PMID: 29544744 PMCID: PMC5920707 DOI: 10.1016/j.jdiacomp.2017.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/29/2017] [Accepted: 12/21/2017] [Indexed: 12/13/2022]
Abstract
AIMS To compare adherence and persistence to oral antidiabetic drugs (OAD) between patients who are new users of second generation antipsychotics (SGA) versus new users of other depression therapies in adults with type 2 diabetes mellitus (T2DM) and major depressive disorder (MDD). METHODS Adults 18-64 years with previously-treated T2DM and MDD (past OAD and SSRI/SNRI use) who are new users of SGA or non-SGA therapies (bupropion, lithium, mirtazapine, thyroid hormone, tricyclic antidepressant) were identified in the 2009-2015 MarketScan® Commercial Claims and Encounters database. Multivariate regression models were used to determine the odds of a ≥10% decline in OAD adherence over 180- and 365-days, and time to OAD discontinuation, adjusting for differences between groups. RESULTS A total of 8664 (21.5% SGA), 8311 (22.1% SGA), and 17,524 (21.3% SGA) patients met inclusion criteria for the 180-day adherence, 365-day adherence, and persistence cohorts, respectively. Over 180-days, 16.6% of SGA and 13.3% of non-SGA initiators had a ≥10% decline in OAD adherence (adjusted odds ratio [OR] = 1.41, 95% CI 1.21-1.63). Over 365-days, 22.3% of SGA and 18.9% of non-SGA initiators had a ≥ 10% decline (OR = 1.34, 95% CI 1.17-1.53). Time to OAD discontinuation was similar between groups (adjusted hazard ratio = 1.03, 95% CI 0.94-1.12). CONCLUSION Use of SGA was associated with a 1.3-1.4 times higher odds of a ≥10% decline in OAD adherence. Adherence to OAD is critical for optimal diabetes control and reductions in this magnitude may impact A1C. Close monitoring of OAD adherence after SGA initiation is warranted.
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Affiliation(s)
- Shan Xing
- University of Illinois at Chicago, Department of Pharmacy, Systems, Outcomes and Policy, College of Pharmacy, United States
| | - Gregory S Calip
- University of Illinois at Chicago, Department of Pharmacy, Systems, Outcomes and Policy, College of Pharmacy, United States
| | - Alex D Leow
- University of Illinois at Chicago, Department of Psychiatry, College of Medicine, United States; University of Illinois at Chicago, Department of Bioengineering, College of Engineering, College of Medicine, United States
| | - Shiyun Kim
- University of Illinois at Chicago, Department of Pharmacy Practice, College of Pharmacy, United States
| | - Glen T Schumock
- University of Illinois at Chicago, Department of Pharmacy, Systems, Outcomes and Policy, College of Pharmacy, United States
| | - Daniel R Touchette
- University of Illinois at Chicago, Department of Pharmacy, Systems, Outcomes and Policy, College of Pharmacy, United States
| | - Todd A Lee
- University of Illinois at Chicago, Department of Pharmacy, Systems, Outcomes and Policy, College of Pharmacy, United States.
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12
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Hamm JA, Buck KD, Gonzalvo JD. Clinical Application of Patient-Centered Diabetes Care for People With Serious Mental Illness. Clin Diabetes 2017; 35:313-320. [PMID: 29263574 PMCID: PMC5734178 DOI: 10.2337/cd17-0041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IN BRIEF Patients with serious mental illness (SMI) have markedly higher mortality rates than those without SMI. A large portion of this disparity is explained by higher rates of diabetes and cardiovascular illness, highlighting the need for people with diabetes and SMI to have access to the highest quality diabetes care. This article applies principles of patient-centered diabetes care to those with SMI, exploring a novel approach to diabetes care embedded within a community mental health setting.
