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Blackburn DF, Yao S, Taylor JG, Alefan Q, Lix LM, Eurich DT, Choudhry NK. Measuring the Influence of Side Effect Expectations, Beliefs, and Incident Side Effects on the Risk for Drug Discontinuation Among Individuals Starting New Medications, a Cross-sectional Study. Patient Prefer Adherence 2024; 18:979-989. [PMID: 38774475 PMCID: PMC11107835 DOI: 10.2147/ppa.s451012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/04/2024] [Indexed: 05/24/2024] Open
Abstract
Purpose To measure the impact of beliefs, expectations, side effects, and their combined effects on the risk for medication nonpersistence. Patients and methods Using a cross-sectional design, individuals from Saskatchewan, Canada who started a new antihypertensive, cholesterol-lowering, or antihyperglycemic medication were surveyed about risk factors for nonpersistence including: (a) beliefs measured by a composite score of three questions asking about the threat of the condition, importance of the drug, and harm of the drug; (b) incident side effects attributed to treatment; and (c) expectations for side effects before starting treatment. Descriptive statistics and logistic regression models were used to quantify the influence of these risk factors on the outcome of nonpersistence. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. Results Among 3,029 respondents, 5.8% (n=177) reported nonpersistence within four months after starting the new drug. After adjustment for numerous covariates representing sociodemographics, health-care providers, medication experiences and beliefs, both negative beliefs (OR: 7.26, 95%CI: 4.98-10.59) and incident side effects (OR: 8.00, 95%CI: 5.49-11.68) were associated with the highest odds of nonpersistence with no evidence of interaction. In contrast, expectations for side effects before starting treatment exhibited an important interaction with incident side effects following treatment initiation. Among respondents with incident side effects (n=741, 24.5%), the risk for early nonpersistence was 11.5% if they indicated an expectation for side effects before starting the medication compared to 23.6% if they did not (adjusted OR: 0.38, 95%CI: 0.25-0.60). Conclusion Expectations for side effects may be a previously unrecognized but important marker of the probability to persist with treatment. A high percentage of new medication users appeared unprepared for the possibility of side effects from their new medication making them less resilient if side effects occur.
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Affiliation(s)
- David F Blackburn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Shenzhen Yao
- Public Health Surveillance Unit, Vancouver Coastal Health Authority, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Jeff G Taylor
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Qais Alefan
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Lisa M Lix
- Department of Community Health Sciences, Max Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Niteesh K Choudhry
- Department of Medicine, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, USA
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Ensing HT, Schulte RA, Koster ES. Implementing a newly prescribed cardiovascular medicine in daily routine: The patient perspective at readmission to primary care. Res Social Adm Pharm 2023; 19:293-300. [PMID: 36266176 DOI: 10.1016/j.sapharm.2022.10.003] [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: 12/03/2021] [Revised: 09/20/2022] [Accepted: 10/10/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Readmission to primary care is challenging for patients due to involvement of multiple healthcare providers across different settings and implementing new medicines into their daily routine. Elucidating patients' needs is crucial to tailor counseling support. OBJECTIVE To explore the patient perspectives on implementing a newly prescribed cardiovascular medicine into their daily routine at readmission to primary care. METHODS A qualitative study was performed within the outpatient pharmacy. Adult patients who were prescribed a new cardiovascular medicine by their treating hospital physician at hospital discharge or during an outpatient clinic visit were eligible to participate. Purposive sampling was applied to equally distribute adherence-influencing factors. Patients were interviewed by telephone and inclusion continued until theoretical data saturation. An adapted Greenhalgh framework for implementation research was used for a thematic content analysis by conceptualizing the new medicine as an innovation that requires implementation by a patient (adopter). RESULTS Data saturation was reached at 44 patients of which 19 discontinued their new medicine at the time of the interview. Reasons for discontinuing included: side-effects, insufficient efficacy or negligence. Patients considered a lack of basic knowledge on their newly prescribed cardiovascular medicine as a major barrier for adopting it into their daily routine. They were in need of information on risks and benefits of their new medicine. A noticeable effect and tailored counseling facilitated patients in taking their medicine as prescribed. Patients mentioned personalized organizing tools and routinization of medication intake as important success factors for addressing their practical challenges with their new medicine. CONCLUSIONS By applying the adapted Greenhalgh framework, this study provided a unique and structured insight in patients' barriers and facilitators that could influence their ability to implement a new cardiovascular medicine at readmission to primary care. This knowledge enables pharmacists to tailor their patient support and provide individualized patient counseling.
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Affiliation(s)
- Hendrik T Ensing
- Outpatient Pharmacy 'de Brug 24/7', Zorggroep Almere, Almere, the Netherlands
| | - Roos A Schulte
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Ellen S Koster
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands.
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Hempenius M, Rijken S, Groenwold RHH, Hek K, de Boer A, Klungel OH, Gardarsdottir H. Primary nonadherence to drugs prescribed by general practitioners: A Dutch database study. Br J Clin Pharmacol 2023; 89:268-278. [PMID: 35896043 PMCID: PMC10087833 DOI: 10.1111/bcp.15472] [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: 11/22/2021] [Revised: 04/26/2022] [Accepted: 07/19/2022] [Indexed: 11/02/2022] Open
Abstract
AIM Primary nonadherence (PNA) is defined as not filling the first prescription for a drug treatment. PNA can lead not only to poor patient outcomes but also to exposure misclassification in written prescription databases. This study aims to estimate PNA in primary care in the Netherlands and to investigate associated factors. METHODS Patients from the Nivel Primary Care Database (Nivel-PCD) who received a new prescription (>1 year not prescribed) from a general practitioner in 2012 were linked to pharmacy dispensing information of consenting pharmacies based on sex, year of birth, four-digit postal code and at least 50% matching Anatomical Therapeutic Classification codes. PNA was defined as not having a prescription dispensed within 30 days from the prescribing date. PNA was assessed overall and per drug class. The associations between PNA and several patient- and prescription-related characteristics were assessed using mixed-effects logistic regression models. RESULTS After matching 86 361 of 396 251 subjects (21.8%) in the Nivel-PCD records to the pharmacy records, this study included 65 877 subjects who received 181 939 new drug prescriptions. Overall, PNA was 11.5%. PNA was lowest for thyroid hormones (5.5%) and highest for proton pump inhibitors (12.8%). Several factors were associated with PNA, such as having comorbidities (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.37-1.56 for >3 active diagnoses, compared to no active diagnoses) or reimbursement status (OR 2.78, 95% CI 2.65-2.92 for not reimbursed drugs compared to fully reimbursed drugs). CONCLUSIONS A total of 11.5% of newly prescribed drugs were not dispensed. This can lead to overestimation of the actual drug exposure status when using written prescription databases.
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Affiliation(s)
- Mirjam Hempenius
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Simone Rijken
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Rolf H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Karin Hek
- Department of Integrated Primary Care, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Olaf H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Pharmacy, Division Laboratory and Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands.,Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland
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Alefan Q, Yao S, Taylor JG, Lix LM, Eurich D, Choudhry N, Blackburn DF. Factors associated with early nonpersistence among patients experiencing side effects from a new medication. J Am Pharm Assoc (2003) 2021; 62:717-726.e5. [PMID: 34980560 DOI: 10.1016/j.japh.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Drug discontinuation (i.e., nonpersistence) is often attributed to the emergence of adverse effects. However, it is not known whether other factors increase the risk of nonpersistence when adverse effects occur. OBJECTIVES To identify factors associated with early nonpersistence among patients experiencing adverse effects from newly prescribed medications. METHODS A questionnaire was mailed to new users of antihypertensive, antihyperglycemic, and lipid-lowering medications in Saskatchewan, Canada, between 2019 and 2020. Only respondents experiencing adverse effects were included. Responses were compared between the nonpersistent group (i.e., people who had discontinued their medication) and the persistent group (i.e., those who were taking their medication at the time of the survey). Statistically significant factors were tested in multivariable logistic regression models. Odds ratios (ORs) and 95% CIs were reported. RESULTS Of the 3973 returned questionnaires, 813 respondents experienced adverse -effects from their new medication and were included in the study. Of these, 143 respondents (17.5%) had stopped their medication at the time of survey completion; most discontinuations (72.1%) occurred within 1 month of the first dose. Nonpersistent patients were older, had lower income, and were less likely to be taking an antihyperglycemic medication. After covariate adjustment, 6 factors were independently associated with nonpersistence: age less than 65 years (OR 1.56 [95% CI 1.01-2.41]), female sex (1.67 [1.08-2.59]), health condition not considered dangerous (2.09 [1.25-3.51]), medication not considered important for health (6.90 [4.40-10.84]), failure to expect adverse effects before starting medication (2.67 [1.74-4.10]), and taking 2 or more medications (0.45 [0.27-0.73]). CONCLUSION Despite the strong link between the emergence of adverse effects and early nonpersistence, our findings confirm that this association is highly influenced by several factors external to the physical experiences caused by the new medication.
