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Baéz-Gutiérrez N, Rodríguez-Ramallo H, Sánchez-Fidalgo S. Medication adherence and persistence in heart failure: A protocol for a systematic review and meta-analysis. FARMACIA HOSPITALARIA 2024:S1130-6343(24)00117-X. [PMID: 39142941 DOI: 10.1016/j.farma.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 08/16/2024] Open
Abstract
OBJECTIVE To study medication adherence and persistence among heart failure patients, assess the methods utilised for estimating medication adherence, and identify optimal adherence thresholds and their impact on clinical outcomes. METHODS A systematic search will be conducted in PubMed, Embase, CINAHL, Web of Science, and Scopus databases. Observational studies assessing medication adherence or persistence among heart failure patients via electronic healthcare databases will be included. A narrative synthesis will describe medication adherence and persistence reported and methods used to measure it. A meta-analysis will be attempted to evaluate the impact of secondary medication adherence (multiple and by drug class) on clinical outcomes, including hospitalisation, emergency visits, and mortality. The I2 statistic will be employed to study heterogeneity and the GRADE framework to evaluate evidence certainty. This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines and is registered with the Prospective Register of Ongoing Systematic Reviews CRD42024509542. DISCUSSION This study aims to evaluate medication adherence and persistence in heart failure management through electronic health databases, intending to explore widely used measurement methods and their limitations, and to identify adherence thresholds associated with improved clinical outcomes. By examining these aspects, we anticipate proposing enhancements for future research and establishing desired adherence goals. This approach highlights the expected significance of our findings in advancing patient care and research methodologies.
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Affiliation(s)
- Nerea Baéz-Gutiérrez
- Pharmacy Department, University Hospital Nuestra Señora de Valme, Seville, Spain; Preventive Medicine and Public Health Department, University of Seville, Seville, Spain
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Matsumoto M, Harada S, Ikuta H, Iida M, Kato S, Sata M, Shibuki T, Ishibashi Y, Miyagawa N, Hisamatsu M, Hirata A, Kuwabara K, Takeuchi A, Sugiyama D, Suzuki S, Nakamura T, Okamura T, Takebayashi T. Evaluation of Medication Adherence Among Prevalent Users in Hypertension, Dyslipidemia, and Diabetes Using Health Insurance Claims: A Population-Based Cohort Study in Japan. Pharmacoepidemiol Drug Saf 2024; 33:e5855. [PMID: 39145400 DOI: 10.1002/pds.5855] [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: 01/25/2024] [Revised: 05/28/2024] [Accepted: 05/31/2024] [Indexed: 08/16/2024]
Abstract
PURPOSE Hypertension (HT), dyslipidemia (DL), and diabetes mellitus (DM) are major risk factors for cardiovascular diseases. Despite the wide availability of medications to reduce this risk, poor adherence to medications remains an issue. The aim of this study is to evaluate medication adherence of prevalent users in these disease medications (HT, DL, DM) using claims data. Factors associated with non-adherence were also examined. METHODS Of 7538 participants of the Tsuruoka Metabolomics Cohort Study, 3693 (HT: 2702, DL: 2112, DM: 661) were identified as prevalent users of these disease medications. Information on lifestyle was collected through a questionnaire. Adherence was assessed by a proportion of days covered (PDC) and participants with PDC ≥0.8 were defined as adherent. Predictors of non-adherence were determined by performing multivariable logistic regression. RESULTS Medication adherence differed by treatment status. Among those without comorbidities, those with HT-only showed the highest adherence (90.2%), followed by those with DM-only (81.2%) and those with DL-only (80.8%). Factors associated with non-adherence in each medication group were skipping breakfast and poor understanding of medications among those with HT medications, females, having comorbidities, having a history of heart disease, and drinking habit among those with DL medications, and good sleep quality and skipping breakfast among those with DM medications. CONCLUSION While participants showed high medication adherence, differences were observed across medication groups. The identified predictors of non-adherence could help target those in need of adherence support.
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Affiliation(s)
- Minako Matsumoto
- Department of Preventive Medicine, Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Sei Harada
- Department of Preventive Medicine, Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Harufumi Ikuta
- Division of Pharmaceutical Care Sciences, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Miho Iida
- Department of Preventive Medicine, Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Suzuka Kato
- Department of Preventive Medicine, Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Mizuki Sata
- Department of Preventive Medicine, Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Takuma Shibuki
- Department of Preventive Medicine, Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiki Ishibashi
- Department of Preventive Medicine, Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Naoko Miyagawa
- Department of Preventive Medicine, Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Moeko Hisamatsu
- Division of Pharmaceutical Care Sciences, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Aya Hirata
- Department of Preventive Medicine, Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Kazuyo Kuwabara
- Department of Preventive Medicine, Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Ayano Takeuchi
- Faculty of Science and Engineering, Chuo University, Tokyo, Japan
| | - Daisuke Sugiyama
- Faculty of Nursing and Medical Care and Graduate School of Health Management, Keio University, Fujisawa, Japan
| | - Sayo Suzuki
- Division of Pharmaceutical Care Sciences, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Tomonori Nakamura
- Division of Pharmaceutical Care Sciences, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Tomonori Okamura
- Department of Preventive Medicine, Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Toru Takebayashi
- Department of Preventive Medicine, Public Health, Keio University School of Medicine, Tokyo, Japan
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Parkin S, Neale J, Strang J. 'Matters-of-concern' associated with discontinuation of long-acting injectable buprenorphine: Findings from a longitudinal qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 129:104470. [PMID: 38843737 DOI: 10.1016/j.drugpo.2024.104470] [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: 11/28/2023] [Revised: 05/17/2024] [Accepted: 05/18/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND Discontinuation of medications such as methadone and buprenorphine amongst patients receiving opioid agonist treatment (OAT) is an international phenomenon. Recent developments in OAT medication include depot-injections of buprenorphine. Circumstances underlying discontinuation of these new formulations of medication are not fully understood from a qualitative perspective. METHODS Data derive from a longitudinal qualitative study of patients' experience of long-acting injectable buprenorphine (LAIB), involving semi-structured telephone-interviews held at six-points in time. The relevant dataset for this article consists of 44 interview transcripts, generated from 8 participants who were each affected by discontinuation of LAIB prescriptions (during the first 12-months of treatment). Analyses sought to identify circumstances associated with LAIB discontinuation and data were further situated within a framework of 'evidence making intervention' and associated 'matters-of-concern'. Matters-of-concern relate to the ways in which an intervention is 'made' and constructed through engagement and practice, from the perspective of the recipient. FINDINGS In this study, participants experienced either 'discontinuation of LAIB prescriptions by treatment services' or patient-led 'opt-out' from treatment. Matters-of-concern underlying the former were associated with late attendance for scheduled appointments, non-prescribed substance use or receiving a custodial sentence. Matters-of-concern relating to patient-initiated discontinuation were associated with personal circumstances that affected treatment motivation, side-effects (of buprenorphine), a preference to resume heroin use, or because individual treatment goals had been achieved. CONCLUSION The assorted matters-of-concern that influence discontinuation of LAIB demonstrate that such OAT is complex and multi-faceted, is neither fixed nor stable, and does not generate universally shared outcome. Experiences of LAIB discontinuation are shaped by a wide range of social, temporal and treatment-related effects that include disconnected therapeutic alliance between patient and treatment providers. In order to maximise the benefits of LAIB it is necessary to develop meaningful therapeutic alliances (notwithstanding policy boundaries) to enable exploration of matters-of-concern during treatment.
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Affiliation(s)
- Stephen Parkin
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK.
| | - Joanne Neale
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8BB, UK; Centre for Social Research in Health, University of New South Wales, NSW 2052, Australia
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8BB, UK; South London & Maudsley (SLaM) NHS Foundation Trust, London SE5 8AZ, UK
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Inotai A, Kaló Z, Petykó Z, Gyöngyösi K, O’Keeffe DT, Czech M, Ágh T. Facilitators and Barriers of Incremental Innovation by Fixed Dose Combinations in Cardiovascular Diseases. J Cardiovasc Dev Dis 2024; 11:186. [PMID: 39057609 PMCID: PMC11277553 DOI: 10.3390/jcdd11070186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
Despite the availability of affordable pharmaceuticals treating cardiovascular diseases (CVDs), many of the risk factors remain poorly controlled. Fixed-dose combinations (FDCs), a form of incremental innovation, have already demonstrated improvements over combinations of single medicines in adherence and hard clinical endpoints. Nevertheless, there are many barriers related to the wider use of FDCs in CVDs. Our aim was to identify these barriers and explore system-level facilitators from a multi-stakeholder perspective. Identified barriers include (i) hurdles in evidence generation for manufacturers, (ii) limited acceptance of adherence as an endpoint by clinical guideline developers and policymakers, (iii) limited options for a price premium for incremental innovation for healthcare payers, (iv) limited availability of real-world evidence, and (v) methodological issues to measure improved adherence. Initiatives to standardize and link healthcare databases in European countries, movements towards improved patient centricity in healthcare, and extended value assessment provide opportunities to capture the benefits of FDCs. Still, there is an emerging need to facilitate the generalizability of sporadic clinical evidence across different FDCs and to improve adherence measures. Finally, healthcare payers need to be convinced to pay a fair premium price for the added value of FDCs to incentivize incremental innovation in CVD treatment.
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Affiliation(s)
- András Inotai
- Center for Health Technology Assessment, Semmelweis University, 1091 Budapest, Hungary; (A.I.); (Z.P.); (K.G.)
- Syreon Research Institute, 1142 Budapest, Hungary;
| | - Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University, 1091 Budapest, Hungary; (A.I.); (Z.P.); (K.G.)
- Syreon Research Institute, 1142 Budapest, Hungary;
| | - Zsuzsanna Petykó
- Center for Health Technology Assessment, Semmelweis University, 1091 Budapest, Hungary; (A.I.); (Z.P.); (K.G.)
- Syreon Research Institute, 1142 Budapest, Hungary;
| | - Kristóf Gyöngyösi
- Center for Health Technology Assessment, Semmelweis University, 1091 Budapest, Hungary; (A.I.); (Z.P.); (K.G.)
- Syreon Research Institute, 1142 Budapest, Hungary;
| | | | - Marcin Czech
- Department of Pharmacoeconomics, Institute of Mother and Child, 01-211 Warsaw, Poland;
| | - Tamás Ágh
- Syreon Research Institute, 1142 Budapest, Hungary;
- Medication Adherence Research Group, Center for Health Technology Assessment and Pharmacoeconomic Research, University of Pécs, 7623 Pécs, Hungary
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Nelson AJ, Pagidipati NJ, Bosworth HB. Improving medication adherence in cardiovascular disease. Nat Rev Cardiol 2024; 21:417-429. [PMID: 38172243 DOI: 10.1038/s41569-023-00972-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
Non-adherence to medication is a global health problem with far-reaching individual-level and population-level consequences but remains unappreciated and under-addressed in the clinical setting. With increasing comorbidity and polypharmacy as well as an ageing population, cardiovascular disease and medication non-adherence are likely to become increasingly prevalent. Multiple methods for detecting non-adherence exist but are imperfect, and, despite emerging technology, a gold standard remains elusive. Non-adherence to medication is dynamic and often has multiple causes, particularly in the context of cardiovascular disease, which tends to require lifelong medication to control symptoms and risk factors in order to prevent disease progression. In this Review, we identify the causes of medication non-adherence and summarize interventions that have been proven in randomized clinical trials to be effective in improving adherence. Practical solutions and areas for future research are also proposed.
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Affiliation(s)
- Adam J Nelson
- Victorian Heart Institute, Melbourne, Victoria, Australia
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | | | - Hayden B Bosworth
- Duke Clinical Research Institute, Duke University, Durham, NC, USA.
- Population Health Sciences, Duke University, Durham, NC, USA.
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Qiu S, Hubbard AE, Gutiérrez JP, Pimpale G, Juárez-Flores A, Ghosh R, de Jesús Ascencio-Montiel I, Bertozzi SM. Estimating the effect of realistic improvements of metformin adherence on COVID-19 mortality using targeted machine learning. GLOBAL EPIDEMIOLOGY 2024; 7:100142. [PMID: 38590914 PMCID: PMC10999684 DOI: 10.1016/j.gloepi.2024.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 04/10/2024] Open
Abstract
Background Type 2 diabetes elevates the risk of severe outcomes in COVID-19 patients, with multiple studies reporting higher case fatality rates. Metformin is a widely used medication for glycemic management. We hypothesize that improved adherence to metformin may lower COVID-19 post-infection mortality risk in this group. Utilizing data from the Mexican Social Security Institute (IMSS), we investigate the relationship between metformin adherence and mortality following COVID-19 infection in patients with chronic metformin prescriptions. Methods This is a retrospective cohort study consisting of 61,180 IMSS beneficiaries who received a positive polymerase chain reaction (PCR) or rapid test for SARS-CoV-2 and had at least two consecutive months of metformin prescriptions prior to the positive test. The hypothetical intervention is improved adherence to metformin, measured by proportion of days covered (PDC), with the comparison being the observed metformin adherence values. The primary outcome is all-cause mortality following COVID-19 infection. We defined the causal parameter using shift intervention, an example of modified treatment policies. We used the targeted learning framework for estimation of the target estimand. Findings Among COVID-19 positive patients with chronic metformin prescriptions, we found that a 5% and 10% absolute increase in metformin adherence is associated with a respective 0.26% (95% CI: -0.28%, 0.79%) and 1.26% (95% CI: 0.72%, 1.80%) absolute decrease in mortality risk. Interpretation Subject to the limitations of a real-world data study, our results indicate a causal association between improved metformin adherence and reduced COVID-19 post-infection mortality risk.
