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Cramer JA, Yan T, Tieu R, Knoth RL, Fincher C, Malhotra M, Choi J. Risk of hospitalization among patients with epilepsy using long versus short half-life adjunctive antiepileptic drugs. Epilepsy Behav 2020; 102:106634. [PMID: 31783318 DOI: 10.1016/j.yebeh.2019.106634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/19/2019] [Accepted: 09/28/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION While antiepileptic drugs (AEDs) remain the primary treatment for epilepsy, many patients continue to have seizures. Uncontrolled seizures may be related to AED half-life, since short half-life (SHL) AEDs require more frequent dosing compared with the simplified regimens of long half-life (LHL) AEDs. Long half-life AEDs may also improve seizure control by extending missed dose forgiveness periods. The value of LHL AEDs may be assessed as reduced healthcare utilization. The study's objective was to examine the impact of adding an LHL versus SHL adjunctive AED on the risk of hospitalizations in patients with uncontrolled epilepsy. METHODS This was a retrospective, longitudinal cohort study using the Symphony Health Solution Patient Integrated Dataverse. Patients ≥12 years old with uncontrolled epilepsy (≥2 medical claims ≥30 days apart) were identified during a study period (8/1/2012-7/31/2017). Patients were selected if they were subsequently initiated an adjunctive AED (excluding modified release formulations), and the prescription date served as the index. Patients were stratified into two mutually exclusive cohorts based on the index AED half-life (≤20 versus >20 h). Poisson regressions with robust error variances were performed for the relative risks (RRs) of all-cause, epilepsy-related, and injury-related hospitalizations. RESULTS A total of 4984 patients were identified (2705 in the LHL and 2279 in the SHL cohort). Compared with those in the SHL cohort, patients in the LHL cohort were significantly younger [mean (SD, years): 43.9 (18.5) versus 49.2 (17.2), p < 0.001] and were less comorbid [mean (SD) of Charlson comorbidity index: 1.2 (1.8) versus 1.8 (2.2), p < 0.001]. In the one-year postindex date, adjusting for group differences, the risks of both all-cause and epilepsy-related hospitalizations were significantly lower in the LHL cohort than in the SHL cohort [all-cause: 0.84 (95% CI: 0.76-0.93), p = 0.0006; epilepsy-related: 0.83 (0.73-0.94), p = 0.0046].Injury-related hospitalizations did not differ between LHL and SHL cohorts. CONCLUSION In patients with uncontrolled epilepsy who were initiated on an adjunctive AED, the choice of an LHL versus SHL was associated with significantly lower risks of all-cause and epilepsy-related hospitalizations.
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Affiliation(s)
| | - Tingjian Yan
- Partnership for Health Analytic Research, LLC, 280 S. Beverly Dr., Ste. 404, Beverly Hills, CA 90212, USA
| | - Ryan Tieu
- Partnership for Health Analytic Research, LLC, 280 S. Beverly Dr., Ste. 404, Beverly Hills, CA 90212, USA
| | | | | | - Manoj Malhotra
- Eisai Inc., 100 Tice Blvd., Woodcliff Lake, NJ 07677, USA
| | - Jiyoon Choi
- Eisai Inc., 100 Tice Blvd., Woodcliff Lake, NJ 07677, USA.
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Abstract
Medication noncompliance is a pervasive problem resulting in significant morbidity and mortality. There are many terms used to describe medication-taking behavior including compliance, adherence, intelligent compliance, and drug forgiveness. More recently, clinicians have focused on the need for a collaborative partnership with patients to attain medication adherence. Problems identified include the patient’s failing to initiate therapy, under using or overusing a drug, stopping a drug too soon, and mistiming or skipping doses. Adherence to medications is a complex health behavior. There are many risk factors associated with decreased compliance, and many strategies have been shown to improve drug-taking behavior and patient outcomes. By careful assessment, the pharmacist can identify the high-risk patient, recommend an individualized care plan, and provide the follow-up necessary to successfully change patient behavior. Pharmacists should focus on improving their own application of behavior modification principles and patient communication skills. Improved medication compliance results in improved humanistic, clinical, and economic outcomes.
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Affiliation(s)
- Patricia A. Tabor
- Blackstock Family Practice Academic Associates, University of Texas at Austin, Pharmacy Practice Division, One University Station A1910, Austin, TX 78712-0127,
| | - Debra A. Lopez
- Scott & White Hospital, Health Plan, and Clinic, University of Texas College of Pharmacy, Scott & White Clinic, 4945 Williams Drive, Georgetown, TX 78628
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Insel KC, Reminger SL, Hsiao CP. The Negative Association of Independent Personality and Medication Adherence. J Aging Health 2016; 18:407-18. [PMID: 16648393 DOI: 10.1177/0898264306286200] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: This investigation examines the association of personality factors and medication adherence among older adults. Method: The Six-Factor Personality Questionnaire was mailed to participants involved in a medication adherence investigation. Medication adherence was monitored with an electronic monitoring cap for 8 weeks for one prescribed daily medication. Results: Sixty older adults, mean age 77 years (range 67 to 93 years), returned the questionnaire (69% response rate). Stepwise regression analysis demonstrates that when age and level of education are controlled, independence predicts medication adherence. This factor demonstrates a negative relationship with adherence suggesting that higher levels of independence may be related to lower adherence to prescribed medication. The facet component self-reliance is predictive of poor medication adherence. Discussion: The finding that higher self-reliance is associated with lower adherence in an older population deserves further investigation and clinical consideration.
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Affiliation(s)
- Kathleen C Insel
- University of Arizona, College of Nursing, P.O. Box 210203, Tucson, AZ 85721, USA.