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Evans C, Marrie RA, Yao S, Zhu F, Walld R, Tremlett H, Blackburn D, Kingwell E. Medication adherence in multiple sclerosis as a potential model for other chronic diseases: a population-based cohort study. BMJ Open 2021; 11:e043930. [PMID: 33550262 PMCID: PMC7925877 DOI: 10.1136/bmjopen-2020-043930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To determine whether better medication adherence in multiple sclerosis (MS) might be due to specialised disease-modifying drug (DMD) support programmes by: (1) establishing higher adherence in MS than in other chronic diseases and (2) determining if higher adherence is associated with patient-specific or treatment-specific factors. DESIGN Retrospective cohort study with data from 1 January 1996 to 31 December 2015. SETTING Population-based health administrative data from three Canadian provinces. PARTICIPANTS Individual cohorts were created using validated case definitions for MS, epilepsy, Parkinson's disease (PD) and rheumatoid arthritis (RA). Subjects were included if they received ≥1 dispensation for a disease-related drug between 1 January 1997 and 31 December 2014. MAIN OUTCOME MEASURES Proportion of subjects with optimal adherence (≥80%) measured by the medication possession ratio 1 year after the index date (first dispensation of disease-related drug). RESULTS 126 478 subjects were included in the primary analysis (MS, n=6271; epilepsy, n=55 739; PD, n=21 304; RA, n=43 164). Subjects with epilepsy (adjusted OR, aOR 0.29; 95% CI 0.19 to 0.45), PD (aOR 0.42; 95% CI 0.29 to 0.63) or RA (aOR 0.26; 95% CI 0.19 to 0.35) were less likely to have optimal 1-year adherence compared with subjects with MS. Within the MS cohort, adherence was higher for DMD than for chronic-use non-MS medications, and no consistent patient-related predictors of adherence were observed across all four non-MS medication classes, including having optimal adherence to DMD. CONCLUSIONS Subjects with MS were significantly more likely to have optimal 1-year adherence than subjects with epilepsy, RA and PD, and optimal adherence appears related to treatment-specific factors rather than patient-related factors. This supports the hypothesis that higher adherence to the MS DMDs could be due to the specialised support programmes; these programmes may serve as a model for use in other chronic conditions.
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Affiliation(s)
- Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ruth Ann Marrie
- Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shenzhen Yao
- Saskatchewan Health Quality Council, Saskatoon, Saskatchewan, Canada
| | - Feng Zhu
- Neurology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Randy Walld
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Helen Tremlett
- Neurology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - David Blackburn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Elaine Kingwell
- Neurology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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Vilaplana-Carnerero C, Aznar-Lou I, Peñarrubia-María MT, Serrano-Blanco A, Fernández-Vergel R, Petitbò-Antúnez D, Gil-Girbau M, March-Pujol M, Mendive JM, Sánchez-Viñas A, Carbonell-Duacastella C, Rubio-Valera M. Initiation and Single Dispensing in Cardiovascular and Insulin Medications: Prevalence and Explanatory Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3358. [PMID: 32408626 PMCID: PMC7277594 DOI: 10.3390/ijerph17103358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Adherence problems have negative effects on health, but there is little information on the magnitude of non-initiation and single dispensing. OBJECTIVE The aim of this study was to estimate the prevalence of non-initiation and single dispensation and identify associated predictive factors for the main treatments prescribed in Primary Care (PC) for cardiovascular disease (CVD) and diabetes. METHODS Cohort study with real-world data. Patients who received a first prescription (2013-2014) for insulins, platelet aggregation inhibitors, angiotensin-converting enzyme inhibitors (ACEI) or statins in Catalan PC were included. The prevalence of non-initiation and single dispensation was calculated. Factors that explained these behaviours were explored. RESULTS At three months, between 5.7% (ACEI) and 9.1% (antiplatelets) of patients did not initiate their treatment and between 10.6% (statins) and 18.4% (ACEI) filled a single prescription. Body mass index, previous CVD, place of origin and having a substitute prescriber, among others, influenced the risk of non-initiation and single dispensation. CONCLUSIONS The prevalence of non-initiation and single dispensation of CVD medications and insulin prescribed in PC in is high. Patient and health-system factors, such as place of origin and type of prescriber, should be taken into consideration when prescribing new medications for CVD and diabetes.
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Affiliation(s)
- Carles Vilaplana-Carnerero
- Research and Development Unit, Institut de Recerca Sant Joan de Déu, 08830 Barcelona, Catalonia, Spain; (C.V.-C.); (I.A.-L.); (M.G.-G.); (A.S.-V.); (C.C.-D.)
- School of Pharmacy, University of Barcelona, 08028 Barcelona, Catalonia, Spain;
| | - Ignacio Aznar-Lou
- Research and Development Unit, Institut de Recerca Sant Joan de Déu, 08830 Barcelona, Catalonia, Spain; (C.V.-C.); (I.A.-L.); (M.G.-G.); (A.S.-V.); (C.C.-D.)
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública—CIBERESP), 28029 Madrid, Spain; (M.T.P.-M.); (A.S.-B.)
| | - María Teresa Peñarrubia-María
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública—CIBERESP), 28029 Madrid, Spain; (M.T.P.-M.); (A.S.-B.)
- Primary Care Research Institute (IDIAP Jordi Gol), 08007 Barcelona, Spain; (R.F.-V.); (J.M.M.)
- Catalan Institute of Health, 08028 Barcelona, Spain;
| | - Antoni Serrano-Blanco
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública—CIBERESP), 28029 Madrid, Spain; (M.T.P.-M.); (A.S.-B.)
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Catalonia, Spain
| | - Rita Fernández-Vergel
- Primary Care Research Institute (IDIAP Jordi Gol), 08007 Barcelona, Spain; (R.F.-V.); (J.M.M.)
- Catalan Institute of Health, 08028 Barcelona, Spain;
| | | | - Montserrat Gil-Girbau
- Research and Development Unit, Institut de Recerca Sant Joan de Déu, 08830 Barcelona, Catalonia, Spain; (C.V.-C.); (I.A.-L.); (M.G.-G.); (A.S.-V.); (C.C.-D.)
- School of Pharmacy, University of Barcelona, 08028 Barcelona, Catalonia, Spain;
- Primary Care Prevention and Health Promotion Research Network, 08007 Barcelona, Catalonia, Spain
| | - Marian March-Pujol
- School of Pharmacy, University of Barcelona, 08028 Barcelona, Catalonia, Spain;
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública—CIBERESP), 28029 Madrid, Spain; (M.T.P.-M.); (A.S.-B.)
| | - Juan Manuel Mendive
- Primary Care Research Institute (IDIAP Jordi Gol), 08007 Barcelona, Spain; (R.F.-V.); (J.M.M.)
- Catalan Institute of Health, 08028 Barcelona, Spain;
- Primary Care Prevention and Health Promotion Research Network, 08007 Barcelona, Catalonia, Spain
| | - Alba Sánchez-Viñas
- Research and Development Unit, Institut de Recerca Sant Joan de Déu, 08830 Barcelona, Catalonia, Spain; (C.V.-C.); (I.A.-L.); (M.G.-G.); (A.S.-V.); (C.C.-D.)
| | - Cristina Carbonell-Duacastella
- Research and Development Unit, Institut de Recerca Sant Joan de Déu, 08830 Barcelona, Catalonia, Spain; (C.V.-C.); (I.A.-L.); (M.G.-G.); (A.S.-V.); (C.C.-D.)