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Affiliation(s)
- Sky Qiu
- University of California, School of Public Health, Berkeley, CA, USA
| | - Alan E. Hubbard
- University of California, School of Public Health, Berkeley, CA, USA
| | - Juan Pablo Gutiérrez
- Center for Policy, Population and Health Research, School of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ganesh Pimpale
- University of California, Department of Mechanical Engineering, Berkeley, CA, USA
| | - Arturo Juárez-Flores
- Center for Policy, Population and Health Research, School of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Rakesh Ghosh
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | | | - Stefano M. Bertozzi
- University of California, School of Public Health, Berkeley, CA, USA
- University of Washington, School of Public Health, Seattle, WA, USA
- Instituto Nacional de Salud Pública, Cuernavaca, MOR, Mexico
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7
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Steiner JF. Medication Adherence-From Measurer to Measured. JAMA Intern Med 2024; 184:599-600. [PMID: 38557725 DOI: 10.1001/jamainternmed.2024.0292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
This essay by a researcher who developed a widely used medication adherence measure explores his experience with being labeled “nonadherent.”
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Affiliation(s)
- John F Steiner
- Institute for Health Research, Kaiser Permanente Colorado, Aurora
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Muntner P, Ghazi L, Jones J, Dhalwani N, Poudel B, Wen Y, Chen L, Wang Z, Bittner V, Kalich B, Farkouh ME, Woodward M, Colantonio LD, Rosenson RS. Persistence and Adherence to PCSK9 Inhibitor Monoclonal Antibodies Versus Ezetimibe in Real-World Settings. Adv Ther 2024; 41:2399-2413. [PMID: 38691317 PMCID: PMC11133193 DOI: 10.1007/s12325-024-02868-z] [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: 02/01/2024] [Accepted: 04/04/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION The cardiovascular disease risk reduction benefits of proprotein convertase subtilisin/kexin type 9 inhibitor monoclonal antibodies (PCSK9i mAb) and ezetimibe are dependent on remaining on treatment and being persistent and adherent. We estimated the percentage of patients on therapy, persistent and adherent at 182 and 365 days among US adults with health insurance who initiated a PCSK9i mAb (n = 16,588) or ezetimibe (n = 83,086) between July 2015 and December 2019. METHODS Using pharmacy fill claims, being on therapy was defined as having a day of medication supply in the last 60 of 182 and 365 days following treatment initiation, being persistent was defined as not having a gap of 60 days or more between the last day of supply from one prescription fill and the next fill, and being adherent was defined by having medication available to take on ≥ 80% of the 182 and 365 days following treatment initiation. We estimated multivariable-adjusted risk ratios for being persistent and adherent comparing patients initiating PCSK9i mAb versus ezetimibe using Poisson regression. RESULTS At 182 days following initiation, 80% and 68% were on therapy and 76% and 64% were persistent among patients who initiated a PCSK9i mAb and ezetimibe, respectively. Among patients who were on therapy and persistent at 182 days following initiation, 88% and 81% of those who initiated a PCSK9i mAb and ezetimibe, respectively, were on therapy at 365 days. Among those on therapy and persistent at 182 days following initiation, being persistent and being adherent at 365 days were each more common among PCSK9i mAb versus ezetimibe initiators (persistent: 82% versus 76%, multivariable-adjusted risk ratio 1.07; 95% confidence interval [CI] 1.06-1.08; adherent: 74% versus 71%, multivariable-adjusted risk ratio 1.02; 95% CI 1.01-1.03). CONCLUSIONS These data suggest approaches to increase persistence and adherence to PCSK9i mAb and ezetimibe should be implemented prior to or within 182 days following treatment initiation.
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Affiliation(s)
- Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294, USA
| | - Lama Ghazi
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294, USA.
| | - Jenna Jones
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Nafeesa Dhalwani
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Bharat Poudel
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294, USA
| | - Ying Wen
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294, USA
| | - Ligong Chen
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294, USA
| | - Zhixin Wang
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294, USA
| | - Vera Bittner
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Michael E Farkouh
- Department of Medicine, Cedar-Sinai School of Medicine, Los Angeles, CA, USA
| | - Mark Woodward
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Lisandro D Colantonio
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294, USA
| | - Robert S Rosenson
- Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
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Kato T, Ines M, Minamisawa M, Benjumea D, Keohane D, Alvir J, Kim R, Chen Y, Peixoto T, Kent M, Wogen J, Ishii T, Crowley A, Sugino T, Izumiya Y. Tafamidis medication adherence and persistence in patients with transthyretin amyloid cardiomyopathy in Japan. ESC Heart Fail 2024. [PMID: 38783561 DOI: 10.1002/ehf2.14736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/13/2023] [Accepted: 01/19/2024] [Indexed: 05/25/2024] Open
Abstract
AIMS This study aimed to describe baseline characteristics and adherence among patients with transthyretin amyloid cardiomyopathy (ATTR-CM) treated with tafamidis (VYNDAQEL®) in Japan using the Japanese Medical Data Vision (MDV) database. METHODS AND RESULTS This study was a non-interventional, retrospective cohort study of adult (≥18 years old) patients in the Japanese MDV claims database diagnosed with ATTR-CM and with at least two tafamidis prescriptions of dose strength 4 × 20 mg/day between 1 March 2019 and 31 August 2021. The date of the first prescription was defined as the index date, with follow-up time defined as the time between the first and last prescription plus the days' supply from the last refill. Baseline characteristics were assessed during a 12 month pre-index period. Adherence was measured using two metrics: (i) the modified medication possession ratio (mMPR), calculated by taking the sum of days supplied for all fills within the follow-up period, divided by the number of days of follow-up, and reported as a percentage, with patients classified as adherent with an mMPR of ≥80%, and (ii) the proportion of days covered (PDC), calculated by taking the total number of days' supply dispensed during the follow-up period divided by the number of days of follow-up, adjusting for any days' supply overlap. A total of 210 patients were identified; the mean (standard deviation) age of the cohort was 77 (5.9) years, and the majority (89%) were male. The most common baseline cardiovascular comorbidities were heart failure (85%), ischaemic heart disease (66%), hypertensive diseases (49%), and diabetes (35%); 75% of patients received heart failure medications in the 12 months prior to index, with the most common being beta-blockers (49%), diuretics (48%), angiotensin receptor blockers (30%), angiotensin-converting enzyme inhibitors (22%), and sodium-glucose cotransporter-2 inhibitors (8.1%). Over an average 14 month follow-up, mean mMPR was 96% with a median of 100% [inter-quartile range (IQR): 97-101%]; 93% of patients were adherent (defined as an mMPR ≥ 80%). In the same follow-up period, mean PDC was 93.6% with a median of 99% (IQR: 93-100%). Persistence was high with 78% of patients having a 0 day gap between prescription refills. CONCLUSIONS This study found high adherence rates to tafamidis in this real-world Japanese patient population. Adherence rates in this study were similar to those reported by the tafamidis clinical trial and a previously published US commercial claims adherence analysis. Further studies should be conducted to assess the impact of real-world adherence on real-world outcomes.
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Affiliation(s)
- Takao Kato
- Department of Cardiovascular Medicine, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | | | - Masatoshi Minamisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | | | | | | | | | | | | | | | | | | | | | | | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Stawowczyk E, Ward T, Paoletti E, Senni M, de Arellano AR. Hyperkalemia in chronic kidney disease patients with and without heart failure: an Italian economic modelling study. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:42. [PMID: 38769560 PMCID: PMC11106859 DOI: 10.1186/s12962-024-00547-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Hyperkalemia (HK) is frequently present in chronic kidney disease (CKD). Risk factors for HK among CKD patients include comorbidities and renin-angiotensin-aldosterone system inhibitor (RAASi) treatment. Current standard of care (SoC) often necessitates RAASi down-titration or discontinuation, resulting in poorer cardiorenal outcomes, hospitalization and mortality. This study evaluates the cost-effectiveness of patiromer for HK in CKD patients with and without heart failure (HF) in an Italian setting. METHODS A lifetime Markov cohort model was developed based on OPAL-HK to assess the health economic impact of patiromer therapy in comparison to SoC after accounting for the effects of HK and RAASi use on clinical events. Outcomes included accumulated clinical events, number needed to treat (NNT) and the incremental cost-effectiveness ratio (ICER). Subgroup analysis was conducted in CKD patients with and without HF. RESULTS Patiromer was associated with an incremental discounted cost of €4,660 and 0.194 quality adjusted life years (QALYs), yielding an ICER of €24,004. Per 1000 patients, patiromer treatment prevented 275 moderate/severe HK events, 54 major adverse cardiovascular event, 246 RAASi discontinuation and 213 RAASi up-titration/restart. Subgroup analysis showed patiromer was more effective in preventing clinical events in CKD patients with HF compared to those without; QALY gains were greater in CKD patients without HF versus those with HF (0.267 versus 0.092, respectively). Scenario analysis and sensitivity analysis results support base-case conclusions. CONCLUSION Patiromer is associated with QALY gains in CKD patients with and without HF compared to SoC in Italy. Patiromer prevented HK events, enabled RAASi therapy maintenance and reduced cardiovascular event risk.
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Affiliation(s)
- Ewa Stawowczyk
- Health Economics and Outcomes Research Ltd, Cardiff, UK.
| | - Thomas Ward
- Health Economics and Outcomes Research Ltd, Cardiff, UK
- Health Economics Group, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Ernesto Paoletti
- Nephrology, Dialysis and Transplantation, University of Genoa and Policlinico, San Martino Genoa, Italy
| | - Michele Senni
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
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11
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Wickham ME, McGrail KM, Law MR, Cragg A, Hohl CM. Validating methods used to identify non-adherence adverse drug events in Canadian administrative health data. Br J Clin Pharmacol 2024; 90:1240-1246. [PMID: 38320955 DOI: 10.1111/bcp.16014] [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: 07/24/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 02/08/2024] Open
Abstract
AIMS Medication non-adherence is a type of adverse drug event that can lead to untreated and exacerbated chronic illness, and that drives healthcare utilization. Research using medication claims data has attempted to identify instances of medication non-adherence using the proportion of days covered or by examining gaps between medication refills. We sought to validate these measures compared to a gold standard diagnosis of non-adherence made in hospital. METHODS This was a retrospective analysis of adverse drug events diagnosed during three prospective cohorts in British Columbia between 2008 and 2015 (n = 976). We linked prospectively identified adverse drug events to medication claims data to examine the sensitivity and specificity of typical non-adherence measures. RESULTS The sensitivity of the non-adherence measures ranged from 22.4% to 37.5%, with a proportion of days covered threshold of 95% performing the best; the non-persistence measures had sensitivities ranging from 10.4% to 58.3%. While a 7-day gap was most sensitive, it classified 61.2% of the sample as non-adherent, whereas only 19.6% were diagnosed as such in hospital. CONCLUSIONS The methods used to identify non-adherence in administrative databases are not accurate when compared to a gold standard diagnosis by healthcare providers. Research that has relied on administrative data to identify non-adherent patients both underestimates the magnitude of the problem and may label patients as non-adherent who were in fact adherent.
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Affiliation(s)
- Maeve E Wickham
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Kimberlyn M McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Amber Cragg
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Corinne M Hohl
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Emergency Department, Vancouver General Hospital, Vancouver, BC, Canada
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Gulayin PE, Gutierrez L, Pinto D, Fontana S, Ávila M, Gómez W, Irazola V. A Multi-Component Intervention to Improve Therapeutic Adherence in Uncontrolled Hypertensive Patients Within the Primary Care Level: A Before-and-After Study. High Blood Press Cardiovasc Prev 2024; 31:271-278. [PMID: 38717676 DOI: 10.1007/s40292-024-00645-1] [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: 01/15/2024] [Accepted: 04/17/2024] [Indexed: 06/09/2024] Open
Abstract
INTRODUCTION Non-adherence to medication severely affects chronic disease control. AIM To assess whether a multi-component intervention implemented at the public primary care level in Argentina improves adherence to antihypertensive medication and helps to reduce blood pressure (BP) levels in uncontrolled hypertensive patients. METHODS A before-and-after study was conducted in five public primary care clinics located in the city of Almirante Brown, Argentina. One hundred and twenty-five uncontrolled hypertensive patients received a multi-component intervention based on the Chronic Care model and the 5As strategy (Ask, Advise, Agree, Assist, and Arrange). Medication possession ratio (MPR) and BP values were assessed before and after a 6-month period. RESULTS The follow-up rate was 96.8%. Main baseline characteristics were as follows, male: 44.8%, mean age: 57.1 years (± 8.1), exclusive public healthcare coverage: 83.5%, primary school level or less: 68.8%, and mean systolic/diastolic BP: 157.4 (± 13.6)/97.7 (± 8.2) mmHg. After implementing the intervention, a significant increase in the proportion of adequate adherence (MPR ≥ 80%) was observed, from 16.8% at baseline to 47.2% (p < 0.001). A significant reduction of 16.4 mmHg (CI 95%: 19.6, 13.1) was observed for systolic blood pressure (SBP) and 12.0 mmHg (CI 95%: 14.2, 9.9) for diastolic blood pressure (DBP) (p < 0.001). At 6 months, 51.2% of the population achieved blood pressure control (SBP < 140 mmHg and DBP < 90 mmHg). CONCLUSIONS The study intervention was associated with an increased adherence rate, achieving a significant reduction in BP values and reaching BP control in more than half of the population.