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Affiliation(s)
- Jay A. Hamm
- Eskenazi Health, Midtown Community Mental Health, Indianapolis, IN
- Purdue University, College of Pharmacy, West Lafayette, IN
| | - Kelly D. Buck
- Richard L. Roudebush VA Medical Center, Indianapolis, IN
| | - Jasmine D. Gonzalvo
- Eskenazi Health, Midtown Community Mental Health, Indianapolis, IN
- Purdue University, College of Pharmacy, West Lafayette, IN
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13
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Brown K, Fortenberry K, Gren L, Gunning K, McAdam-Marx C. Achievement of Adequate Glycemic Control in Patients With Type 2 Diabetes and Comorbid Mental Health Conditions Treated in a Primary Care Setting. Diabetes Spectr 2017; 30:277-287. [PMID: 29151718 PMCID: PMC5687112 DOI: 10.2337/ds16-0038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study investigated the association between the presence of a mental health condition (MHC) diagnosis and glycemic control in patients with type 2 diabetes in a primary care clinic network. METHODS This retrospective cross-sectional study compared adequate glycemic control (A1C <8.0%) in patients with type 2 diabetes with and without any MHC, as well as by MHC subtypes of depression or anxiety, bipolar or schizophrenia disorders, and substance use disorder. RESULTS Of 3,025 patients with type 2 diabetes, 721 (24%) had a diagnosis for one or more MHC. The majority (54.9%) were <65 years of age, female (54.9%), and Caucasian (74.5%). Mean A1C was statistically lower in the MHC cohort at 7.14 ± 1.66% compared to 7.38 ± 1.73% in the group without any MHC (P = 0.001). Furthermore, those with an MHC were more likely to attain adequate glycemic control than those without an MHC (odds ratio 1.27, 95% CI 1.01-1.59). Among patients with MHCs, similar rates of adequate glycemic control were seen between those with depression or anxiety and those with other MHCs. However, fewer patients with substance use disorder had adequate glycemic control compared to those without this condition (66.7 vs. 80.10%, P = 0.004). CONCLUSION Patients with diabetes and MHCs had slightly better glycemic control than those without any MHC. However, the presence of substance use disorder may present more barriers to adequate glycemic control. Additional research is needed to identify barriers unique to each MHC to optimize diabetes management in this population.
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Affiliation(s)
| | - Katherine Fortenberry
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
| | - Lisa Gren
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
| | - Karen Gunning
- Department of Pharmacotherapy and
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
| | - Carrie McAdam-Marx
- Pharmaceutical Evaluation and Policy Division, University of Arkansas for Medical Sciences, Little Rock, AR
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14
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Lunghi C, Zongo A, Moisan J, Grégoire JP, Guénette L. Factors associated with antidiabetic medication non-adherence in patients with incident comorbid depression. J Diabetes Complications 2017; 31:1200-1206. [PMID: 28325698 DOI: 10.1016/j.jdiacomp.2017.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 10/20/2022]
Abstract
AIM To identify factors associated with antidiabetic drug (AD) non-adherence among patients with type 2 diabetes and depression. STUDY DESIGN AND SETTINGS We conducted a population-based retrospective cohort study among new AD users with a diagnosis of depression following AD initiation. We used public health insurance data from Quebec. The dependent variable was non-adherence (i.e., <90% of days covered by ≥1AD) in the year after a depression diagnosis. Different sociodemographic, clinical and medication-related variables were assessed as potential factors of non-adherence to AD treatment. We performed univariate and multivariate logistic regressions. RESULTS We identified 3106 new users of ADs with a diagnosis of depression between 2000 and 2006. Of these individuals, 52% were considered non-adherent to their ADs. Baseline non-adherence, younger age, the addition of another AD to the initial treatment, <4 drug claims, visits with several different physicians, high socioeconomic status, and a small number of diabetes complications were associated with AD non-adherence. CONCLUSIONS The factors identified in the present study may help clinicians recognize patients with type 2 diabetes and incident depression at increased risk for non-adherence. In these patients, close follow-up and targeted interventions could help improve adherence to AD treatment, improve glycemic control and reduce complications.