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Gwadry-Sridhar FH, Manias E, Lal L, Salas M, Hughes DA, Ratzki-Leewing A, Grubisic M. Impact of interventions on medication adherence and blood pressure control in patients with essential hypertension: a systematic review by the ISPOR medication adherence and persistence special interest group. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:863-871. [PMID: 23947982 DOI: 10.1016/j.jval.2013.03.1631] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 03/09/2013] [Accepted: 03/16/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To systematically review the evidence on the impact of interventions to improve medication adherence in adults prescribed antihypertensive medications. METHODS An electronic search was undertaken of articles published between 1979 and 2009, without language restriction, that focused on interventions to improve antihypertensive medication adherence among patients (≥18 years) with essential hypertension. Studies must have measured adherence as an outcome of the intervention. We followed standard guidelines for the conduct and reporting of the review and conducted a narrative synthesis of reported data. RESULTS Ninety-seven articles were identified for inclusion; 35 (35 of 97, 36.1%) examined interventions to directly improve medication adherence, and the majority (58 of 97, 59.8%) were randomized controlled trials. Thirty-four (34 of 97, 35.1%) studies reported a statistically significant improvement in medication adherence. DISCUSSION/CONCLUSIONS Interventions aimed at improving patients' knowledge of medications possess the greatest potential clinical value in improving adherence with antihypertensive therapy. However, we identified several limitations of these studies, and advise future researchers to focus on using validated adherence measures, well-designed randomized controlled trials with relevant adherence and clinical outcomes, and guidelines on the appropriate design and analysis of adherence research.
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Affiliation(s)
- Femida H Gwadry-Sridhar
- Faculty of Science, Department of Computer Science, The University of Western Ontario, London, Ontario, Canada.
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Adisa R, Fakeye TO. Effect of number and type of antidiabetes medications on adherence and glycemia of ambulatory type 2 diabetes patients in southwestern Nigeria. Pharm Pract (Granada) 2013; 11:156-65. [PMID: 24223081 PMCID: PMC3809134 DOI: 10.4321/s1886-36552013000300006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 07/21/2013] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To determine the influence of number and type of antidiabetes medications on adherence and glycemia of ambulatory type 2 diabetes patients in southwestern Nigeria. METHODS A cross-sectional study using pre-tested structured questionnaire among 176 consented patients recruited from the endocrinology clinics of two teaching hospitals between November, 2010 and January, 2011; and a retrospective review of case notes of the cohort for details of prescribed medications and blood glucose values. Descriptive statistics were used to summarize the data. Tests of proportions were evaluated using Chi-square or Fisher's exact test as appropriate. The differences in mean fasting blood glucose (FBG) between and among categorical variables were compared using student t-test and ANOVA respectively, with p<0.05 considered significant. RESULTS Mean number of prescribed medications was 4.6 ±1.4. Almost two thirds 103 (60.6%) were placed on >4 medications. Adherence was better among patients on >4 medications compared to those on ≤4 medications (p=0.05). However, patients on >4 medications were mostly older adults (>60 years of age), and they were in the majority (66.7%) who had tertiary education compared to 33.3% of those on ≤4 medications who had tertiary education (p=0.02). Adherence rates to antidiabetes medications were in the ranking of oral antidiabetes medications (OAM) alone (50.0%) > insulin plus OAM (44.0%) > insulin alone (41.7%) with no significant difference (p=0.77). There was a significant difference in mean FBG among patients on >4 medications (172.1 ±61.1mg/dL) versus (198.8 ±83.8mg/dL) among those on ≤4 medications (p=0.02). CONCLUSIONS Prescribing more than four medications is linked to improved adherence and glycemic outcome. However, age and educational background of patients are important factors that need to be considered when prescribing multiple medications for type 2 diabetes.
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Affiliation(s)
- Rasaq Adisa
- Department of Clinical Pharmacy & Pharmacy Administration, Faculty of Pharmacy, University of Ibadan . Ibadan ( Nigeria )
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Landfeldt E, Ström O, Robbins S, Borgström F. Adherence to treatment of primary osteoporosis and its association to fractures--the Swedish Adherence Register Analysis (SARA). Osteoporos Int 2012; 23:433-43. [PMID: 21286686 DOI: 10.1007/s00198-011-1549-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 01/13/2011] [Indexed: 10/18/2022]
Abstract
SUMMARY Osteoporosis treatments reduce the risk of fractures. The objective of this study was to investigate adherence to treatment of osteoporosis and its association to fractures in Sweden. Adherence to treatment of osteoporosis in Sweden is poor, and time on treatment was found to be significantly associated with fracture incidence. INTRODUCTION The objective of this study was to estimate persistence and compliance to treatment of primary osteoporosis in Sweden. A second aim was to investigate the determinants of non-persistence and the association between adherence and fracture incidence. METHODS Patients were identified through filled prescriptions for alendronate, risedronate, strontium ranelate, and raloxifene between 2005 and 2009 from the Swedish Prescribed Drug Register. Persistence was investigated using survival analysis. Medication possession ratio (MPR) was used to measure compliance in persistent patients. The outcome measure in the analysis of adherence and fracture incidence was hospitalized osteoporotic fractures. RESULTS The final cohort consisted of 56,586 treatment-naïve patients (mean age 71, 86% women). A total of 51%, 35%, 25%, and 14% were still on treatment (switching allowed) after 1, 2, 3, and 4 years, respectively. Average MPR in persistent patients was 94.2% (CI(95) 94.2-94.3%). Compared with <1 month of therapy, treatment for 1 month to 1 year, 1 to 2 years, and 2 to 3 years was associated with a lower 3-year fracture incidence (HR 0.86, p = 0.091; HR 0.67, p < 0.001; and HR 0.59, p < 0.001, respectively). No significant relationship was identified between MPR and fracture risk. CONCLUSIONS Persistence to treatment of osteoporosis in Sweden is poor and approximately 50% of all treatment-naïve patients discontinue therapy within 1 year. Average refill compliance, estimated only while the patients were persistent, was found to be close to perfect. A strong association was identified between treatment persistence and fracture incidence, which calls for action to improve the current situation.
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Wysocki S. The state of hormonal contraception today: enhancing clinician/patient communications. Am J Obstet Gynecol 2011; 205:S18-20. [PMID: 21961820 DOI: 10.1016/j.ajog.2011.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 06/24/2011] [Accepted: 07/05/2011] [Indexed: 11/17/2022]
Abstract
Women's health nurses and nurse practitioners have a unique opportunity to provide high-quality primary and preventive care and play a critical role in coordinating and delivering effective contraceptive methods. The strategies and techniques that they routinely employ during counseling and education can help improve women's adoption and appropriate use of contraceptive methods.
