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Palandri F, Auteri G, Abruzzese E, Caocci G, Bonifacio M, Mendicino F, Latagliata R, Iurlo A, Branzanti F, Garibaldi B, Trawinska MM, Cattaneo D, Krampera M, Mulas O, Martino EA, Cavo M, Vianelli N, Impera S, Efficace F, Heidel F, Breccia M, Elli EM, Palumbo GA. Ruxolitinib Adherence in Myelofibrosis and Polycythemia Vera: the "RAMP" Italian multicenter prospective study. Ann Hematol 2024; 103:1931-1940. [PMID: 38478023 PMCID: PMC11090921 DOI: 10.1007/s00277-024-05704-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/09/2024] [Indexed: 05/14/2024]
Abstract
Ruxolitinib is beneficial in patients with myelofibrosis (MF) and polycythemia vera (PV). Information on ruxolitinib adherence is scant. The Ruxolitinib Adherence in Myelofibrosis and Polycythemia Vera (RAMP) prospective multicenter study (NCT06078319) included 189 ruxolitinib-treated patients. Patients completed the Adherence to Refills and Medications Scale (ARMS) and Distress Thermometer and Problem List (DTPL) at the earliest convenience, after registration in the study, and at later timepoints. At week-0, low adherence (ARMS > 14) and high distress (DT ≥ 4) were declared by 49.7% and 40.2% of patients, respectively. The main reason for low adherence was difficult ruxolitinib supply (49%), intentional (4.3%) and unintentional (46.7%) non-take. In multivariable regression analysis, low adherence was associated to male sex (p = 0.001), high distress (p < 0.001), and treatment duration ≥ 1 year (p = 0.03). Over time, rates of low adherence and high distress remained stable, but unintentional non-take decreased from 47.9% to 26.0% at week-48. MF patients with stable high adherence/low distress were more likely to obtain/maintain the spleen response at week-24. Low adherence to ruxolitinib represents an unmet clinical need that require a multifaceted approach, based on reason behind it (patients characteristics and treatment duration). Its recognition may help distinguishing patients who are truly refractory and those in need of therapy optimization.
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Affiliation(s)
- F Palandri
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seràgnoli", Bologna, Italy.
| | - G Auteri
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento Di Medicina Specialistica, Diagnostica E Sperimentale, Università Di Bologna, Bologna, Italy
| | - E Abruzzese
- Hematology, S.Eugenio Hospital, Tor Vergata University, ASL Roma2, Rome, Italy
| | - G Caocci
- Hematology Unit, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - M Bonifacio
- Hematology and Bone Marrow Transplant Unit, Section of Biomedicine of Innovation, Department of Engineering for Innovative Medicine, University of Verona, Verona, Italy
| | - F Mendicino
- U.O.C. Di Ematologia, Department of Hemato-Oncology, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - R Latagliata
- Hematology Unit, Ospedale Belcolle, Viterbo, Italy
| | - A Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F Branzanti
- Dipartimento Di Medicina Specialistica, Diagnostica E Sperimentale, Università Di Bologna, Bologna, Italy
| | - B Garibaldi
- Postgraduate School of Hematology, University of Catania, Catania, Italy
| | - M M Trawinska
- Hematology, S.Eugenio Hospital, Tor Vergata University, ASL Roma2, Rome, Italy
| | - D Cattaneo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Krampera
- Hematology and Bone Marrow Transplant Unit, Section of Biomedicine of Innovation, Department of Engineering for Innovative Medicine, University of Verona, Verona, Italy
| | - O Mulas
- Hematology Unit, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - E A Martino
- U.O.C. Di Ematologia, Department of Hemato-Oncology, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - M Cavo
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento Di Medicina Specialistica, Diagnostica E Sperimentale, Università Di Bologna, Bologna, Italy
| | - N Vianelli
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seràgnoli", Bologna, Italy
| | - S Impera
- Department of Hematology, ARNAS Garibaldi, Catania, Italy
| | - F Efficace
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - F Heidel
- Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School (MHH), Hannover, Germany
| | - M Breccia
- Division of Cellular Biotechnologies and Hematology, University Sapienza, Rome, Italy
| | - E M Elli
- Divisione di Ematologia e Unità Trapianto di Midollo, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - G A Palumbo
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università Di Catania, Catania, Italy
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Song M, Song YM. The Effect of Shared Decision-Making by Mental Health Nurses on Medication Adherence in Patients with Alcohol Use Disorders: Provider-Patient Communication Pathway Model. JOURNAL OF HEALTH COMMUNICATION 2023; 28:777-788. [PMID: 37823392 DOI: 10.1080/10810730.2023.2268561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
The involvement of patients with mental health issues in their own treatment decision-making has often been overlooked. This study aimed to investigate the impact of shared decision-making between mental health nurses and patients with alcohol use disorders (AUD) on medication adherence. The provider-patient communication pathway model was utilized to examine the ways in which therapeutic communication strategies employed by mental health nurses positively influence medication adherence. The study employed a percentile bootstrap method and pairwise comparison tests in structural equation modeling. The results revealed that shared decision-making between AUD patients and mental health nurses directly enhanced medication adherence, as well as indirectly influenced adherence through the mediating factors of therapeutic alliance and alcohol abstinence self-efficacy. These findings hold both theoretical and practical implications for involving patients with AUD in therapeutic decision-making within psychiatric and mental health nursing settings, as well as for improving medication adherence among this patient population.
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Affiliation(s)
- MoonJU Song
- Division of Admission Management and Policy Development, National Center for Mental Health, Seoul, Republic of Korea
- College of Nursing, Korea University, Seoul, Republic of Korea
| | - Yul-Mai Song
- Department of Nursing, Honam University, Gwangju, Republic of Korea
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Lasala R, Santoleri F, Romagnoli A, Abrate P, Musicco F, Costantini A. Medication adherence reporting in pivotal clinical trials: overview of oral oncological drugs. Eur J Hosp Pharm 2023; 30:328-332. [PMID: 35058307 PMCID: PMC10647863 DOI: 10.1136/ejhpharm-2021-002998] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/20/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess how and to what extent adherence to medication is reported in pivotal clinical trials of oral cancer drugs. METHODS All drugs authorised by the European Medicines Agency from 1 January 2014 to 31 December 2019 were considered for analysis. For each pivotal trial we extracted the journal of publication, phase of the study, posology, mention of adherence within the main text of the published article or additional material and the terms in which the adherence was reported. RESULTS Thirty drugs were included in the analysis from 56 clinical trials. Eleven articles (19.6%) contained a mention of medication adherence in the main document, 26 (46.4%) in the supplementary material and 19 (33.9%) did not contain any reference to adherence. Seven studies reported medication adherence between the results, expressed as number of patients discontinuing treatment for non-compliance and mean or median percentage. CONCLUSIONS Medication adherence in pivotal clinical trials of oral oncological drugs is poorly represented. There should be a greater level of reporting in the results and it should be included among the minimum set of recommendations in reporting health research.
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Stewart SJF, Moon Z, Horne R. Medication nonadherence: health impact, prevalence, correlates and interventions. Psychol Health 2023; 38:726-765. [PMID: 36448201 DOI: 10.1080/08870446.2022.2144923] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 12/05/2022]
Abstract
Nonadherence to medicines is a global problem compromising health and economic outcomes for individuals and society. This article outlines how adherence is defined and measured, and examines the impact, prevalence and determinants of nonadherence. It also discusses how a psychosocial perspective can inform the development of interventions to optimise adherence and presents a series of recommendations for future research to overcome common limitations associated with the medication nonadherence literature. Nonadherence is best understood in terms of the interactions between an individual and a specific disease/treatment, within a social and environmental context. Adherence is a product of motivation and ability. Motivation comprises conscious decision-making processes but also from more 'instinctive', intuitive and habitual processes. Ability comprises the physical and psychological skills needed to adhere. Both motivation and ability are influenced by environmental and social factors which influence the opportunity to adhere as well as triggers or cues to actions which may be internal (e.g. experiencing symptoms) or external (e.g. receiving a reminder). Systematic reviews of adherence interventions show that effective solutions are elusive, partly because few have a strong theoretical basis. Adherence support targeted at the level of individuals will be more effective if it is tailored to address the specific perceptions (e.g. beliefs about illness and treatment) and practicalities (e.g. capability and resources) influencing individuals' motivation and ability to adhere.
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Affiliation(s)
- Sarah-Jane F Stewart
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Zoe Moon
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Rob Horne
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
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Ni Y, Tong C, Xu L, Qian W, Huang L, Zhang A, Fang Q. Prevalence and associated factors of medication adherence among infertile women undergoing frozen-thawed embryo transfer cycle: A cross-sectional study. Front Pharmacol 2023; 14:1148867. [PMID: 37007001 PMCID: PMC10064053 DOI: 10.3389/fphar.2023.1148867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/09/2023] [Indexed: 03/19/2023] Open
Abstract
Objective: This study aimed to explore the prevalence and associated factors of medication adherence among infertile women undergoing frozen-thawed embryo transfer (FET) cycle.Methods: A cross-sectional study was conducted with 556 infertile women undergoing FET cycle in total. The Self-efficacy for Appropriate Medication Use Scale (SEAMS), Herth Hope Index (HHI) scale, and Social Support Rating Scale (SSRS) were used to evaluate the patients. Data were described by univariate and multivariate analyses. Logistic regression method was performed to analyse the factors potentially associated with medication adherence.Results: The average score of Self-efficacy for Appropriate Medication Use Scale (SEAMS) was 30.38 ± 6.65, and 65.3% of participants showed non-adherence. Multiple regression analysis indicated that first-time FET cycle, treatment stage, methods of daily medication, social support and hope level were the main associated factors of the medication adherence among infertile women undergoing FET cycle (p < 0.001).Conclusion: This study revealed the medication adherence is at medium level among infertile women undergoing FET cycle, especially in patients with repeated FET cycles. The study also suggested that improving the hope level and social support of infertile women undergoing FET cycle may increase medication adherence.
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Affiliation(s)
- Ying Ni
- Department of Gynecology and Obstetrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenye Tong
- Department of Gynecology and Obstetrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lianying Xu
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen Qian
- Department of Gynecology and Obstetrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Limin Huang
- Department of Gynecology and Obstetrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Aijun Zhang
- Department of Gynecology and Obstetrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Qiong Fang, ; Aijun Zhang,
| | - Qiong Fang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Qiong Fang, ; Aijun Zhang,
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Andelic N, Feeney A. Poor mental health is associated with the exacerbation of personal debt problems: A study of debt advice adherence. Int J Soc Psychiatry 2023; 69:286-293. [PMID: 35240881 PMCID: PMC9983051 DOI: 10.1177/00207640221083205] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND It is known that there is an association between debt and poor mental health. However, much of the literature is observational and focuses on how debt may lead to poor mental health. Here, we are interested in how poor mental health may be associated with debt advice adherence. AIMS The aim of the study was to investigate the relationship between mental health and debt advice adherence in individuals applying for a formal debt resolution mechanism (an Individual Voluntary Arrangement, IVA). METHOD Eighty-six participants completed a survey measuring mental health (MHI-5), memory for information discussed during the appointment, attitudes towards IVAs, and trust in the advisor shortly after having a debt advice appointment. Adherence to the advice (whether participants completed the IVA application) was measured 10 weeks later. RESULTS The study found that the sample demonstrated poor levels of mental health overall but that non-adherent participants had significantly poorer mental health than those who adhered to the advice. CONCLUSION These results suggest that (a) mental health needs to be considered when advising people with problem debt and (b) future research might examine if mental health support should coincide with important decision points in the debtor's journey out of debt.
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Affiliation(s)
- Nicole Andelic
- University of Aberdeen, UK
- Nicole Andelic, Economics Department,
Business School, University of Aberdeen, Dunbar Street, Aberdeen AB24 3FX, UK.