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Affiliation(s)
- Carlotta Lunghi
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre - Université Laval, Québec, QC, Canada
| | - Arsène Zongo
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre - Université Laval, Québec, QC, Canada
| | - Jocelyne Moisan
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre - Université Laval, Québec, QC, Canada
| | - Jean-Pierre Grégoire
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre - Université Laval, Québec, QC, Canada
| | - Line Guénette
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre - Université Laval, Québec, QC, Canada.
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15
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Are people with schizophrenia adherent to diabetes medication? A comparative meta-analysis. Psychiatry Res 2017; 250:17-24. [PMID: 28135643 DOI: 10.1016/j.psychres.2017.01.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/17/2017] [Accepted: 01/19/2017] [Indexed: 02/07/2023]
Abstract
Individuals living with schizophrenia are 2-3 times more likely to experience type 2 diabetes mellitus. Diabetes medication adherence is essential to reduce morbidity and mortality in this population. We conducted a meta-analysis of diabetes medication adherence among people with schizophrenia, and compared this to those without schizophrenia. A systematic search strategy was used to identify all articles reporting adherence to diabetes medications among patients with schizophrenia. In total, 10 unique studies reporting data from 33,910 people with schizophrenia were included. Random effects meta-analysis showed people with schizophrenia adhered to medication on 77.3% of days prescribed (n=32080, 95%CI=73.6-81%, I2=99.2%,), and adhered on 4.6% more days per year than those without schizophrenia (p<0.01, 95%CI=2.4-6.7%, I2=92.5%, schizophrenia n=19367, controls=170,853). Furthermore, 56% of individuals with schizophrenia (n=33680) were considered "adherent" (i.e. >80% adherence over 12-24 month) to diabetes medication, which was significantly more than those without schizophrenia (OR=1.34, 95%CI: 1.18-1.52, p<0.01). Factors which were positively associated with diabetes medication adherence were age, number of outpatient visits, along with multiple medication administration variables. Future prospective research should examine diabetes monitoring, medication prescription, and subsequent adherence in fully representative samples. Novel interventions for maximizing compliance to diabetes medication in this vulnerable population should also be explored.
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16
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Gorczynski P, Patel H, Ganguli R. Adherence to Diabetes Medication in Individuals with Schizophrenia: A Systematic Review of Rates and Determinants of Adherence. ACTA ACUST UNITED AC 2017; 10:191-200. [DOI: 10.3371/csrp.gopa.013114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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17
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Jimenez K, Vargas C, Garcia K, Guzman H, Angulo M, Billimek J. Evaluating the Validity and Reliability of the Beliefs About Medicines Questionnaire in Low-Income, Spanish-Speaking Patients With Diabetes in the United States. DIABETES EDUCATOR 2016; 43:114-124. [PMID: 27831521 DOI: 10.1177/0145721716675740] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose The purpose of this study was to examine the reliability and validity of a Spanish version of the Beliefs about Medicines Questionnaire (BMQ) as a measure to evaluate beliefs about medications and to differentiate adherent from nonadherent patients among low-income Latino patients with diabetes in the United States. Methods Seventy-three patients were administered the BMQ and surveyed for evidence of medication nonadherence. Internal consistency of the BMQ was assessed by Cronbach's alpha along with performing a confirmatory factor analysis. Criterion validity was assessed by comparing mean scores on 3 subscales of the BMQ (General Overuse, General Harm, and Specific Necessity-Concerns difference score) between adherent patients and patients reporting nonadherence for 3 different reasons (unintentional nonadherence, cost-related nonadherence, and nonadherence due to reasons other than cost) using independent samples t tests. Results The BMQ is a reliable instrument to examine beliefs about medications in this Spanish-speaking population. Construct validity testing shows nearly identical factor loading as the original construct map. General Overuse scores were significantly more negative for patients reporting each reason for nonadherence compared with their adherent counterparts. Necessity-Concerns difference scores were significantly more negative for patients reporting nonadherence for reasons other than cost compared with those who did not report this reason for nonadherence. Conclusion The Spanish version of the BMQ is appropriate to assess beliefs about medications in Latino patients with type 2 diabetes in the United States and may help identify patients who become nonadherent to medications for reasons other than out-of-pocket costs.