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Affiliation(s)
- Susan Wysocki
- National Association of Nurse Practitioners in Women's Health, Washington, DC, USA
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Wynne HA, Blagburn J. Drug treatment in an ageing population: practical implications. Maturitas 2010; 66:246-50. [PMID: 20399044 DOI: 10.1016/j.maturitas.2010.03.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 03/04/2010] [Indexed: 12/16/2022]
Abstract
The population of the industrialised nations is ageing. By 2020 those of 65 years and older will constitute nearly 17% of the US population; it is predicted that the proportion of the population aged 80 years and over will then range from 3.5 to 6.5%, around the world. Those over 65, due to age-related chronic disease and more prophylactic prescribing, receive a disproportionate number of drugs; in the UK for example, 45% of the total prescriptions dispensed. Older patients may benefit from prophylactic treatments to a greater extent than younger people because of a higher absolute risk of disease and it is therefore important that they are not inappropriately denied these. However, it is also important that, as each additional drug prescribed brings an increased risk of an adverse drug effect, prescribers have enough knowledge of pharmacological issues in old age to enable them to weigh up these conflicting pressures to arrive at good prescribing decisions.
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Affiliation(s)
- Hilary Anne Wynne
- Department of Care of the Elderly, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
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Swanlund SL. Successful cardiovascular medication management processes as perceived by community-dwelling adults over age 74. Appl Nurs Res 2010; 23:22-9. [DOI: 10.1016/j.apnr.2008.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 03/17/2008] [Accepted: 03/22/2008] [Indexed: 11/30/2022]
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Appelgren KE, Nietert PJ, Hulsey TC, Hollis BW, Wagner CL. Analyzing adherence to prenatal supplement: does pill count measure up? Int J Endocrinol 2010; 2010:631971. [PMID: 20169132 PMCID: PMC2821652 DOI: 10.1155/2010/631971] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 08/03/2009] [Accepted: 10/20/2009] [Indexed: 11/24/2022] Open
Abstract
Objective. To determine if adherence as measured by pill count would show a significant association with serum-based measures of adherence. Methods. Data were obtained from a prenatal vitamin D supplementation trial where subjects were stratified by race and randomized into three dosing groups: 400 (control), 2000, or 4000 IU vitamin D(3)/day. One measurement of adherence was obtained via pill counts remaining compared to a novel definition for adherence using serum 25-hydroxy-vitamin D (25-OH-D) levels (absolute change in 25(OH)D over the study period and the subject's steady-state variation in their 25(OH)D levels). A multivariate logistic regression model examined whether mean percent adherence by pill count was significantly associated with the adherence measure by serum metabolite levels. Results. Subjects' mean percentage of adherence by pill count was not a significant predictor of adherence by serum metabolite levels. This finding was robust across a series of sensitivity analyses. Conclusions. Based on our novel definition of adherence, pill count was not a reliable predictor of adherence to protocol, and calls into question how adherence is measured in clinical research. Our findings have implications regarding the determination of efficacy of medications under study and offer an alternative approach to measuring adherence of long half-life supplements/medications.
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Affiliation(s)
- Kristie E. Appelgren
- Department of Pediatrics, Duke University, Durham, NC 27710, USA
- *Kristie E. Appelgren:
| | - Paul J. Nietert
- Department of Biostatistics, Bioinformatics, and Epidemiology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Thomas C. Hulsey
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Bruce W. Hollis
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Carol L. Wagner
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA
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A framework for planning and critiquing medication compliance and persistence research using prospective study designs. Clin Ther 2009; 31:421-35. [DOI: 10.1016/j.clinthera.2009.02.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2008] [Indexed: 11/22/2022]
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Swanlund SL, Scherck KA, Metcalfe SA, Jesek-Hale SR. Keys to Successful Self-Management of Medications. Nurs Sci Q 2008; 21:238-46. [DOI: 10.1177/0894318408319276] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Medication use by community-dwelling elderly accounts for a significant portion of all U.S. drug use. Many elderly manage over three prescriptions a day. Recent evidence indicates that non-adherence to prescribed drug regimens can lead to symptoms that result in hospitalizations. The study's purpose was to explore self-management of medications as perceived by community-dwelling elderly. Guided by Orem's Self-Care Deficit Nursing Theory, 19 older adults were interviewed about their medication self-management practices. Inductive data analysis revealed three major themes: successful self-management of medications, living orderly, and aging well. Success in establishing individual management systems may be the result of developing and maintaining orderly lifestyles.
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Oldenmenger WH, Echteld MA, de Wit R, Sillevis Smitt PAE, Stronks DL, Stoter G, van der Rijt CCD. Analgesic adherence measurement in cancer patients: comparison between electronic monitoring and diary. J Pain Symptom Manage 2007; 34:639-47. [PMID: 17703909 DOI: 10.1016/j.jpainsymman.2007.01.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Revised: 01/22/2007] [Accepted: 02/02/2007] [Indexed: 01/01/2023]
Abstract
Adherence to analgesics in cancer patients has scarcely been studied. In this study, the Medication Event Monitoring System (MEMS) and medication diaries were compared with respect to feasibility and adherence measurements. Forty-six outpatients with nociceptive pain caused by cancer were asked to use MEMS for their analgesics and to record their medication usage in a diary for four weeks. Seventy-nine percent of the patients used MEMS for the full four-week period; 70% did so for the diary. The majority of patients were satisfied with both MEMS and diary. Adherence data assessed by MEMS and diary were comparable. Patients used the amount of analgesics adequately (taking adherence: 87%) but took them irregularly (timing adherence: 53%). Subgroup analyses in patients using single and multiple analgesic regimens confirmed the comparable suitability of both methods. MEMS and a medication diary are equally useful for analgesic adherence measurement in cancer patients with pain.
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Affiliation(s)
- Wendy H Oldenmenger
- Department of Medical Oncology, Erasmus Medical Center, Rotterdam, The Netherlands.