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública—CIBERESP), 28029 Madrid, Spain; (M.T.P.-M.); (A.S.-B.)
| | - Maria Rubio-Valera
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública—CIBERESP), 28029 Madrid, Spain; (M.T.P.-M.); (A.S.-B.)
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Catalonia, Spain
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Carvalho AS, Santos P. Medication Adherence In Patients With Arterial Hypertension: The Relationship With Healthcare Systems' Organizational Factors. Patient Prefer Adherence 2019; 13:1761-1774. [PMID: 31802854 PMCID: PMC6802622 DOI: 10.2147/ppa.s216091] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/01/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Arterial hypertension is one of the most common diseases in the world, presenting a great impact on global mortality. Despite having good medication, the best control depends on patient's adherence. Our aim is to characterize the relationship of adherence to medication in hypertensive patients with consultation length and other organizational factors of healthcare systems. PATIENTS AND METHODS We performed a comprehensive review of literature using the MeSH terms "hypertension" and "medication adherence". 61 articles were selected for inclusion and adherence parameters were extracted, allowing us to estimate the mean adherence for each country. The adherence was then correlated with organizational aspects of healthcare systems: consultation length, number of health providers (doctors, nurses and pharmacists), number of hospital beds, health expenditure and general government expenditure. RESULTS Adherence to medication ranged between 11.8% in Indonesia and 85.0% in Australia. There is much heterogeneity in methodology, but the Morisky Medication Adherence Scale was the preferred method, used in 63.6% of the cases. We found no relation with consultation length, but a significant one with the greater number of health professionals available. Some differences were observed when considering European countries or Morisky Medication Adherence Scale alone. CONCLUSION The better the drugs, the better the control of blood pressure, if patients take them. Rather than investing in the prescription of more drugs, it is important to address non-adherence and reduce it to promote better blood pressure control. Organizational factors are relevant constraints and depend on administrative and political decisions. Although they are not always considered, they greatly impact the adherence to medication.
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Affiliation(s)
- Ana Sofia Carvalho
- Department of Medicine of Community, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of University of Porto, Porto, Portugal
| | - Paulo Santos
- Department of Medicine of Community, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of University of Porto, Porto, Portugal
- Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
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Kumamaru H, Lee MP, Choudhry NK, Dong YH, Krumme AA, Khan N, Brill G, Kohsaka S, Miyata H, Schneeweiss S, Gagne JJ. Using Previous Medication Adherence to Predict Future Adherence. J Manag Care Spec Pharm 2019; 24:1146-1155. [PMID: 30362915 PMCID: PMC10397923 DOI: 10.18553/jmcp.2018.24.11.1146] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Medication nonadherence is a major public health problem. Identification of patients who are likely to be and not be adherent can guide targeted interventions and improve the design of comparative-effectiveness studies. OBJECTIVE To evaluate multiple measures of patient previous medication adherence in light of predicting future statin adherence in a large U.S. administrative claims database. METHODS We identified a cohort of patients newly initiating statins and measured their previous adherence to other chronic preventive medications during a 365-day baseline period, using metrics such as proportion of days covered (PDC), lack of second fills, and number of dispensations. We measured adherence to statins during the year after initiation, defining high adherence as PDC ≥ 80%. We built logistic regression models from different combinations of baseline variables and previous adherence measures to predict high adherence in a random 50% sample and tested their discrimination using concordance statistics (c-statistics) in the other 50%. We also assessed the association between previous adherence and subsequent statin high adherence by fitting a modified Poisson model from all relevant covariates plus previous mean PDC categorized as < 25%, 25%-79%, and ≥ 80%. RESULTS Among 89,490 statin initiators identified, a prediction model including only demographic variables had a c-statistic of 0.578 (95% CI = 0.573-0.584). A model combining information on patient comorbidities, health care services utilization, and medication use resulted in a c-statistic of 0.665 (95% CI = 0.659-0.670). Models with each of the previous medication adherence measures as the only explanatory variable yielded c-statistics ranging between 0.533 (95% CI = 0.529-0.537) for lack of second fill and 0.666 (95% CI = 0.661-0.671) for maximum PDC. Adding mean PDC to the combined model yielded a c-statistic of 0.695 (95% CI = 0.690-0.700). Given a sensitivity of 75%, the predictor improved the specificity from 47.7% to 53.6%. Patients with previous mean PDC < 25% were half as likely to show high adherence to statins compared with those with previous mean PDC ≥ 80% (risk ratio = 0.49, 95% CI = 0.46-0.50). CONCLUSIONS Including measures of previous medication adherence yields better prediction of future statin adherence than usual baseline clinical measures that are typically used in claims-based studies. DISCLOSURES This study was funded by the Patient-Centered Outcomes Research Institute (ME-1309-06274). Kumamaru, Kohsaka, and Miyata are affiliated with the Department of Healthcare Quality Assessment at the University of Tokyo, which is a social collaboration department supported by National Clinical Database. The department was formerly supported by endowments from Johnson & Johnson K.K., Nipro, Teijin Pharma, Kaketsuken K.K., St. Jude Medical Japan, Novartis Pharma K.K., Taiho Pharmaceutical, W. L. Gore & Associates, Olympus Corporation, and Chugai Pharmaceutical. Gagne has received grants from Novartis Pharmaceuticals and Eli Lilly and Company to the Brigham and Women's Hospital for unrelated work. He is a consultant to Aetion, a software company, and to Optum. Choudhry has received grants from the National Heart, Lung, and Blood Institute, PhRMA Foundation, Merck, Sanofi, AstraZeneca, CVS, and MediSafe. Schneeweiss is consultant to WHISCON and Aetion, a software manufacturer of which he also owns equity. He is principal investigator of investigator-initiated grants to the Brigham and Women's Hospital from Bayer, Genentech, and Boehringer Ingelheim unrelated to the topic of this study. He does not receive personal fees from biopharmaceutical companies. No potential conflict of interest was reported by the other authors.
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Affiliation(s)
- Hiraku Kumamaru
- 1 Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, and Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Japan
| | - Moa P Lee
- 2 Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Niteesh K Choudhry
- 2 Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Yaa-Hui Dong
- 3 Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, and Faculty of Pharmacy, School of Pharmaceutical Science, National Yang-Ming University, Taipei, Taiwan
| | - Alexis A Krumme
- 2 Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Nazleen Khan
- 2 Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gregory Brill
- 2 Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Shun Kohsaka
- 4 Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hiroaki Miyata
- 4 Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Japan
| | - Sebastian Schneeweiss
- 2 Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Joshua J Gagne
- 2 Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Dalvi V, Mekoth N. Patient non-adherence: an interpretative phenomenological analysis. Int J Health Care Qual Assur 2017; 30:274-284. [PMID: 28350217 DOI: 10.1108/ijhcqa-03-2016-0033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose While interpretative phenomenological analysis (IPA) has been used in health psychology research, it has so far not been applied to seek deeper insights into the patients' experiences about treatment. The purpose of this paper is to address this gap by using IPA to understand patient non-adherence. Design/methodology/approach In total, 18 patients with chronic conditions seeking healthcare services in Goa and Karnataka, India, were selected by using the snowball sampling method. In-depth interviews were conducted face to face. A semi-structured questionnaire developed by the researchers was used to collect the data. IPA was used to explore the themes to predict patient non-adherence. Findings The study results indicate that economic factors, health system related factors, social factors and psychological factors impact patient non-adherence. Patient non-adherence includes medication non-adherence and lifestyle modification non-adherence. Research limitations/implications Being cross sectional in design, the results may not be as appropriate as the results derived from a longitudinal study given that non-adherence occurs over time. Practical implications Patient non-adherence is a global health issue. Multidisciplinary approach to enhance patient adherence to treatment should form part of public healthcare policy. Social implications Exploring the factors influencing patient non-adherence will help the health-care industry stakeholders to reduce healthcare cost and improve patient's quality of life. Originality/value Although there is extensive quantitative research on the prevalence of non-adherence, qualitative research is limited. This paper addresses this gap by using IPA to understand patient non-adherence and its factors and dimensions.