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Affiliation(s)
- Krystal Jimenez
- Health Policy Research Institute, University of California, Irvine (Ms Jimenez, Ms Vargas, Ms Garcia, Ms Guzman, Dr Billimek)
| | - Cristina Vargas
- Health Policy Research Institute, University of California, Irvine (Ms Jimenez, Ms Vargas, Ms Garcia, Ms Guzman, Dr Billimek)
| | - Karla Garcia
- Health Policy Research Institute, University of California, Irvine (Ms Jimenez, Ms Vargas, Ms Garcia, Ms Guzman, Dr Billimek)
| | - Herlinda Guzman
- Health Policy Research Institute, University of California, Irvine (Ms Jimenez, Ms Vargas, Ms Garcia, Ms Guzman, Dr Billimek)
| | - Marco Angulo
- Department of Family Medicine, School of Medicine, University of California, Irvine (Dr Angulo, Dr Billimek)
| | - John Billimek
- Health Policy Research Institute, University of California, Irvine (Ms Jimenez, Ms Vargas, Ms Garcia, Ms Guzman, Dr Billimek).,Department of Medicine, Division of General Internal Medicine and Primary Care, School of Medicine, University of California, Irvine (Dr Billimek).,Department of Family Medicine, School of Medicine, University of California, Irvine (Dr Angulo, Dr Billimek)
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18
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Saeedi O, Ashraf H, Malouf M, Slade EP, Medoff DR, Li L, Kreyenbuhl J. Prevalence of diagnosed ocular disease in veterans with serious mental illness. Gen Hosp Psychiatry 2016; 43:1-5. [PMID: 27796250 PMCID: PMC5111362 DOI: 10.1016/j.genhosppsych.2016.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 08/02/2016] [Accepted: 08/11/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the prevalence of diagnosed ocular disease and eye disease treatment between Veteran's Administration (VA) patients with and without serious mental illness (SMI). METHODS Retrospective comparison of diagnosed ocular disease and treatment prevalence among patients with and without diagnosed SMI in fiscal year 2011 in the VA Capitol Health Care System (VISN 5). RESULTS We identified 6462 VA patients with SMI and 137,933 without SMI. The prevalence of diagnosed ocular disease was 22.7% in SMI patients and 35.4% in non-SMI patients (P<.001). Those with SMI had a higher prevalence of glaucoma (10.2% vs. 7.1%, P<.0001), cataract (12.6% vs. 9.2%, P<.0001) and dry eye (4.0% vs. 2.7%, P<.0001). Less than half (34.3%) of SMI subjects had been seen in ophthalmology or optometry vs. 23.0% of controls (P<.0001). CONCLUSION VA patients with SMI have a greater prevalence of diagnosed ocular disease, particularly cataract, glaucoma and dry eye. While SMI patients utilize eye care services at a higher rate than the general VA population, the majority of subjects with SMI do not get recommended annual eye examinations. More consistent annual ocular screening among VA patients with SMI may be indicated.
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Affiliation(s)
- Osamah Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 W. Redwood Street, Suite 470, Baltimore, MD 21201, USA.