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Schönfeld S, Rathmer I, Michaelsen MM, Hoetger C, Onescheit M, Lange S, Werdecker L, Esch T. Effects of a Mindfulness Intervention Comprising an App, Web-Based Workshops, and a Workbook on Perceived Stress Among Nurses and Nursing Trainees: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e37195. [PMID: 35916708 PMCID: PMC9382546 DOI: 10.2196/37195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Previous research has found digitally supported mindfulness interventions to be effective when used for stress management among workers in high-stress occupations. Findings on digitally supported mindfulness interventions among nurses working in acute inpatient care settings are heterogeneous, lack long-term follow-up, and do not assess adherence and acceptability. Objective This study aimed to investigate the effectiveness and efficacy of a digitally supported mindfulness intervention designed to improve health- and work-related outcomes among nurses and nursing trainees working in acute inpatient care settings. Methods We will conduct a multicenter randomized controlled trial using a wait-list control group design. Randomization will be stratified by hospital and job status (nurse or nursing trainee). Recruitment will take place on the web and offline during the working hours of nurses and nursing trainees. The intervention group will receive a digitally supported mindfulness intervention, which will comprise an app, 2 web-based workshops, and a workbook, whereas the wait-list control group will be scheduled to receive the same intervention 14 weeks later. The 2 web-based workshops will be led by a certified mindfulness-based stress reduction trainer. Nurses will use the app and the workbook independently. Self-report web-based surveys will be conducted on the web at baseline, at 10 weeks after allocation, at 24 weeks after allocation, and at 38 weeks after allocation. Outcomes of interest will include perceived stress (primary outcome), health- and work-related variables, and variables related to adherence and acceptability of the digitally supported mindfulness intervention. We will perform intention-to-treat and per-protocol analyses. Results Data collection will be completed by the beginning of August 2022. Data analyses will be completed by December 2022. Conclusions Our study design, including long-term follow-up and the investigation of variables related to adherence and acceptability, will ensure rigorous evaluation of effectiveness and efficacy. Relative to costly in-person intervention efforts, this program may present a cost-effective and potentially highly scalable alternative. Findings regarding effectiveness, efficacy, adherence, and acceptability will inform stakeholders’ decisions regarding the implementation of similar interventions to promote the well-being of nurses and nursing trainees, which may, in turn, alleviate detrimental stress-related outcomes (eg, burnout) because of work-related demands. Trial Registration German Clinical Trials Register DRKS00025997; https://tinyurl.com/433cas7u International Registered Report Identifier (IRRID) DERR1-10.2196/37195
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Affiliation(s)
- Simone Schönfeld
- Institute for Integrative Health Care and Health Promotion (IGVF), Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Ines Rathmer
- Institute for Integrative Health Care and Health Promotion (IGVF), Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Maren M Michaelsen
- Institute for Integrative Health Care and Health Promotion (IGVF), Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Cosima Hoetger
- Institute for Integrative Health Care and Health Promotion (IGVF), Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Miriam Onescheit
- Institute for Integrative Health Care and Health Promotion (IGVF), Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Silke Lange
- Interprofessional Graduate College in Integrative Medicine and Health, Witten/Herdecke University, Witten, Germany
| | - Lena Werdecker
- Institute for Integrative Health Care and Health Promotion (IGVF), Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Tobias Esch
- Institute for Integrative Health Care and Health Promotion (IGVF), Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
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Gori S, Modena A, Foglietta J, Verzè M, Inno A, Casarin A, Russo A, Nicolis F. Adherence to oral hormonal anticancer agents in breast cancer. TUMORI JOURNAL 2022:3008916221096183. [PMID: 35603579 DOI: 10.1177/03008916221096183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is an increasing trend towards using oral antitumoral agents in oncological patients. Compared to parenteral therapy, oral treatment offers convenience for both the patient and the healthcare system, with similar efficacy. However, the benefit deriving from oral drugs will be obtained only if patients adhere strictly to the treatment. Medical oncologists must therefore seek to optimize patient adherence. Breast cancer patients, particularly, are often treated with oral hormonal anticancer agents. In this review, we summarized evidence about adherence of breast cancer patients to oral hormonal anticancer agents and the consequences of poor compliance, the barriers to oral treatment and strategies to overcome them.
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Affiliation(s)
- Stefania Gori
- Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Alessandra Modena
- Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | | | - Matteo Verzè
- Health Direction, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Alessandro Inno
- Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Alessandra Casarin
- Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Antonio Russo
- Department of Surgical, Oncological & Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Fabrizio Nicolis
- Health Direction, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
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Kim IA, Nosulya EV, Ragimova DR. [Features of adherence to treatment of patients with chronic rhinosinusitis with nasal polyps]. Vestn Otorinolaringol 2022; 87:81-86. [PMID: 35274897 DOI: 10.17116/otorino20228701181] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic polypous rhinosinusitis (CPR) is characterized by refractory to drug therapy and a high potential for recurrence after surgical treatment. One of the important factors limiting the effectiveness of drug therapy of CPR, in particular intranasal glucocorticosteroids (inGCSs), is the insufficient level of adherence to treatment of patients with CPR. OBJECTIVE Generalization of data on the significance and ways to increase adherence to treatment of patients with CPR. MATERIAL AND METHODS Materials of scientific publications included in the Cochrane Library, Russian Science Citation Index, MEDLINE, PubMed information bases were used as a data source. The material was selected based on the following keywords: "chronic rhinosinusitis", "nasal polyps", "intranasal glucocorticosteroids", "adherence to treatment". RESULTS Despite the fact that inGCSs are one of the main pathogenetically justified methods of treating CPR, their use is limited by many factors, one of which is the level of patient compliance with the treatment regimen. CONCLUSION Improving adherence to treatment is one of the important reserves for increasing the effectiveness of drug therapy for chronic polypous rhinosinusitis.
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Affiliation(s)
- I A Kim
- National Medical Research Center for Otorhinolaryngology, Moscow, Russia
| | - E V Nosulya
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - D R Ragimova
- Pirogov Russian National Research Medical University, Moscow, Russia
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Schepman PB, Thakkar S, Robinson RL, Beck CG, Malhotra D, Emir B, Hansen RN. A Retrospective Claims-Based Study Evaluating Clinical and Economic Burden Among Patients With Moderate to Severe Osteoarthritis Pain in the United States. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2022; 9:58-67. [PMID: 35620454 PMCID: PMC8888122 DOI: 10.36469/jheor.2022.31895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/10/2022] [Indexed: 06/15/2023]
Abstract
Background: There has been limited evaluation of medication adherence, healthcare resource utilization (HCRU), and healthcare costs over time in patients with osteoarthritis (OA), and stratification by pain severity level has not been reported. Assessing such longitudinal changes may be useful to patients and healthcare providers for tracking disease progression, informing treatment options, and employing strategies to optimize patient outcomes. Objectives: To characterize treatment patterns, HCRU, and costs over time in patients with moderate to severe (MTS) OA pain in the United States. Methods: We conducted a retrospective claims analysis, using IBM® MarketScan® databases, from 2013-2018. Eligible patients were aged ≥45 years with ≥12 months pre-index (baseline) and ≥24 months (follow-up) of continuous enrollment; index date was defined as a physician diagnosis of hip or knee OA. An algorithm was employed to identify MTS OA pain patients, who were propensity score matched with patients having non-MTS OA pain. Data were summarized using descriptive statistics and univariate analyses. Results: After propensity score matching, the overall OA pain cohorts consisted of 186 374 patients each: 61% were female, mean age was 63 years, and two-thirds (65.6%) were of working age (45-65 years). Sleep-related conditions, anxiety, and depression were significantly higher in the MTS OA pain cohort vs non-MTS (P<0.001). At baseline and 12- and 24-month follow-ups, receipt of prescription pain medications, HCRU, and direct medical costs were significantly higher in the MTS OA pain cohort (all P<0.01). Medication adherence was significantly higher in the MTS OA pain cohort for all medication classes except analgesics/antipyretics, which were significantly lower vs the non-MTS OA pain cohort (all P<0.0001). Conclusions: The burden of MTS OA pain is substantial, with patterns that show increasing medication use, HCRU, and costs vs non-MTS OA pain patients over time. Understanding the heterogeneity within the OA population may allow us to further appreciate the true burden of illness for patients in pain.
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Affiliation(s)
| | | | | | | | | | | | - Ryan N Hansen
- The CHOICE Institute, School of Pharmacy, University of Washington, Seattle, Washington, USA
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Passardi A, Foca F, Caffo O, Tondini CA, Zambelli A, Vespignani R, Bartolini G, Sullo FG, Andreis D, Dianti M, Eccher C, Piras EM, Forti S. A Remote Monitoring System to Optimize the Home Management of Oral Anticancer Therapies (ONCO-TreC): Prospective Training-Validation Trial. J Med Internet Res 2022; 24:e27349. [PMID: 35080505 PMCID: PMC8829690 DOI: 10.2196/27349] [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: 01/22/2021] [Revised: 06/10/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background A platform designed to support the home management of oral anticancer treatments and provide a secure web-based patient–health care professional communication modality, ONCO-TreC, was tested in 3 cancer centers in Italy. Objective The overall aims of the trial are to customize the platform; assess the system’s ability to facilitate the shared management of oral anticancer therapies by patients and health professionals; and evaluate system usability and acceptability by patients, caregivers, and health care professionals. Methods Patients aged ≥18 years who were candidates for oral anticancer treatment as monotherapy with an Eastern Cooperative Oncology Group performance status score of 0 to 1 and a sufficient level of familiarity with mobile devices were eligible. ONCO-TreC consisted of a mobile app for patients and a web-based dashboard for health care professionals. Adherence to treatment (pill count) and toxicities reported by patients through the app were compared with those reported by physicians in medical records. Usability and acceptability were evaluated using questionnaires. Results A total of 40 patients were enrolled, 38 (95%) of whom were evaluable for adherence to treatment. The ability of the system to measure adherence to treatment was high, with a concordance of 97.3% (95% CI 86.1%-99.9%) between the investigator and system pill count. Only 60% (3/5) of grade 3, 54% (13/24) of grade 2, and 19% (7/36) of grade 1 adverse events reported by physicians in the case report forms were also reported in the app directly by patients. In total, 94% (33/35) of patients had ≥1 app launch each week, and the median number of daily accesses per patient was 2. Approximately 71% (27/38) and 68% (26/38) of patients used the app for messages and vital sign entering, respectively, at least once during the study period. Conclusions ONCO-TreC is an important tool for measuring and monitoring adherence to oral anticancer drugs. System usability and acceptability were very high, whereas its reliability in registering toxicity could be improved. Trial Registration ClinicalTrials.gov NCT02921724; https://www.clinicaltrials.gov/ct2/show/NCT02921724
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Affiliation(s)
- Alessandro Passardi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Orazio Caffo
- Department of Medical Oncology, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Carlo Alberto Tondini
- Department of Medical Oncology, Azienda Socio-Sanitaria Territoriale "Papa Giovanni XXIII", Bergamo, Italy
| | - Alberto Zambelli
- Department of Medical Oncology, Azienda Socio-Sanitaria Territoriale "Papa Giovanni XXIII", Bergamo, Italy
| | - Roberto Vespignani
- IT Service, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Giulia Bartolini
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Francesco Giulio Sullo
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Daniele Andreis
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Marco Dianti
- Center for Information and Communication Technology, eHealth Unit, Fondazione "Bruno Kessler", Trento, Italy
| | - Claudio Eccher
- Center for Information and Communication Technology, eHealth Unit, Fondazione "Bruno Kessler", Trento, Italy
| | - Enrico Maria Piras
- Center for Information and Communication Technology, eHealth Unit, Fondazione "Bruno Kessler", Trento, Italy
| | - Stefano Forti
- Center for Information and Communication Technology, eHealth Unit, Fondazione "Bruno Kessler", Trento, Italy
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12
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Monitoring Antihypertensive Medication Adherence by LC-MS/MS: Method Establishment and Clinical Application. J Cardiovasc Pharmacol 2021; 78:581-596. [PMID: 34269698 DOI: 10.1097/fjc.0000000000001105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/26/2021] [Indexed: 11/27/2022]
Abstract
ABSTRACT Proper medication compliance is critical for the integrity of clinical practice, directly related to the success of clinical trials to evaluate both pharmacological and device-based therapies. Here, we established a liquid chromatography tandem mass spectrometry (LC-MS/MS) method to accurately detect 55 chemical entities in human urine sample, which accounting for the most commonly used 172 antihypertensive drugs in China. The established method had good accuracy, intra-day and inter-day precision for all analyses in both bench tests and validated in 21 hospitalized patients. We utilized this method to monitor and ensure drug compliance, and exclude the inferring impacts of medication compliance as a key confounder for our pivotal trial of a catheter-based, renal mapping and selective renal denervation to treat hypertension. It is found that in the urine samples from 92 consecutive subjects, 85 subjects (92.4%) were consistent with their prescriptions after 28 days run-in periods, 90 (97.8%) and 85 (95.5%) patients completely complied with their medications during the 3-month and 6-month follow-up period, respectively. Thus, using LC-MS/MS method with specificity, accuracy and precision, we ensured drug compliance of patients, excluded the key confounder of drug interferences and ensured the quality of our device-based clinical trial for treatment of hypertension.