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Affiliation(s)
- Vidya Dalvi
- Department of Commerce, Government College of Arts, Science and Commerce, Quepem, India
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Ocak E, Kocaoz D, Acar B. How can we improve medical adherence to intranasal corticosteroids in children? Int J Pediatr Otorhinolaryngol 2017; 100:194-197. [PMID: 28802371 DOI: 10.1016/j.ijporl.2017.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/10/2017] [Accepted: 07/10/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To evaluate the factors which may be related to nonadherence to intranasal corticosteroids (ICS) in the treatment of allergic rhinitis (AR) in children. METHODS A prospective study was conducted on children with AR diagnosis in a tertiary referral hospital. All participants were provided with mometasone furoate nasal sprays for 30 days after the diagnosis. Caregivers were called back when the therapy was over and completed a questionnaire about the factors that may influence the adherence to the treatment. Afterwards each caregiver completed the Turkish language validated Morisky Medical Adherence Scale (MMAS-8) form. Each factor was evaluated according to MMAS-8 score and all variables were analyzed statistically. RESULTS A total number of 76 children with a mean age of 7.82 years were included in the study. The mean overall MMAS-8 score was 2.80. There was only one factor significantly related to low adherence; the number of dependent children to the caregiver (p = 0.011). Besides this 71.51% of the answers to MMAS-8 scale were compatible with good adherence. CONCLUSION The clinician must consider the factors which may lead to non-adherence while setting up a treatment plan. The demographic and sociocultural factors must be taken into consideration and treatment schedule should be made in respect of daily activities of the children. Moreover the father can be involved in the therapy plan and back up the mother as they are usually the responsible parent for children's medical therapy.
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Affiliation(s)
- Emre Ocak
- Department of Otorhinolaryngology, Kecioren Research and Training Hospital, Ankara, Turkey
| | - Deniz Kocaoz
- Department of Otorhinolaryngology, Kecioren Research and Training Hospital, Ankara, Turkey
| | - Baran Acar
- Department of Otorhinolaryngology, Kecioren Research and Training Hospital, Ankara, Turkey
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Ocak E, Acar B, Kocaöz D. Medical adherence to intranasal corticosteroids in adult patients. Braz J Otorhinolaryngol 2017; 83:558-562. [PMID: 27472982 PMCID: PMC9444794 DOI: 10.1016/j.bjorl.2016.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/24/2016] [Accepted: 06/30/2016] [Indexed: 01/17/2023] Open
Abstract
Introduction The adherence to medical treatment in allergic rhinitis is poorly evaluated in clinical practice. Objectives To evaluate adherence to intranasal corticosteroids in the treatment of allergic rhinitis patients. Methods This prospective study was conducted on adult patients who were admitted to the outpatient clinic of the otolaryngology department tertiary hospital. Patients diagnosed with moderate to severe persistent AR and who had not used any nasal sprays were enrolled in the study. The patients were provided with mometasone furoate nasal sprays. On the 30th day, all participants filled out a questionnaire regarding the factors that may have influenced their adherence to the treatment. Afterwards, each patient filled out the Turkish-language-validated Morisky Medical Adherence Scale (MMAS-8) form. Each factor that may have affected adherence to the prescribed medication was evaluated according to the MMAS-8 score and all variables were analyzed statistically. Results Fifty-nine adult patients with a mean age of 32.5 years (range 21–52 years) were included in the study. The mean overall MMAS-8 score was 3.64. Two factors were significantly related to low adherence: number of dependent children (p = 0.001) and benefit from the medication (p = 0.001). In addition, patients with higher education levels seemed to be more adherent than the rest of the group. Conclusion Clinicians must keep in mind the factors related to non-adherence in order to achieve better treatment outcomes. Therefore, based on our results, patients must be informed that medications should be taken properly regardless of the benefit, and the treatment should be scheduled with respect to daily activities, particularly for patients caring for more than two children.
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Affiliation(s)
- Emre Ocak
- Kecioren Training and Research Hospital, Department of Otorhinolaryngology, Ankara, Turkey
| | - Baran Acar
- Kecioren Training and Research Hospital, Department of Otorhinolaryngology, Ankara, Turkey.
| | - Deniz Kocaöz
- Kecioren Training and Research Hospital, Department of Otorhinolaryngology, Ankara, Turkey
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Evans C, Marrie RA, Zhu F, Leung S, Lu X, Kingwell E, Zhao Y, Tremlett H. Adherence to disease-modifying therapies for multiple sclerosis and subsequent hospitalizations. Pharmacoepidemiol Drug Saf 2017; 26:702-711. [PMID: 28370875 DOI: 10.1002/pds.4207] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 02/22/2017] [Accepted: 03/13/2017] [Indexed: 01/11/2023]
Abstract
PURPOSE The aim of this study was to examine the association between optimal adherence to first-line disease-modifying therapies (DMT) for multiple sclerosis (MS) and hospitalizations. METHODS We used population-based administrative data from three Canadian provinces. All individuals receiving DMT (interferon-B-1b, interferon-B-1a, or glatiramer acetate) between January 1, 1996, and December 31, 2011 (British Columbia); March 31, 2012 (Manitoba); or March 31, 2014, (Saskatchewan) were included. Adherence was estimated for the first year of DMT (year 0), using the medication possession ratio (MPR). The association between optimal adherence (MPR ≥ 80%) and all-cause and MS-specific hospitalizations in the subsequent 1, 2, and 5 years was assessed using Hurdle Poisson and logistic regression. Rate and odds ratios were adjusted (aRR and aOR) for sociodemographic factors and prior health-care utilization. RESULTS Overall, 4746 subjects were followed for a mean 7.8 (SD 4.0) years; 3598 (76%) were women. Optimal DMT adherence was achieved in 3564/4746 (75.1%) subjects. Subsequent all-cause and MS-specific hospitalizations were lower for subjects with optimal versus suboptimal adherence, but none reached statistical significance (1-year period, aRR = 0.77, 95%CI: 0.47-1.26; aOR = 0.80, 95%CI: 0.52-1.25). Similar findings were observed in the 2-year and 5-year periods. Prior health-care utilization (hospitalizations and medications) was associated with future hospitalizations; for every additional medication class, the 5-year all-cause hospitalization rate and likelihood of an MS-specific hospitalization increased by 5% and 11%, respectively (aRR = 1.05, 95%CI: 1.02-1.07; and aOR = 1.11, 95%CI: 1.07-1.14). CONCLUSIONS Hospitalization rates were lower in subjects with optimal DMT adherence, but findings were not statistically significant. Prior hospitalization and polypharmacy were associated with increased risk for future hospitalizations in MS. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Charity Evans
- College of Pharmacy & Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Feng Zhu
- Department of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
| | - Stella Leung
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Xinya Lu
- Saskatchewan Health Quality Council, Saskatoon, SK, Canada
| | - Elaine Kingwell
- Department of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
| | - Yinshan Zhao
- Department of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
| | - Helen Tremlett
- Department of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
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Bock JO, Hajek A, Weyerer S, Werle J, Wagner M, Maier W, Stark A, Kaduszkiewicz H, Wiese B, Moor L, Stein J, Riedel-Heller SG, König HH. The Impact of Depressive Symptoms on Healthcare Costs in Late Life: Longitudinal Findings From the AgeMooDe Study. Am J Geriatr Psychiatry 2017; 25:131-141. [PMID: 27931772 DOI: 10.1016/j.jagp.2016.10.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 10/25/2016] [Accepted: 10/25/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine whether depressive symptoms affect healthcare costs in old age longitudinally. DESIGN Multicenter prospective observational cohort study (two waves with nt1 = 1,195 and nt2 = 951) in Germany. SETTING Community. PARTICIPANTS Participants aged 75 years and older recruited via general practitioners. MEASUREMENTS Depressive symptoms were assessed by the Geriatric Depression Scale (GDS). The health-related resource use was measured retrospectively from a societal perspective based on a questionnaire, covering outpatient services, inpatient treatment, pharmaceuticals, as well as formal and informal nursing care. Hybrid regression models were used to determine the between- and within-effect of depressive symptoms on healthcare costs, adjusting for important covariates. RESULTS Six-month total cost increased from €3,090 (t1) to €3,748 (t2). The hybrid random effects models showed that individuals with more depressive symptoms had higher healthcare costs compared with individuals with less depressive symptoms (between-effect). Moreover, an intra-individual increase in depressive symptoms increased healthcare costs by €539.60 (within-effect) per symptom on GDS. CONCLUSIONS Our findings emphasize the economic importance of depressive symptoms in old age. Appropriate interventions to treat depressive symptoms in old age might also be a promising strategy to reduce healthcare costs.