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Grymonpre R, Cheang M, Fraser M, Metge C, Sitar DS. Validity of a prescription claims database to estimate medication adherence in older persons. Med Care 2006; 44:471-7. [PMID: 16641666 DOI: 10.1097/01.mlr.0000207817.32496.cb] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prescription claims data have been used to estimate refill medication adherence through calculations of cumulative medication acquisition (CMA) and cumulative medication gap (CMG) values. Few studies have assessed the validity of these calculated rates. OBJECTIVES We sought to assess the validity of CMA and CMG calculated from the Manitoba prescription claims database (DPIN) against pill count medication adherence, targeting overall medications and angiotensin converting enzyme inhibitors (ACEIs). METHODS Using a survey of a convenience sample of subjects recruited through community pharmacies, subjects who were eligible for study (ie, 65 years or older, noninstitutionalized, taking 2 or more "discrete" prescribed medications, including an ACEI, and willing to provide informed consent) were studied. Pill counts were conducted on all prescribed medicines during 3 home interviews over the course of 4 months. Ten months of DPIN data also were collected on each subject. RESULTS The concordance between CMA and pill count for overall medications was 411/522 (79%) and for ACEIs was 89/101 (88%) with no systematic differences (McNemar's P = 0.68 and P = 0.097, respectively). CMG and pill count showed even better concordance of 438/514 (85%) for overall medications and 96/101 (95%) for ACEIs, although systematic differences were noted for overall medications (McNemar's P = 0.0012) but not for ACEIs (McNemar's P = 0.500). Spearman's rank correlations were weak for all comparisons. CONCLUSIONS The high concordance between prescription claims database and pill counts suggested that the rate with which patients refill their medications usually is consistent with the rate they consume them. DPIN is not accurate for nondiscrete dosage forms or medications prescribed for "as-required" use.
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Affiliation(s)
- Ruby Grymonpre
- Faculty of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada.
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Abstract
The objective of this article was to review patient adherence to topical medications and its relationship to health outcomes in dermatologic disease. To this end, MEDLINE searches from January 1966 through June 2006 and EMBASE searches from January 1974 through June 2006 were conducted. Relevant human efficacy studies, including randomized controlled trials, observational studies, and case-control studies, were selected on the basis of the key words 'compliance,' 'adherence,' 'pharmionics,' 'topical,' 'medication,' or 'dermatology.' Studies were included and reviewed on the basis of their experimental design, controls, and statistical analysis. Analysis revealed that suboptimal adherence to topical medications is a common cause of minimal response or lack of response to drugs and is linked with poor dermatologic outcomes in diseases such as psoriasis, atopic dermatitis, and acne. It is concluded that non-adherence to topical medications is as common as non-adherence to oral medications, and its relationship to poor health outcomes is clear. Several barriers to topical medication adherence and predictors of non-adherence are similar to those for oral medications, while other barriers and predictors are unique to topical medications and the nature of dermatologic disease. Further studies of effective interventions to increase adherence are necessary to improve health outcomes in dermatology.
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Affiliation(s)
- Ivy A Lee
- Department of Dermatology, School of Medicine, University of California, San Francisco, California 94143-0989, USA
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Insel KC, Cole L. Individualizing memory strategies to improve medication adherence. Appl Nurs Res 2005; 18:199-204. [PMID: 16298695 DOI: 10.1016/j.apnr.2004.08.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2004] [Revised: 07/20/2004] [Accepted: 08/20/2004] [Indexed: 11/17/2022]
Abstract
Changes in cognitive processes are well documented among even essentially healthy community-dwelling older adults. Although these changes do not produce the level of cognitive impairment associated with dementia, they do have the capacity to influence the degree to which elderly individuals self-manage chronic conditions. This pilot investigation tested the effect of an intervention to improve remembering to take medications and tracking if medications were taken as intended. Twenty-seven older adults (age range = 67-89 years, M = 78 years) all self-managing prescribed medications had one medication electronically monitored for 8 weeks preintervention and then 8 weeks postintervention. The percentage of days the correct number of doses was taken increased from a mean of 64.5% to that of 78%. With the use of Wilcoxon's signed ranks test, this improvement in adherence is significant. When participants with dementia or mild cognitive impairment were eliminated from the analysis (n = 6), the intervention continued to improve adherence (70.6% to 86%), suggesting that many older adults have the potential to improve adherence through individualized implementation of memory strategies.
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Miller AH, Larkin GL, Jimenez CH. Predictors of medication refill–seeking behavior in the ED. Am J Emerg Med 2005; 23:423-8. [PMID: 16032604 DOI: 10.1016/j.ajem.2005.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Determine predictors of medication refill-seeking behavior in ED patients with chronic illness. METHODS/DESIGN Prospective cross-sectional ED survey conducted for 6 weeks. SETTING Public hospital ED (>140,000 visits per year). SUBJECTS ED patients (>18 years) taking chronic medications for congestive heart failure, diabetes, and/or hypertension. RESULTS Of 1168 patients surveyed, 344 (29%) presented to the ED secondary to running out of medications and requiring a medication refill. Univariate predictors included age younger than 50 years, non-Hispanic ethnicity, low income (<5000 dollars per year), self-pay payor status, and being told to call a primary care physician before medication would be refilled. Lack of knowledge about refill or pharmacy numbers on the medication bottle resulted in patients being more than twice as likely to be in the ED for a medication refill (odds ratio 2.4 [1.6, 3.6] and 2.0 [1.3, 2.9], respectively). CONCLUSION Presenting for medication refills is common in ED patients with chronic illness.
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Affiliation(s)
- Adam H Miller
- Division of Emergency Medicine, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390-8579, USA.
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Abstract
Compliance, or adherence, as it relates to health care is the extent to which a person's behavior coincides with medical or health advice. Medication compliance is critical for all aspects of pediatrics, specifically in successful treatment, disease prevention, and health promotion. Compliance depends on the patient's and physician's committing to the same objectives. It is unfortunate that numerous studies and physician accounts reveal difficulties in achieving compliance with pediatric medication therapy. Medication compliance in pediatric patients ranges from 11% to 93%. At least one third of all patients fail to complete relatively short-term treatment regimens. Poor compliance places children at risk for problems such as continued disease, complicates the physician-patient relationship, and prevents accurate assessment of the quality of care provided. This article presents the issue in the context of its incidence of and barriers to compliance and provides general principles to improve compliance in pediatrics by improving communication and characteristics of the practice setting. A one-on-one relationship between physician and patient is needed for communication and improved compliance.
