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Houghton DC, Merritt CR, Miller SN, Mitchell JM, Parker D, Hommel JD, Cunningham KA, Wilkes DM. Electronic Real-Time Monitoring Reveals Limited Adherence to Long-Term Opioid Prescriptions in Pain Patients. J Pain Res 2024; 17:1815-1827. [PMID: 38799276 PMCID: PMC11127646 DOI: 10.2147/jpr.s436898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 04/15/2024] [Indexed: 05/29/2024] Open
Abstract
Background Pain management physicians are increasingly focused on limiting prescription opioid abuse, yet existing tools for monitoring adherence have limited accuracy. Medication event monitoring system (MEMS) is an emerging technology for tracking medication usage in real-time but has not been tested in chronic pain patients on long-term opioid regimens. Objective We conducted a pilot clinical trial to investigate the utility of MEMS for monitoring opioid adherence and compared to traditional methods including self-report diaries, urine drug screen (UDS), and physicians' opinions. Methods Opioid-maintained chronic pain patients were recruited from a pain management clinic. Participants (n=28) were randomly assigned to either receive MEMS bottles containing their opioid medication for a 90-day period or to continue using standard medication bottles. MEMS bottles were configured to record and timestamp all bottle openings and the number of pills that were removed from the bottle (via measurement of weight change). Results Participants who received MEMS demonstrated highly heterogenous dosing patterns, with a substantial number of patients rapidly removing excessive amounts of medication and/or "stockpiling" medication. By comparison, physicians rated all participants as either "totally compliant" or "mostly compliant". UDS results did not reveal any illicit drug use, but 25% of participants (n=7) tested negative for their prescribed opioid metabolite. MEMS data did not correlate with physician-rated adherence (P=0.24) and UDS results (P=0.77). MEMS data consistently revealed greater non-adherence than self-report data (P<0.001). Conclusion These results highlight the limits in our understanding of naturalistic patterns of daily opioid use in chronic pain patients as well as support the use of MEMS for detecting potential misuse as compared to routine adherence monitoring methods. Future research directions include the need to determine how MEMS could be used to improve patient outcomes, minimize harm, and aid in clinical decision-making. Trial Registration This study was preregistered on ClinicalTrials.gov (NCT03752411).
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Affiliation(s)
- David C Houghton
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Christina R Merritt
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, USA
| | - Sierra N Miller
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
| | - Jasmine M Mitchell
- Department of Family and Community Medicine, UT McGovern Medical School, Houston, TX, USA
| | - David Parker
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
| | - Jonathan D Hommel
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, USA
| | - Kathryn A Cunningham
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, USA
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, USA
| | - Denise M Wilkes
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA
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Singh AP, Chaudhary V, Kumari S, Dhir D, Devi V, Pal B. Nonadherence to antiepileptic medication and associated factors among persons with epilepsy in India: A systematic review and meta-analysis. Epilepsy Res 2024; 202:107358. [PMID: 38603915 DOI: 10.1016/j.eplepsyres.2024.107358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/15/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Nonadherence to antiepileptic drugs (AEDs) is a prevalent issue in India, contributing to suboptimal seizure control, higher morbidity and mortality, increased hospitalization rates, and a substantial effect on the overall quality of life for individuals with epilepsy. OBJECTIVES This study aimed to measure the prevalence of medication adherence among individuals with epilepsy in India and to identify factors associated with nonadherence. METHODS Following PRISMA guidelines, we searched PubMed, Scopus, Embase, and Google Scholar for studies on AED adherence in India. Quality assessment employed Newcastle Ottawa Scale adapted for cross-sectional studies. Pooled prevalence was ascertained using a random-effects model in R software (version 4.2.2), with a 95% confidence interval. Heterogeneity was estimated with the I2 statistic, and publication bias was appraised via a funnel plot. Subgroup analyses, based on study region and adherence measurement tool, were done to investigate heterogeneity. RESULTS Nine cross-sectional studies with 1772 participants were analyzed. The pooled prevalence of adherence to AEDs in India stood at 49.9% (95% CI: 39.8%-60.1%). Subgroup analyses showed comparable adherence rates in the South (50.9%) and North (46.5%) regions of India. However, adherence rates varied substantially based on the measurement tool: Morisky Medication Adherence Scale-4 (MMAS-4) reported 71.3%, MMAS-8 indicated 45.9%, and Morisky Green Levine (MGL) adherence scale exhibited 42.0%. Factors contributing to non-adherence to antiepileptic therapies involved poor socioeconomic status, lower education levels, polytherapy, drug-related side effects, and substance abuse. CONCLUSIONS Almost half of persons with epilepsy in India were non-adherent to their AEDs. This underscores the importance for healthcare professionals to pay greater attention to improving the adherence rate to AEDs within the healthcare service.