| | - Hasan Ashraf
- Indiana University School of Medicine, Department of Internal Medicine, 340 W 10th St #6200, Indianapolis, IN 46202, USA
| | - Marc Malouf
- Malouf Eye Center 4400 Telfair Blvd, Camp Springs, MD 20746, Camp Springs, MD, USA
| | - Eric P. Slade
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), 10 N Greene Street, Baltimore, MD 21201, USA, University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, 110 South Paca St., 4th Floor, Baltimore, MD 21201, USA
| | - Deborah R. Medoff
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), 10 N Greene Street, Baltimore, MD 21201, USA, University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, 110 South Paca St., 4th Floor, Baltimore, MD 21201, USA
| | - Lan Li
- University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, 110 South Paca St., 4th Floor, Baltimore, MD 21201, USA
| | - Julie Kreyenbuhl
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), 10 N Greene Street, Baltimore, MD 21201, USA, University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, 110 South Paca St., 4th Floor, Baltimore, MD 21201, USA
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Capoccia K, Odegard PS, Letassy N. Medication Adherence With Diabetes Medication: A Systematic Review of the Literature. DIABETES EDUCATOR 2015; 42:34-71. [PMID: 26637240 DOI: 10.1177/0145721715619038] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE The primary purpose of this systematic review is to synthesize the evidence regarding risk factors associated with nonadherence to prescribed glucose-lowering agents, the impact of nonadherence on glycemic control and the economics of diabetes care, and the interventions designed to improve adherence. METHODS Medline, EMBASE, the Cochrane Collaborative, BIOSIS, and the Health and Psychosocial Instruments databases were searched for studies of medication adherence for the period from May 2007 to December 2014. Inclusion criteria were study design and primary outcome measuring or characterizing adherence. Published evidence was graded according to the American Association of Clinical Endocrinologists protocol for standardized production of clinical practice guidelines. RESULTS One hundred ninety-six published articles were reviewed; 98 met inclusion criteria. Factors including age, race, health beliefs, medication cost, co-pays, Medicare Part D coverage gap, insulin use, health literacy, primary nonadherence, and early nonpersistence significantly affect adherence. Higher adherence was associated with improved glycemic control, fewer emergency department visits, decreased hospitalizations, and lower medical costs. Adherence was lower when medications were not tolerated or were taken more than twice daily, with concomitant depression, and with skepticism about the importance of medication. Intervention trials show the use of phone interventions, integrative health coaching, case managers, pharmacists, education, and point-of-care testing improve adherence. CONCLUSION Medication adherence remains an important consideration in diabetes care. Health professionals working with individuals with diabetes (eg, diabetes educators) are in a key position to assess risks for nonadherence, to develop strategies to facilitate medication taking, and to provide ongoing support and assessment of adherence at each visit.
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Affiliation(s)
- Kam Capoccia
- College of Pharmacy, Western New England University, Springfield, Massachusetts (Dr Capoccia)
| | - Peggy S Odegard
- School of Pharmacy, University of Washington, Seattle, Washington (Dr Odegard)
| | - Nancy Letassy
- College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma (Dr Letassy)
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Chwastiak LA, Freudenreich O, Tek C, McKibbin C, Han J, McCarron R, Wisse B. Clinical management of comorbid diabetes and psychotic disorders. Lancet Psychiatry 2015; 2:465-476. [PMID: 26360289 DOI: 10.1016/s2215-0366(15)00105-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 03/06/2015] [Accepted: 03/09/2015] [Indexed: 12/17/2022]
Abstract
Individuals with psychotic disorders experience substantial health disparities with respect to diabetes, including increased risk of incident diabetes and of poor diabetes outcomes (eg, diabetes complications and mortality). Low-quality medical care for diabetes is a significant contributor to these poor health outcomes. A thoughtful approach to both diabetes pharmacotherapy and drug management for psychotic disorders is essential, irrespective of whether treatment is given by a psychiatrist, a primary care provider, or an endocrinologist. Exposure to drugs with high metabolic liability should be minimised, and both psychiatric providers and medical providers need to monitor patients to ensure that medical care for diabetes is adequate. Promising models of care management and team approaches to coordination and integration of care highlight the crucial need for communication and cooperation among medical and psychiatric providers to improve outcomes in these patients. Evidence-based programmes that promote weight loss or smoking cessation need to be more accessible for these patients, and should be available in all the settings where they access care.