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Affiliation(s)
- Pablo Elías Gulayin
- Instituto de Efectividad Clínica y Sanitaria, Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina.
- Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina.
| | - Laura Gutierrez
- Instituto de Efectividad Clínica y Sanitaria, Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina
| | - Diana Pinto
- Instituto de Efectividad Clínica y Sanitaria, Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina
| | - Silvina Fontana
- Secretaría de Salud de la localidad de Almirante Brown, Pcia, Buenos Aires, Argentina
| | - Mariana Ávila
- Secretaría de Salud de la localidad de Almirante Brown, Pcia, Buenos Aires, Argentina
| | - Walter Gómez
- Secretaría de Salud de la localidad de Almirante Brown, Pcia, Buenos Aires, Argentina
| | - Vilma Irazola
- Instituto de Efectividad Clínica y Sanitaria, Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina
- Comisión Nacional de Investigaciones Científico Tecnológicas, CONICET, Buenos Aires, Argentina
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Calvo-Garcia A, Ramírez Herráiz E, Llorente Cubas IM, Varas De Dios B, Benedí González J, Morell Baladrón A, García-Vicuña R. The Real-World Effectiveness, Persistence, Adherence, and Safety of Janus Kinase Inhibitor Baricitinib in Rheumatoid Arthritis: A Long-Term Study. J Clin Med 2024; 13:2517. [PMID: 38731045 PMCID: PMC11084207 DOI: 10.3390/jcm13092517] [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: 03/22/2024] [Revised: 04/10/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024] Open
Abstract
Background/Aim: Baricitinib (BAR) is the first oral selective Janus kinase inhibitor approved in Europe for rheumatoid arthritis (RA). Real-world data are still needed to clarify its long-term benefits/risk profile. This study aimed to evaluate the effectiveness, persistence, adherence, and safety of BAR in a real-world setting. Methods: An ambispective study was conducted between October 2017 and December 2021 in RA patients starting BAR. The effectiveness was evaluated, assessing changes from the baseline of the Disease Activity Score using 28-joint counts-C reactive protein (DAS28CRP), and the achievement of low disease activity/remission. Drug persistence was evaluated using Kaplan-Meier analysis. Adherence was estimated using the medication possession ratio (MPR) and the 5-item Compliance Questionnaire for Rheumatology. Safety was assessed determining global incidence proportion and adverse event adjusted incidence rates. Results: In total, 61/64 recruited patients were finally analyzed, 83.6% were female, 78.7% were seropositive, the mean age was 58.1 (15.4) years, and the disease duration was 13.9 (8.3) years. A total of 32.8% of patients were naïve to biologics and 16.4% received BAR as monotherapy. The median exposure to BAR was 12.4 (6.6-31.2) months (range 3.1-51.4). A significant change in DAS28CRP was observed after treatment (difference -1.2, p = 0.000). 70.5% and 60.7% of patients achieved low disease activity or remission, respectively, and 50.8% (31/61) remained on BAR throughout the follow-up, with a median persistence of 31.2 (9.3-53.1) months. The average MPR was 0.96 (0.08) and all patients exhibited "good adherence" according to the questionnaire. In total, 21.3% of patients discontinued baricitinib due to toxicity. Conclusions: In our real-world practice, BAR demonstrated effectiveness, large persistence, high adherence to treatment, and an acceptable safety profile.
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Affiliation(s)
- Alberto Calvo-Garcia
- Pharmacy Service, Hospital Universitario La Princesa, IIS-Princesa, 28006 Madrid, Spain; (A.C.-G.); (E.R.H.); (A.M.B.)
| | - Esther Ramírez Herráiz
- Pharmacy Service, Hospital Universitario La Princesa, IIS-Princesa, 28006 Madrid, Spain; (A.C.-G.); (E.R.H.); (A.M.B.)
| | | | - Blanca Varas De Dios
- Rheumatology Service, Hospital Universitario Santa Cristina, 28006 Madrid, Spain;
| | - Juana Benedí González
- Pharmacology, Pharmacognosy and Botany Department, Pharmacy Faculty, Complutense University of Madrid, 28040 Madrid, Spain;
| | - Alberto Morell Baladrón
- Pharmacy Service, Hospital Universitario La Princesa, IIS-Princesa, 28006 Madrid, Spain; (A.C.-G.); (E.R.H.); (A.M.B.)
| | - Rosario García-Vicuña
- Rheumatology Service, Hospital Universitario La Princesa, IIS-Princesa, 28006 Madrid, Spain;
- Department of Medicine, Faculty of Medicine, Autonomous University of Madrid, 28049 Madrid, Spain
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Choi E, Mizuno H, Wang Z, Fang C, Mefford MT, Reynolds K, Ghazi L, Shimbo D, Muntner P. Antihypertensive medication persistence and adherence among non-Hispanic Asian US patients with hypertension and fee-for-service Medicare health insurance. PLoS One 2024; 19:e0300372. [PMID: 38507422 PMCID: PMC10954118 DOI: 10.1371/journal.pone.0300372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 02/26/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Less than 50% of non-Hispanic Asian adults taking antihypertensive medication have controlled blood pressure. METHODS We compared non-persistence and low adherence to antihypertensive medication between non-Hispanic Asian and other race/ethnicity groups among US adults ≥66 years who initiated antihypertensive medication between 2011 and 2018 using a 5% random sample of Medicare beneficiaries (non-Hispanic Asian, n = 2,260; non-Hispanic White, n = 56,000; non-Hispanic Black, n = 5,792; Hispanic, n = 4,212; and Other, n = 1,423). Non-persistence was defined as not having antihypertensive medication available to take in the last 90 of 365 days following treatment initiation. Low adherence was defined as having antihypertensive medication available to take on <80% of the 365 days following initiation. RESULTS In 2011-2012, 2013-2014, 2015-2016 and 2017-2018, the proportion of non-Hispanic Asian Medicare beneficiaries with non-persistence was 29.1%, 25.6%, 25.4% and 26.7% (p-trend = 0.381), respectively, and the proportion with low adherence was 58.1%, 54.2%, 53.4% and 51.6%, respectively (p-trend = 0.020). In 2017-2018, compared with non-Hispanic Asian beneficiaries, non-persistence was less common among non-Hispanic White beneficiaries (risk ratio 0.74 [95%CI, 0.64-0.85]), non-Hispanic Black beneficiaries (0.80 [95%CI 0.68-0.94]) and those reporting Other race/ethnicity (0.68 [95%CI, 0.54-0.85]) but not among Hispanic beneficiaries (1.04 [95%CI, 0.88-1.23]). Compared to non-Hispanic Asian beneficiaries, non-Hispanic White beneficiaries and beneficiaries reporting Other race/ethnicity were less likely to have low adherence to antihypertensive medication (relative risk 0.78 [95%CI 0.72-0.84] and 0.84 [95%CI 0.74-0.95], respectively); there was no association for non-Hispanic Black or Hispanic beneficiaries. CONCLUSIONS Non-persistence and low adherence to antihypertensive medication were more common among older non-Hispanic Asian than non-Hispanic White adults.
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Affiliation(s)
- Eunhee Choi
- The Columbia Hypertension Center and Lab, Columbia University Irving Medical Center, New York, New York, United Kingdom
| | - Hiroyuki Mizuno
- The Columbia Hypertension Center and Lab, Columbia University Irving Medical Center, New York, New York, United Kingdom
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Zhixin Wang
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Chloe Fang
- The Columbia Hypertension Center and Lab, Columbia University Irving Medical Center, New York, New York, United Kingdom
| | - Matthew T. Mefford
- Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, California, United States of America
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, California, United States of America
- Department of Health Systems Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, California, United States of America
| | - Lama Ghazi
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Daichi Shimbo
- The Columbia Hypertension Center and Lab, Columbia University Irving Medical Center, New York, New York, United Kingdom
| | - Paul Muntner
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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15
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Gasoyan H, Pfoh ER, Schulte R, Le P, Rothberg MB. Early- and later-stage persistence with antiobesity medications: A retrospective cohort study. Obesity (Silver Spring) 2024; 32:486-493. [PMID: 38053443 DOI: 10.1002/oby.23952] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/29/2023] [Accepted: 10/18/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE The study's objective was to examine the percentage of patients with an initial antiobesity medication (AOM) fill who were persistent with AOM at 3, 6, and 12 months and to characterize factors associated with persistence at 12 months. METHODS This retrospective cohort study used electronic health records from January 2015 to July 2023 in a large health system in Ohio and Florida and included adults with BMI ≥30 kg/m2 who had an initial AOM prescription filled between 2015 and 2022. RESULTS The authors identified 1911 patients with a median baseline BMI of 38 (IQR, 34-44). Over time, 44% were persistent with AOM at 3 months, 33% at 6 months, and 19% at 12 months. Across categories of AOM, the highest 1-year persistence was in patients receiving semaglutide (40%). Semaglutide (adjusted odds ratio [AOR] = 4.26, 95% CI: 3.04-6.05) was associated with higher odds of 1-year persistence, and naltrexone-bupropion (AOR = 0.68, 95% CI: 0.46-1.00) was associated with lower odds, compared with phentermine-topiramate. Among patients who were persistent at 6 months, a 1% increase in weight loss at 6 months was associated with 6% increased odds of persistence at year 1 (AOR = 1.06, 95% CI: 1.03-1.09). CONCLUSIONS Later-stage persistence with AOM varies considerably based on the drug and the weight loss at 6 months.
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Affiliation(s)
- Hamlet Gasoyan
- Center for Value-Based Care Research, Department of Internal Medicine and Geriatrics, Primary Care Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Elizabeth R Pfoh
- Center for Value-Based Care Research, Department of Internal Medicine and Geriatrics, Primary Care Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Rebecca Schulte
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Phuc Le
- Center for Value-Based Care Research, Department of Internal Medicine and Geriatrics, Primary Care Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Department of Internal Medicine and Geriatrics, Primary Care Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
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16
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Romagnoli A, Santoleri F, Costantini A, Di Risio A. Adherence, persistence and switching rates of apixaban, dabigatran and rivaroxaban in non-valvular atrial fibrillation: a multicentre real-life analysis at 3 years. Eur J Hosp Pharm 2024; 31:156-161. [PMID: 35961767 PMCID: PMC10895192 DOI: 10.1136/ejhpharm-2022-003338] [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: 04/04/2022] [Accepted: 08/02/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Adherence to and persistence with long-term treatment with oral anticoagulants play a significant role in preventing adverse events and mortality in patients with cardiac conditions. The aim of this study was to evaluate the adherence, persistence and switching rate at 3 years in real-life patients with non-valvular atrial fibrillation receiving treatment with first-line new oral anticoagulants. METHODS The study assessed all patients treated with drugs with the ATC codes B01AA, B01AE, B01AF and dispensed in pharmacies in the Lanciano-Vasto-Chieti and Pescara Local Health Units from 1 January 2011 to 30 September 2021. Adherence was calculated as the proportion of days covered; persistence was calculated as the difference in days between the start and end of treatment; and the switching rate was calculated as the difference in days between the start of treatment and the switch. RESULTS A total of 4270 patients were analysed. The absolute adherence figure at 3 years was 0.85. The lowest adherence levels were found in patients treated with dabigatran with an absolute value of 0.72, while the highest levels were found in patients treated with rivaroxaban with an absolute value at 3 years of 0.88. The persistence curves at 3 years of treatment with dabigatran showed a statistically significant difference (p<0.0001) compared with those of rivaroxaban and apixaban. CONCLUSIONS The data collected over a 3-year period showed that adherence and persistence levels and switch data were optimal and comparable in patients with non-valvular atrial fibrillation receiving treatment with either rivaroxaban or apixaban. In contrast, patients treated with dabigatran had worrying adherence and persistence levels.