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13
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Ibrahim ME, Castillo-Mancilla JR, Yager J, Brooks KM, Bushman L, Saba L, Kiser JJ, MaWhinney S, Anderson PL. Individualized Adherence Benchmarks for HIV Pre-Exposure Prophylaxis. AIDS Res Hum Retroviruses 2021; 37:421-428. [PMID: 33191774 PMCID: PMC8213008 DOI: 10.1089/aid.2020.0108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Tenofovir diphosphate (TFV-DP) concentrations measured with dried blood spots (DBS) can be used to classify adherence to emtricitabine/tenofovir disoproxil fumarate (F/TDF) for HIV pre-exposure prophylaxis (PrEP). A TFV-DP of 700 fmol/punch was previously associated with high PrEP efficacy, and was estimated to represent ≥4 doses/week on average. However, interindividual variability in TFV-DP concentrations may lead to adherence misclassification and decrease the precision of adherence-efficacy relationships. The purpose of this analysis was to evaluate sources of TFV-DP variability to improve the precision of TFV-DP for adherence assessments by incorporating individual characteristics. Data and samples from a 36-week study of TFV-DP in DBS, collected biweekly, among 48 HIV-negative volunteers (25 Females/26 Caucasian/10 African American/14 Hispanic) receiving F/TDF at 33%, 67%, and 100% of daily dosing under directly observed therapy were used for analysis. The simplest pharmacokinetic model to describe TFV-DP accumulation with acceptable performance was a one-compartment constant input model. Covariates, including laboratory values and demographics were ranked in importance of their association with post hoc pharmacokinetic (PK) parameters using random forest analyses. Weight and platelet count were included in the final model and simulations were conducted to generate benchmarks for <2, 2-3, 4-5, and 6-7 doses/week. Based on these simulations, the previously established protective TFV-DP concentration of ≥700 fmol/punch was observed in those taking 2-3 (in individuals ≤110 kg) and ≥4 (in individuals >110 kg) doses/week, amounting to a much lower rate of misspecification (17% vs. 30%) with this individualized model versus previous interpretations. Incorporating body weight and platelet count improved the precision of TFV-DP concentrations for adherence assessments. Previous benchmarks were conservative, indicating that the pharmacological forgiveness of F/TDF may be higher than currently recognized and supports continued investigation of intermittent PrEP dosing regimens. Clinical Trial Registration number, NCT02022657.
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Affiliation(s)
- Mustafa E. Ibrahim
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
| | - Jose R. Castillo-Mancilla
- Department of Medicine, Division of Infectious Diseases, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Jenna Yager
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
| | - Kristina M. Brooks
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
| | - Lane Bushman
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
| | - Laura Saba
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
| | - Jennifer J. Kiser
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
| | - Samantha MaWhinney
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Peter L. Anderson
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
- Address correspondence to: Peter L. Anderson, Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, V20-C238, Room 4101, 12850 E. Montview Boulevard, Aurora, CO 80045, USA
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14
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Sugiyama H, Harada N, Amasawa E, Hirao M, Yahagi N. A Prototype Method for Selecting Interventions for Enhancing Medication Adherence in Medicine Taking Processes. JOURNAL OF CHEMICAL ENGINEERING OF JAPAN 2021. [DOI: 10.1252/jcej.20we090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | - Norikazu Harada
- Department of Chemical System Engineering, The University of Tokyo
| | - Eri Amasawa
- Department of Chemical System Engineering, The University of Tokyo
| | - Masahiko Hirao
- Department of Chemical System Engineering, The University of Tokyo
| | - Naohisa Yahagi
- Graduate School of Media and Governance, Keio University
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15
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Jankowska-Polańska B, Świątoniowska-Lonc N, Karniej P, Polański J, Tański W, Grochans E. Influential factors in adherence to the therapeutic regime in patients with type 2 diabetes and hypertension. Diabetes Res Clin Pract 2021; 173:108693. [PMID: 33592212 DOI: 10.1016/j.diabres.2021.108693] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/11/2020] [Accepted: 01/28/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Medication non-adherence is a global problem and the most common cause of treatment failure. Researchers warn that only one in two patients with chronic conditions adhere to their medication. Therefore, the primary objective of the study was to assess influential factors in adherence to the therapeutic regime in patients with type 2 diabetes and hypertension. The secondary objective was to evaluate medication adherence in patients with hypertension (HT) and/or diabetes (DM) and compare the level of adherence among patients with either diabetes or hypertension. METHODS The study included 1303 patients divided into three groups according to the type of chronic condition. The Adherence to Refills and Medications Scale (ARMS) was used to assess the level of adherence with pharmacological recommendations. RESULTS A comparison of adherence between the groups demonstrated that the level of adherence was highest in patients with diabetes alone (17 ± 5.15) and was lowest in patients with co-existing HT and diabetes (19.9 ± 7.51). A single-factor linear regression model analysis showed that the presence of hypertension alone has a positive effect on adherence to medications, while the co-existence of diabetes and hypertension has a statistically significantly negative impact on medication adherence. The sociodemographic predictors of higher adherence included female gender (β = -0.06; p = 0.024), high school education (β = -0.16 and p = 0.001) and being unemployed (β = -0.08; p = 0.0100). CONCLUSION Patients with co-existing diabetes and HT taking antihypertensive and antidiabetic drugs have the lowest adherence rates, and the co-existence of two chronic conditions is a statistically significant independent determinant of decreased adherence. Variables confirmed in the multiple-factor model as having an independent impact on the level of adherence include the type of condition suffered, female gender, education and professional status. Practical implication. The primary objective is to undertake actions whose aim is to improve adherence in order to enhance patients' functioning, reduce the number of follow-up visits and the hospitalisation rate, and thus limit the economic consequences of treating disease complications.
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Affiliation(s)
- Beata Jankowska-Polańska
- Department of Clinical Nursing, Public Health Department, Wroclaw Medical University, 5 Bartla Street, 51-618 Wrocław, Poland.
| | - Natalia Świątoniowska-Lonc
- Department of Clinical Nursing, Public Health Department, Wroclaw Medical University, 5 Bartla Street, 51-618 Wrocław, Poland.
| | - Piotr Karniej
- Department of Health Promotion, Public Health Department, Wroclaw Medical University, 5 Bartla Street, 51-618 Wrocław, Poland.
| | - Jacek Polański
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, 213 Borowska street, 50-556 Wrocław, Poland.
| | - Wojciech Tański
- 4th Military Teaching Hospital, 5 Weigla street, 50-981 Wrocław, Poland.
| | - Elżbieta Grochans
- Department of Nursing, Pomeranian Medical University in Szczecin, 1 Rybacka street, 70-204 Szczecin, Poland.
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16
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Ibrahim KM, Schommer JC, Morisky DE, Rodriguez R, Gaither C, Snyder M. The Association between Medication Experiences and Beliefs and Low Medication Adherence in Patients with Chronic Disease from Two Different Societies: The USA and the Sultanate of Oman. PHARMACY 2021; 9:pharmacy9010031. [PMID: 33546425 PMCID: PMC7931077 DOI: 10.3390/pharmacy9010031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 12/03/2022] Open
Abstract
This cross-sectional study aimed to describe the association between medication experiences and beliefs and self-reported medication adherence in patients with chronic diseases in two different samples from two different societies: the USA and the Sultanate of Oman. The Morisky Medication Adherence Score (MMAS-8) questionnaire was used to measure medication adherence. Three items (statements) were used for measuring medication experiences and beliefs variable on a four-point Likert scale adapted from the 2015 National Consumer Survey of the Medication Experience and Pharmacists’ Role (NCSME&PR). In the U.S., quantitative secondary data analysis of 13,731 participants was conducted using the 2015 NCSME&PR, a self-administered online survey coordinated by Qualtrics Panels between 28 April 2015 and 22 June 2015. The same variables were translated into Arabic, with studies conducted at the Royal Court Medical Center in Oman, and data from 714 participants were collected between 16 June 2019 and 16 August 2019. Data were analyzed using IMB/SPSS version 24.0 software. Chi-square analysis and descriptive statistics were used. The results showed that the low adherence rates for medication (MMAS-8 < 6) were 56% and 52% in Omani and U.S. groups, respectively. Approximately 90% of the U.S. and Omani participants believed that “medicines are a life-saver”; however, medication adherence was higher in Oman (30%) than in the United States (9%) for these participants. In total, 60% of the U.S. and 29% of Omani participants believed that “medicines are a burden”; however, about 60–65% of participants in both countries were in the low medication adherence group. Additionally, 63% of the U.S. and 83% of the Omani participants disagreed that “medicines do more harm than good”; however, medication adherence in the U.S. (15%) was higher than in Oman (8%). In conclusion, a decrease in low medication adherence was observed with positive medication experiences and beliefs. However, the impacts of medication experiences and beliefs on low medication adherence rates were different from one population to another. The “medication burden” statement resulted in the highest percentage of difference in terms of low medication adherence rates between those who agree and those who disagree in the U.S. group (20%), whereas the “medicines are a life-saver” statement resulted in a greater difference in the Omani group (30%). Proper communication between patients and healthcare providers based on the patient’s medication experiences and beliefs will substantially improve medication adherence.
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Affiliation(s)
- Kamla M. Ibrahim
- Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA; (J.C.S.); (R.R.); (C.G.)
- Correspondence:
| | - Jon C. Schommer
- Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA; (J.C.S.); (R.R.); (C.G.)
| | - Donald E. Morisky
- Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA;
| | - Raquel Rodriguez
- Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA; (J.C.S.); (R.R.); (C.G.)
| | - Caroline Gaither
- Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA; (J.C.S.); (R.R.); (C.G.)
| | - Mark Snyder
- Center for the Study of the Individual and Society, Department of Psychology, College of Liberal Arts, University of Minnesota, Minneapolis, MN 55455, USA;
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17
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Valgimigli M, Garcia-Garcia HM, Vrijens B, Vranckx P, McFadden EP, Costa F, Pieper K, Vock DM, Zhang M, Van Es GA, Tricoci P, Baber U, Steg G, Montalescot G, Angiolillo DJ, Serruys PW, Farb A, Windecker S, Kastrati A, Colombo A, Feres F, Jüni P, Stone GW, Bhatt DL, Mehran R, Tijssen JGP. Standardized classification and framework for reporting, interpreting, and analysing medication non-adherence in cardiovascular clinical trials: a consensus report from the Non-adherence Academic Research Consortium (NARC). Eur Heart J 2020; 40:2070-2085. [PMID: 29992264 DOI: 10.1093/eurheartj/ehy377] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/20/2018] [Accepted: 07/04/2018] [Indexed: 01/02/2023] Open
Abstract
Non-adherence has been well recognized for years to be a common issue that significantly impacts clinical outcomes and health care costs. Medication adherence is remarkably low even in the controlled environment of clinical trials where it has potentially complex major implications. Collection of non-adherence data diverge markedly among cardiovascular randomized trials and, even where collected, is rarely incorporated in the statistical analysis to test the consistency of the primary endpoint(s). The imprecision introduced by the inconsistent assessment of non-adherence in clinical trials might confound the estimate of the calculated efficacy of the study drug. Hence, clinical trials may not accurately answer the scientific question posed by regulators, who seek an accurate estimate of the true efficacy and safety of treatment, or the question posed by payers, who want a reliable estimate of the effectiveness of treatment in the marketplace after approval. The Non-adherence Academic Research Consortium is a collaboration among leading academic research organizations, representatives from the U.S. Food and Drug Administration and physician-scientists from the USA and Europe. One in-person meeting was held in Madrid, Spain, culminating in a document describing consensus recommendations for reporting, collecting, and analysing adherence endpoints across clinical trials. The adoption of these recommendations will afford robustness and consistency in the comparative safety and effectiveness evaluation of investigational drugs from early development to post-marketing approval studies. These principles may be useful for regulatory assessment, as well as for monitoring local and regional outcomes to guide quality improvement initiatives.