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Baines LS, Zawada ET, Jindal RM. Psychosocial profiling: a holistic management tool for non-compliance*. Clin Transplant 2005; 19:38-44. [PMID: 15659132 DOI: 10.1111/j.1399-0012.2004.00291.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We introduce a new concept of psychosocial profiling as a tool that provides the transplant team with a psychosocial framework for identification, intervention and management of non-compliance. This will also increase our understanding of emotional problems experienced by patients before transplant, as a result of living with the uncertainty and medical side effects of chronic illness. Psychosocial profiling is adaptable throughout the transplant process and gives every patient an opportunity of psychosocial support to help him or her into a position of emotional stability and compliance with their medications and postoperative care. Implementation of this strategy will move health care professionals from being gatekeepers to managers and facilitators of holistic care in recipients of transplants.
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Medication Adherence for Antihypertensive Therapy. Hypertension 2005. [DOI: 10.1016/b978-0-7216-0258-5.50131-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Cramer JA, Okikawa J, Bellaire S, Clauson P. Compliance with inhaled insulin treatment using the AERx iDMS Insulin Diabetes Management System. Diabetes Technol Ther 2004; 6:800-7. [PMID: 15684632 DOI: 10.1089/dia.2004.6.800] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The AERx Insulin Diabetes Management System [AERx iDMS, jointly developed by Novo Nordisk (Bagsvaerd, Denmark) and Aradigm Corp. (Hayward, CA)] provides insulin by pulmonary administration. This investigation was designed as a pilot trial to demonstrate the ability of patients to use the electronic device to deliver mealtime inhaled insulin doses and explore the impact on compliance. METHODS AERx iDMS was evaluated in a substudy of a 12-week, multicenter open trial by adult patients with type 2 diabetes previously on any insulin regimen. The device was used for dosing fast-acting human insulin immediately before main meals, in combination with bedtime NPH insulin. The AERx iDMS device recorded the date and time of each insulin inhalation, insulin units used, and inhalation technique during aerosol delivery. Compliance was defined as the percentage of prescribed doses taken during the treatment period, dose timing, and the efficiency of dosing technique. RESULTS Insulin dosing for 49 patients (age 59.1 +/- 7.7 years) using AERx iDMS was monitored for 78.9 +/- 10 days (range, 41-94 days) with 226 +/- 35 doses (range, 122-272 doses). Patients inhaled on average 2.9 +/- 0.3 doses of insulin daily, taking an average of 11.8 +/- 5.6 units per dose. Compliance with the prescribed regimen was 94.3 +/- 9.1% (range, 45-100%). Overall, 4.2 +/- 9.5% of prescribed doses were omitted. Hemoglobin A1c decreased 0.77 +/- 0.96% from baseline to the end of the study. Inhalation technique was excellent, with 97% of patients experiencing fewer than five inadequate doses. CONCLUSIONS Excellent compliance with AERx iDMS dosing, timing, and inhalation technique showed that the device was well accepted by patients. The electronic monitoring feature could be used as an educational tool to help patients and clinicians manage insulin dosing.
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Affiliation(s)
- J A Cramer
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06516-2770, USA.
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Lau DT, Nau DP. Oral antihyperglycemic medication nonadherence and subsequent hospitalization among individuals with type 2 diabetes. Diabetes Care 2004; 27:2149-53. [PMID: 15333476 DOI: 10.2337/diacare.27.9.2149] [Citation(s) in RCA: 209] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study examines the association between oral antihyperglycemic medication nonadherence and subsequent hospitalization among individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS Using administrative claims data (2000-2001) from a managed care organization in the Midwestern U.S., this study analyzed 900 enrollees, aged 18 years and over, with type 2 diabetes who were taking oral antihyperglycemic agents both years but who did not use insulin. Nonadherence was defined as a medication possession ratio (MPR) <80%. Multivariate logistic regression analyses were performed where hospitalization in 2001 was regressed on nonadherence to the oral antihyperglycemic drug regimen in 2000, while controlling for nonadherence to drugs for hypertension and dyslipidemia and for hospitalization in 2000, age, sex, intensity of the diabetes drug regimen, and comorbidities. RESULTS The proportion of enrollees who were nonadherent to the antihyperglycemic drug regimen in 2001 was 28.9%, whereas 18.8 and 26.9% were nonadherent to antihypertensive and lipid-modifying drugs, respectively. The increase in the hospitalization rate for 2001 was most apparent where the antihyperglycemic MPR for 2000 dropped to <80%. Enrollees who were nonadherent to oral diabetes medications in 2000 were at higher risk of hospitalization in 2001 (odds ratio 2.53; 95% CI 1.38-4.64), whereas nonadherence to drugs for hypertension and dyslipidemia were not significantly associated with hospitalization. CONCLUSIONS Patients with type 2 diabetes who do not obtain at least 80% of their oral antihyperglycemic medications across 1 year are at a higher risk of hospitalization in the following year.
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Affiliation(s)
- Denys T Lau
- Pfizer Research Fellowship Program, Department of Health Management and Policy, The University of Michigan School of Public Policy, Ann Arbor, Michigan, USA
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Abstract
OBJECTIVE The purpose of this study was to determine the extent to which patients omit doses of medications prescribed for diabetes. RESEARCH DESIGN AND METHODS A literature search (1966-2003) was performed to identify reports with quantitative data on adherence with oral hypoglycemic agents (OHAs) and insulin and correlations between adherence rates and glycemic control. Adequate documentation of adherence was found in 15 retrospective studies of OHA prescription refill rates, 5 prospective electronic monitoring OHA studies, and 3 retrospective insulin studies. RESULTS Retrospective analyses showed that adherence to OHA therapy ranged from 36 to 93% in patients remaining on treatment for 6-24 months. Prospective electronic monitoring studies documented that patients took 67-85% of OHA doses as prescribed. Electronic monitoring identified poor compliers for interventions that improved adherence (61-79%; P < 0.05). Young patients filled prescriptions for one-third of prescribed insulin doses. Insulin adherence among patients with type 2 diabetes was 62-64%. CONCLUSIONS This review confirms that many patients for whom diabetes medication was prescribed were poor compliers with treatment, including both OHAs and insulin. However, electronic monitoring systems were useful in improving adherence for individual patients. Similar electronic monitoring systems for insulin administration could help healthcare providers determine patients needing additional support.