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Affiliation(s)
- Lydia A Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
| | - Oliver Freudenreich
- Department of Psychiatry, Massachusetts General Hospital, Harvard University School of Medicine, Boston, MA, USA
| | - Cenk Tek
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | | | - Jaesu Han
- Department of Psychiatry, University of California, Davis, Sacramento, CA, USA; Department of Family and Community Medicine, University of California, Davis, Sacramento, CA, USA
| | - Robert McCarron
- Department of Psychiatry, University of California, Davis, Sacramento, CA, USA; Department of Family and Community Medicine, University of California, Davis, Sacramento, CA, USA
| | - Brent Wisse
- Department of Medicine, Division of Endocrinology, University of Washington School of Medicine, Seattle, WA, USA
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von Esenwein SA, Druss BG. Using electronic health records to improve the physical healthcare of people with serious mental illnesses: a view from the front lines. Int Rev Psychiatry 2014; 26:629-37. [PMID: 25553780 DOI: 10.3109/09540261.2014.987221] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Individuals with serious mental illnesses (SMI) treated in the public mental health sector die decades younger than the general population. Poor quality and fragmentation of care are risk factors underlying the poor health of this population. Integrated electronic health records (EHR) can play a vital role in efforts to improve quality and outcomes of care in patients with SMI. The objective of this paper is to describe the current state of efforts to integrate and improve the mental and physical care of individuals with SMI in the public sector, with an emphasis on the use of electronic health records (EHR). While a range of encouraging initiatives exists throughout the country, technological and medico-legal challenges are providing significant barriers for the successful integration of care and EHRs for many partnering organizations. Furthermore, there is a lack of rigorous research studying the effectiveness and sustainability of these programmes. Recommendations are made for the alleviation of policy barriers and future areas of inquiry.
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Affiliation(s)
- Silke A von Esenwein
- Center for Behavioral Health Policy Studies, Rollins School of Public Health, Emory University , Atlanta, Georgia , USA
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22
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Long JA, Wang A, Medvedeva EL, Eisen SV, Gordon AJ, Kreyenbuhl J, Marcus SC. Glucose control and medication adherence among veterans with diabetes and serious mental illness: does collocation of primary care and mental health care matter? Diabetes Care 2014; 37:2261-7. [PMID: 24879839 DOI: 10.2337/dc13-0051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Persons with serious mental illness (SMI) may benefit from collocation of medical and mental health healthcare professionals and services in attending to their chronic comorbid medical conditions. We evaluated and compared glucose control and diabetes medication adherence among patients with SMI who received collocated care to those not receiving collocated care (which we call usual care). RESEARCH DESIGN AND METHODS We performed a cross-sectional, observational cohort study of 363 veteran patients with type 2 diabetes and SMI who received care from one of three Veterans Affairs medical facilities: two sites that provided both collocated and usual care and one site that provided only usual care. Through a survey, laboratory tests, and medical records, we assessed patient characteristics, glucose control as measured by a current HbA1c, and adherence to diabetes medication as measured by the medication possession ration (MPR) and self-report. RESULTS In the sample, the mean HbA1c was 7.4% (57 mmol/mol), the mean MPR was 80%, and 51% reported perfect adherence to their diabetes medications. In both unadjusted and adjusted analyses, there were no differences in glucose control and medication adherence by collocation of care. Patients seen in collocated care tended to have better HbA1c levels (β = -0.149; P = 0.393) and MPR values (β = 0.34; P = 0.132) and worse self-reported adherence (odds ratio 0.71; P = 0.143), but these were not statistically significant. CONCLUSIONS In a population of veterans with comorbid diabetes and SMI, patients on average had good glucose control and medication adherence regardless of where they received primary care.