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Affiliation(s)
- Marco Valgimigli
- Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland
| | - Hector M Garcia-Garcia
- Interventional Cardiology Department, MedStar Washington Hospital Center, Washington, DC, USA
| | - Bernard Vrijens
- Department of Biostatistics, University of Liège, Liège, Wallonia, Belgium
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium.,Faculty of Medicine and Life Sciences Hasselt University, Hasselt, Belgium
| | | | - Francesco Costa
- Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland.,Department of Clinical and Experimental Medicine, Policlinic "G Martino", University of Messina, Italy
| | - Karen Pieper
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - David M Vock
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Min Zhang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Pierluigi Tricoci
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Usman Baber
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gabriel Steg
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, Paris, France
| | - Gilles Montalescot
- Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Patrick W Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, London, UK
| | - Andrew Farb
- Division of Cardiovascular and Renal Products, Center for Drug Evaluation and Research, Food and Drug Administration
| | - Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Antonio Colombo
- Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Department, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Fausto Feres
- Division of Cardiology, Istituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Peter Jüni
- Institute of Primary Health Care, Toronto, Canada
| | - Gregg W Stone
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, USA
| | - Roxana Mehran
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jan G P Tijssen
- European Cardiovascular Research Institute, Rotterdam, The Netherlands.,Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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18
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Chen PF, Chang EH, Unni EJ, Hung M. Development of the Chinese Version of Medication Adherence Reasons Scale (ChMAR-Scale). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5578. [PMID: 32748853 PMCID: PMC7432295 DOI: 10.3390/ijerph17155578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 11/17/2022]
Abstract
Medication non-adherence is a concern in chronic disease management. Currently, there is no scale that characterizes sufficient non-adherent reasons for practical use in the Chinese population. This study developed and validated the Chinese version of the Medication Adherence Reasons Scale (ChMAR-Scale) and described non-adherence reasons in adult patients taking blood pressure medicine in Taiwan. A forward-backward procedure was used to translate the original MAR-Scale, and new items pertinent to cultural differences were added. Patients aged above 20 years old who were taking blood pressure medicine were recruited from a regional hospital and eight community pharmacies in the Taipei metropolitan area. Data analyses were conducted with IBM SPSS 19 (Armonk, NY, USA). Exploratory factor analysis revealed six domains, including belief, self-perception, forgetfulness, management, availability, and miscellaneous issues, with Cronbach's alphas ranging from 0.649 to 0.852, item-total correlations ranging from 0.362 to 0.719, and factor loadings ranging from 0.365 to 0.775. Criterion-related validity with the visual analog scale and two global items were 0.525, 0.436, and 0.502. Forgetfulness, belief issues, and self-perception issues were the most common non-adherence reasons. In conclusion, the ChMAR-Scale showed good psychometric properties and identified more reasons for medication non-adherence than other existing scales. Healthcare providers should be vigilant of these problems while consulting patients.
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Affiliation(s)
- Pin-Fang Chen
- Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei 110301, Taiwan;
| | - Elizabeth H. Chang
- Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei 110301, Taiwan;
- Department of Pharmacy, Wan Fang Hospital, Taipei Medical University, Taipei 116081, Taiwan
- Research Center for Pharmacoeconomics, College of Pharmacy, Taipei Medical University, Taipei 110301, Taiwan
| | - Elizabeth J. Unni
- Department of Social, Behavioral, and Administrative Sciences, Touro College of Pharmacy, New York, NY 10027, USA;
| | - Man Hung
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA;
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19
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Abstract
A sarcoidosis patient may be refractory to corticosteroid therapy. This may be because corticosteroids are ineffective in relieving the sarcoidosis patient's symptoms/dysfunction or because the clinician has determined that the risks of corticosteroids outweigh their benefits. Interestingly, when corticosteroids truly fail to improve a sarcoidosis patient's condition, it is very rarely because of failure of the drug as an anti-granulomatous agent; rather, it is usually because the patient's symptoms were unrelated to active sarcoid granulomas. In this manuscript, we review the causes of corticosteroid refractory sarcoidosis. The clinician should consider these causes when confronted with a sarcoidosis patient who is either not responding to corticosteroids, developing corticosteroid side-effects, or is at significant risk of developing such side-effects. We believe that determining the cause of corticosteroid refractory sarcoidosis may aid the clinicians in optimizing the care of sarcoidosis patients and clinical researchers in appropriately stratifying patients for clinical trials.
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20
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Maliyar K, O'Toole A, Gooderham MJ. Long-Term Single Center Experience in Treating Plaque Psoriasis With Guselkumab. J Cutan Med Surg 2020; 24:588-595. [PMID: 32510235 DOI: 10.1177/1203475420932514] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinical trial data have shown guselkumab, an interleukin-23 inhibitor, to be efficacious and safe for the treatment of psoriasis. However, there is very little real-world experience using guselkumab in the community setting that has been documented. OBJECTIVES The goal of this study was to determine real-life outcomes of guselkumab use in patients with moderate-to-severe psoriasis in a community dermatology practice. METHODS A retrospective chart review of electronic medical records was conducted in patients with moderate-to-severe psoriasis who were prescribed guselkumab at a community dermatology office in Ontario, Canada. RESULTS Of the 89 patients who received at least 1 dose of guselkumab, 79 had follow-up information at the time of review, with 71 patients receiving ongoing treatment. In our cohort of patients, 73.3% achieved clinically significant clearance of psoriasis with a global assessment of clear or almost clear defined as a body surface area involvement of <1%. Guselkumab was generally well tolerated and caused no serious adverse events. The most common reported side effects were nasopharyngitis, headaches, upper respiratory tract infections, gastrointestinal upset, and arthralgia. CONCLUSION Overall, guselkumab was a safe and well-tolerated treatment with significant clinical improvement in our patient population.
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Affiliation(s)
- Khalad Maliyar
- 7938 Faculty of Medicine, University of Toronto, ON, Canada
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21
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Abstract
Elderly patients are the main users of drugs and they differ from younger patients. They are a heterogeneous population that cannot be defined only by age but should rather be stratified based on their frailty. The elderly have distinctive pharmacokinetic and pharmacodynamic characteristics, are frequently polymorbid, and are therefore treated with multiple drugs. They may experience adverse reactions that are difficult to recognize, since some of them present non-specific symptoms easily mistaken for geriatric conditions. Paradoxically, the elderly are underrepresented in clinical trials, especially the frail individuals whose pharmacological response and expected treatment outcome can be different from those of non-frail patients. This means that the benefit-risk balance of drugs used in frail elderly patients is frequently unknown. We present some proposals to overcome the barriers preventing the enrollment of frail elderly patients in clinical trials, and strategies for monitoring their therapy to minimize the risk of adverse reactions. Automated alerts for drug and drug-disease interactions could help appropriate prescribing but should flag only clinically relevant interactions. Pharmaceutical forms should be designed to allow easy dose adjustment and, together with packaging and labeling, should account for the physical and cognitive limitations of frail elderly patients. Aggregate pharmacovigilance reports should summarize the safety profile in the elderly, but rather than presenting the results by age they should focus on patients' frailty, perhaps using the number of comorbidities as a proxy when information on frailty is not available.
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22
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Sbarigia U, Kariburyo F, Sah J, Colasurdo J, Xie L, Katz EG, Sylvester S. Evaluating the Effect of Standard of Care Treatment on Burden of Chronic Hepatitis B: A Retrospective Analysis of the United States Veterans Population. Adv Ther 2020; 37:1156-1172. [PMID: 32009232 PMCID: PMC7089729 DOI: 10.1007/s12325-020-01240-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Indexed: 12/13/2022]
Abstract
Introduction This study aimed to characterize chronic hepatitis B (CHB)-infected patients and estimate the association between nucleos(t)ide analogue (NA) persistence and economic outcomes using data from the Veterans Health Administration (VHA) database. Methods Patients (at least 18 years of age) with two or more claims for CHB and at least one pharmacy claim for NA were identified using VHA data from 1 April 2013 to 31 March 2018. The index date was the first NA prescription fill date during 1 October 2014 to 31 March 2017. Persistence and non-persistence to NA treatment were assessed during the first 2 years post index date. Non-persistence was defined as at least one failure to refill medication within 30 days from the run-out date. Generalized linear models were used to compare health care utilization and costs between persistent and non-persistent patients. Results Among patients treated with NAs (N = 2368), 1428 (60%) were CHB mono-infected and 748 (32%) were HIV co-infected. Total costs per patient per year (PPPY) were $39,240, $29,957, and $55,220 PPPY for NA-treated, mono-infected, and HIV co-infected patients, respectively. An inception cohort of 564 patients (24%), without a NA prescription in the 6 months pre-index period and at least 2 years of follow-up, was created. Persistence among the inception cohort was 29% for first year and 14% for first 2 years. After adjustment for baseline differences, persistent patients had lower cumulative overall health care costs compared to non-persistent patients, with a net cost saving of $851 (p > 0.05) in the first 2 years. Conclusion CHB is associated with considerable economic burden. We observed suboptimal persistence to NAs which decreased over time. Short-term savings could be generated for CHB-infected patients when they remain persistent to NAs. Electronic supplementary material The online version of this article (10.1007/s12325-020-01240-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Urbano Sbarigia
- Janssen Scientific Affairs, Pharmaceutica NV, Global Health Economics and Market Access, Beerse, Belgium
| | - Furaha Kariburyo
- STATinMED Research, Health Economics and Outcomes Research, Ann Arbor, MI, USA.
| | - Janvi Sah
- STATinMED Research, Health Economics and Outcomes Research, Ann Arbor, MI, USA
| | - Jamie Colasurdo
- Janssen Research and Development, Epidemiology, Raritan, NJ, USA
| | - Lin Xie
- STATinMED Research, Health Economics and Outcomes Research, Ann Arbor, MI, USA
| | - Eva G Katz
- Janssen Research and Development, Epidemiology, Raritan, NJ, USA
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Alkhawaldeh JMA, Soh KL, Mukhtar FBM, Ooi CP. Effectiveness of stress management interventional programme on occupational stress for nurses: A systematic review. J Nurs Manag 2020; 28:209-220. [PMID: 31887233 DOI: 10.1111/jonm.12938] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 12/07/2019] [Accepted: 12/20/2019] [Indexed: 02/03/2023]
Abstract
AIM The purpose of this systematic review is to evaluate the effectiveness of stress management interventional programme in reducing occupational stress among nurses. BACKGROUND Nursing professionals are placed continuously at the forefront in the area of health care which makes them highly exposed to professional stress. EVALUATION Randomized controlled trial studies (RCTs) were systematically searched in eight different databases for works published in English from 2011 to 2019; inclusion criteria were applied by two reviewers critically and assessed the risk of bias using Consolidated Standards of Reporting Trials (CONSORT). KEY ISSUES The systematic search contributed to the extraction of approximately 10 most relevant RCTs. Most of the RCTs considered in this systematic review revealed that the stress reduction interventions and strategies were effective in reducing the levels of occupational stress experienced by nurses. CONCLUSIONS Current review shows that stress management interventional programme tends to be effective, but additional well-designed RCTs are needed to confirm their effectiveness. IMPLICATIONS FOR NURSING MANAGEMENT Implementing stress management interventions within health care organisations are likely to assist nurses in reducing occupational stress and in improving coping strategies used by nurses for dealing with stress.