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Affiliation(s)
- Alessia Romagnoli
- Territorial Pharmaceutical Service, Local Health Unit Lanciano Vasto Chieti, Chieti, Italy
| | | | | | - Angelora Di Risio
- Territorial Pharmaceutical Service, Local Health Unit Lanciano Vasto Chieti, Chieti, Italy
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17
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McCurdy JD, Stwalley D, Olsen MA, Deepak P. Comparative Effectiveness of Biologic Therapies in Preventing Penetrating Complications in Patients With Crohn's Disease. Clin Gastroenterol Hepatol 2024; 22:377-385.e5. [PMID: 37673348 DOI: 10.1016/j.cgh.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND & AIMS Comparative effectiveness of biologics in preventing penetrating disease (PD) in Crohn's disease (CD) is not well established. We compared the risk of developing luminal and perianal PD (LPD and PPD) between biologics used as first-line therapies. METHODS Adults (>17 years) with CD who initiated their first biologic (anti-tumor necrosis factor [anti-TNF], ustekinumab [UST], or vedolizumab [VDZ]) were identified from Merative Commercial Database (2006 and 2020). We excluded preexisting PD using a minimum look-back period of 1 year. Cohorts were balanced by inverse probability of treatment weighting based on age, sex, comorbidities, prior CD surgery, and CD severity. Pairwise comparisons were performed by Cox proportional hazards models, adjusted for immunomodulator exposure, and with biologic exposure treated as a time-dependent variable based on a medication possession ratio of 0.8. RESULTS Our analysis included 40,693 patients: 93% anti-TNF, 3% UST, and 4% VDZ. After inverse probability of treatment weighting all comparisons were well balanced. Anti-TNF was protective against LPD (hazard ratio, 0.66; 95% confidence interval, 0.55-0.78; P < .0001) and PPD (hazard ratio, 0.88; 95% confidence interval, 0.80-0.96; P = .0045) compared with VDZ and LPD (hazard ratio, 0.37; 95% confidence interval, 0.30-0.46; P < .0001) compared with UST. There were no significant differences in the risk of LPD and PPD between VDZ and UST. These results were similar after limiting the study period to after 2016. CONCLUSIONS Anti-TNF therapy was associated with a lower risk of LPD and PPD compared with VDZ, and lower risk of LPD compared with UST. Further studies are needed to validate these findings and to determine potential reasons for these differences.
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Affiliation(s)
- Jeffrey D McCurdy
- Department of Medicine, University of Ottawa, Ottawa, Canada; The Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Dustin Stwalley
- Center for Administrative Data Research, Institute for Informatics, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Margaret A Olsen
- Center for Administrative Data Research, Institute for Informatics, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Parakkal Deepak
- Division of Gastroenterology, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
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Ágh T, Hiligsmann M, Borah B, Beaudart C, Turcu-Stiolica A, Manias E, Jakab I, Pednekar P, Zeber J, Peterson AM. Systematic Review of Outcomes for Assessment of Medication Adherence Enhancing Interventions: An ISPOR Special Interest Group Report. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:133-142. [PMID: 37952839 DOI: 10.1016/j.jval.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/17/2023] [Accepted: 10/27/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES The lack of universal guidance on outcome measures for evaluating medication adherence enhancing interventions (MAEIs) poses a challenge for assessing their effectiveness. This literature review aimed to provide a systematic overview of outcome measures currently used for the value assessment of MAEIs. METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched MEDLINE, PsycINFO, Scopus, CINAHL, and Academic Search Complete for randomized and nonrandomized clinical trials, prospective cohort studies, model-based economic evaluations, and value frameworks published in English between January 2010 and September 2020. Two independent reviewers screened all titles and abstracts, followed by a full-text review. Due to the large number of relevant studies, data extraction was limited to articles published between January 2018 and September 2020. We collected data on the general characteristics of the study, the type of intervention, and the outcomes measured. RESULTS We screened 14 685 records and identified 308 articles for data extraction. Behavioral interventions were the most common (n = 143), followed by educational interventions (n = 110) and mixed-method interventions (n = 73). Outcomes were clustered into 7 categories with medication adherence (n = 286) being the most frequently measured, followed by clinical outcomes (n = 155), health-related quality of life (n = 57), resource use (n = 43), patient satisfaction (n = 31), economic outcomes (n = 18), and other outcomes (n = 76). CONCLUSIONS Various outcomes measures have been used to evaluate MAEIs, with only a small number of studies exploring economic and patient-reported outcomes. Future research is warranted to develop a consensus-based set of criteria for assessing MAEIs to facilitate the comparison of interventions and enable informed decision making.
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Affiliation(s)
- Tamás Ágh
- Syreon Research Institute, Budapest, Hungary; Center for Health Technology Assessment and Pharmacoeconomic Research, University of Pécs, Pécs, Hungary.
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care & Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Bijan Borah
- Division of Health Care Delivery Research, Mayo Clinic College of Medicine and Science and the Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Charlotte Beaudart
- Research Institute for Life Sciences (NARILIS), Department of Biomedical Sciences, Faculty of Medicine, University of Namur, Namur, Belgium
| | - Adina Turcu-Stiolica
- Faculty of Pharmacy, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Elizabeth Manias
- School of Nursing and Midwifery, Monash University, Clayton, Australia; Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia
| | | | | | - John Zeber
- Department of Health Promotion & Policy, University of Massachusetts, Amherst, MA, USA
| | - Andrew M Peterson
- Philadelphia College of Pharmacy, Saint Joseph's University, Philadelphia, PA, USA
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Oliveira R, Monteiro-Soares M, Guerreiro JP, Pereira R, Teixeira-Rodrigues A. Estimating Type 2 Diabetes Prevalence: A Model of Drug Consumption Data. PHARMACY 2024; 12:18. [PMID: 38392925 PMCID: PMC10892415 DOI: 10.3390/pharmacy12010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Abstract
Observational, cross-sectional prevalence studies are costly and time-consuming. The development of indirect methods estimating prevalence used to obtain faster, less-expensive, and more robust results would be an advantage for several healthcare applications. This study aimed to use the drug dispensing data from community pharmacies to estimate the prevalence of Type 2 Diabetes mellitus (T2DM) in the Portuguese population. A cross-sectional study was conducted using a database of dispensed medicines with an indication for Diabetes mellitus in 2018 and 2021, stratified by geographic region. The methodology was based on a sequential method of acquiring prevalence estimates obtained through exposure to medicines using the daily doses defined per thousand inhabitants per day and adjusted to the rate of adherence to therapy, prescription patterns, and concomitance of antidiabetic drugs. The estimated overall T2DM prevalence in 2018 was 13.9%, and it was 14.2% for 2021. The results show the increased consumption of antidiabetic drugs, with fixed-dose combination antidiabetics and new antidiabetics being particularly important in 2021. This work allowed for the development of a model to obtain the estimated prevalence of T2DM based on drug consumption, using a simple, fast, and robust method that is in line with the available evidence. However, with the recent expanding indications for new antidiabetics, the inclusion of further data in the model needs to be studied.
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Affiliation(s)
- Rita Oliveira
- FP-BHS—Biomedical and Health Sciences Research Unit, FFP-I3ID—Instituto de Investigação, Inovação e Desenvolvimento, Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Rua Carlos da Maia 296, 4200-150 Porto, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, MedTech, Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo de Ferreira 228, 4050-313 Porto, Portugal
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo de Ferreira 228, 4050-313 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Matilde Monteiro-Soares
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4050-313 Porto, Portugal;
- MEDCIDS—Departamento de Medicina da Comunidade Informação e Decisão em Saúde, Faculty of Medicine, University of Porto, 4050-313 Porto, Portugal
- Portuguese Red Cross Health School Lisbon, Avenida de Ceuta nº 1, 1300-125 Lisbon, Portugal
- Cross I&D, Avenida de Ceuta nº 1, 1300-125 Lisbon, Portugal
| | - José Pedro Guerreiro
- Centre for Health Evaluation & Research/Infosaúde, National Association of Pharmacies, 1300-125 Lisbon, Portugal; (J.P.G.); (R.P.); (A.T.-R.)
| | - Rúben Pereira
- Centre for Health Evaluation & Research/Infosaúde, National Association of Pharmacies, 1300-125 Lisbon, Portugal; (J.P.G.); (R.P.); (A.T.-R.)
| | - António Teixeira-Rodrigues
- Centre for Health Evaluation & Research/Infosaúde, National Association of Pharmacies, 1300-125 Lisbon, Portugal; (J.P.G.); (R.P.); (A.T.-R.)
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
- ICVS/3Bs PT Government Associate Laboratory, Campus de Gualtar, 4710-057 Braga, Portugal
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20
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Donneyong MM, Bynum M, Kemavor A, Crossnohere NL, Schuster A, Bridges J. Patient satisfaction with the quality of care received is associated with adherence to antidepressant medications. PLoS One 2024; 19:e0296062. [PMID: 38180988 PMCID: PMC10769059 DOI: 10.1371/journal.pone.0296062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 12/05/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND There is a paucity of evidence on the association between satisfaction with quality of care and adherence to antidepressants. OBJECTIVES To examine the association between patient satisfaction with healthcare and adherence to antidepressants. METHODS A cohort study design was used to identify antidepressant users from the 2010-2016Medical Expenditure Panel Survey data, a national longitudinal complex survey study design on the cost and healthcare utilization of the noninstitutionalized population in the United States. The Consumer Assessment of Healthcare Providers and Systems were used to measure participants' satisfaction with access and quality of care, patient-provider communication and shared decision-making (SDM). Patients were considered satisfied if they ranked the quality of care at ≥9 (range: 0[worst]- 10[best]). Antidepressant adherence was measured based on medication refill and complete discontinuation. MEPS sampling survey-weighted multivariable-adjusted logistic regression models were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between satisfaction and adherence to antidepressants. We tested for the potential presence of reverse associations by restricting the analysis to new users of antidepressants. The roles of patient-provider communication and SDM on the satisfaction-adherence association were examined through structural equation models (SEM). RESULTS Among 4,990 (weighted counts = 8,661,953) antidepressant users, 36% were adherent while 39% discontinued antidepressants therapy. Half of antidepressant users were satisfied with the healthcare received. Satisfied patients were 26% (OR = 1.26, 95%CI: 1.08, 1.47) more likely to adhere and 17% (OR = 0.83, 95%CI: 0.71, 0.96) less likely to discontinue, compared to unsatisfied antidepressant users. Patient satisfaction was also associated with higher odds (OR = 1.41, 95%CI: 1.06, 1.88) of adherence among a subgroup of new users of antidepressants. The SEM analysis revealed that satisfaction was a manifestation of patient-provider communication (β = 2.03, P-value<0.001) and SDM (β = 1.14, P-value<0.001). CONCLUSIONS Patient satisfaction is a potential predictor of antidepressant adherence. If our findings are confirmed through intervention studies, improving patient-provider communication and SDM could likely drive both patient satisfaction and adherence to antidepressants.
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Affiliation(s)
- Macarius M. Donneyong
- Division of Outcomes and Translational Sciences, College of Pharmacy, The Ohio State University, Columbus, OH, United States of America
| | - Mary Bynum
- Healthcare Management, Franklin University, Columbus, Ohio, United States of America
| | - Ameena Kemavor
- ADAMH Board of Franklin County, Columbus, OH, United States of America
| | - Norah L. Crossnohere
- Division of General Internal Medicine, The Ohio State College of Medicine, Columbus, Ohio, United States of America
| | - Anne Schuster
- Department of Biomedical Informatics, The Ohio State College of Medicine, Columbus, Ohio, United States of America
| | - John Bridges
- Department of Biomedical Informatics, The Ohio State College of Medicine, Columbus, Ohio, United States of America
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Giometto S, Finocchietti M, Paoletti O, Lombardi N, Celani MG, Sciancalepore F, Lucenteforte E, Kirchmayer U. Adherence to riluzole therapy in patients with amyotrophic lateral sclerosis in three Italian regions-The CAESAR study. Pharmacoepidemiol Drug Saf 2024; 33:e5736. [PMID: 38014926 DOI: 10.1002/pds.5736] [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: 06/12/2023] [Revised: 09/12/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Amyotrophic lateral sclerosis (ALS) is a rare neurodegenerative disease. Riluzole may increase survival and delay the need for mechanical ventilation. The CAESAR project ('Comparative evaluation of the efficacy and safety of drugs used in rare neuromuscular and neurodegenerative diseases', FV AIFA project 2012-2013-2014) involves evaluating prescribing patterns, and analysing effectiveness and comparative safety of drugs, in patients with neurodegenerative diseases. The aim of this study is to evaluate adherence to riluzole in patients with ALS during the first year of use, identifying adherence clusters. METHODS A retrospective cohort study was conducted using administrative data from Latium, Tuscany, and Umbria. We identified subjects with a new diagnosis of ALS between 2014 and 2019, with the first dispensation of riluzole within 180 days of diagnosis. We considered a two-year look-back period for the characterization of patients, and we followed them from the date of first dispensing of riluzole for 1 year. We calculated 12 monthly adherence measures, through a modified version of the Medication Possession Ratio, estimating drug coverage with Defined Daily Dose. Adherence trajectories were identified using a three-step method: (1) calculation of statistical measures; (2) principal component analysis; (3) cluster analysis. Patient characteristics at baseline and during follow-up were described and compared between adherence groups identified. RESULTS We included 264 ALS patients as new users of riluzole in Latium, 344 in Tuscany, and 63 in Umbria. We observed a higher frequency of males (56.2%) and a mean age of 67.4 (standard deviation, SD, 10.4) in the overall population. We identified two clusters in all regions: one more numerous, including adherent patients (60%, 74%, 88%, respectively), and another one including patients who discontinued therapy (40%, 26%, 12%, respectively). In Tuscany patients discontinuing riluzole more frequently died (28.6% vs. 15.4%, p-value <0.01). Additionally, low-adherers had a higher frequency of central nervous system disorders (69.0% vs. 52.5%, p-value 0.01), and a greater use of non-pharmacological treatments (p-values ≤0.01 for invasive ventilation and tracheostomy). We did not observe any differences in Lazio, whereas in Umbria we observed a higher use of drugs for dementia-related psychiatric problems among low-adherers (57.1% vs. 7.8%, respectively, p-value <0.01), although with small numbers. CONCLUSION Most ALS patients who start riluzole adhere to therapy during the first year. Patients who discontinue therapy early show greater fragility and mortality.