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Affiliation(s)
- Aditya Pratap Singh
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Vaibhav Chaudhary
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Sweta Kumari
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Deepali Dhir
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Varsha Devi
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Biplab Pal
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India.
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Todd A, Waldron C, McGeagh L, Norris R, Bolnykh I, Stewart SJ, Slodkowska‐Barabasz J, Moon Z, Cahir C, Thompson S, Harmer V, Wells M, Watson E, Sharp L. Identifying determinants of adherence to adjuvant endocrine therapy following breast cancer: A systematic review of reviews. Cancer Med 2024; 13:e6937. [PMID: 38240343 PMCID: PMC10905548 DOI: 10.1002/cam4.6937] [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: 08/23/2023] [Revised: 11/01/2023] [Accepted: 12/17/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND In oestrogen-receptor positive breast cancer, daily oral adjuvant endocrine therapy (ET) for at least 5 years significantly reduces risks of recurrence and breast cancer-specific mortality. However, many women are poorly adherent to ET. Development of effective adherence support requires comprehensive understanding of influences on adherence. We undertook an umbrella review to identify determinants of ET adherence. METHODS We searched PubMed, Embase, CINAHL, PsycINFO, Cochrane and PROSPERO (inception to 08/2022) to identify systematic reviews on factors influencing ET adherence. Abstracted determinants were mapped to the World Health Organization's dimensions of adherence. Reviews were quality appraised and overlap assessed. RESULTS Of 5732 citations screened, 17 reviews were eligible (9 quantitative primary studies; 4 qualitative primary studies; 4 qualitative or quantitative studies) including 215 primary papers. All five WHO dimensions influenced ET non-adherence: The most consistently identified non-adherence determinants were patient-related factors (e.g. lower perceived ET necessity, more treatment concerns, perceptions of ET 'cons' vs. 'pros'). Healthcare system/healthcare professional-related factors (e.g. perceived lower quality health professional interaction/relationship) were also important and, to a somewhat lesser extent, socio-economic factors (e.g. lower levels of social/economic/material support). Evidence was more mixed for medication-related and condition-related factors, but several may be relevant (e.g. experiencing side-effects, cost). Potentially modifiable factors are more influential than non-modifiable/fixed factors (e.g. patient characteristics). CONCLUSIONS The evidence-base on ET adherence determinants is extensive. Future empirical studies should focus on less well-researched areas and settings. The determinants themselves are numerous and complex in indicating that adherence support should be multifaceted, addressing multiple determinants.
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Affiliation(s)
- Adam Todd
- Newcastle UniversityNewcastle upon TyneUK
| | | | | | | | - Iakov Bolnykh
- Newcastle UniversityNewcastle upon TyneUK
- The Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | | | | | - Zoe Moon
- University College LondonLondonUK
| | | | | | | | - Mary Wells
- Imperial College Healthcare NHS TrustLondonUK
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Spetz K, Olbers T, Östbring M, Moon Z, Horne R, Andersson E. Using the 5-Item Medication Adherence Report Scale (MARS-5) to Screen for Non-adherence to Vitamin and Mineral Supplementation After Bariatric Surgery. Obes Surg 2024; 34:576-582. [PMID: 38177555 PMCID: PMC10810978 DOI: 10.1007/s11695-023-07027-x] [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: 12/01/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Poor adherence to recommended vitamin and mineral supplementation after bariatric surgery is common and challenging for healthcare professionals to identify. There are several questionnaires for self-reporting of adherence to chronic medication, but none has so far been evaluated for assessment of adherence to vitamin and mineral supplementation after bariatric surgery. The aim of this study was to assess the accuracy of the 5-item Medication Adherence Report Scale (MARS-5) in measuring adherence to vitamin and mineral supplementation post bariatric surgery (gastric bypass or sleeve gastrectomy). METHOD The psychometric properties of MARS-5 for vitamin and mineral supplementation were validated in two cohorts: one at 1 year post bariatric surgery (n = 120) and the other at 2 years post-surgery (n = 211). MARS-5 was compared to pharmacy refill data for vitamin B12 and combined calcium/vitamin D as reference. RESULTS Correlation analyses demonstrated that the MARS-5 had acceptable validity compared to objectively measured adherence rates from pharmacy refill data (calculated as continuous, multiple-interval measures of medication availability/gaps-coefficient ranged from 0.49 to 0.54). Internal reliability (Cronbach's α) was high: 0.81 and 0.95, respectively. There was a clear ceiling effect where one out of three had a maximum score on MARS-5. CONCLUSION MARS-5 demonstrated acceptable psychometric properties for assessment of adherence to vitamin and mineral supplementation post bariatric surgery.