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Affiliation(s)
- Ja'far Mohammad Aqeel Alkhawaldeh
- Department of Nursing and Rehabilitation, Faculty of Medicines and Health Sciences, University Putra Malaysia (UPM), Serdang, Malaysia.,Faculty of Nursing, Isra University, Amman, Jordan
| | - Kim Lam Soh
- Department of Nursing and Rehabilitation, Faculty of Medicines and Health Sciences, University Putra Malaysia (UPM), Serdang, Malaysia
| | - Firdaus Binti Mamat Mukhtar
- Department of Psychiatry, Faculty of Medicines And Health Sciences, University Putra Malaysia (UPM), Serdang, Malaysia
| | - Cheow Peng Ooi
- Department of Medicine, Faculty of Medicines and Health Sciences, University Putra Malaysia (UPM), Serdang, Malaysia
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Reeves L, Robinson K, McClelland T, Adedoyin CA, Broeseker A, Adunlin G. Pharmacist Interventions in the Management of Blood Pressure Control and Adherence to Antihypertensive Medications: A Systematic Review of Randomized Controlled Trials. J Pharm Pract 2020; 34:480-492. [PMID: 32067555 DOI: 10.1177/0897190020903573] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Pharmacists are ideally positioned to promote optimal use and assess the adherence of prescription medications in patients with chronic diseases. This systematic review of randomized controlled trials (RCTs) ascertains the effectiveness of pharmacist interventions to improve blood pressure (BP) control and medication adherence in patients with hypertension. DATA SOURCES Electronic databases were searched for studies in English published between January 1, 1995, and January 31, 2018. Eligibility criteria included patients with a diagnosis of hypertension tested with RCT where pharmacist-led interventions occurred. The primary outcome was BP control and the secondary outcome was adherence to hypertensive medication. Quality of studies was assessed using the Cochrane Risk of Bias Tool. DATA SYNTHESIS Thirty-five studies met the inclusion-exclusion criteria and were included in this study. Major themes included pharmacist-led interventions with medication counseling, patient education, distribution of interventions materials, individualized care plans, and check-in meetings. The vast majority of trials (n = 29) showed statistically significant improvement in BP in the intervention groups at follow-up. Of the 35 studies, most (n = 20) assessed medication adherence; several trials (n = 9) showed statistically significant improvement in medication adherence in patients receiving additional pharmaceutical care services. None of the RCTs was considered to have a high risk of bias. CONCLUSION Pharmacist-led interventions improved BP control and medication adherence through education, counseling, or a combination of both. Future research is needed to determine the most effective pharmacists' interventions in managing hypertension and to assess the cost-effectiveness of these interventions.
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Affiliation(s)
- Landon Reeves
- McWhorter School of Pharmacy, 1744Samford University, Birmingham, AL, USA
| | - Kristian Robinson
- McWhorter School of Pharmacy, 1744Samford University, Birmingham, AL, USA
| | - Taylor McClelland
- McWhorter School of Pharmacy, 1744Samford University, Birmingham, AL, USA
| | - Christson A Adedoyin
- Department of Social Work, School of Public Health, 1744Samford University, Birmingham, AL, USA
| | - Amy Broeseker
- McWhorter School of Pharmacy, 1744Samford University, Birmingham, AL, USA
| | - Georges Adunlin
- McWhorter School of Pharmacy, 1744Samford University, Birmingham, AL, USA
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Ojieabu W. Pharmacist’s contribution to medication adherence among patients with type 2 diabetes in endocrinology clinic. JOURNAL OF DIABETOLOGY 2020. [DOI: 10.4103/jod.jod_16_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Dermody SS, Wardell JD, Stoner SA, Hendershot CS. Predictors of Daily Adherence to Naltrexone for Alcohol Use Disorder Treatment During a Mobile Health Intervention. Ann Behav Med 2019; 52:787-797. [PMID: 30124761 DOI: 10.1093/abm/kax053] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Adherence to medications for treating alcohol use disorder (AUD) is poor. To identify predictors of daily naltrexone adherence over time, a secondary data analysis was conducted of a trial evaluating a mobile health intervention to improve adherence. Methods Participants seeking treatment for AUD (n = 58; Mage = 38 years; 71% male) were prescribed naltrexone for 8 weeks. Adherence was tracked using the Medication Event Monitoring System (MEMS). In response to daily text messages, participants reported the previous day's alcohol use, craving, and naltrexone side effects. Using multilevel structural equation modeling (MSEM), we examined baseline dispositional factors and within-person, time-varying factors as predictors of daily adherence. Results Naltrexone adherence decreased over time. Adherence was higher on days when individuals completed daily mobile assessments relative to days when they did not (odds ratio [OR] = 2.53, 95% confidence interval [CI] 1.61 to 3.98), irrespective of intervention condition. Days when individuals drank more than their typical amount were related to lower next-day adherence (OR = 0.93, 95% CI 0.88 to 0.99). A similar pattern was supported for craving (OR = 0.88, 95% CI 0.79 to 0.98). Weekend days were associated with lower adherence than weekdays (OR = 0.71, 95% CI 0.58 to 0.86); this effect was partly mediated by heavier daily drinking (indirect effect = -0.02, 95% CI -0.04 to -0.003) and stronger-than-usual craving (indirect effect = -0.01, 95% CI -0.02 to 0.00) on weekend days. Conclusions The results further demonstrate the need to improve adherence to AUD pharmacotherapy. The present findings also support developing interventions that target daily-level risk factors for nonadherence. Mobile health interventions may be one means of developing tailored and adaptive adherence interventions.
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Affiliation(s)
- Sarah S Dermody
- School of Psychological Science, Oregon State University, Corvallis, USA.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jeffery D Wardell
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Susan A Stoner
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA
| | - Christian S Hendershot
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Horii T, Momo K, Yasu T, Kabeya Y, Atsuda K. Determination of factors affecting medication adherence in type 2 diabetes mellitus patients using a nationwide claim-based database in Japan. PLoS One 2019; 14:e0223431. [PMID: 31593574 PMCID: PMC6782087 DOI: 10.1371/journal.pone.0223431] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 09/20/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The extent of medication adherence in patients with type 2 diabetes mellitus (T2DM) several years after starting treatment with hypoglycemic agents remains unknown. Most previous work on medication adherence targeting this group of patients has been undertaken across a single year or is questionnaire based. This study aimed to determine medication adherence status and factors affecting adherence 3 years after initiation of hypoglycemic agents, using a nationwide medical claim-based database in Japan. METHODS This retrospective study was conducted on data from 884 subjects with T2DM to better understand medication adherence, the effects of polypharmacy, and other factors. We also investigated the effects of medication nonadherence on hemoglobin A1c levels. Proportion of days covered was defined as the number of days for which a hypoglycemic agent was prescribed and in the patient's possession to the number of days in the observation period. A proportion of days covered ≥0.8 were considered adherent, and those with a value <0.8 as nonadherence. Polypharmacy was defined as taking ≥5 medications. RESULTS Of the 884 patients investigated, 440 were considered adherent during the study period. Significant factors related to adherence included number of medications (3 or 4, or ≥5), male sex, age 50-<60 years, and total number of visits ≥17. Medication adherence was also a factor related to patients with hemoglobin A1c values < 7.0% at the end of the observation period. CONCLUSIONS We surveyed medication adherence for 3 years with post medication initiation, and found that subjects aged 50-<60 years, those with ≥3 concomitant medications, and those with a total number of visits ≥17 were more likely to be adherent and persistent, and more likely to continue their hypoglycemic agents. A high degree of medication adherence was found to have a positive influence on hemoglobin A1c levels.
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Affiliation(s)
- Takeshi Horii
- Research and Education Center for Clinical Pharmacy, Division of Clinical Pharmacy, Laboratory of Pharmacy Practice and Science 1, Kitasato University School of Pharmacy, Kanagawa, Japan
| | - Kenji Momo
- Department of Pharmacy, The Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Department of Hospital Pharmaceutics, School of pharmacy, Showa University, Tokyo, Japan
| | - Takeo Yasu
- Department of Medicinal Therapy Research, Pharmaceutical Education and Research Center, Meiji Pharmaceutical University, Tokyo, Japan
| | - Yusuke Kabeya
- Department of Home Care Medicine, Sowa Hospital, Kanagawa, Japan
| | - Koichiro Atsuda
- Research and Education Center for Clinical Pharmacy, Division of Clinical Pharmacy, Laboratory of Pharmacy Practice and Science 1, Kitasato University School of Pharmacy, Kanagawa, Japan
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Elsayed MA, El-Sayed NM, Badi S, Ahmed MH. Factors affecting adherence to antiepileptic medications among Sudanese individuals with epilepsy: A cross-sectional survey. J Family Med Prim Care 2019; 8:2312-2317. [PMID: 31463248 PMCID: PMC6691456 DOI: 10.4103/jfmpc.jfmpc_405_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Nonadherence to medication is widespread in epilepsy and other chronic diseases. Studies reporting adherence to antiepileptic medications are very limited in African countries. Adherence reports from low income African countries are few in contrast to multiple studies from high-income countries. Therefore, the aim of this study is to measure the level of adherence to antiepileptic medication in Sudanese population. Methods: A descriptive cross-sectional study of 96 individuals with epilepsy recruited from neurology outpatient clinics in three tertiary centers in Sudan. Data were collected by using a structured questionnaire containing Morisky Medication Adherence Scale-4 (MMAS-4) and Belief about Medication Questionnaire and analyzed by statistical package of social sciences. Results: About 35% of patients were estimated to be nonadherent. Most of the patients (93%) acknowledged their need for antiepileptic drugs. However, 35% had high concern score. Adherence is affected by attitude toward antiepileptic drugs (AEDs) and presence of side effects to AEDs. The relation between side effects and adherence was significant (P value 0.000). Furthermore, there was a statistically insignificant relation between the number of drugs used and adherence (P value 0.002). There was a significant relation between adherence, necessity mean score, concern mean score, and necessity concern differential P value 0.000 for all. Conclusion: Nonadherence to antiepileptic medication was reported in almost in one third of individuals in this cohort. There were statistically significant associations between nonadherence and both side effects and number of medications used in the treatment of epilepsy. Therefore, family physician should always check compliance with antiepileptic medication. Patient's education about adherence to medication through family physician may in part decrease the recurrence of epileptic seizures. Further research is needed to explore ways to increase adherence with AEDs in a low resource country like Sudan.
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Affiliation(s)
- Muaz A Elsayed
- Department of Neurology, Faculty of Medicine, Omdurman Islamic University, Omdurman Teaching Hospital, Khartoum, Sudan
| | | | - Safaa Badi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Omdurman Islamic University, Khartoum, Sudan
| | - Mohamed H Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eagelstone, Milton Keynes, Buckinghamshire, UK
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López-Campos JL, Quintana Gallego E, Carrasco Hernández L. Status of and strategies for improving adherence to COPD treatment. Int J Chron Obstruct Pulmon Dis 2019; 14:1503-1515. [PMID: 31371936 PMCID: PMC6628097 DOI: 10.2147/copd.s170848] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/05/2019] [Indexed: 12/19/2022] Open
Abstract
Despite the wide application of adherence as a concept, the definition, evaluation and improvement of the adherence to treatment by patients with chronic obstructive pulmonary disease (COPD) still present some challenges. First, it is necessary to clearly define the concepts of treatment adherence, compliance and persistence. Second, it is critical to consider the various methods of evaluating and quantifying adherence when interpreting adherence studies. In addition, the advantages and disadvantages of the different ways of measuring treatment adherence should be taken into account. Another subject of some debate is the number of variables associated with COPD treatment adherence. Adherence is a complex concept that goes beyond the dosage or the use of inhalation devices, and a number of variables are involved in determining adherence, from the clinical aspects of the disease to the patient's confidence in the doctor's expertise and the level of social support experienced by the patient. Notably, despite these challenges, the importance of adherence has been well established by clinical trials and routine clinical practice. The available evidence consistently shows the substantial impact that a lack of adherence has on the control of the disease and its long-term prognosis. For these reasons, the correct evaluation of therapeutic adherence should be a key objective in clinical interviews of patients. In recent years, various initiatives for improving adherence have been explored. All these initiatives have been based on patient education. Therefore, health care professionals should be aware of the issues pertaining to adherence and take the opportunity to educate patients each time they contact the health care system.