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Affiliation(s)
- Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, Hamburg, Germany.
| | - André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, Hamburg, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jochen Werle
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Michael Wagner
- Department of Psychiatry, University of Bonn and German Center for Neurodegenerative Diseases within the Helmholtz Association, Bonn, Germany
| | - Wolfgang Maier
- Department of Psychiatry, University of Bonn and German Center for Neurodegenerative Diseases within the Helmholtz Association, Bonn, Germany
| | - Anne Stark
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hanna Kaduszkiewicz
- Institute of General Practice, Medical Faculty, University of Kiel, Kiel, Germany
| | - Birgitt Wiese
- Institute for General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Hannover, Germany
| | - Lilia Moor
- Institute for General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Hannover, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, Hamburg, Germany
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Blackburn DF, Evans CD, Eurich DT, Mansell KD, Jorgenson DJ, Taylor JG, Semchuk WM, Shevchuk YM, Remillard AJ, Tran DA, Champagne AP. Community Pharmacists Assisting in Total Cardiovascular Health (CPATCH): A Cluster-Randomized, Controlled Trial Testing a Focused Adherence Strategy Involving Community Pharmacies. Pharmacotherapy 2016; 36:1055-1064. [DOI: 10.1002/phar.1831] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- David F. Blackburn
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Charity D. Evans
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Dean T. Eurich
- School of Public Health; University of Alberta; Edmonton Alberta Canada
| | - Kerry D. Mansell
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Derek J. Jorgenson
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Jeff G. Taylor
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | | | - Yvonne M. Shevchuk
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Alfred J. Remillard
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - David A. Tran
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Anne P. Champagne
- Drug Plan and Extended Benefits Branch; Ministry of Health; Government of Saskatchewan; Regina Saskatchewan Canada
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Sonawane Deshmukh KB, Qian J, Garza KB, Wright BM, Zeng P, Ganduglia Cazaban CM, Hansen RA. Achieving Adherence After First-Line Antihypertensive Treatment: Should Fixed-Dose Combinations Receive Priority? J Clin Hypertens (Greenwich) 2016; 18:934-41. [PMID: 26917089 PMCID: PMC8031934 DOI: 10.1111/jch.12799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/09/2016] [Accepted: 01/17/2016] [Indexed: 11/29/2022]
Abstract
Data on the long-term outcomes of the use of fixed-dose combinations (FDCs) or free-pill combinations (FPCs), titration of doses, and switching are currently unavailable for identifying a preferred strategy for adherence. In the lack of these evidences, adherence can be a useful guiding criteria. The authors conducted a retrospective cohort study using the BlueCross BlueShield of Texas (2008-2012) database to compare adherence among 5998 patients who received treatment modifications (TMs). Results of the propensity score-adjusted model indicate that FDC and uptitration strategies have higher odds of adherence compared with the switch strategy (P<.05). Among patients with a history of poor adherence, the odds of adherence were up to 26% higher for the FDC strategy compared with alternative strategies (P<.05). Factors including age, number of comedications, first-line drug class, and health services utilization are associated with adherence. In conclusion, FDCs should be prioritized for TM, particularly if the patient has a history of poor adherence.
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Affiliation(s)
| | - Jingjing Qian
- Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL
| | - Kimberly B Garza
- Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL
| | - Bradley M Wright
- Pharmacy Practice, Auburn University, Auburn, AL
- The University of Alabama at Birmingham, Huntsville, AL
| | - Peng Zeng
- Mathematics and Statistics, Auburn University, Auburn, AL
| | - Cecilia M Ganduglia Cazaban
- Management Policy and Community Health, The University of Texas Health Science Centre at Houston, Houston, TX
| | - Richard A Hansen
- Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL.
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Schaffer AL, Pearson SA, Buckley NA. How does prescribing for antihypertensive products stack up against guideline recommendations? An Australian population-based study (2006-2014). Br J Clin Pharmacol 2016; 82:1134-45. [PMID: 27302475 DOI: 10.1111/bcp.13043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/01/2016] [Accepted: 06/12/2016] [Indexed: 12/21/2022] Open
Abstract
AIMS We describe choice of first-line antihypertensive drug therapy and uptake of fixed-dose combinations (FDCs) in Australia, and investigate the impact of initiation on FDCs and other non-recommended first-line therapies on treatment discontinuation. METHOD This was a population-based retrospective cohort study using a random 10% sample of persons dispensed an Australian Pharmaceutical Benefits Scheme listed medicine from 1 July 2005 to 30 June 2014. The primary outcomes were adherence to Australian recommendations at initiation of antihypertensive therapy, discontinuation of initial therapy and discontinuation of any therapy in the first year after initiation. RESULTS In our sample of 55 937 persons initiating therapy, 42.0% did so outside Australian recommendations, including not initiating on recommended monotherapy (26.3%) and not initiating on the lowest recommended dose (30.6%). Only 1.7% of individuals who were dispensed an FDC established therapy on the free combination regimen (as recommended) prior to switching. After adjusting for covariates, persons initiating on non-recommended monotherapy (OR = 2.64, 95% CI 2.47-2.83) or FDCs of two or more antihypertensives (OR = 1.42, 95% CI 1.30-1.55), were more likely to discontinue all antihypertensive drug treatment in the first year compared to persons initiating on recommended monotherapy. CONCLUSION More than half of antihypertensive initiators conformed to Australian guidelines. Initiation on FDCs and other non-recommended treatments was associated with lower persistence on antihypertensive therapy in the first year. Long-term effectiveness and outcomes may be enhanced by initiating with low dose monotherapy.
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Affiliation(s)
- Andrea L Schaffer
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Nicholas A Buckley
- Blackburn Building (D06), University of Sydney, Sydney, NSW, 2006, Australia
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Evans C, Marrie RA, Zhu F, Leung S, Lu X, Melesse DY, Kingwell E, Zhao Y, Tremlett H. Adherence and persistence to drug therapies for multiple sclerosis: A population-based study. Mult Scler Relat Disord 2016; 8:78-85. [PMID: 27456879 DOI: 10.1016/j.msard.2016.05.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/01/2016] [Accepted: 05/04/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We aimed to estimate the prevalence and predictors of optimal adherence and persistence to the disease-modifying therapies (DMT) for multiple sclerosis (MS) in 3 Canadian provinces. METHODS We used population-based administrative databases in British Columbia (BC), Saskatchewan, and Manitoba. All individuals receiving DMT (interferon-B-1b, interferon-B-1a, and glatiramer acetate) between 1-January-1996 and 31-December-2011 (BC), 31-March-2014 (Saskatchewan), or 31-March-2012 (Manitoba) were included. One-year adherence was estimated using the proportion of days covered (PDC). Persistence was defined as time to DMT discontinuation. Regression models were used to assess predictors of adherence and persistence; results were pooled using random effects meta-analysis. RESULTS 4830 individuals were included. When results were combined, an estimated 76.4% (95% CI: 69.1-82.4%) of subjects exhibited optimal adherence (PDC ≥80%). Median time to discontinuation of the initial DMT was 1.9 years (95% CI: 1.6-2.1) in Manitoba, 2.8 years (95% CI: 2.5-3.0) in BC, and 4.0 years (95% CI: 3.5-4.6) in Saskatchewan. Age, sex and socioeconomic status were not associated with adherence or persistence. Individuals who had ≥4 physician visits during the year prior to the first DMT dispensation were more likely to exhibit optimal adherence compared to those with fewer (0-3) physician visits. CONCLUSIONS We observed adherence that is higher than what has been reported for other chronic diseases, and other non-population-based MS cohorts. Closer examination as to why adherence appears to be relatively better in MS and how adherence influences disease outcomes could contribute to our understanding of MS, and prove useful in the management of other chronic diseases.