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Affiliation(s)
- Kristina Spetz
- Department of Biomedical and Clinical Sciences, and Department of Surgery, Linköping University, Norrköping, Sweden.
| | - Torsten Olbers
- Department of Biomedical and Clinical Sciences, and Department of Surgery, Linköping University, Norrköping, Sweden
| | - Malin Östbring
- Department of Medicine and Optometry, Linnaeus University, Kalmar, and Pharmaceutical Department, Kalmar County Council, Kalmar, Sweden
| | - Zoe Moon
- Centre for Behavioral Medicine, School of Pharmacy, University College London, London, UK
| | - Rob Horne
- Centre for Behavioral Medicine, School of Pharmacy, University College London, London, UK
| | - Ellen Andersson
- Department of Biomedical and Clinical Sciences, and Department of Surgery, Linköping University, Norrköping, Sweden
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Poot CC, de Boer J, Goto L, van de Hei SJ, Chavannes NH, Visch VT, Meijer E. The Design of a Persuasive Game to Motivate People with Asthma in Adherence to Their Maintenance Medication. Patient Prefer Adherence 2023; 17:2719-2736. [PMID: 37933305 PMCID: PMC10625736 DOI: 10.2147/ppa.s423161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/14/2023] [Indexed: 11/08/2023] Open
Abstract
Objective This study aimed to design a persuasive game, using objective adherence data, to motivate people with asthma to adhere to their medication regimen. Methods A participatory user-centered design approach was employed, involving end-users and other stakeholders throughout the study. The approach consisted of four phases. Semi-structured interviews and a survey were conducted to understand user needs and reasons for poor adherence (Phase 1: define). Key themes were identified, leading to the formulation of behavior change strategies and design and game requirements. Several design directions were ideated, resulting in a concept for a serious game (Phase 2: ideate). Two rounds of user-tests were performed to evaluate a prototype of the serious game in terms of usability, perceived impact on medication adherence and motivation (Phase 3: prototype and Phase 4: evaluate). Results Findings from semi-structured interviews (n = 6) and the online survey (n = 20) revealed that people's non-adherence was often attributed to the perception of asthma as an episodic condition, the delayed experienced effect of maintenance inhalers, and lack of knowledge regarding difference of effect between maintenance and reliever inhalers. The study used behavior change strategies to translate these insights into design requirements for the development of the narrative-based persuasive game Ademgenoot. This six-week challenge-based game combines various behavior change strategies, including personal goal setting and continuous visual feedback, as well as persuasive game design elements, such as a narrative and rewards, with the aim of enhancing motivation to adhere to their medication regimen. User-testing (n = 8; round 1 and 2) showed that Ademgenoot is feasible in clinical practice and has the potential to support people with mild asthma in adherence to their maintenance medication. Discussion Future efforts should be directed towards a larger evaluation to assess the impact on motivation and inhaler use behaviour.
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Affiliation(s)
- Charlotte C Poot
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
- National eHealth Living Lab (NeLL), Leiden University Medical Centre, Leiden, The Netherlands
| | - Jasmijn de Boer
- Department of Human-Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Lyè Goto
- Department of Human-Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Susanne J van de Hei
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- General Practitioners Research Institute, Groningen, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
- National eHealth Living Lab (NeLL), Leiden University Medical Centre, Leiden, The Netherlands
| | - Valentijn T Visch
- Department of Human-Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
- National eHealth Living Lab (NeLL), Leiden University Medical Centre, Leiden, The Netherlands
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Blom JMC, Rivi V, Tascedda F, Pani L. The nexus of social alliances and diverse moral domains: a bedrock for participatory clinical research. Front Med (Lausanne) 2023; 10:1250247. [PMID: 37849486 PMCID: PMC10577180 DOI: 10.3389/fmed.2023.1250247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/18/2023] [Indexed: 10/19/2023] Open
Affiliation(s)
- Johanna M. C. Blom
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Veronica Rivi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Tascedda
- Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Consorzio Interuniversitario per le Biotecnologie, Trieste, Italy
| | - Luca Pani
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, United States
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