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Affiliation(s)
- José Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Esther Quintana Gallego
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Carrasco Hernández
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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30
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Golomb D, Nevo A, Goldberg H, Ehrlich Y, Margel D, Lifshitz D. Long-Term Adherence to Medications in Secondary Prevention of Urinary Tract Stones. J Endourol 2019; 33:469-474. [DOI: 10.1089/end.2019.0040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Dor Golomb
- Department of Urology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amihay Nevo
- Department of Urology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hanan Goldberg
- Department of Urology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Ehrlich
- Department of Urology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Margel
- Department of Urology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Lifshitz
- Department of Urology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
Introduction Patients with hypothyroidism are managed with life-long levothyroxine (LT4) therapy. However, as with other chronic illnesses, drug adherence (DA) is a prominent issue in these patients. The aim of this study is to identify the extent of DA to LT4 in hypothyroidism patients and study the clinical factors contributing to DA in these patients. Methods This cross-sectional study assessed patient adherence to LT4 therapy by Modified Morisky Adherence Scale (MMAS). Factors predicting the pattern of medication adherence were also assessed in all patients. Data were entered and analyzed using SPSS v. 22.0. Results On MMAS, 79 (27.3%) participants indicated low adherence, 117 (40.48%) indicated medium adherence, and 93 (32.2%) participants indicated high adherence. Regular endocrinologist visits and knowledge about medication were highest in high adherent patients (p < 0.05). Need for assistance in taking medication, avoidance of medication with symptomatic relief and busy work schedule was highest in low adherent patients (p < 0.05). Conclusion Patients with hypothyroidism showed moderate adherence to their treatment.
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Affiliation(s)
- Rohan Kumar
- Medical Education and Simulation, Jinnah Sindh Medical University, Karachi, PAK
| | - Faizan Shaukat
- Internal Medicine, Jinnah Postgraduate Medical Center, Karachi, PAK
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Steinkamp JM, Goldblatt N, Borodovsky JT, LaVertu A, Kronish IM, Marsch LA, Schuman-Olivier Z. Technological Interventions for Medication Adherence in Adult Mental Health and Substance Use Disorders: A Systematic Review. JMIR Ment Health 2019; 6:e12493. [PMID: 30860493 PMCID: PMC6434404 DOI: 10.2196/12493] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/13/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Medication adherence is critical to the effectiveness of psychopharmacologic therapy. Psychiatric disorders present special adherence considerations, notably an altered capacity for decision making and the increased street value of controlled substances. A wide range of interventions designed to improve adherence in mental health and substance use disorders have been studied; recently, many have incorporated information technology (eg, mobile phone apps, electronic pill dispensers, and telehealth). Many intervention components have been studied across different disorders. Furthermore, many interventions incorporate multiple components, making it difficult to evaluate the effect of individual components in isolation. OBJECTIVE The aim of this study was to conduct a systematic scoping review to develop a literature-driven, transdiagnostic taxonomic framework of technology-based medication adherence intervention and measurement components used in mental health and substance use disorders. METHODS This review was conducted based on a published protocol (PROSPERO: CRD42018067902) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review guidelines. We searched 7 electronic databases: MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, Web of Science, Engineering Village, and ClinicalTrials.gov from January 2000 to September 2018. Overall, 2 reviewers independently conducted title and abstract screens, full-text screens, and data extraction. We included all studies that evaluate populations or individuals with a mental health or substance use disorder and contain at least 1 technology-delivered component (eg, website, mobile phone app, biosensor, or algorithm) designed to improve medication adherence or the measurement thereof. Given the wide variety of studied interventions, populations, and outcomes, we did not conduct a risk of bias assessment or quantitative meta-analysis. We developed a taxonomic framework for intervention classification and applied it to multicomponent interventions across mental health disorders. RESULTS The initial search identified 21,749 results; after screening, 127 included studies remained (Cohen kappa: 0.8, 95% CI 0.72-0.87). Major intervention component categories include reminders, support messages, social support engagement, care team contact capabilities, data feedback, psychoeducation, adherence-based psychotherapy, remote care delivery, secure medication storage, and contingency management. Adherence measurement components include self-reports, remote direct visualization, fully automated computer vision algorithms, biosensors, smart pill bottles, ingestible sensors, pill counts, and utilization measures. Intervention modalities include short messaging service, mobile phone apps, websites, and interactive voice response. We provide graphical representations of intervention component categories and an element-wise breakdown of multicomponent interventions. CONCLUSIONS Many technology-based medication adherence and monitoring interventions have been studied across psychiatric disease contexts. Interventions that are useful in one psychiatric disorder may be useful in other disorders, and further research is necessary to elucidate the specific effects of individual intervention components. Our framework is directly developed from the substance use disorder and mental health treatment literature and allows for transdiagnostic comparisons and an organized conceptual mapping of interventions.
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Affiliation(s)
| | - Nathaniel Goldblatt
- Outpatient Addiction Services, Department of Psychiatry, Cambridge Health Alliance, Somerville, MA, United States
| | | | - Amy LaVertu
- Tufts University School of Medicine, Boston, MA, United States
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York City, NY, United States
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Zev Schuman-Olivier
- Outpatient Addiction Services, Department of Psychiatry, Cambridge Health Alliance, Somerville, MA, United States.,Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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Kim HJ, Jeong HE, Bae JH, Baek YH, Shin JY. Characteristics and trends of spontaneous reporting of therapeutic ineffectiveness in South Korea from 2000 to 2016. PLoS One 2019; 14:e0212905. [PMID: 30817781 PMCID: PMC6395031 DOI: 10.1371/journal.pone.0212905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 02/12/2019] [Indexed: 11/18/2022] Open
Abstract
Therapeutic ineffectiveness involves drug-related therapeutic failure, inefficacy or resistance and has not been sufficiently studied. Objective of our study was to evaluate reporting trends in therapeutic ineffectiveness by year and describe factors affecting therapeutic ineffectiveness using the Korea Adverse Event Reporting System. Proportion of therapeutic ineffectiveness reports was based on total submitted reports between 2000 and 2016. Utilizing 2016 alone, we compared the characteristics of therapeutic ineffectiveness with age group and gender matching by random extraction. We conducted a logistic regression analysis to estimate reporting odds ratios (ROR) and its 95% confidence intervals (CI) for reports by type of reporters, e.g., doctors, pharmacists, or consumers. We presented most frequent reports by the anatomical main groups and therapeutic subgroups according to the Anatomical Therapeutic Chemical (ATC) classification system. For the 17-years, the proportion of therapeutic ineffectiveness adverse drug reactions reporting ranged from 0.0% to 3.7% between 2000 and 2016. Of 228,939 reports, 2,797 (1.2%) were submitted in 2016. Consumers accounted for 6.92% of reports and doctors accounted for 45.49%, in which, consumers were more likely to report therapeutic ineffectiveness than doctors (adjusted ROR 3.98; 95% CI, 2.92 to 5.41). According to the ATC classification system, "nervous system" was the most frequently reported anatomical group (18.7%) and "parathyroid hormones and analogues" was reported most frequently in the pharmacological subgroup (23.7%). Teriparatide, a drug used to treat osteoporosis, had the most reports (11.0%). Therapeutic ineffectiveness reports may be used as a scientific tool for the reevaluation of respective drugs in order to confirm of its therapeutic effects.
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Affiliation(s)
- Hye-Jun Kim
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Han Eol Jeong
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Ji-Hwan Bae
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Yeon-Hee Baek
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
- * E-mail:
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Hameed MA, Dasgupta I. Medication adherence and treatment-resistant hypertension: a review. Drugs Context 2019; 8:212560. [PMID: 30774692 PMCID: PMC6365088 DOI: 10.7573/dic.212560] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/28/2018] [Accepted: 01/02/2019] [Indexed: 12/11/2022] Open
Abstract
Nonadherence is a common reason for treatment failure and treatment resistance. No matter how it is defined, it is a major issue in the management of chronic illnesses. There are numerous methods to assess adherence, each with its own strengths and weaknesses; however, no single method is considered the best. Nonadherence is common in patients with hypertension, and it is present in a large proportion of patients with uncontrolled blood pressure taking three or more antihypertensive agents. Availability of procedure-based treatment options for these patients has shed further light on this important issue with development of new methods to assess adherence. There is, however, no consensus on the management of nonadherence, which reflects the complex interplay of factors responsible for it.
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Affiliation(s)
- Mohammed Awais Hameed
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, UK
| | - Indranil Dasgupta
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, UK
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35
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Nakagawa S, Nakaishi M, Hashimoto M, Ito H, Yamamoto W, Nakashima R, Tanaka M, Fujii T, Omura T, Imai S, Nakagawa T, Yonezawa A, Imai H, Mimori T, Matsubara K. Effect of medication adherence on disease activity among Japanese patients with rheumatoid arthritis. PLoS One 2018; 13:e0206943. [PMID: 30388179 PMCID: PMC6214559 DOI: 10.1371/journal.pone.0206943] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/21/2018] [Indexed: 11/19/2022] Open
Abstract
For the optimum efficacy of disease-modifying anti-rheumatic drugs (DMARDs), patients need to be adherent to their medication regimen. To clarify the effects of medication adherence on disease activity in Japanese patients with rheumatoid arthritis (RA), we conducted a cohort study in patients with various stages of RA. Patients were enrolled from the Kyoto University RA Management Alliance cohort, and followed up prospectively for 12 months. In this study, a total of 475 patients were analyzed and divided into 9 groups according to their medication adherence and the RA disease duration. The primary outcomes were based on the rate of a disease flare. The secondary outcomes were the changes in disease activity score using 28 joints (DAS28-ESR), simplified disease activity index (SDAI) and physical disability by health assessment questionnaire-disability index (HAQ). The changes in DAS28-ESR, HAQ, and the risk of disease flare in the highly adherent patients were significantly lower than those of the less adherent patients among the groups with RA ≤ 4.6 years but not those among the other groups. Taken together, this study identified a significant association between medication adherence and the disease flare during early-stage RA or short disease duration. These results emphasize the need to pay more attention to medication adherence in preventing the disease progression of RA.
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Affiliation(s)
- Shunsaku Nakagawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
- * E-mail:
| | - Mayumi Nakaishi
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Motomu Hashimoto
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiromu Ito
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Wataru Yamamoto
- Department of Health Information Management, Kurashiki Sweet Hospital, Kurashiki, Japan
| | - Ran Nakashima
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masao Tanaka
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takao Fujii
- Department of Clinical Immunology and Rheumatology, Wakayama Medical University, Wakayama, Japan
| | - Tomohiro Omura
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Satoshi Imai
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Takayuki Nakagawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Atsushi Yonezawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Hirohisa Imai
- Graduate School of Medicine, Department of Medical and Pharmaceutical Community Healthcare, the University of Tokyo, Tokyo, Japan
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuo Matsubara
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
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36
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Darbishire PL, Mashrah D. Comparison of Student and Patient Perceptions for Medication Non-adherence. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2018; 82:6444. [PMID: 30559498 PMCID: PMC6291675 DOI: 10.5688/ajpe6444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 10/10/2017] [Indexed: 06/09/2023]
Abstract
Objective. To compare pharmacy students' perceptions with patients' reasons for medication non-adherence. Methods. Pharmacy students completing an experiential rotation recruited patients exhibiting medication non-adherence from community pharmacies and asked them to respond to statements about reasons for their medication non-adherence. Patient responses were ranked in order of prevalence and compared to self-reported student perceptions on reasons for non-adherence. Results. There was a significant difference between patients' and students' rankings of reasons for medication non-adherence. Significant factors for patients included medications that interfere with lifestyle, sexual health and drinking alcohol; whereas, students believed that cognitive-related issues were patients' primary reasons for non-adherence to their medications. Conclusion. Educational opportunities to reflect on and discuss differing perspectives should be provided in the pharmacy curriculum to better equip students to address medication adherence issues and improve patient care.