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Affiliation(s)
- Judith A Long
- Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PADepartment of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Andrew Wang
- Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA
| | - Elina L Medvedeva
- Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA
| | - Susan V Eisen
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MABoston University School of Public Health, Boston, MA
| | - Adam J Gordon
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PAMental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PAUniversity of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Julie Kreyenbuhl
- Mental Illness Research, Education and Clinical Center, VA Capitol Health Care Network, Baltimore, MDDivision of Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Steven C Marcus
- Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PAPenn School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA
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Clifford S, Perez-Nieves M, Skalicky AM, Reaney M, Coyne KS. A systematic literature review of methodologies used to assess medication adherence in patients with diabetes. Curr Med Res Opin 2014; 30:1071-85. [PMID: 24432796 DOI: 10.1185/03007995.2014.884491] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Adhering to prescribed medication is often a problem for patients with diabetes yet there is no consensus on how best to measure adherence in this patient population. This systematic literature review critically reviewed and summarized the methods used to measure medication adherence in patients with diabetes (on oral hypoglycemic agents [OHAs] and/or insulin) in original research published between 2007-2013. STUDY DESIGN Literature review. METHODS A systematic search for methods to assess medication adherence in patients with type I or type II diabetes was conducted using PubMed, EMBASE, PsychInfo, and Cochrane databases. Two researchers independently screened abstracts for initial eligibility and then applied the inclusion/exclusion criteria to the relevant full-text articles. RESULTS Fifty-nine articles met the criteria for inclusion. Subjective assessment (observer-reported and patient-reported), pill counts, Medication Event Monitoring System (MEMS), cell-phone real-time assessment, and logbooks were used in prospective studies. In pharmacy claims databases, medication possession ratios (MPRs), or some derivation thereof, were utilized. Each method has strengths and weaknesses, but few approaches specifically addressed issues unique to assessing insulin adherence. Three novel approaches (using cell-phone real-time assessment, computerized logbooks, and a questionnaire about different dosing irregularities) provided insight on timing and dosing issues that could be useful for highlighting interventions to improve insulin adherence. CONCLUSION No gold standard exists for measuring medication adherence in patients with diabetes. The plethora of adherence methods precludes the comparison of adherence rates across studies. Greater consistency is therefore needed in adherence measurement, including question content, recall period, and response options for self-report measures. Novel methods for understanding adherence to variable-dosed insulin require further research. Researchers should select a methodology that best fits their research question, study design, patient population and resources.
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Ethnic differences in primary care management of diabetes and cardiovascular disease in people with serious mental illness. Br J Gen Pract 2012; 62:e582-8. [PMID: 22867683 DOI: 10.3399/bjgp12x653642] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Patients with serious mental illness (SMI) have high rates of cardiovascular disease (CVD). In contrast to widespread perception, their access to effective chronic disease management is as high as for the general population. However, previous studies have not included analysis by ethnicity. AIM To identify differences in CVD and diabetes management, by ethnicity, among people with SMI. DESIGN AND SETTING Three inner east London primary care trusts with an ethnically diverse and socially deprived population. Data were obtained from 147 of 151 general practices. METHOD Coded demographic and clinical data were obtained from GP electronic health records using EMIS Web. The sample used was the GP registered population on diabetes or CVD registers (52,620); of these, 1223 also had SMI. RESULTS The population prevalence of CVD and diabetes is 7.2%; this rises to 18% among those with SMI. People with SMI and CVD or diabetes were found to be as likely to achieve clinical targets as those without SMI. Blood pressure control was significantly better in people with SMI; however, they were more likely to smoke and have a body mass index above 30 kg/m(2). Ethnic differences in care were identified, with south Asian individuals achieving better cholesterol control and black African or Caribbean groups achieving poorer blood pressure control. CONCLUSION Risk factor management for those with SMI shows better control of blood pressure and glycosylated haemoglobin than the general population. However, smoking and obesity rates remain high and should be the target of public health programmes. Ethnic differences in management mirror those in the general population. Ethnic monitoring for vulnerable groups provides evidence to support schemes to reduce health inequalities.