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Affiliation(s)
- Sabrina Giometto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | - Niccolò Lombardi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | | | - Francesco Sciancalepore
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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22
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 1. Improving Care and Promoting Health in Populations: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S11-S19. [PMID: 38078573 PMCID: PMC10725798 DOI: 10.2337/dc24-s001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at https://professional.diabetes.org/SOC.
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Betts AC, Murphy CC, Shay LA, Balasubramanian BA, Markham C, Roth ME, Allicock M. Polypharmacy and medication fill nonadherence in a population-based sample of adolescent and young adult cancer survivors, 2008-2017. J Cancer Surviv 2023; 17:1688-1697. [PMID: 36346577 PMCID: PMC10164839 DOI: 10.1007/s11764-022-01274-0] [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: 06/15/2022] [Accepted: 10/11/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE We examined the association between polypharmacy-an established risk factor for nonadherence in the elderly-and medication fill nonadherence in a large national sample of adolescent and young adult cancer survivors (AYAs) in the USA. METHODS We pooled data (2008-2017) from the Medical Expenditure Panel Survey. We defined polypharmacy as ≥ 3 unique medications prescribed, based on self-report and pharmacy data, and medication fill nonadherence as self-reported delay or inability to obtain a necessary medication. We estimated prevalence of medication fill nonadherence among AYAs (age 18-39 years with a cancer history). We used logistic regression to estimate the association between (1) polypharmacy and medication fill nonadherence in AYAs, and (2) total number of medications prescribed and medication fill nonadherence, controlling for sex, number of chronic conditions, disability, and survey year. RESULTS AYAs (n = 598) were predominantly female (76.2%), age 30-39 years (64.9%), and non-Hispanic White (72.1%). Nearly half were poor (19.0%) or near-poor/low income (21.6%). One in ten AYAs reported medication fill nonadherence (9.75%). Of these, more than 70% cited cost-related barriers as the reason. AYAs with polypharmacy had 2.49 times higher odds of medication fill nonadherence (95%CI 1.11-5.59), compared to those without polypharmacy. Odds of medication fill nonadherence increased by 16% with each additional medication prescribed (AOR 1.16, 95% CI 1.07-1.25). CONCLUSIONS Polypharmacy may be an important risk factor for medication fill nonadherence in AYAs in the USA. IMPLICATIONS FOR CANCER SURVIVORS Improving AYAs' medication adherence requires eliminating cost-related barriers, particularly for those with polypharmacy.
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Affiliation(s)
- Andrea C Betts
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA.
| | - Caitlin C Murphy
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Houston, TX, USA
| | - L Aubree Shay
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, San Antonio, TX, USA
| | - Bijal A Balasubramanian
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Dallas, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Dallas, TX, USA
| | - Christine Markham
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Houston, TX, USA
| | - Michael E Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marlyn Allicock
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Dallas, TX, USA
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24
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魏 泸, 杨 先, 范 箬, 王 丹, 刘 军, 何 昌, 李 杨, 左 传, 周 涵, 刘 祥, 刘 元. [Association Between Medication Compliance and Various Risky Behaviors in Patients With Schizophrenia]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:1201-1207. [PMID: 38162067 PMCID: PMC10752770 DOI: 10.12182/20231360303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Indexed: 01/03/2024]
Abstract
Objective To investigate the status of medication adherence and various types of risky behaviors of schizophrenia patients in a certain area of western China and to explore accordingly the correlation between the two. Methods A total of 292 667 patients with schizophrenia were enrolled in a follow-up survey between 2006 and 2018. In addition, based on the outcome-wide analysis strategy, a multivariate Cox proportional risk regression model was used to estimate and compare the impact of medication adherence on different types of risky behaviors in schizophrenia patients. Results In this 13-year prospective cohort, 65 175 patients (31.4%) showed good medication adherence, while 142 394 patients (68.6%) showed poor medication adherence. The incidence rates of various risky behaviors during the follow-up period were as follows, minor nuisances, 12.25%, violation of the Law of the People's Republic of China on Penalties for Administration of Public Security (APS law), 3.82%, violation of criminal law, 0.94%, suicide completed, 0.28%, self-harm, 1.42%, and attempted suicide, 0.82%. Schizophrenia patients who had poor medication adherence had higher risks of committing violence against others and self-inflicted injury compared to patients with good medication adherence did, with the associated effects being minor nuisances (hazard ratio [HR]=1.31, 95% confidence interval [CI]: 1.27-1.35), violation of APS law (HR=1.47, 95% CI: 1.38-1.56), violation of criminal law (HR=1.17, 95% CI: 1.05-1.31), and self-harm (HR=1.43, 95% CI: 1.32-1.56), respectively, while the risk of suicide completed is lower in schizophrenia patients with poor medication adherence than that in patients with good medication adherence (HR=0.56, 95% CI: 0.47-0.66). There was no statistically significant association between attempted suicide and medication adherence. Conclusion There are variations in the direction and strength of the association between medication adherence and different types of risky behaviors and further research is needed to elucidate the mechanisms of the association.
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Affiliation(s)
- 泸懿 魏
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 先梅 杨
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 箬馨 范
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 丹 王
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 军 刘
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 昌九 何
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 杨 李
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 传隆 左
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 涵闻 周
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 祥 刘
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 元元 刘
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
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25
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Bianchini ML, Aquilante CL, Kao DP, Martin JL, Anderson HD. Patient-Level Exposure to Actionable Pharmacogenomic Medications in a Nationally Representative Insurance Claims Database. J Pers Med 2023; 13:1574. [PMID: 38003889 PMCID: PMC10672722 DOI: 10.3390/jpm13111574] [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: 10/06/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The prevalence of exposure to pharmacogenomic medications is well established but little is known about how long patients are exposed to these medications. AIM Our objective was to describe the amount of exposure to actionable pharmacogenomic medications using patient-level measures among a large nationally representative population using an insurance claims database. METHODS Our retrospective cohort study included adults (18+ years) from the IQVIA PharMetrics® Plus for Academics claims database with incident fills of 72 Clinical Pharmacogenetics Implementation Consortium level A, A/B, or B medications from January 2012 through September 2018. Patient-level outcomes included the proportion of days covered (PDC), number of fills, and average days supplied per fill over a 12-month period. RESULTS Over 1 million fills of pharmacogenetic medications were identified for 605,355 unique patients. The mean PDC for all medications was 0.21 (SD 0.3), suggesting patients were exposed 21% (77 days) of the year. Medications with the highest PDC (0.55-0.89) included ivacaftor, tamoxifen, clopidogrel, HIV medications, transplant medications, and statins; with the exception of statins, these medications were initiated by fewer patients. Pharmacogenomic medications were filled an average of 2.8 times (SD 3.0, range 1-81) during the year following the medication's initiation, and the average days supplied for each fill was 22.3 days (SD 22.4, range 1-180 days). CONCLUSION Patient characteristics associated with more medication exposure were male sex, older age, and comorbid chronic conditions. Prescription fill data provide patient-level exposure metrics that can further our understanding of pharmacogenomic medication utilization and help inform opportunities for pharmacogenomic testing.
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Affiliation(s)
- Monica L. Bianchini
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (M.L.B.); (C.L.A.); (J.L.M.)
| | - Christina L. Aquilante
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (M.L.B.); (C.L.A.); (J.L.M.)
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - David P. Kao
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - James L. Martin
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (M.L.B.); (C.L.A.); (J.L.M.)
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - Heather D. Anderson
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (M.L.B.); (C.L.A.); (J.L.M.)
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
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Lomanto Silva R, Swabe GM, Sattui SE, Magnani JW. Association of patient copayment and medication adherence in systemic lupus erythematosus. Lupus Sci Med 2023; 10:e000966. [PMID: 37852670 PMCID: PMC10603349 DOI: 10.1136/lupus-2023-000966] [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: 05/19/2023] [Accepted: 09/06/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To investigate the association of medication copayment and treatment adherence to hydroxychloroquine and immunosuppressants for SLE. METHODS We conducted a retrospective analysis of health claims data using Optum's de-identified Clinformatics Data Mart Database. Individuals with SLE continuously enrolled for 180 days from 1 July 2010 to 31 December 2019 were included. Adherence was defined as the proportion of days covered ≥80%. Copayment for a 30-day supply of medication was dichotomised as high (≥$10) or low (<$10). We examined the association between copayment and odds of adherence in multivariable-adjusted logistic regression models, including age, sex, race or ethnicity, comorbidities, educational attainment and household income. RESULTS We identified 12 510 individuals (age 54.2±15.5 years; 88.2% female sex), of whom 9510 (76%) were prescribed hydroxychloroquine and 1880 (15%) prescribed hydroxychloroquine and an additional immunosuppressant (azathioprine, methotrexate or mycophenolate mofetil). Median (IQR) 30-day copayments were $8 (4-10) for hydroxychloroquine, $7 (2-10) for azathioprine, $8 (3-11) for methotrexate and $10 (5-20) for mycophenolate mofetil. High copayments were associated with OR of adherence of 0.61 (95% CI 0.55 to 0.68) for hydroxychloroquine, OR 0.44 (95% CI 0.30 to 0.66) for azathioprine and OR 0.69 (95% CI 0.49 to 0.96) for mycophenolate mofetil. For methotrexate, the association was not significant. CONCLUSION In a large, administrative health claims database, we identified that high copayments were associated with reduced adherence to commonly prescribed medications for SLE. Incorporating awareness of the burden of copayments and its consequences into healthcare is essential to promote optimal medication adherence.
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Affiliation(s)
- Raisa Lomanto Silva
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gretchen M Swabe
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sebastian Eduardo Sattui
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jared W Magnani
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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27
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Gaujoux-Viala C, Bergmann JF, Goguillot M, Mélaine A, Guérin M, Edouard A, Bénard S, Fautrel B. Suboptimal management of rheumatoid arthritis in France: a real-world study based on data from the French National Health Data System. RMD Open 2023; 9:e003075. [PMID: 37914177 PMCID: PMC10619049 DOI: 10.1136/rmdopen-2023-003075] [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: 02/16/2023] [Accepted: 08/28/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVES The emergence of targeted therapy is changing rheumatoid arthritis (RA) management, but real-world data remain limited. This study aimed to describe real-world RA treatment patterns using data from a French national claims database. METHODS This longitudinal study used the French Permanent Representative Sample (Echantillon Généraliste des Bénéficiaires) claims database. Patients with RA were identified between 2013 and 2017, with treatment patterns, persistence and adherence described. RESULTS The study population included 2553 patients with RA. Disease-modifying antirheumatic drugs (DMARDs) were prescribed for 1512 (59.2%) patients, of whom 721 (47.6%) did not require discontinuation or treatment switch. There were 377 (24.9%) treatment discontinuations and 114 patients (7.5%) switched to a targeted DMARD (biological and synthetic (Janus kinase inhibitor) DMARDs). Among the 2315 patients with RA in 2017, almost half (n=1102, 47.6%) were not treated with a DMARD. Most (85.7%) received symptomatic treatment (analgesics (81.0%), steroids (49.2%), non-steroidal anti-inflammatory drugs (39.5%)). Of the 1142 treatment initiations identified, 713 (62.4%) were conventional synthetic DMARDs (csDMARDs), with methotrexate being the most frequent (n=553, 48.45%). One-year persistence rates varied between 55.9% (49.2-62.0%) for tumour necrosis factor inhibitors, and 63.4% (59.6-67.0%) for csDMARDs. Treatment adherence, assessed through medication possession ratio, varied between 71.9% and 90.8%, with ≥80% being the adherence cut-off. Almost half of DMARD initiations were associated with long-term (>6 months), high-dose oral steroid use (~7 mg/day prednisone equivalent). CONCLUSION Despite a diverse therapeutic arsenal, there remains a medical need that is not covered by current RA management, which is frequently compensated for by overprescription of steroids.