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Affiliation(s)
- Joyce A Cramer
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.
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Lara-Torre E, Edwards CP, Perlman S, Hertweck SP. Bone mineral density in adolescent females using depot medroxyprogesterone acetate. J Pediatr Adolesc Gynecol 2004; 17:17-21. [PMID: 15010034 DOI: 10.1016/j.jpag.2003.11.017] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE To examine bone mineral density (BMD) on a semi-annual basis among control subjects and adolescent females receiving depot medroxyprogesterone acetate (DMPA) injection or oral contraceptives. DESIGN Non-randomized prospective study. SETTING Teenage pregnancy prevention intervention clinic. PARTICIPANTS Adolescent females who were new users of DMPA injection (N=58, age 12-21) or the oral contraceptive pill (N=71, age 11-19) and normal menstruating girls (N=19, age 15-18). INTERVENTIONS Baseline and 6-monthly measures of lumbar vertebral BMD using dual-energy X-ray absorptiometry over a 2-year period. MAIN OUTCOME MEASURES comparison of percent change on BMD over time between DMPA users, pill users, and normal menstruating girls. RESULTS There was no difference on group characteristics at baseline except for the ethnicity between the controls and the DMPA group. There was a statistically significant decrease in BMD between DMPA users and controls at 6 months (-3.02% change, P=0.014) 12 months (-3.38% change, P=0.001) 18 months (-4.81% change, P<0.001) and 24 months (-6.81% change, P=0.010). There was no statistical difference between pill users and controls. CONCLUSION There is a relationship between DMPA use and a decrease in BMD compared to normal menstruating controls that seems to persist up to 24 months.
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Ruskin PE, Wende JVD, Clark CR, Fenton J, Deveau J, Thapar R, Prasad M, Kehr BA. Feasibility of Using the Med-eMonitor System in the Treatment of Schizophrenia: A Pilot Study. ACTA ACUST UNITED AC 2003. [DOI: 10.1177/009286150303700304] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
OBJECTIVE Our objective was to evaluate the safety, efficacy, and need for dosage adjustments when patients taking the Neoral formulation of cyclosporine are converted to the generic formulation, Gengraf. METHODS From September 2001 through January 2002, patients receiving follow-up care in the renal transplant clinic at the VA Tennessee Valley Healthcare System were converted from Neoral to Gengraf based on a 1:1 dosing equivalency. Steady-state cyclosporine trough concentrations were obtained both prior to and following Neoral-to-Gengraf conversions. Patients were also monitored for changes in serum creatinine, hospitalization, cyclosporine toxicity, graft rejection, and need for further adjustment in cyclosporine regimen. RESULTS Forty-one patients were included in data analysis. There were no differences in cyclosporine concentrations (P =.0853) or serum creatinine (P =.4469) following conversion to Gengraf. There were no reports of cyclosporine toxicity, no episodes of graft rejection, and no need for further dose adjustment related to the generic conversion. CONCLUSIONS Neoral and Gengraf are therapeutically equivalent cyclosporine formulations, such that renal transplant recipients maintained on Neoral can be safely and effectively converted to the Gengraf formulation based on a 1:1 conversion ratio. The use of Gengraf over Neoral within the Veterans Affairs Healthcare System offers a reduced cost alternative but maintains equal efficacy and outcomes.
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Affiliation(s)
- W Carnahan
- VA Tennessee Valley Healthcare System, Nashville, Tennessee 37212, USA.
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Lyon ME, Trexler C, Akpan-Townsend C, Pao M, Selden K, Fletcher J, Addlestone IC, D'Angelo LJ. A family group approach to increasing adherence to therapy in HIV-infected youths: results of a pilot project. AIDS Patient Care STDS 2003; 17:299-308. [PMID: 12880493 DOI: 10.1089/108729103322108175] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This paper describes the development of a novel, pilot program in which a combined family group and peer approach were used to increase adherence to antiretroviral therapy in HIV-infected youths. Twenty-three HIV-positive youths, 15-22 years of age and 23 family members or "treatment buddies" participated in one of three 12-week programs. The intervention had six biweekly family and youth education sessions and six biweekly youth-only education sessions. Devices to increase adherence to antiretroviral therapy such as pill boxes, calendars, and watch alarms were introduced at youth-only sessions. Eighteen of the 23 youths completed a group. Ninety-one percent of youths self-reported increased adherence to medications after completion of a group. Four participants experienced a one-log reduction in viral loads to undetectable levels during the intervention. Two participants continued to decline antiretroviral medications at the end of the intervention and demonstrated no decrease in viral load. Participants tested five devices and rated the multiple alarm watch as the best aid for improving adherence to medication. Family/treatment buddies rated the overall program as highly helpful, citing social support as most valuable. An unanticipated benefit was an increase in other health behaviors, including medical and dental appointments, hepatitis B and influenza immunizations, and referrals to mental health and substance abuse treatment.
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Affiliation(s)
- Maureen E Lyon
- Division of Adolescent and Young Adult Medicine/Burgess Clinic Children's National Medical Center (CNMC), Washington, DC 20010-2970, USA.