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McGinty EE, Blasco-Colmenares E, Zhang Y, dosReis SC, Ford DE, Steinwachs DM, Guallar E, Daumit G. Post-myocardial-infarction quality of care among disabled Medicaid beneficiaries with and without serious mental illness. Gen Hosp Psychiatry 2012; 34:493-9. [PMID: 22763001 PMCID: PMC3428513 DOI: 10.1016/j.genhosppsych.2012.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 05/03/2012] [Accepted: 05/04/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective was to examine the association between serious mental illness and quality of care for myocardial infarction among disabled Maryland Medicaid beneficiaries. METHODS We conducted a retrospective cohort study of disabled Maryland Medicaid beneficiaries with myocardial infarction from 1994 to 2004. Cardiac procedures and guideline-based medication use were compared for persons with and without serious mental illness. RESULTS Of the 633 cohort members with myocardial infarction, 137 had serious mental illness. Serious mental illness was not associated with differences in receipt of cardiac procedures or guideline-based medications. Overall use of guideline-based medications was low; 30 days after the index hospitalization for myocardial infarction, 19%, 35% and 11% of cohort members with serious mental illness and 22%, 37% and 13% of cohort members without serious mental illness had any use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers and statins, respectively. Study participants with and without serious mental illness had similar rates of mortality. Overall, use of beta-blockers [hazard ratio 0.93, 95% confidence interval (CI) 0.90-0.97] and statins (hazard ratio 0.93, 95% CI 0.89-0.98) was associated with reduced risk of mortality. CONCLUSIONS Quality improvement programs should consider how to increase adherence to medications of known benefit among disabled Medicaid beneficiaries with and without serious mental illness.
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Affiliation(s)
- Emma E. McGinty
- Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health
| | - Elena Blasco-Colmenares
- Department of Anesthesiology/Critical Care Medicine Johns Hopkins University School of Medicine
| | - Yiyi Zhang
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health
| | - Susan C. dosReis
- Psychiatry and Behavioral Sciences Johns Hopkins School of Medicine
| | | | - Donald M. Steinwachs
- Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health
| | - Eliseo Guallar
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health
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Aakre JM, Medoff DR, Dixon LB, Kreyenbuhl JA. Beliefs about antipsychotic versus hypoglycemic medications among individuals with serious mental illness and type 2 diabetes. Patient Prefer Adherence 2012; 6:389-94. [PMID: 22654509 PMCID: PMC3363297 DOI: 10.2147/ppa.s30975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study compared the beliefs held by individuals with coexisting serious mental illness and type 2 diabetes regarding the necessity and risks of taking antipsychotic versus hypoglycemic medications. We also investigated whether nonadherent patients differed from adherent patients in their beliefs about medications. METHODS Forty-four individuals with type 2 diabetes and serious mental illness who were prescribed hypoglycemic and antipsychotic medications completed a cross-sectional assessment of medication beliefs and adherence for both medication types. RESULTS Patients perceived a greater need for hypoglycemic versus antipsychotic medications; however, their beliefs were not associated with nonadherence to either medication type. CONCLUSION These results suggest that individuals with coexisting serious mental illness and type 2 diabetes have stronger convictions regarding the necessity of their diabetes medication for maintaining their health.
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Affiliation(s)
- Jennifer M Aakre
- VA Capitol Healthcare Network Mental Illness Research, Education, and Clinical Center, Baltimore VA Medical Center, Baltimore, MD, USA
- Correspondence: Jennifer Aakre, Baltimore VA Medical Center, 209 West Fayette St (VA Annex), Baltimore, MD 21201, USA, Tel +1 410 637 1877, Fax +1 410 605 7739, Email
| | - Deborah R Medoff
- VA Capitol Healthcare Network Mental Illness Research, Education, and Clinical Center, Baltimore VA Medical Center, Baltimore, MD, USA
- Division of Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lisa B Dixon
- VA Capitol Healthcare Network Mental Illness Research, Education, and Clinical Center, Baltimore VA Medical Center, Baltimore, MD, USA
- Division of Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Julie A Kreyenbuhl
- VA Capitol Healthcare Network Mental Illness Research, Education, and Clinical Center, Baltimore VA Medical Center, Baltimore, MD, USA
- Division of Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
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