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Affiliation(s)
- Cécile Gaujoux-Viala
- Desbrest Institute of Epidemiology and Public Health, University of Montpellier, INSERM, Department of Rheumatology, CHU Nîmes, Montpellier, France
| | | | | | | | | | | | | | - Bruno Fautrel
- Sorbonne Université - Assistance Publique Hôpitaux de Paris, INSERM UMRS 1136, Hôpital de La Pitié Salpêtrière, Paris, France
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Vauterin D, Van Vaerenbergh F, Vanoverschelde A, Quint JK, Verhamme K, Lahousse L. Methods to assess COPD medications adherence in healthcare databases: a systematic review. Eur Respir Rev 2023; 32:230103. [PMID: 37758274 PMCID: PMC10523153 DOI: 10.1183/16000617.0103-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/20/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The Global Initiative for Chronic Obstructive Lung Disease 2023 report recommends medication adherence assessment in COPD as an action item. Healthcare databases provide opportunities for objective assessments; however, multiple methods exist. We aimed to systematically review the literature to describe existing methods to assess adherence in COPD in healthcare databases and to evaluate the reporting of influencing variables. METHOD We searched MEDLINE, Web of Science and Embase for peer-reviewed articles evaluating adherence to COPD medication in electronic databases, written in English, published up to 11 October 2022 (PROSPERO identifier CRD42022363449). Two reviewers independently conducted screening for inclusion and performed data extraction. Methods to assess initiation (dispensing of medication after prescribing), implementation (extent of use over a specific time period) and/or persistence (time from initiation to discontinuation) were listed descriptively. Each included study was evaluated for reporting variables with an impact on adherence assessment: inpatient stays, drug substitution, dose switching and early refills. RESULTS 160 studies were included, of which four assessed initiation, 135 implementation and 45 persistence. Overall, one method was used to measure initiation, 43 methods for implementation and seven methods for persistence. Most of the included implementation studies reported medication possession ratio, proportion of days covered and/or an alteration of these methods. Only 11% of the included studies mentioned the potential impact of the evaluated variables. CONCLUSION Variations in adherence assessment methods are common. Attention to transparency, reporting of variables with an impact on adherence assessment and rationale for choosing an adherence cut-off or treatment gap is recommended.
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Affiliation(s)
- Delphine Vauterin
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Frauke Van Vaerenbergh
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Anna Vanoverschelde
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jennifer K Quint
- School of Public Health and National Heart and Lung Institute, Imperial College London, London, UK
| | - Katia Verhamme
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lies Lahousse
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Hernandez I, Divino V, Xie L, Hood DW, DeKoven M, Kariuki W, Bell G, Russ C, Cheng D, Cato M, Atreja N, Hines DM. A Real-World Evaluation of Primary Medication Nonadherence in Patients with Nonvalvular Atrial Fibrillation Prescribed Oral Anticoagulants in the United States. Am J Cardiovasc Drugs 2023; 23:559-572. [PMID: 37301789 DOI: 10.1007/s40256-023-00588-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Nonadherence to oral anticoagulants (OACs) is a challenge to stroke risk reduction in patients with nonvalvular atrial fibrillation (NVAF). Data on primary medication nonadherence (PMN) in NVAF are lacking. OBJECTIVES Our aim was to assess the rates and predictors of PMN among NVAF patients who were newly prescribed an OAC. METHODS This was a retrospective database analysis of linked healthcare claims and electronic health record data. Adult NVAF patients with a prescription order for an OAC (apixaban, rivaroxaban, dabigatran, or warfarin) between January 2016 and June 2019 were identified (date of first prescription order = index date). Patients had a 1-year baseline and a 6-month post-index period to assess the rates of PMN, defined as having a prescription order but no paid claim for any OAC on or within 30 days after the index date. Sensitivity analyses explored 60-, 90- and 180-day PMN thresholds. Logistic regression models were used to examine the predictors of PMN. RESULTS Among 20,393 patients, the overall 30-day PMN rate was 28.4%; PMN rates decreased to 17% with a 180-day threshold. PMN was numerically lowest for warfarin among OACs and numerically lowest for apixaban among direct OACs. A CHA2DS2-VASc score of ≥ 3, commercial insurance, and African American race were associated with higher odds of PMN. CONCLUSIONS More than one-quarter of patients experienced PMN within 30 days of their initial prescription order. This rate decreased over a longer period, suggesting a delay in fills. Understanding the factors associated with PMN is warranted to develop effective interventions for improving OAC treatment rates in NVAF.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Dong Cheng
- Bristol Myers Squibb, Lawrenceville, NJ, USA
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30
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Zeitouny S, Cheng L, Wong ST, Tadrous M, McGrail K, Law MR. Prevalence and predictors of primary nonadherence to medications prescribed in primary care. CMAJ 2023; 195:E1000-E1009. [PMID: 37553145 PMCID: PMC10446155 DOI: 10.1503/cmaj.221018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Most research on medication adherence has focused on secondary nonadherence and persistence to therapy. Medication prescriptions that are never filled by patients (primary nonadherence) remain understudied in the general population. METHODS We linked prescribing data from primary care electronic medical records to comprehensive pharmacy dispensing claims between January 2013 and April 2019 in British Columbia (BC) to estimate primary nonadherence, defined as failure to dispense a new medication or its equivalent within 6 months of the prescription date. We used hierarchical multivariable logistic regression to determine prescriber, patient and medication factors associated with primary nonadherence among community-dwelling patients in primary care. RESULTS Among 150 565 new prescriptions to 34 243 patients, 17% of prescriptions were never filled. Primary nonadherence was highest for drugs prescribed mostly on an as-needed basis, including topical corticosteroids (35.1%) and antihistamines (23.4%). In multivariable analysis, primary nonadherence was lower for prescriptions issued by male prescribers (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.50-0.88). Primary nonadherence decreased with patient age (OR 0.91, 95% CI 0.90-0.92 for each additional 10 years) but increased with polypharmacy among patients aged 65 years or older. Patients filled more than 82% of their medication prescriptions within 2 weeks after their primary care provider visit. INTERPRETATION The prevalence of primary nonadherence to new prescriptions was 17%. Interventions to address primary nonadherence could target older patients with multiple medication use and within the first 2 weeks of the prescription issue date.
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Affiliation(s)
- Seraphine Zeitouny
- Centre for Health Services and Policy Research, School of Population and Public Health (Zeitouny, Cheng, Wong, McGrail, Law), University of British Columbia, Vancouver, BC; Leslie Dan Faculty of Pharmacy (Tadrous), University of Toronto; Women's College Research Institute (Tadrous), Women's College Hospital, Toronto, Ont.
| | - Lucy Cheng
- Centre for Health Services and Policy Research, School of Population and Public Health (Zeitouny, Cheng, Wong, McGrail, Law), University of British Columbia, Vancouver, BC; Leslie Dan Faculty of Pharmacy (Tadrous), University of Toronto; Women's College Research Institute (Tadrous), Women's College Hospital, Toronto, Ont
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, School of Population and Public Health (Zeitouny, Cheng, Wong, McGrail, Law), University of British Columbia, Vancouver, BC; Leslie Dan Faculty of Pharmacy (Tadrous), University of Toronto; Women's College Research Institute (Tadrous), Women's College Hospital, Toronto, Ont
| | - Mina Tadrous
- Centre for Health Services and Policy Research, School of Population and Public Health (Zeitouny, Cheng, Wong, McGrail, Law), University of British Columbia, Vancouver, BC; Leslie Dan Faculty of Pharmacy (Tadrous), University of Toronto; Women's College Research Institute (Tadrous), Women's College Hospital, Toronto, Ont
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health (Zeitouny, Cheng, Wong, McGrail, Law), University of British Columbia, Vancouver, BC; Leslie Dan Faculty of Pharmacy (Tadrous), University of Toronto; Women's College Research Institute (Tadrous), Women's College Hospital, Toronto, Ont
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health (Zeitouny, Cheng, Wong, McGrail, Law), University of British Columbia, Vancouver, BC; Leslie Dan Faculty of Pharmacy (Tadrous), University of Toronto; Women's College Research Institute (Tadrous), Women's College Hospital, Toronto, Ont
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Stacey I, Ralph A, de Dassel J, Nedkoff L, Wade V, Francia C, Wyber R, Murray K, Hung J, Katzenellenbogen J. The evidence that rheumatic heart disease control programs in Australia are making an impact. Aust N Z J Public Health 2023; 47:100071. [PMID: 37364309 DOI: 10.1016/j.anzjph.2023.100071] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/16/2022] [Accepted: 02/26/2023] [Indexed: 06/28/2023] Open
Abstract
OBJECTIVE Rheumatic heart disease (RHD) comprises heart-valve damage caused by acute rheumatic fever (ARF). The Australian Government Rheumatic Fever Strategy funds RHD Control Programs to support detection and management of ARF and RHD. We assessed epidemiological changes during the years of RHD Control Program operation. METHODS Linked RHD register, hospital and death data from four Australian jurisdictions were used to measure ARF/RHD outcomes between 2010 and 2017, including: 2-year progression to severe RHD/death; ARF recurrence; secondary prophylaxis delivery and earlier disease detection. RESULTS Delivery of secondary prophylaxis improved from 53% median proportion of days covered (95%CI: 46-61%, 2010) to 70% (95%CI: 71-68%, 2017). Secondary prophylaxis adherence protected against progression to severe RHD/death (hazard ratio 0.2, 95% CI 0.1-0.8). Other measures of program effectiveness (ARF recurrences, progression to severe RHD/death) remained stable. ARF case numbers and concurrent ARF/RHD diagnoses increased. CONCLUSIONS RHD Control Programs have contributed to major success in the management of ARF/RHD through increased delivery of secondary prevention yet ARF case numbers, not impacted by secondary prophylaxis and sensitive to increased awareness/surveillance, increased. IMPLICATIONS FOR PUBLIC HEALTH RHD Control Programs have a major role in delivering cost-effective RHD prevention. Sustained investment is needed but with greatly strengthened primordial and primary prevention.
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Affiliation(s)
- Ingrid Stacey
- School of Population and Global Health, The University of Western Australia, Australia.
| | - Anna Ralph
- Menzies School of Health Research, Charles Darwin University, Australia; Department of Medicine, Royal Darwin Hospital, Australia.
| | - Jessica de Dassel
- Rheumatic heart disease Control Program, Northern Territory Health, Australia.
| | - Lee Nedkoff
- School of Population and Global Health, The University of Western Australia, Australia; Cardiology Population Health Laboratory, Victor Chang Cardiac Research Institute, Australia.
| | - Vicki Wade
- Menzies School of Health Research, Charles Darwin University, Australia; National Heart Foundation of Australia, Australia.
| | - Carl Francia
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia; Department of Physiotherapy, The Prince Charles Hospital, Australia.
| | - Rosemary Wyber
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, Australian National University, Australia; Telethon Kids Institute, Australia.
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Australia.
| | - Joseph Hung
- School of Medicine, The University of Western Australia, Australia.
| | - Judith Katzenellenbogen
- School of Population and Global Health, The University of Western Australia, Australia; Telethon Kids Institute, Australia.
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Tomida J, Yoshida T, Senda S, Sato T, Nakatsuma A, Iihara N. Statin persistence and adherence among older initiators: A nationwide cohort study using the national health insurance claims database in Japan. Pharmacoepidemiol Drug Saf 2023; 32:873-885. [PMID: 36960485 DOI: 10.1002/pds.5622] [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: 12/15/2022] [Revised: 02/28/2023] [Accepted: 03/19/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE This study clarifies the reality of persistence and adherence to statins in older Japanese people who initiated statin use and compares it between primary and secondary prevention cohorts. METHODS The nationwide study using the national claims database targeted statin initiators aged ≥55 years from FY2014 to FY2017 in Japan. Persistence and adherence to statins were analyzed overall and according to subgroups based on sex, age stratum, and prevention cohorts. Permissible gap of median days that statins were supplied per prescription to an individual was employed. Persistence rates were estimated as Kaplan-Meier estimates. Poor adherence during persistence was evaluated and defined as <0.8 of the proportion of days covered. RESULTS Of 3 675 949 initiators, approximately 80% initiated statin use with strong variants. The persistence rate at 1 year was 0.61. Poor adherence to statins during persistence was 8.0% in all patients and this value gradually improved with increasing age. Persistence rate and adherence were lower for the primary prevention cohort than for the secondary prevention cohort, and a notable sex difference was observed for the secondary prevention cohort, which was lower in females but was almost never and slightly observed in the primary prevention cohorts without and with high-risk factors, respectively. CONCLUSIONS Many statin initiators discontinued statins shortly following statin initiation but adherence while on statin therapy was good. Attentively watching older patients not to discontinue statins and listening to their reasons for discontinuation are required, especially for initiators in primary prevention and females in secondary prevention.