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Affiliation(s)
- Patricia L. Darbishire
- Purdue University College of Pharmacy, West Lafayette, Indiana
- Editorial Board Member, American Journal of Pharmaceutical Education, Arlington, Virginia
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37
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Murage MJ, Tongbram V, Feldman SR, Malatestinic WN, Larmore CJ, Muram TM, Burge RT, Bay C, Johnson N, Clifford S, Araujo AB. Medication adherence and persistence in patients with rheumatoid arthritis, psoriasis, and psoriatic arthritis: a systematic literature review. Patient Prefer Adherence 2018; 12:1483-1503. [PMID: 30174415 PMCID: PMC6110273 DOI: 10.2147/ppa.s167508] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Proper adherence and persistence to medications are crucial for better quality of life and improved outcomes in rheumatoid arthritis (RA), psoriasis (PsO), and psoriatic arthritis (PsA). We systematically describe current adherence and persistence patterns for RA, PsO, and PsA, with a focus on biologics and identifying factors associated with adherence and persistence. PATIENTS AND METHODS Using various databases, a systematic literature review of US-based studies published from 2000 to 2015 on medication adherence and persistence to biologics and associated factors was conducted among patients with RA, PsO, and PsA. RESULTS Using the medication possession ratio or the percentage of days covered >80%, RA and PsO adherence rates for etanercept, adalimumab, and infliximab ranged from 16% to 73%, 21% to 70%, and 38% to 81%, respectively. Using the criteria of a ≥45-day gap, RA persistence rates for etanercept, adalimumab, and infliximab ranged from 46% to 89%, 42% to 94%, and 41% to 76%, respectively. In PsO, persistence rates for etanercept and adalimumab ranged from 34% to 50% and 50% to 62%, respectively. Similar persistence rates were observed in PsA. Experienced biologics users showed better adherence and persistence. Younger age, female gender, higher out-of-pocket costs, greater disease severity, and more comorbidities were associated with lower adherence and persistence rates. Qualitative surveys revealed that nonpersistence was partly due to perceived ineffectiveness and safety/tolerability concerns. CONCLUSION Biologic adherence and persistence rates in RA, PsO, and PsA in the United States were low, with significant opportunity for improvement. Various factors - including decrease in disease severity; reduction of comorbidities; lower out-of-pocket costs; refilling at specialty pharmacies; and awareness of drug effectiveness, safety, and tolerability - can inform targeted approaches to improve these rates.
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Affiliation(s)
| | | | - Steven R Feldman
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | | | | | - Russel T Burge
- Eli Lilly and Company, Indianapolis, IN, USA,
- University of Cincinnati, Division of Pharmaceutical Sciences, Winkle College of Pharmacy, Cincinnati, OH, USA
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Abstract
Obesity in adolescence will probably have major implications not only for the affected adolescents but also for society. Those who have obesity during adolescence usually have obesity into adulthood, which causes many medical and psychological issues that can result in premature death. Furthermore, obesity in adolescents is associated with a range of social problems, including difficulties securing an apprenticeship or a job or finding a partner. Adolescents with obesity are also at increased risk of having children with obesity later in life. All these consequences lead to high costs for the health-care system. Although efficient treatment options are available that have been proven in randomized controlled trials, such as lifestyle interventions for adolescents with obesity and bariatric surgery for adolescents with severe obesity, these interventions frequently fail in clinical practice as treatment adherence is low in adolescents and most adolescents with obesity do not seek medical care. Therefore, improving treatment adherence and identifying treatment barriers are necessary.
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Affiliation(s)
- Thomas Reinehr
- Department of Pediatric Endocrinology, Diabetes, and Nutrition Medicine, Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, Dr. Friedrich Steiner Street 5, Datteln 45711, Germany
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Khunti K, Seidu S, Kunutsor S, Davies M. Association Between Adherence to Pharmacotherapy and Outcomes in Type 2 Diabetes: A Meta-analysis. Diabetes Care 2017; 40:1588-1596. [PMID: 28801474 DOI: 10.2337/dc16-1925] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 04/25/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE A previous study suggests an association between poor medication adherence and excess mortality in chronic disease. The purpose of this study was to assess the association between medication adherence and risk of cardiovascular disease (CVD), all-cause mortality, and hospitalization in type 2 diabetes. RESEARCH DESIGN AND METHODS We conducted an electronic search on many electronic databases from inception to 27 April 2016. We selected randomized controlled trials and case-control and cohort studies reporting on CVD, all-cause mortality, or hospitalization outcomes by adherence in adults with type 2 diabetes. Two reviewers independently screened for eligible studies and extracted outcome data. Pooled relative risks (RRs) were calculated using a random-effects meta-analysis; risk of bias in each of the included studies was assessed using the GRADE approach. RESULTS Eight observational studies were included (n = 318,125). The mean rate of poor adherence was 37.8% (95% CI 37.6-38.0). Adjusted estimates were provided by five studies only. The RRs of good (≥80%) versus poor adherence to medication were 0.72 (95% CI 0.62-0.82, I2 = 0%, three studies) for all-cause mortality and 0.90 (0.87-0.94, I2 = 63%, seven studies) for hospitalization. No evidence of small study bias was observed. Only one study reported CVD outcomes by adherence. CONCLUSIONS We identified no trials reporting on outcomes by adherence, suggesting a systematic failure to include this information. Pooled estimates from available observational studies suggest that good medication adherence is associated with reduced risk of all-cause mortality and hospitalization in people with type 2 diabetes, although bias cannot be excluded as an explanation for these findings.
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Affiliation(s)
- Kamlesh Khunti
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, U.K. .,Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, U.K
| | - Samuel Seidu
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, U.K.,Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, U.K
| | - Setor Kunutsor
- School of Clinical Sciences, University of Bristol, Southmead Hospital, Southmead, U.K
| | - Melanie Davies
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, U.K.,Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, U.K
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40
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Lowndes BR, Finnie D, Hathaway J, Ridgeway JL, Vickers-Douglas K, Bruce C, Hallbeck MS. Iterative Implementation of a Remote Cardiac Patient Monitoring Device using Qualitative Analysis and Human Factors Engineering. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/1541931213601874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Remote monitoring has the potential to improve patient care and satisfaction while reducing the cost of care and burden on the healthcare system for Congestive Heart Failure (CHF) and Atrial Fibrillation (AF) patients. However, the device must be convenient and easy for the population to use correctly. In this study, human factors and qualitative researchers evaluated the use of a remote cardiac monitoring device during a clinical trial with 74 CHF and AF patients. Human factors usability concerns centered on device use and the information presented in the manual. The key themes identified during the qualitative analysis were related to patient education. These findings were incorporated into device design, user manual, or education material updates. This study illustrates how these methods can infuse patient experience into device design to inform continued quality improvement and usability refinement specifically in devices to aid CHF and AF patients without added burden.
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Affiliation(s)
- Bethany R Lowndes
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic
- Department of Health Sciences Research, Mayo Clinic
| | - Dawn Finnie
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic
| | | | - Jennifer L. Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic
| | | | | | - M. Susan Hallbeck
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic
- Department of Health Sciences Research, Mayo Clinic
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41
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Romero R, Erez O, Hüttemann M, Maymon E, Panaitescu B, Conde-Agudelo A, Pacora P, Yoon BH, Grossman LI. Metformin, the aspirin of the 21st century: its role in gestational diabetes mellitus, prevention of preeclampsia and cancer, and the promotion of longevity. Am J Obstet Gynecol 2017; 217:282-302. [PMID: 28619690 DOI: 10.1016/j.ajog.2017.06.003] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/30/2017] [Accepted: 06/05/2017] [Indexed: 12/16/2022]
Abstract
Metformin is everywhere. Originally introduced in clinical practice as an antidiabetic agent, its role as a therapeutic agent is expanding to include treatment of prediabetes mellitus, gestational diabetes mellitus, and polycystic ovarian disease; more recently, experimental studies and observations in randomized clinical trials suggest that metformin could have a place in the treatment or prevention of preeclampsia. This article provides a brief overview of the history of metformin in the treatment of diabetes mellitus and reviews the results of metaanalyses of metformin in gestational diabetes mellitus as well as the treatment of obese, non-diabetic, pregnant women to prevent macrosomia. We highlight the results of a randomized clinical trial in which metformin administration in early pregnancy did not reduce the frequency of large-for-gestational-age infants (the primary endpoint) but did decrease the frequency of preeclampsia (a secondary endpoint). The mechanisms by which metformin may prevent preeclampsia include a reduction in the production of antiangiogenic factors (soluble vascular endothelial growth factor receptor-1 and soluble endoglin) and the improvement of endothelial dysfunction, probably through an effect on the mitochondria. Another potential mechanism whereby metformin may play a role in the prevention of preeclampsia is its ability to modify cellular homeostasis and energy disposition, mediated by rapamycin, a mechanistic target. Metformin has a molecular weight of 129 Daltons and therefore readily crosses the placenta. There is considerable evidence to suggest that this agent is safe during pregnancy. New literature on the role of metformin as a chemotherapeutic adjuvant in the prevention of cancer and in prolonging life and protecting against aging is reviewed briefly. Herein, we discuss the mechanisms of action and potential benefits of metformin.
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42
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Oung AB, Kosirog E, Chavez B, Brunner J, Saseen JJ. Evaluation of medication adherence in chronic disease at a federally qualified health center. Ther Adv Chronic Dis 2017; 8:113-120. [PMID: 28815008 PMCID: PMC5546648 DOI: 10.1177/2040622317714966] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 05/17/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND While medication adherence in chronic disease has been evaluated in the general population, limited data are available among Medicaid recipients, especially within federally qualified health centers (FQHCs). This study determined baseline medication adherence for Medicaid recipients receiving care in an FQHC for first-line medications used in hypertension, hyperlipidemia, and diabetes. Secondary outcomes included baseline adherence for individual patient factors. METHODS Patients from the Salud Family Health Centers, an FQHC with a large percentage of both Spanish-speaking patients and providers, were included in this study. Using retrospective prescription claims reports from 1 January 2015 to 1 October 2015, medication possession ratios (MPRs) and proportion of days covered (PDC) were calculated for each medication group. Patients with adherence ⩾0.80 were considered adherent. RESULTS From 1034 individual patients, 1788 medications were evaluated. Using MPRs, adherence rates were highest among medications for hypertension (67.2% adherent), followed by hyperlipidemia (67.0%), and lastly diabetes (58.0%); p < 0.001. Likewise, using PDC, adherence rates were highest for medications for hypertension (56.6%), followed by hyperlipidemia (52.2%), and lastly diabetes (45.0%); p = 0.010. Lower rates of adherence were seen among men, patients age 18-29 years old, African Americans, and patients with English documented as their preferred language. CONCLUSIONS Although overall medication adherence rates within our FQHC patients were comparable with those in previous literature, differences seen among medication groups and patient individual factors suggest that there is still much to be learned in improving adherence. Future efforts will require a multifaceted approach, tailored to patient-specific needs.
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Affiliation(s)
- Alvin B. Oung
- School of Pharmacy, University of Wyoming, Laramie, WY, USA
| | - Emily Kosirog
- University of Colorado Anschutz Medical Campus, 12850 E. Montview Blvd. (C238), Aurora, CO 80045, USA
| | - Benjamin Chavez
- Skaggs School of Pharmacy and Pharmaceutical Sciences, Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jason Brunner
- Skaggs School of Pharmacy and Pharmaceutical Sciences, Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Joseph J. Saseen
- Skaggs School of Pharmacy and Pharmaceutical Sciences, Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- School of Medicine, Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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43
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Wabe N, Wiese MD. Treating rheumatoid arthritis to target: physician and patient adherence issues in contemporary rheumatoid arthritis therapy. J Eval Clin Pract 2017; 23:486-493. [PMID: 27650675 DOI: 10.1111/jep.12620] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 07/10/2016] [Accepted: 07/11/2016] [Indexed: 11/29/2022]
Abstract
Development of the treat-to-target (T2T) strategy, the process whereby drug therapy is adjusted until the therapeutic goal is achieved, has revolutionized how rheumatoid arthritis (RA) patients are treated. With the advent of T2T, the management of RA is more effective than ever, with the possibility of remission and other favorable clinical and patient-reported outcomes. Effective implementation of a T2T strategy in routine clinical practice mainly depends on the long-term commitment of physician and patient to T2T treatment recommendations. However, as T2T is a complex process involving aggressive early management with several steps of therapy modifications requiring frequent close monitoring of disease activity and drug toxicities, it may be more liable to suboptimal adherence in real-life clinical practice. The aim of the review is to present key issues related to patient medication adherence and physician adherence to the current RA treatment recommendations and their importance in optimizing the outcome of treatment in RA treated according to T2T strategy.