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Affiliation(s)
- Charity Evans
- College of Pharmacy & Nutrition, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 5E5, Canada.
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, University of Manitoba, Health Sciences Centre, GF 543-820 Sherbrook Street, Winnipeg, MB, Canada R3A 1R9.
| | - Feng Zhu
- Department of Medicine (Neurology), University of British Columbia, UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5.
| | - Stella Leung
- Department of Community Health Sciences, University of Manitoba, Health Sciences Centre, GF 543-820 Sherbrook Street, Winnipeg, MB, Canada R3A 1R9.
| | - Xinya Lu
- Saskatchewan Health Quality Council, 241-111 Research Drive, Saskatoon, SK, Canada S7N 3R2.
| | - Dessalegn Y Melesse
- Department of Community Health Sciences, University of Manitoba, Health Sciences Centre, GF 543-820 Sherbrook Street, Winnipeg, MB, Canada R3A 1R9.
| | - Elaine Kingwell
- Department of Medicine (Neurology), University of British Columbia, UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5.
| | - Yinshan Zhao
- Department of Medicine (Neurology), University of British Columbia, UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5.
| | - Helen Tremlett
- Department of Medicine (Neurology), University of British Columbia, UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5.
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Yamagata K, Makino H, Iseki K, Ito S, Kimura K, Kusano E, Shibata T, Tomita K, Narita I, Nishino T, Fujigaki Y, Mitarai T, Watanabe T, Wada T, Nakamura T, Matsuo S. Effect of Behavior Modification on Outcome in Early- to Moderate-Stage Chronic Kidney Disease: A Cluster-Randomized Trial. PLoS One 2016; 11:e0151422. [PMID: 26999730 PMCID: PMC4801411 DOI: 10.1371/journal.pone.0151422] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 02/24/2016] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Owing to recent changes in our understanding of the underlying cause of chronic kidney disease (CKD), the importance of lifestyle modification for preventing the progression of kidney dysfunction and complications has become obvious. In addition, effective cooperation between general physicians (GPs) and nephrologists is essential to ensure a better care system for CKD treatment. In this cluster-randomized study, we studied the effect of behavior modification on the outcome of early- to moderate-stage CKD. DESIGN Stratified open cluster-randomized trial. SETTING A total of 489 GPs belonging to 49 local medical associations (clusters) in Japan. PARTICIPANTS A total of 2,379 patients (1,195 in group A (standard intervention) and 1,184 in group B (advanced intervention)) aged between 40 and 74 years, who had CKD and were under consultation with GPs. INTERVENTION All patients were managed in accordance with the current CKD guidelines. The group B clusters received three additional interventions: patients received both educational intervention for lifestyle modification and a CKD status letter, attempting to prevent their withdrawal from treatment, and the group B GPs received data sheets to facilitate reducing the gap between target and practice. MAIN OUTCOME MEASURE The primary outcome measures were 1) the non-adherence rate of accepting continuous medical follow-up of the patients, 2) the collaboration rate between GPs and nephrologists, and 3) the progression of CKD. RESULTS The rate of discontinuous clinical visits was significantly lower in group B (16.2% in group A vs. 11.5% in group B, p = 0.01). Significantly higher referral and co-treatment rates were observed in group B (p<0.01). The average eGFR deterioration rate tended to be lower in group B (group A: 2.6±5.8 ml/min/1.73 m2/year, group B: 2.4±5.1 ml/min/1.73 m2/year, p = 0.07). A significant difference in eGFR deterioration rate was observed in subjects with Stage 3 CKD (group A: 2.4±5.9 ml/min/1.73 m2/year, group B: 1.9±4.4 ml/min/1.73 m2/year, p = 0.03). CONCLUSION Our care system achieved behavior modification of CKD patients, namely, significantly lower discontinuous clinical visits, and behavior modification of both GPs and nephrologists, namely significantly higher referral and co-treatment rates, resulting in the retardation of CKD progression, especially in patients with proteinuric Stage 3 CKD. TRIAL REGISTRATION The University Hospital Medical Information Network clinical trials registry UMIN000001159.
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Affiliation(s)
- Kunihiro Yamagata
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- * E-mail: (KY)
| | - Hirofumi Makino
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Kunitoshi Iseki
- Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan
| | - Sadayoshi Ito
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenjiro Kimura
- Department of Nephrology and Hypertension, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Eiji Kusano
- Division of Nephrology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Takanori Shibata
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Kimio Tomita
- Department of Nephrology, University of Kumamoto, Kumamoto, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
| | - Tomoya Nishino
- Division of Nephrology, Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Yoshihide Fujigaki
- Internal Medicine 1, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Tetsuya Mitarai
- Division of Nephrology and Hypertension, Saitama Medical Center, Saitama Medical School, Saitama, Japan
| | - Tsuyoshi Watanabe
- Department of Internal Medicine III, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takashi Wada
- Division of Nephrology, Department of Laboratory Medicine, Institute of Medical, Pharmaceutical, and Health Sciences, Faculty of Medicine, Kanazawa University, Ishikawa, Japan
| | | | - Seiichi Matsuo
- Department of Nephrology, University of Nagoya, Aichi, Japan
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Abstract
Patient nonadherence significantly burdens the treatment of allergic rhinitis (AR). Fewer than half of prescribed doses of intranasal corticosteroid medication are taken. The challenges for immunotherapies are even greater. While sustained treatment for 3 to 5 years is required for full benefit, most patients receiving immunotherapy, either subcutaneous or sublingual, stop treatment within the first year. Although research into interventions to improve AR adherence is lacking, lessons learned from adherence interventions in other chronic health conditions can be applied to AR. Two well-established, overriding models of care-the chronic care model and patient-centered care-can improve adherence. The patient-centered care model includes important lessons for allergy providers in their daily practice, including understanding and targeting modifiable barriers to adherence. Additionally, recent studies have begun to leverage health information and communication technologies to reach out to patients and promote adherence, extending patient-centered interventions initiated by providers during office visits.
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Affiliation(s)
- Bruce G Bender
- Department of Pediatrics, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA,
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Ramipril/amlodipine single pill – Effectiveness, tolerance and patient satisfaction with antihypertensive therapy in relation to nutritional status. Pharmacol Rep 2014; 66:1043-9. [PMID: 25443733 DOI: 10.1016/j.pharep.2014.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 05/28/2014] [Accepted: 06/25/2014] [Indexed: 01/12/2023]
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Bender BG, Oppenheimer J. The special challenge of nonadherence with sublingual immunotherapy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:152-5. [PMID: 24607041 DOI: 10.1016/j.jaip.2014.01.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 01/16/2014] [Accepted: 01/20/2014] [Indexed: 01/06/2023]
Abstract
Patient nonadherence is a problem that impacts all chronic illness treatments. To determine the degree of nonadherence and its impact on treatment effect in sublingual immunotherapy (SLIT), we conducted a systematic review of published research that assessed adherence or tested interventions to improve SLIT adherence. Adherence to SLIT is similar to other long-term therapies. Across studies, 55% to 82% of patients abandoned SLIT before completing the recommended course of therapy. Only 1 study attempted to test an educational intervention to improve SLIT adherence. Composite evidence indicates that 3 to 5 years of sustained SLIT is required for full long-term benefits, but fewer than half of the patients on SLIT persist to that point. Surprisingly little research has addressed the consequence of partial adherence, including implication to its cost-benefit profile or strategies to improve adherence. Lessons from research into treatments of other chronic health conditions suggest several adherence interventions that may be applied to SLIT, including strategic use of communication and education tools, incorporation of standardized follow-up visits, and employment of telecommunication technologies.
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Affiliation(s)
- Bruce G Bender
- Department of Pediatrics, National Jewish Health, Denver, Colo.