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Affiliation(s)
- Junko Tomida
- Kagawa School of Pharmaceutical Sciences, Tokushima Bunri University, 1314-1 Shido, Sanuki, Kagawa, 769-2193, Japan
| | - Tomoji Yoshida
- Faculty of Health and Welfare, Tokushima Bunri University, 1314-1 Shido, Sanuki, Kagawa, 769-2193, Japan
| | - Shoichi Senda
- Kagawa School of Pharmaceutical Sciences, Tokushima Bunri University, 1314-1 Shido, Sanuki, Kagawa, 769-2193, Japan
| | - Tsugumichi Sato
- Kagawa School of Pharmaceutical Sciences, Tokushima Bunri University, 1314-1 Shido, Sanuki, Kagawa, 769-2193, Japan
- Faculty of Pharmaceutical Sciences, Tokyo University of Science, 2641 Yamazaki, Noda-City, Chiba, 278-8510, Japan
| | - Akira Nakatsuma
- Kagawa School of Pharmaceutical Sciences, Tokushima Bunri University, 1314-1 Shido, Sanuki, Kagawa, 769-2193, Japan
| | - Naomi Iihara
- Kagawa School of Pharmaceutical Sciences, Tokushima Bunri University, 1314-1 Shido, Sanuki, Kagawa, 769-2193, Japan
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Richerson JT, Wagner TH, Abrams T, Skelton K, Biswas K, Illarmo S, McSherry F, Fallon MT, Frakt A, Pizer S, Magruder KM, Groer S, Dorn PA, Huang GD, Stock EM. Therapeutic and Economic Benefits of Service Dogs Versus Emotional Support Dogs for Veterans With PTSD. Psychiatr Serv 2023; 74:790-800. [PMID: 36718602 DOI: 10.1176/appi.ps.20220138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This work aimed to assess the therapeutic and economic benefits of service dogs versus emotional support dogs for veterans with posttraumatic stress disorder (PTSD). METHODS Veterans with PTSD (N=227) participating in a multicenter trial were randomly assigned to receive a service or emotional support dog; 181 veterans received a dog and were followed up for 18 months. Primary outcomes included overall functioning (assessed with World Health Organization Disability Assessment Scale II [WHODAS 2.0]) and quality of life (Veterans RAND 12-Item Health Survey [VR-12]). Secondary outcomes included PTSD symptoms (PTSD Checklist for DSM-5), suicidal ideation, depression, sleep quality, health care costs and utilization, medication adherence, employment, and productivity. RESULTS Participants paired with a dog had a mean±SD age of 50.6±13.6 years (range 22-79), and most were male (80%), White (66%), and non-Hispanic (91%). Adjusted linear mixed repeated-measures models indicated no difference between the two groups on WHODAS 2.0 or VR-12 scores. Participants with service dogs had a 3.7-point greater reduction in PTSD symptoms versus participants with emotional support dogs (p=0.036). No reduced health care utilization or cost was associated with receiving a service dog. Veterans with service dogs had an increase of 10 percentage points in antidepressant adherence compared with those with emotional support dogs (p<0.01). CONCLUSIONS Both groups appeared to benefit from having a service or emotional support dog. No significant differences in improved functioning or quality of life were observed between the groups. Those in the service dog group had a greater reduction in PTSD symptoms and better antidepressant adherence, improvements that should be explored further.
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Affiliation(s)
- Joan T Richerson
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Todd H Wagner
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Thad Abrams
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Kelly Skelton
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Kousick Biswas
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Samantha Illarmo
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Frances McSherry
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Michael T Fallon
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Austin Frakt
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Steven Pizer
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Kathryn M Magruder
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Shirley Groer
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Patricia A Dorn
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Grant D Huang
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
| | - Eileen M Stock
- U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang)
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Emanuel S, Kaba RA, Delanerolle G, Field BCT, Lip GYH, de Lusignan S. Correct dosing, adherence and persistence of DOACs in atrial fibrillation and chronic kidney disease: a systematic review and meta-analysis. Open Heart 2023; 10:e002340. [PMID: 37419525 DOI: 10.1136/openhrt-2023-002340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 06/16/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) and atrial fibrillation (AF) are increasing in prevalence globally and share common risk factors.Our aim was to characterise real-world evidence on direct oral anticoagulant (DOAC) prescribing for people with AF and CKD, in terms of adherence, persistence and renal dose titration. METHODS PubMed, EMBASE and CINAHL were searched from inception to June 2022. Our search terms included a combination of Medical Subject Headings (MeSH) terms and keywords including 'atrial fibrillation', 'chronic kidney disease', 'adherence', 'persistence', 'direct oral anticoagulants' and 'dosing'. Data extraction and quality assessment were undertaken by two reviewers independently. Meta-analyses for pooled estimates were performed using DerSimonian and Laird random-effects models. Age, sex, diabetes, hypertension and heart failure were chosen as variables of interest. RESULTS From 19 studies, a total of 252 117 patients were included with CKD and AF. Meta-analysis was only possible in seven studies with 128 406 patients, five on DOAC dose titration and two on adherence. There were insufficient studies on persistence. Our meta-analysis of dosing showed that 68% of patients with CKD and AF had correct dosing. There was no evidence to show any association between correct DOAC dosing and variables of interest. Overall, 67% of patients were DOAC adherent. CONCLUSION Adherence and correct dosing of DOACs were suboptimal compared with other medications in the pooled studies with respect to CKD and AF. Thus, further research is required as the lack of generalisation of findings is a rate-limiting factor for improved DOAC management in AF and CKD. PROSPERO REGISTRATION NUMBER CRD;42022344491.
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Affiliation(s)
- Subo Emanuel
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Riyaz A Kaba
- Cardiovascular Clinical Academic Group,Molecular and Clinical Sciences Institute, University of London and St George's University Hospitals NHS Foundation Trust, London, UK
- Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, UK
- Department of Biological Sciences, Royal Holloway, University of London, London, UK
| | - Gayathri Delanerolle
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Southern Health NHS Foundation Trust, Winchester, UK
| | - Benjamin C T Field
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
- Department of Diabetes and Endocrinology, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Royal College of General Practitioners, Research and Surveillance Centre, London, UK
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Muntner P, Foti K, Wang Z, Alanaeme CJ, Choi E, Bress AP, Shimbo D, Kronish I. Discontinuation of Renin-Angiotensin System Inhibitors During the Early Stage of the COVID-19 Pandemic. Am J Hypertens 2023; 36:404-410. [PMID: 36960855 PMCID: PMC10267613 DOI: 10.1093/ajh/hpad027] [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: 01/06/2023] [Revised: 03/01/2023] [Accepted: 03/20/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND In March and April 2020, medical societies published statements recommending continued use of renin-angiotensin system (RAS) inhibitors despite theoretical concerns that these medications could increase COVID-19 severity. Determining if patients discontinued RAS inhibitors during the COVID-19 pandemic could inform responses to future public health emergencies. METHODS We analyzed claims data from US adults with health insurance in the Marketscan database. We identified patients who filled a RAS inhibitor and were persistent, defined by not having a ≥30-day gap without medication available, and high adherence, defined by having medication available on ≥80% of days, from March 2019 to February 2020. Among these patients, we estimated the proportion who discontinued their RAS inhibitor (i.e., had ≥30 consecutive days without a RAS inhibitor available to take) between March and August 2020. For comparison, we estimated the proportion of patients that discontinued a RAS inhibitor between March and August 2019 after being persistent with high adherence from March 2018 to February 2019. RESULTS Among 816,380 adults who were persistent and adherent to a RAS inhibitor from March 2019 to February 2020, 10.8% discontinued this medication between March and August 2020. Among 822,873 adults who were persistent and adherent to a RAS inhibitor from March 2018 to February 2019, 11.7% discontinued this medication between March and August 2019. The multivariable-adjusted relative risk for RAS inhibitor discontinuation in 2020 vs. 2019 was 0.94 (95% CI 0.93-0.95). CONCLUSIONS There was no evidence of an increase in RAS inhibitor discontinuation during the early stage of the COVID-19 pandemic.
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Affiliation(s)
- Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kathryn Foti
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Zhixin Wang
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Chibuike J Alanaeme
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Eunhee Choi
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Adam P Bress
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Daichi Shimbo
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Ian Kronish
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
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Mommers I, van Boven JFM, Schuiling-Veninga CCM, Bos JHJ, Koetsier M, Hak E, Bijlsma MJ. Real-World Dispensing Patterns of Inhalation Medication in Young Adult Asthma: An Inception Cohort Study. Clin Epidemiol 2023; 15:721-732. [PMID: 37337562 PMCID: PMC10276997 DOI: 10.2147/clep.s410036] [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: 03/08/2023] [Accepted: 05/08/2023] [Indexed: 06/21/2023] Open
Abstract
Purpose The Global Initiative for Asthma (GINA) suggests a step-wise approach for pharmacological treatment of asthma. Valid study of real-world treatment patterns using dispensing databases includes proper measurement of medication adherence. We aim to explore such patterns by applying a time-varying proportion of days covered (tPDC)-based algorithm. Patients and Methods We designed a retrospective inception cohort study using the University of Groningen IADB.nl community pharmacy dispensing database. Included were 19,184 young adults who initiated asthma medication anywhere between 1994 and 2021, in the Netherlands. Main treatment steps were defined as: 1 - SABA/ICS-formoterol as needed, 2 - low dose ICS, 3 - low dose ICS + LABA or tiotropium, or intermediate dose ICS, 4 - intermediate to high dose ICS + LABA or tiotropium, triple therapy, or high dose ICS, 5 - treatment prescribed by a specialist. Changes in treatment steps were determined using a time-varying proportion of days covered (tPDC)-based algorithm. Individual drug treatment trajectories were visualized over time using a lasagna plot. Results At initiation, of the 19,184 included individuals, 52%, 7%, 15%, 16%, and 10% started treatment in steps 1 to 5, respectively. The median (IQR) follow-up time was 3 (1-7) years. Median (IQR) number of switches was 1 (0-3). Comparing starting step to last observed step, 37% never switched between treatment steps, 20% of individuals stepped down and 22% stepped up. Conclusion The low proportion of treatment switches between steps indicates that tailoring of treatment to patients' needs might be suboptimal. The tPDC-based algorithm functions well in translating dispensing data into continuous drug-utilization data, enabling a more granular assessment of treatment patterns among asthma patients.
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Affiliation(s)
- Irene Mommers
- Pharmacotherapy, Epidemiology and -Economics, University of Groningen, Groningen, the Netherlands
| | - Job F M van Boven
- Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, Groningen, the Netherlands
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Jens H J Bos
- Pharmacotherapy, Epidemiology and -Economics, University of Groningen, Groningen, the Netherlands
| | - Marten Koetsier
- Pharmacotherapy, Epidemiology and -Economics, University of Groningen, Groningen, the Netherlands
| | - Eelko Hak
- Pharmacotherapy, Epidemiology and -Economics, University of Groningen, Groningen, the Netherlands
| | - Maarten J Bijlsma
- Pharmacotherapy, Epidemiology and -Economics, University of Groningen, Groningen, the Netherlands
- Laboratory of Population Health, Max Planck Institute for Demographic Research, Rostock, Germany
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Wimhurst JJ, Nsude CC, Greene JS. Standardizing the factors used in wind farm site suitability models: A review. Heliyon 2023; 9:e15903. [PMID: 37168883 PMCID: PMC10165411 DOI: 10.1016/j.heliyon.2023.e15903] [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: 02/10/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/13/2023] Open
Abstract
As global wind energy capacity continues to expand, the need to site commercial wind farms in productive, affordable, and technically feasible locations has become increasingly important. The use of wind farm site suitability models to identify these locations has grown consequently, thus increasing interest in standardizing certain aspects of these models' development. This systematic review of wind farm site suitability studies seeks to identify similarities and differences in the selection and representation of their enlisted siting factors. The review focuses on how subjective modeling decisions, such as vocabulary choices and dataset selection, occur in the literature, based on five identified themes: 1) Deciding Upon Siting Factors, which explains how a study's geographical context, selected modeling approach, and modeler decisions can influence siting factor selection; 2) Classifying Data and Siting Factor Terminology, which addresses the extent and the advantages of consistent siting factor vocabulary; 3) Implementing Siting Factors as Constraints or as Evaluation Criteria, which covers the importance of consistent implementation and of specifying logic when enlisting siting factors to assess potential wind farm sites; 4) Utilizing Primary and Secondary Data, which details how a study's reliance on external or self-collected datasets influences siting factor representation; and 5) Data Source and Accessibility, which highlights the inconsistent provision of citations and dataset sources, and the availability of datasets for siting factors to the broader scientific community. Standardizing the selection and representation of siting factors would benefit comparisons between wind farm site suitability studies and communication of model outputs to a wider audience.