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Affiliation(s)
- Nasir Wabe
- School of Pharmacy and Medical Sciences and Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Michael D Wiese
- School of Pharmacy and Medical Sciences and Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
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44
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Effect of acute coronary syndrome patients' education on adherence to dual antiplatelet therapy. J Saudi Heart Assoc 2017; 29:252-258. [PMID: 28983168 PMCID: PMC5623036 DOI: 10.1016/j.jsha.2017.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 02/21/2017] [Accepted: 02/22/2017] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the effect of acute coronary syndrome (ACS) patients’ education on their adherence to dual antiplatelet therapy (DAPT) and on lifestyle modifications. Methods Patients who were prescribed acetyl salicylic acid and clopidogrel DAPT within 15 days of having an ACS event were enrolled in this study. Patients were randomized into two arms: the first arm received the study intervention, which consisted of education on coronary artery disease and the importance of sustained platelet inhibition, whereas the second arm was the control group. Both arms received education on lifestyle modifications. Patients completed six visits over 1 year. At each visit, pill count was used to assess adherence to DAPT, data on lifestyle modifications were collected, and changes in weight and waist circumference were recorded. Cardiovascular risk factors were recorded at baseline and the occurrence of new events was monitored throughout the study. Results There were 153 patients in Arm 1 and 168 in Arm 2. At Month 6, 99.3% of patients in Arm 1 were adherent compared with 94.4% in Arm 2 (p = 0.016). At Month 12, 303 (94.4%) patients from the overall population were adherent to DAPT and there was no significant difference between the two arms (p = 0.443). In addition, no statistically significant difference was found in mean change in weight (3 kg vs. 2 kg, p = 0.064) or mean change in waist circumference (3.5 cm vs. 2.6 cm, p = 0.071) between the two arms. There was a significant decrease in the percentage of smokers (p < 0.001) and a significant increase in the percentage of physically active patients (p < 0.001) within each arm between baseline and Month 12, but the percent change in smokers (z = 1.72, p = 0.085) and percent change in physically active patients (z = 0.76, p = 0.447) between the two arms were not significantly different. Fourteen myocardial infarctions and two strokes occurred throughout the study period. Conclusion Patient education on DAPT showed short-term effect on adherence to treatment. More effective education methods should be developed to improve long-term DAPT adherence.
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45
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Lawrence D, Miller JH, W Flexner C. Medication Adherence. J Clin Pharmacol 2017; 57:422-427. [PMID: 28105688 DOI: 10.1002/jcph.862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/28/2016] [Indexed: 12/17/2022]
Affiliation(s)
- David Lawrence
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James H Miller
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles W Flexner
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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46
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Oussedik E, Foy CG, Masicampo EJ, Kammrath LK, Anderson RE, Feldman SR. Accountability: a missing construct in models of adherence behavior and in clinical practice. Patient Prefer Adherence 2017; 11:1285-1294. [PMID: 28794618 PMCID: PMC5536091 DOI: 10.2147/ppa.s135895] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Piano lessons, weekly laboratory meetings, and visits to health care providers have in common an accountability that encourages people to follow a specified course of action. The accountability inherent in the social interaction between a patient and a health care provider affects patients' motivation to adhere to treatment. Nevertheless, accountability is a concept not found in adherence models, and is rarely employed in typical medical practice, where patients may be prescribed a treatment and not seen again until a return appointment 8-12 weeks later. The purpose of this paper is to describe the concept of accountability and to incorporate accountability into an existing adherence model framework. Based on the Self-Determination Theory, accountability can be considered in a spectrum from a paternalistic use of duress to comply with instructions (controlled accountability) to patients' autonomous internal desire to please a respected health care provider (autonomous accountability), the latter expected to best enhance long-term adherence behavior. Existing adherence models were reviewed with a panel of experts, and an accountability construct was incorporated into a modified version of Bandura's Social Cognitive Theory. Defining accountability and incorporating it into an adherence model will facilitate the development of measures of accountability as well as the testing and refinement of adherence interventions that make use of this critical determinant of human behavior.
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Affiliation(s)
- Elias Oussedik
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Capri G Foy
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - E J Masicampo
- Department of Psychology, Wake Forest University, Winston-Salem, NC, USA
| | - Lara K Kammrath
- Department of Psychology, Wake Forest University, Winston-Salem, NC, USA
| | - Robert E Anderson
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Correspondence: Steven R Feldman, Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA, Tel +1 336 716 7740, Fax +1 336 716 7732, Email
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Jankowska-Polańska B, Chudiak A, Uchmanowicz I, Dudek K, Mazur G. Selected factors affecting adherence in the pharmacological treatment of arterial hypertension. Patient Prefer Adherence 2017; 11:363-371. [PMID: 28280309 PMCID: PMC5338974 DOI: 10.2147/ppa.s127407] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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
BACKGROUND Low adherence to hypertension (HT) management is one of the major contributors to poor blood pressure (BP) control. Approximately 40%-60% of patients with HT do not follow the prescribed treatment. The aim of the study was to analyze the relationship between selected variables and adherence to hypotensive pharmacological treatment. Besides socioclinical variables, the study focused on the role of illness acceptance. PARTICIPANTS AND METHODS The study included 602 patients with HT. Adherence and acceptance of illness were assessed using the following validated instruments: the Acceptance of Illness Scale (AIS) and the Morisky Medication Adherence Scale (MMAS). RESULTS The high-adherence group comprised a significantly higher percentage of patients with high illness acceptance scale scores than that of patients with low-to-moderate scores (42.4 vs 31.8%; P=0.008<0.01). The odds ratio (OR) showed that high adherence to pharmacological treatment was >1.5 times as likely to occur in the high acceptance group as in the low-to-moderate acceptance group (OR =1.58, 95% CI 1.14-2.19). Spearman's rank correlation coefficients showed statistically significant correlations between adherence and sex (men ρ=-0.101; P=0.012), age >45-66 years (ρ=0.098; P=0.015), higher education level (ρ=0.132; P=0.001), grade ESC of HT (ρ=-0.037; P=0.057), receiving one-tablet polytherapy (ρ=0.131; P=0.015), and illness acceptance (ρ=0.090; P=0.024). CONCLUSION Acceptance of illness is correlated with adherence to pharmacological treatment, and consideration should be given to more widespread assessment of illness acceptance in daily practice. Male sex, age >45-66 years, duration of illness grade ESC of HT, and receiving one-tablet polytherapy are significant determinants of adherence to pharmacological treatment in HT.
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Affiliation(s)
- Beata Jankowska-Polańska
- Department of Clinical Nursing, Wroclaw Medical University
- Correspondence: Beata Jankowska-Polańska, Department of Clinical Nursing, Wroclaw Medical University, ul. Bartla 3, 81-618 Wrocław, Poland Email,
| | - Anna Chudiak
- Department of Clinical Nursing, Wroclaw Medical University
| | | | - Krzysztof Dudek
- Department of Logistics and Transport Systems, Faculty of Mechanical Engineering, Wrocław University of Technology
| | - Grzegorz Mazur
- Department and Clinic of Internal and Occupational Diseases and Hypertension, Wroclaw Medical University, Wroclaw, Poland
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Ramanujam VMS, Nayeem F, Anderson KE, Kuo YF, Chen NW, Ju H, Lu LJW. Riboflavin as an independent and accurate biomarker for adherence in a randomized double-blind and placebo-controlled clinical trial. Biomarkers 2016; 22:508-516. [PMID: 27918196 DOI: 10.1080/1354750x.2016.1269201] [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: 10/20/2022]
Abstract
BACKGROUND Medication adherence is critical for success of clinical trials. OBJECTIVE To assess oral riboflavin is an adherence marker. METHODS Riboflavin was incorporated into active treatment and placebo pills for a clinical trial lasting for 2 years. RESULTS The accuracy (area under the receiver operating curve) of urinary riboflavin was 0.91 as a binary classifier of adherence, and was similar or better than for two active study ingredients daidzein (0.92) and genistein (0.87) (all p < 0.0001). Decreased adherence over time was similar in the two study groups. CONCLUSION Riboflavin is an accurate and useful biomarker for study pill ingestion.
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Affiliation(s)
- V-M S Ramanujam
- a Department of Preventive Medicine and Community Health , The University of Texas Medical Branch , Galveston , TX , USA
| | - Fatima Nayeem
- a Department of Preventive Medicine and Community Health , The University of Texas Medical Branch , Galveston , TX , USA
| | - Karl E Anderson
- a Department of Preventive Medicine and Community Health , The University of Texas Medical Branch , Galveston , TX , USA
| | - Yong-Fang Kuo
- a Department of Preventive Medicine and Community Health , The University of Texas Medical Branch , Galveston , TX , USA
| | - Nai-Wei Chen
- a Department of Preventive Medicine and Community Health , The University of Texas Medical Branch , Galveston , TX , USA
| | - Hyunsu Ju
- a Department of Preventive Medicine and Community Health , The University of Texas Medical Branch , Galveston , TX , USA
| | - Lee-Jane W Lu
- a Department of Preventive Medicine and Community Health , The University of Texas Medical Branch , Galveston , TX , USA
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Lee WP, Lee SSS, Xin X, Thumboo J. Towards a better understanding of reasons for non-adherence to treatment among patients with rheumatoid arthritis: A focus group study. PROCEEDINGS OF SINGAPORE HEALTHCARE 2016. [DOI: 10.1177/2010105816677992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To explore common reasons for non-adherence to treatment in patients with rheumatoid arthritis in Singapore. Methods: Patients diagnosed with rheumatoid arthritis for ⩾ 1 year being followed up at the Singapore General Hospital and meeting pre-defined criteria of non-adherence were invited to participate in focus groups to discuss issues related to adherence to their rheumatoid arthritis treatment. Each focus group was homogenous in terms of gender, language spoken and ethnicity. Discussions were audio recorded and subsequently transcribed verbatim for thematic analysis. Results: Of the 26 patients who participated in the study, seven reported non-adherence to medication, two reported non-adherence to doctors’ appointments, and 11 reported non-adherence to both. The most commonly mentioned reasons for non-adherence were forgetfulness ( n=13), low perceived need for treatment ( n=10), actual or perceived medication side effects ( n=6) and intentional delay due to busyness ( n=4). Eleven participants acknowledged more than one of these four reasons for non-adherence. Conclusion: There are multiple reasons for non-adherence to treatment among patients with rheumatoid arthritis in Singapore. Findings from this study provide important empirical evidence to inform strategies to improve adherence and in turn treatment outcomes for this group of patients in Singapore.
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Affiliation(s)
- Wan Pin Lee
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Sharon Song-Song Lee
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Xiaohui Xin
- Medicine Academic Clinical Programme, Singapore General Hospital, Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Duke-NUS Graduate Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Lass N, Reinehr T. Low Treatment Adherence in Pubertal Children Treated with Thyroxin or Growth Hormone. Horm Res Paediatr 2016; 84:240-7. [PMID: 26279278 DOI: 10.1159/000437305] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/29/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Treatment outcome depends largely on treatment adherence (TA). However, studies analyzing TA in chronic endocrine diseases are scarce and controversial in childhood. PATIENTS AND METHODS We studied TA in 103 children treated subcutaneously with growth hormone (GH) and 97 children treated orally with thyroxin. TA was calculated based on the prescription refill rates. The number of GH injections was recorded by an autoinjector device in 23 children treated with GH. RESULTS The correlation between recorded TA and calculated TA based on prescription refill rates was very good (p < 0.001, r = 0.83). TA was lower (p < 0.01) in pubertal children compared to prepubertal children and in children self-administering their medication compared to those whose drug was administered by their parents, both in GH- and thyroxin-treated children. Overall, 67% of the pubertal children treated with GH and 58% of the pubertal children treated with thyroxin missed at least 1 dose per week. TA was higher (p < 0.001) in children with thyroxin treatment compared to children treated with recombinant human GH (8 vs. 26% missed >3 doses/week). DISCUSSION Puberty and self-administration of drugs were negative predictors of TA. Therefore, in puberty, prevention and treatment efforts should be undertaken to improve TA, especially when adolescents administer their drugs themselves.
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Affiliation(s)
- Nina Lass
- Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Datteln, Germany
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