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Schectman JM, Bovbjerg VE, Voss JD. Predictors of medication-refill adherence in an indigent rural population. Med Care 2002; 40:1294-300. [PMID: 12458310 DOI: 10.1097/00005650-200212000-00016] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We evaluated the association of medication refill adherence with demographic and prescription characteristics to determine whether such factors could guide intervention strategies in an indigent rural population. METHODS The study was conducted at a University-based internal medicine practice serving an indigent rural population. Refill data for diabetes, hypertension, and hypercholesterolemia drugs from a closed pharmacy system were used to calculate mean adherence (for all drugs taken by each patient) and minimum adherence (that of the least adhered to drug) for 1984 patients during a 9-month period. RESULTS Mean refill adherence was <80% for 33% of the population and minimum refill adherence was <80% for 55% of the patients. Increasing age, race (white), and prescription length were associated with higher mean and minimum adherence, independent of income, prescription copay, and insurance status. Number of drugs taken had a positive mean but negative minimum adherence association. Gender, number of primary care visits, and dosage schedule were not independently associated with adherence. The model explained 6.8% of the variance in mean adherence. CONCLUSIONS In a rural indigent population, medication refill adherence was associated with race, age, and prescription length, though these factors explained only a small amount of adherence variability. Although ingestion adherence is the goal, refill adherence is a necessary condition for ingestion adherence. To enhance adherence, physicians need better predictors to target their efforts to patients most in need of attention. Prescription claims data could serve this purpose.
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Affiliation(s)
- Joel M Schectman
- Department of Medicine, University of Virginia, PO Box 800744, Charlottesville, VA 22908, USA.
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Lara-Torre E, Schroeder B. Adolescent compliance and side effects with Quick Start initiation of oral contraceptive pills. Contraception 2002; 66:81-5. [PMID: 12204779 DOI: 10.1016/s0010-7824(02)00326-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Adolescents' compliance with use of oral contraceptive pills has been described in the literature. The purpose of this study was to compare traditional Sunday Start to a same day (Quick Start) approach. A retrospective study of patients 22 years of age and younger was performed comparing compliance at 3 months and 12 months and side effects. The groups were divided into Quick Start (N = 77, 40%) and Sunday Start (N = 116, 60%). One hundred twenty-five (65%) patients were compliant at 3 months; 68 patients (35%) were compliant at 12 months. Quick Start users were more likely to comply at 3 months (72% vs. 56%, p = 0.059), especially if they were Caucasian (80% vs. 65%, p = 0.007), with dysmenorrhea (86% vs. 62%, p = 0.006), nulligravid (77% vs. 58%, p = 0.008), or nulliparous (73% vs. 59%, p = 0.038). There was no difference in side effects. There was no significant difference at 1 year in compliance or side effects. Findings suggest better compliance in adolescents at 3 months with the Quick Start approach while maintaining side effect profile.
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Affiliation(s)
- Eduardo Lara-Torre
- Department of OB/GYN, University Hospitals of Cleveland, Case Western Reserve School of Medicine, Cleveland, OH, USA.
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Abstract
Today, 42% of Americans use alternative nonprescription therapies to treat medical conditions; 46% of nonprescription alternative use for principal medical conditions is done without consulting either a medical doctor or a nonphysician practitioner of alternative therapy. Many nontraditional alternatives are used to treat the hot flashes and somatic complaints of menopause, for which options such as hormone replacement therapy and other prescription and over-the-counter drugs are also available. To date, no one agent treats all menopausal symptoms as effectively as estrogen. Selective estrogen-receptor modulators can help prevent osteoporosis but do not relieve menopausal symptoms. However, some women are unwilling or unable to take hormone replacement therapy, and some decide to discontinue therapy. Evidence supporting the use of some nonprescription alternatives for conditions related to menopause is limited. Patients need to be aware of the potential for drug interactions when these alternative therapies are used concomitantly with prescription drugs. The current evidence to support use of hormone replacement therapy, selective estrogen-receptor modulators, and nontraditional alternatives is reviewed here.
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Affiliation(s)
- M L Gass
- Department of Obstetrics and Gynecology, University Menopause and Osteoporosis Center, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
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La Valleur J, Wysocki S. Selection of oral contraceptives or hormone replacement therapy: patient communication and counseling issues. Am J Obstet Gynecol 2001; 185:S57-64. [PMID: 11521123 DOI: 10.1067/mob.2001.116523] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Oral contraceptives and combination hormone replacement therapy are underused by most women. Among users, lack of compliance/adherence to oral contraceptive or hormone replacement therapy regimens can lead to discontinuation and deprive women of the full range of benefits achieved through hormone continuity. To prevent unintended pregnancy and to improve the health outcomes of women of all ages and the overall quality of life, adherence and continuation rates need to be improved for oral contraceptive and hormone replacement therapy use. Effective communication and counseling during the oral contraceptive and hormone replacement therapy regimen selection process and subsequent follow-up interactions are essential. Patients need to be informed in a clear and concise manner that, for most women, the benefits of oral contraceptives and hormone replacement therapy outweigh any associated health risks. Data should be presented without epidemiologic jargon and in terms that are easily understood. It is recommended that realistic expectations concerning the possible side effects, especially during the initial use of hormones, are established before use; furthermore, the selection of a formulation should take into account the unique needs of each patient.
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Affiliation(s)
- J La Valleur
- Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota Medical School, Minneapolis, MN 55455, USA
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Ramsay DS. Patient compliance with oral hygiene regimens: a behavioural self-regulation analysis with implications for technology. Int Dent J 2001; Suppl Creating A Successful:304-11. [PMID: 11197191 DOI: 10.1111/j.1875-595x.2000.tb00580.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Achieving optimal oral health through preventive efforts is a hallmark of the dental profession. A primary goal of a preventively-oriented dental practice is to encourage patients to practice appropriate oral self-care behaviours. When patients are asked to follow an oral self-care regimen, they are being given a target or goal (for example, brush twice a day) and their task is to control or regulate their behaviour to achieve that objective. Unfortunately, patients often fail to meet the expectations set forth by the clinical recommendation. This review examines the problem of poor patient compliance with oral hygiene regimens by applying the general principles that govern the self-regulation of behaviour. The component parts of a behavioural self-regulation model are reviewed in the context of oral self-care. Research in the area of toothbrushing behaviour is reviewed and methods for providing patients with feedback about their degree of compliance are discussed.
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Affiliation(s)
- D S Ramsay
- Department of Pediatric Dentistry, University of Washington, Box #357136, Seattle, WA 98195-7136, USA.