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Bender BG. Can Health Care Organizations Improve Health Behavior and Treatment Adherence? Popul Health Manag 2014; 17:71-8. [DOI: 10.1089/pop.2013.0045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Bruce G. Bender
- Pediatric Behavioral Health, The Center for Health Promotion, National Jewish Health, Denver, Colorado
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Alsabbagh MHDW, Lemstra M, Eurich D, Lix LM, Wilson TW, Watson E, Blackburn DF. Socioeconomic status and nonadherence to antihypertensive drugs: a systematic review and meta-analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:288-96. [PMID: 24636389 DOI: 10.1016/j.jval.2013.11.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 09/30/2013] [Accepted: 11/30/2013] [Indexed: 05/05/2023]
Abstract
BACKGROUND Although conventional wisdom suggests that low socioeconomic status (SES) is a robust predictor of medication nonadherence, the strength of this association remains unclear. OBJECTIVES 1) To estimate the proportion of studies that identified SES as a potential risk indicator of nonadherence, 2) to describe the type of SES measurements, and 3) to quantify the association between SES and nonadherence to antihypertensive pharmacotherapy. METHODS A systematic review and meta-analysis research design was used. We searched multiple electronic databases for studies in English or French examining nonadherence to antihypertensive medications measured by electronic prescription databases where explanatory factors were considered. Two authors independently assessed quality, described the SES measure(s), and recorded its association with nonadherence to antihypertensives. A random-effects model meta-analysis was performed, and heterogeneity was examined by using the I(2) statistic. RESULTS Fifty-six studies with 4,780,293 subjects met the inclusion criteria. Twenty-four of these studies (43%) did not report any SES measures. When it was reported (n = 32), only seven (13%) examined more than one component but none performed a multidimensional assessment. Most of the studies relied on income or income-related measures (such as prescription-drug benefits or co-payments) (27 of 32 [84%]). Meta-analysis could be quantified in 40 cohorts reported in 30 studies. Overall, the pooled adjusted risk estimate for nonadherence according to SES (high vs. low) was 0.89 (95% confidence interval 0.87-0.92; I(2) = 95%; P < 0.001). Similar patterns were observed in all subgroups examined. CONCLUSIONS Published studies have not found a strong association between low SES and nonadherence to antihypertensive medications. However, important limitations in the assessment of SES can be identified in virtually all studies. Future studies are required to ascertain whether a stronger association is observed when SES is determined by comprehensive measures.
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Affiliation(s)
- M H D Wasem Alsabbagh
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Mark Lemstra
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Dean Eurich
- Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Lisa M Lix
- Faculty of Medicine, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Thomas W Wilson
- Department of Medicine, Royal University Hospital, Saskatoon Health Region, Saskatoon, SK, Canada
| | - Erin Watson
- Health Sciences Library, University of Saskatchewan, Saskatoon, SK, Canada
| | - David F Blackburn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada.
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Jensen ML, Jørgensen ME, Hansen EH, Aagaard L, Carstensen B. A multistate model and an algorithm for measuring long-term adherence to medication: a case of diabetes mellitus type 2. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:266-274. [PMID: 24636386 DOI: 10.1016/j.jval.2013.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 10/28/2013] [Accepted: 11/26/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To develop a multistate model and an algorithm for calculating long-term adherence to medication among patients with a chronic disease. METHODS We propose definitions of the different states of waiting, persistence, with sufficient supply to implement the prescribed dosing regimen, gaps, nonpersistence, and nonacceptance and an algorithm for transitions between states to describe long-term adherence to medication treatment. The model and algorithm are operationalized for use in a case with a retrospective cohort of patients with type 2 diabetes mellitus, with access to records of prescribed drugs from a Danish diabetes research hospital and records of filled prescriptions at Danish pharmacies from the Danish Health and Medicines Authority. RESULTS Calculations of long-term adherence to medication are shown for patients with type 2 diabetes mellitus on metformin and/or simvastatin. The study shows how the prevalence of patients waiting to initiate treatment, patients with supply to implement the prescribed dosing regimen, patients not accepting treatment, and patients discontinuing treatment varies over time. CONCLUSIONS The proposed multistate model and algorithm can easily be translated and used for the calculation of adherence to medication in any chronic disease. The model and algorithm take time into account, and thus, changes in incidence rates and prevalence of the different states over time can be estimated on several time scales (calendar time, age of the patient, and time since indication for medication).
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Affiliation(s)
- Majken Linnemann Jensen
- Steno Diabetes Center A/S, Gentofte, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | | | - Ebba Holme Hansen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lise Aagaard
- Faculty of Health, University of Southern Denmark, Odense, Denmark
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Tomko JR, Ahmed N, Mukherjee K, Roma RS, Dilucente D, Orchowski K. Evaluation of a discharge medication service on an acute psychiatric unit. Hosp Pharm 2014; 48:314-20. [PMID: 24421481 DOI: 10.1310/hpj4804-314] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Nonadherence with medication is a major factor that influences acute psychiatric hospital readmission. Pharmacists can positively influence rapid psychiatric readmission due to nonadherence by counseling patients and providing filled prescriptions on discharge. OBJECTIVE This study is a retrospective evaluation of a pharmacist-driven discharge medication service for hospitalized psychiatric patients. Measured outcomes include a comparison of rapid readmissions pre and post implementation. Rapid readmissions between the concurrent study group and excluded group were also compared. METHODS From October 2010 to November 2011, home-destined subjects being discharged from the hospital's behavioral health unit were provided filled psychiatric prescriptions for self-administration upon discharge, coupled with medication counseling. A series of statistical comparisons were made between the 2 prior years' overall rapid readmissions. This was subsequently compared with the overall rapid readmission rate during the study year. The study group's rapid readmissions were then compared to the overall rapid readmission rate of the study year as well as to the concurrent excluded group. RESULTS Thirty-day hospital readmissions were found to be significantly decreased in studied subjects compared to total rapid readmissions during the previous year (P = .004) and to the excluded group (P = .020). CONCLUSION Immediate availability of prescriptions upon discharge, coupled with development of therapeutic alliances with patients, removes some of the barriers to patient medication adherence in the discharged, acute psychiatric patient. The program provided positive outcomes with regard to decreased frequent, rapid readmission to the acute care psychiatric unit due to medication nonadherence.
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Affiliation(s)
- John R Tomko
- Assistant Professor of Pharmacy Practice and Clinical Pharmacy Specialist, Department of Pharmacy, Duquesne University and UPMC Mercy Hospital, Pittsburgh, Pennsylvania
| | | | - Koushik Mukherjee
- Psychiatrist, Mercy Behavioral Health and UPMC Mercy Hospital, Pittsburgh, Pennsylvania
| | - Rebecca S Roma
- Psychiatrist, Mercy Behavioral Health and UPMC Mercy Hospital, Pittsburgh, Pennsylvania
| | - Donna Dilucente
- Department of Nursing Services, Utilization, UPMC Mercy Hospital, Pittsburgh, Pennsylvania
| | - Karen Orchowski
- Pharmacy Manager, UPMC Mercy Ambulatory Pharmacy, Pittsburgh, Pennsylvania
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Tomko JR, Ahmed N, Mukherjee K, Roma RS, Dilucente D, Orchowski K. Evaluation of a discharge medication service on an acute psychiatric unit. Hosp Pharm 2014. [PMID: 24421481 DOI: 10.1310/hpj4804-314.test] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Nonadherence with medication is a major factor that influences acute psychiatric hospital readmission. Pharmacists can positively influence rapid psychiatric readmission due to nonadherence by counseling patients and providing filled prescriptions on discharge. OBJECTIVE This study is a retrospective evaluation of a pharmacist-driven discharge medication service for hospitalized psychiatric patients. Measured outcomes include a comparison of rapid readmissions pre and post implementation. Rapid readmissions between the concurrent study group and excluded group were also compared. METHODS From October 2010 to November 2011, home-destined subjects being discharged from the hospital's behavioral health unit were provided filled psychiatric prescriptions for self-administration upon discharge, coupled with medication counseling. A series of statistical comparisons were made between the 2 prior years' overall rapid readmissions. This was subsequently compared with the overall rapid readmission rate during the study year. The study group's rapid readmissions were then compared to the overall rapid readmission rate of the study year as well as to the concurrent excluded group. RESULTS Thirty-day hospital readmissions were found to be significantly decreased in studied subjects compared to total rapid readmissions during the previous year (P = .004) and to the excluded group (P = .020). CONCLUSION Immediate availability of prescriptions upon discharge, coupled with development of therapeutic alliances with patients, removes some of the barriers to patient medication adherence in the discharged, acute psychiatric patient. The program provided positive outcomes with regard to decreased frequent, rapid readmission to the acute care psychiatric unit due to medication nonadherence.
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Affiliation(s)
- John R Tomko
- Assistant Professor of Pharmacy Practice and Clinical Pharmacy Specialist, Department of Pharmacy, Duquesne University and UPMC Mercy Hospital, Pittsburgh, Pennsylvania
| | | | - Koushik Mukherjee
- Psychiatrist, Mercy Behavioral Health and UPMC Mercy Hospital, Pittsburgh, Pennsylvania
| | - Rebecca S Roma
- Psychiatrist, Mercy Behavioral Health and UPMC Mercy Hospital, Pittsburgh, Pennsylvania
| | - Donna Dilucente
- Department of Nursing Services, Utilization, UPMC Mercy Hospital, Pittsburgh, Pennsylvania
| | - Karen Orchowski
- Pharmacy Manager, UPMC Mercy Ambulatory Pharmacy, Pittsburgh, Pennsylvania
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Lemstra M, Alsabbagh MW. Proportion and risk indicators of nonadherence to antihypertensive therapy: a meta-analysis. Patient Prefer Adherence 2014; 8:211-8. [PMID: 24611002 PMCID: PMC3928397 DOI: 10.2147/ppa.s55382] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE The World Health Organization (WHO) concluded that poor adherence to treatment is the most important cause of uncontrolled high blood pressure, with approximately 75% of patients not achieving optimum blood pressure control. The WHO estimates that between 20% and 80% of patients receiving treatment for hypertension are adherent. As such, the first objective of our study was to quantify the proportion of nonadherence to antihypertensive therapy in real-world observational study settings. The second objective was to provide estimates of independent risk indicators associated with nonadherence to antihypertensive therapy. MATERIALS AND METHODS We performed a systematic literature review and meta-analysis of all studies published between database inception and December 31, 2011 that reviewed adherence, and risk indicators associated with nonadherence, to antihypertensive medications. RESULTS In the end, 26 studies met our inclusion and exclusion criteria and passed our methodological quality evaluation. Of the 26 studies, 48.5% (95% confidence interval 47.7%-49.2%) of patients were adherent to antihypertensive medications at 1 year of follow-up. The associations between 114 variables and nonadherence to antihypertensive medications were reviewed. After meta-analysis, nine variables were associated with nonadherence to antihypertensive medications: diuretics in comparison to angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) and calcium channel blockers (CCBs), ACE inhibitors in comparison to ARBs, CCBs in comparison to ARBs, those with depression or using antidepressants, not having diabetes, lower income status, and minority cultural status. CONCLUSION This study clarifies the extent of adherence along with determining nine independent risk indicators associated with nonadherence to antihypertensive medications.
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Affiliation(s)
- Mark Lemstra
- Academic Family Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Correspondence: Mark Lemstra, Academic Family Medicine, College of Medicine, University of Saskatchewan, 110 Science Place, Saskatoon, SK S7N 5C9, Canada, Tel +1 306 966 2108, Fax +1 306 966 6377, Email
| | - M Wasem Alsabbagh
- Academic Family Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Evans CD, Eurich DT, Lu X, Remillard AJ, Shevchuk YM, Blackburn D. The association between market availability and adherence to antihypertensive medications: an observational study. Am J Hypertens 2013; 26:180-90. [PMID: 23382402 DOI: 10.1093/ajh/hps017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND High adherence to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reported in observational studies has frequently been attributed to improved tolerability. However, these agents are also relatively new to the market compared to other antihypertensive medications. We aimed to determine if an association exists between adherence and market availability of a specific antihypertensive agent. METHODS This retrospective cohort study used administrative data from Saskatchewan, Canada. Subjects were ≥40 years of age and received a new antihypertensive medication between 1994 and 2002. The primary outcome was the proportion of subjects achieving optimal adherence (≥80%) at 1 year, stratified by antihypertensive medication class and the year of availability. Adherence was measured using the cumulative mean gap ratio. RESULTS A total of 36,214 subjects met the inclusion criteria. Optimal adherence was observed in 4987 of 8623 (57.8%) subjects receiving ACEIs and 1013 of 1600 (63.3%) subjects receiving ARBs, but adherence appeared inconsistent when examined within each antihypertensive class. A pattern of increasing mean adherence was observed according to availability in the ACEI subgroup (Spearman r = 0.82; P = 0.007) but not the ARB subgroup (Spearman r = 0.41; P = 0.49). However, the association between availability and optimal adherence converged when ARB and ACEI users were combined (Spearman r = 0.85, P < 0.001). CONCLUSIONS Optimal adherence with ACEIs and ARBs compared to other antihypertensive agents may be associated with their relative availability. To what extent optimal adherence is also associated with improved tolerability, as currently believed, remains to be determined.
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Affiliation(s)
- Charity D Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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Blackburn DF, Swidrovich J, Lemstra M. Non-adherence in type 2 diabetes: practical considerations for interpreting the literature. Patient Prefer Adherence 2013; 7:183-9. [PMID: 23487395 PMCID: PMC3592508 DOI: 10.2147/ppa.s30613] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The rising prevalence of type 2 diabetes poses a serious threat to human health and the viability of many health care systems around the world. Although several prescription medications can play a vital role in controlling symptoms and preventing complications, non-adherence to these therapies is highly prevalent and has been linked to increases in morbidity, mortality, and health care costs. Although a vast array of significant adherence predictors has been identified, the ability to explain or predict non-adherence with known risk-factors remains poor. Further, the definitions, outcomes, and various measures used in the non-adherence literature can be misleading for the unfamiliar reviewer. In this narrative review, a practical overview of important considerations for interpreting adherence endpoints and measures is discussed. Also, an organizational framework is proposed to consider published adherence interventions. This framework may allow for a unique appreciation into areas of limited knowledge and thus highlights targets for future research.
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Affiliation(s)
- David F Blackburn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan
- Correspondence: David F Blackburn College of Pharmacy and Nutrition, 110 Science Place, Saskatoon, Saskatchewan, Canada, S7N 5C9 Te l +1 306 966 2081 Fax +1 306 966 6377 Email
| | - Jaris Swidrovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Mark Lemstra
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan
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Lemstra M, Blackburn D. Nonadherence to statin therapy: discontinuation after a single fill. Can J Cardiol 2012; 28:567-73. [PMID: 22658124 DOI: 10.1016/j.cjca.2012.03.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 03/22/2012] [Accepted: 03/22/2012] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Adherence to statin medications is known to be suboptimal. What is less known is the rate of discontinuation immediately after therapy has been initiated. The primary objective of this study was to determine what proportion of nonadherence in the first year of statin therapy was due to discontinuation after a single fill. METHODS We identified new statin users within low-risk (hypertension [HTN]), medium-risk (coronary heart disease [CHD]), and high-risk (heart failure [HF]) cohorts during a 9-year period. All data came from administrative health care databases. RESULTS The cohorts included 9445 HTN, 1141 CHD, and 778 HF patients. At 1 year, the proportions of patients with less than 80% adherence to statin medications were 47.9% (HTN), 38.3% (CHD), and 50.0% (HF). Among all patients classified as nonadherent at 1 year, 18.0% of HTN, 16.3% of CHD, and 28.2% of HF patients had discontinued statin medications after only 1 dispensation. Within 3 months of starting statin therapy, 29.7%, 40.3%, and 47.5% of all nonadherent HTN, CHD, and HF patients, respectively, had discontinued the new statin medication. After regression analysis, the only independent covariate that was consistently associated with discontinuation after a single fill was receiving fewer medical follow-up visits. CONCLUSIONS Immediate discontinuation after a single fill contributes disproportionately to statin nonadherence. This suggests an important time to prevent nonadherence is within the first month of treatment initiation.
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Affiliation(s)
- Mark Lemstra
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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