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Demyttenaere K, Haddad P. Compliance with antidepressant therapy and antidepressant discontinuation symptoms. Acta Psychiatr Scand Suppl 2001; 403:50-6. [PMID: 11019935 DOI: 10.1111/j.1600-0447.2000.tb10948.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Compliance with antidepressant medication is important in order to achieve all the goals of antidepressant therapy. These goals include symptom resolution, restoration of normal functioning and prevention of relapse or recurrent episodes. METHOD We discuss compliance and review adverse symptoms that may occur when antidepressant treatment is abruptly discontinued or interrupted. RESULTS The physician's role in managing compliance includes preventing or minimizing the risk for discontinuation symptoms, counselling patients regarding the risk for symptoms if doses are missed and choosing pharmacotherapy that is forgiving of non-compliance. Physicians also need to recognize the symptoms of discontinuation syndrome in order to differentiate patients who are non-compliant from patients who require a dosage adjustment or adjunctive therapy. Finally, physicians need to understand how to treat discontinuation symptoms when they do occur. CONCLUSION Since published data indicate that between 30% and 60% of patients do not take their medications as prescribed, non-adherence to antidepressant medication is likely to be a significant clinical issue in the management of many patients.
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Affiliation(s)
- K Demyttenaere
- Department of Psychiatry, University Hospital Leuven, Belgium
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Abstract
Contraceptives are very effective when used and taken properly. Their effectiveness is limited by patient compliance with the prescribed regimens and contributes to unintended pregnancies. Multiple theories and models have been developed to address the issue of contraceptive compliance. This article will examine the consequences of noncompliance, potential reasons for noncompliance, and strategies for improving compliance in individual patients.
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Affiliation(s)
- K L Dardano
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts, USA
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Abstract
OBJECTIVE The aim of this study was to assess symptom frequency and symptom distress associated with adverse effects of immunosuppressive therapy in kidney transplant recipients and to correlate it with compliance and socio-demographic characteristics. METHODS Symptom frequency and symptom distress were evaluated by the 'Adapted Transplant Symptom Frequency and Symptom Distress Scale'. Data were collected from 85 patients who had undergone a kidney transplant between 1995 and 1997. RESULTS Women reported a significantly higher level of symptom frequency and symptom distress when compared with men. The most frequent symptoms reported by women were changed appearance and increased hair growth, whereas for men were increased appetite and 'moon face'. Nevertheless the most distressing symptoms for women were painful menstruation and insomnia and for men were impotence and decreased interest in sex. Concerning compliance the non-compliant group reported a higher level of symptom frequency and symptom distress when compared with the compliant group. These results suggest that complications caused by symptoms associated with the adverse effects of immunosuppressive therapy are perceived differently by men and women and may induce non-compliance.
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Affiliation(s)
- C T de Barros
- Faculdade de Farmácia da Universidade de Lisboa, Sub-Grupo Sócio-Farmácia, P-1600, Lisbon, Portugal.
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Abstract
As average life expectancy increases, so do the incidence of chronic diseases and the number of persons receiving long-term drug therapy. Thus elderly patients' noncompliance with medication regimens has the potential for sweeping medical and economic consequences and is likely to become increasingly important in the design of disease-management programs for this population. The author conducted a MEDLINE search of the English-language literature for the years 1962 to 1997 to identify articles concerning predictors of medication compliance in the elderly. A descriptive analysis of this literature indicated that there remains some uncertainty about the reasons for noncompliant medication-taking in the elderly. Clear associations have been established between elderly patients' medication adherence and race, drug and dosage form, number of medications, cost of medications, insurance coverage, and physician-patient communication. However, the findings are inconsistent with regard to the effects of patients' age, sex, socioeconomic status, living arrangement, comorbidities, number of physician visits, and knowledge, attitudes, and beliefs about health. Until the results of further comprehensive studies are available, the current knowledge should be considered when designing and implementing disease-management programs for the elderly.
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Affiliation(s)
- R Balkrishnan
- Division of Health Policy and Administration, University of North Carolina at Chapel Hill, 27899-7360, USA
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Dartnell JG, Anderson RP, Chohan V, Galbraith KJ, Lyon ME, Nestor PJ, Moulds RF. Hospitalisation for adverse events related to drug therapy: incidence, avoidability and costs. Med J Aust 1996; 164:659-62. [PMID: 8657028 DOI: 10.5694/j.1326-5377.1996.tb122235.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To determine the incidence of hospital admissions for adverse events related to drug therapy, and to assess whether these drug-related admissions (DRAs) could have been reasonably prevented. SETTING A tertiary teaching hospital. DESIGN AND PATIENTS Prospective assessment of all admissions through the emergency department and resulting in a stay of more than 24 hours during 30 consecutive days in November and December 1994 to determine if the admission was related to drug therapy. Cases of intentional overdose were excluded. MAIN OUTCOME MEASURES The number, type, causality and avoidability of drug-related admissions. RESULTS Of 965 admissions, 55 (5.7%) were assessed as being drug-related. Drug-related admissions (DRAs) were designated possibly (38%), probably (46%) or definitely (16%) drug-related; caused by prescribing factors (26%), patient noncompliance (27%) and adverse drug reactions (47%); and classified as definitely (5.5%), possibly (60.0%) and not (34.5%) avoidable. The estimated annual cost to the hospital for all DRAs was $3,496,956 and for unavoidable DRAs was $1,629,494. CONCLUSION The DRA rate we found lies around the middle of the range of other published rates. Few DRAs were judged definitely avoidable and over one-third were unavoidable. Nevertheless, the largest proportion were judged possibly avoidable. As the drugs identified in this study are clearly needed in the community, efforts to reduce DRAs must concentrate on education, counselling and monitoring of drug therapy.
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Affiliation(s)
- J G Dartnell
- Department of Clinical Pharmacology and Therapeutics, Royal Melbourne Hospital, Parkville, VIC
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Cramer JA. Microelectronic systems for monitoring and enhancing patient compliance with medication regimens. Drugs 1995; 49:321-7. [PMID: 7774509 DOI: 10.2165/00003495-199549030-00001] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- J A Cramer
- Department of Veterans Affairs, West Haven, Connecticut, USA
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