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Wendl J, Simon A, Kistler M, Hapfelmeier J, Schneider A, Hapfelmeier A. Medication Adherence and Healthcare Costs in Chronically Ill Patients Using German Claims Data. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:477-487. [PMID: 36933181 PMCID: PMC10119243 DOI: 10.1007/s40258-023-00797-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Despite the importance of medication adherence for chronically ill patients and the vast literature on its relationship to costs, this field suffers from methodological limitations. These are caused, amongst others, by the lack of generalizability of data sources, varying definitions of adherence, costs, and model specification. We aim to address this with different modeling approaches and to contribute evidence on the research question. METHODS We extracted large cohorts of nine chronic diseases (n = 6747-402,898) from German claims data of stationary health insurances between 2012 and 2015 (t0-t3). Defined as the proportion of days covered by medication, we examined the relationship of adherence using several multiple regression models at baseline year t0 with annual total healthcare costs and four sub-categories. Models with concurrent, and differently time-lagged measurements of adherence and costs were compared. Exploratively, we applied non-linear models. RESULTS Overall, we found a positive association between the proportion of days covered by medication and total costs, a weak association with outpatient costs, positive with pharmacy costs, and frequently negative with inpatient costs. There were major differences by disease and its severity but little between years, provided adherence and costs were not measured concurrently. The fit of linear models was mainly not inferior to that of non-linear models. CONCLUSIONS The estimated effect on total costs differed from most other studies, which highlights concerns about generalizability, although effect estimates in sub-categories were as expected. Comparison of time lags indicates the importance of avoiding concurrent measurement. A non-linear relationship should be considered. These methodological approaches are valuable in future research on adherence and its consequences.
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Affiliation(s)
- Johannes Wendl
- Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University of Munich, Orleansstraße 47, 81667, Munich, Germany.
| | | | | | | | - Antonius Schneider
- Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University of Munich, Orleansstraße 47, 81667, Munich, Germany
| | - Alexander Hapfelmeier
- Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University of Munich, Orleansstraße 47, 81667, Munich, Germany
- Institute of AI and Informatics in Medicine, TUM School of Medicine, Technical University of Munich, Munich, Germany
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Borghi C, Jayagopal PB, Konradi A, Bortolotto LA, Degli Esposti L, Perrone V, Snyman JR. Adherence to Triple Single-Pill Combination of Perindopril/Indapamide/Amlodipine: Findings from Real-World Analysis in Italy. Adv Ther 2023; 40:1765-1772. [PMID: 36829102 PMCID: PMC10070199 DOI: 10.1007/s12325-023-02451-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/01/2023] [Indexed: 02/26/2023]
Abstract
INTRODUCTION Single-pill combination therapy for hypertension is recognized to improve adherence to treatment. However, less is known about the benefits of triple single-pill combinations. This retrospective observational analysis aimed to assess changes in adherence when treatment was switched from perindopril (PER)/indapamide (IND) + amlodipine (AML) to PER/IND/AML single-pill combination, in Italian clinical practice. METHODS This analysis used data extracted from administrative databases of Italian healthcare entities. Adult patients receiving PER/IND/AML were selected, and the prescription date was considered as the index date. Among them, those who had a prescription for PER/IND + AML during the 12 months before the index date and a prescription of PER/IND/AML during 6 months of follow-up were included. Adherence was calculated as the proportion of days covered (PDC: PDC < 40%, non-adherent; PDC = 40-79%, partially adherent; PDC ≥ 80%, adherent). RESULTS Among the identified patients, 158 were exposed users and were included in the analysis. When patients were compared before and after switch to triple single-pill combination, the proportion of adherent patients was significantly higher with PER/IND/AML single-pill combination (75.3%) than with PER/IND + AML combination (44.3%) (P < 0.05). Conversely, the proportion of non-adherent patients was lower with the PER/IND/AML single-pill combination (14.6%) vs PER/IND + AML (17.7%) (P < 0.001). CONCLUSION This real-world analysis showed that switching to a triple single-pill combination could offer an opportunity to improve adherence to antihypertensive treatment in real-life clinical practice.
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Affiliation(s)
- Claudio Borghi
- University of Bologna, IRCCS Ospedale S. Orsola, Bologna, Italy.
| | | | - Alexandra Konradi
- Almazov National Medical Research Center, St. Petersburg, Russian Federation
| | | | - Luca Degli Esposti
- CliCon S.r.l, Società Benefit-Health, Economics and Outcomes Research, Bologna, Italy
| | - Valentina Perrone
- CliCon S.r.l, Società Benefit-Health, Economics and Outcomes Research, Bologna, Italy
| | - Jacques R Snyman
- Forte Research (Pty Ltd) and Private Practice, Pretoria, South Africa
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Steiner JF, Powers JD, Malone A, Lyons J, Olson K, Paolino AR, Steiner CA. Hypertension care during the COVID-19 pandemic in an integrated health care system. J Clin Hypertens (Greenwich) 2023; 25:315-325. [PMID: 36919191 PMCID: PMC10085815 DOI: 10.1111/jch.14641] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/06/2023] [Accepted: 01/24/2023] [Indexed: 03/16/2023]
Abstract
Retention in hypertension care, medication adherence, and blood pressure (BP) may have been affected by the COVID-19 pandemic. In a retrospective cohort study of 64 766 individuals with treated hypertension from an integrated health care system, we compared hypertension care during the year pre-COVID-19 (March 2019-February 2020) and the first year of COVID-19 (March 2020-February 2021). Retention in hypertension care was defined as receiving clinical BP measurements during COVID-19. Medication adherence was measured using prescription refills. Clinical care was assessed by in-person and virtual visits and changes in systolic and diastolic BP. The cohort had a mean age of 67.8 (12.2) years, 51.2% were women, and 73.5% were White. In 60 757 individuals with BP measurements pre-COVID-19, 16618 (27.4%) had no BP measurements during COVID-19. Medication adherence declined from 86.0% to 80.8% (p < .001). In-person primary care visits decreased from 2.7 (2.7) to 1.4 (1.9) per year, while virtual contacts increased from 9.5 (12.2) to 11.2 (14.2) per year (both p < .001). Among individuals with BP measurements, mean (SD) systolic BP was 126.5 mm Hg (11.8) pre-COVID-19 and 127.3 mm Hg (12.6) during COVID-19 (p = .14). Mean diastolic BP was 73.5 mm Hg (8.5) pre-COVID-19 and 73.5 mm Hg (8.7) during COVID-19 (p = .77). Even in this integrated health care system, many individuals did not receive clinical BP monitoring during COVID-19. Most individuals who remained in care maintained pre-COVID BP. Targeted outreach may be necessary to restore care continuity and hypertension control at the population level.
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Affiliation(s)
- John F Steiner
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA.,Colorado Permanente Medical Group, Denver, Colorado, USA
| | - J David Powers
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA
| | - Allen Malone
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA
| | - Jason Lyons
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA
| | - Kari Olson
- Pharmacy Department, Kaiser Permanente Colorado, Denver, Colorado, USA
| | - Andrea R Paolino
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA
| | - Claudia A Steiner
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA.,Colorado Permanente Medical Group, Denver, Colorado, USA
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Rickles NM, Mulrooney M, Sobieraj D, Hernandez AV, Manzey LL, Gouveia-Pisano JA, Townsend KA, Luder H, Cappelleri JC, Possidente CJ. A systematic review of primary care-focused, self-reported medication adherence tools. J Am Pharm Assoc (2003) 2023; 63:477-490.e1. [PMID: 36372640 DOI: 10.1016/j.japh.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/23/2022] [Accepted: 09/14/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Clinician recognition of nonadherence is generally low. Tools that clinicians have used to assess medication adherence are self-reported adherence instruments that ask patients questions about their medication use experience. There is a need for more structured reviews that help clinicians comprehensively distinguish which tool might be most useful and valuable for their clinical setting and patient populations. OBJECTIVES This systematic review aimed to (1) identify validated, self-reported medication adherence tools that are applicable to the primary care setting and (2) summarize selected features of the tools as an assessment of clinical feasibility and applicability. METHODS The investigators systematically reviewed MEDLINE via Ovid, Embase via Ovid, International Pharmaceutical Abstracts, and CINAHL from inception to December 1, 2020. Investigators independently screened 3394 citations, identifying 43 articles describing validation parameters for 25 unique adherence tools. After screening each tool, 17 tools met the inclusion criteria and were qualitatively summarized. RESULTS Findings highlight 25 various tool characteristics (i.e., descriptions, parameters and diseases, measures and validity comparators, and other information), which clinicians might consider when selecting a self-reported adherence tool with strong measurement validity that is practical to administer to patients. There was much variability about the nature and extent of adherence measurement. Considerable variation was noted in the objective measures used to correlate to the self-reported tools' measurements. There were wide ranges of correlation between self-reported and objective measures. Several included tools had relatively low to moderate criterion validities. Many manuscripts did not describe whether tools were associated with costs, had copyrights, and were available in other languages; how much time was required for patients to complete self-report tools; and whether patient input informed tool development. CONCLUSION There is a critical need to ensure that adherence tool developers establish a key list of tool characteristics to report to help clinicians and researchers make practical comparisons among tools.
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Patient adherence to fully reimbursed proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) treatment. Wien Klin Wochenschr 2023:10.1007/s00508-023-02154-y. [PMID: 36808306 DOI: 10.1007/s00508-023-02154-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/12/2023] [Indexed: 02/23/2023]
Abstract
AIMS Proprotein convertase subtilisin/kexin-type 9 inhibitor (PCSK9i) treatment reduces cardiovascular events when taken over a long time for secondary prevention. Data on treatment adherence are scarce and maybe affected by co-payment of patients. The aim of this study was to elucidate PCSK9i treatment adherence in a setting of full cost coverage as it is the case in a number of European countries. METHODS AND RESULTS Baseline data and prescription patterns of all 7302 patients with PCSK9i prescriptions dispensed on the account of Austrian Social Insurances between September 2015 and December 2020 were retrieved and analyzed. A gap of ≥ 60 days between prescriptions was defined as treatment discontinuation. Patient adherence was evaluated as the proportion of days covered (PDC) over the observation period and treatment discontinuation rates were investigated by the Kaplan-Meier method. The mean PDC was 81.8% and was significantly lower in female patients. A PDC of ≥ 80% indicating adequate adherence was found in 73.8%. Of the study population 27.4% discontinued PCSK9i treatment and 49.2% thereof re-initiated treatment during the observation period. Most of the patients who discontinued treatment did so within the first year. Male patients and patients under 64 years showed significantly lower discontinuation and higher re-initiation rates. CONCLUSION Considering the high PDC and low discontinuation rates, the majority of patients adhere to PCSK9i treatment. Hence, in a system where PCSK9i treatment is made available at virtually no costs for patients this highly effective treatment is well-accepted as a long-term treatment.
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Alhassoun RK, AlDossary SA. Utilization of remote e-prescription (Anat) in Saudi Arabia during COVID-19: Factors associated with primary adherence and antibiotic prescription. Digit Health 2023; 9:20552076231194925. [PMID: 37654718 PMCID: PMC10467295 DOI: 10.1177/20552076231194925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/28/2023] [Indexed: 09/02/2023] Open
Abstract
Background The COVID-19 pandemic has affected healthcare systems globally. Various health care technologies have been used to mitigate the risk of disease transmission. Telemedicine is one such technology, and remote consulting and prescribing comprise one of its key aspects. In Saudi Arabia, telephone health services have been widely used through the free Medical Consultation Call Center (937). This platform facilitates medical consultations for all citizens, residents, and visitors. After consultations, healthcare providers are able to issue authenticated e-prescriptions using the Anat platform. Objectives To explore the utilization of the Anat remote prescription system in Saudi Arabia during the COVID-19 pandemic and to identify the factors associated with antibiotic prescription and primary medication adherence. Methods This retrospective analysis included data from the Anat e‑prescription system using a stratified random sample of 25000 prescriptions issued in Saudi Arabia in 2020. Predictive factors related to the patients, practitioners, and prescriptions were identified through bivariate and multivariate logistic regression analyses. Results Out of 25,000 e-prescriptions, 8885 were dispensed, resulting in a 35.5% primary medication adherence rate. The significant predictors of primary adherence were children, respiratory diseases, and antibacterial drugs. In addition, antibiotics made up 32.1% of the e-prescriptions. The prescription of antibiotics was significantly associated with male sex, children, genitourinary system diseases, and being treated by radiologists. Conclusions Almost two thirds 62.2% of e-prescriptions were undispensed, with antibiotic eprescriptions at 32.1%. Findings emphasize the need to enhance primary medication adherence and antibiotic prescription interventions. These findings could aid decision-makers in improving patient-centered e-prescribing practices.
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Affiliation(s)
- Roaa Khaled Alhassoun
- Department of Health Informatics, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sharifah Abdullah AlDossary
- Department of Health Informatics, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Cvietusa PJ, Goodrich GK, Shoup JA, King DK, Bender BG. Effect of an Asthma Exacerbation on Medication Adherence. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:248-254. [PMID: 36280138 PMCID: PMC10942659 DOI: 10.1016/j.jaip.2022.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/30/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Few studies have looked at the effect of an asthma exacerbation on asthma medication adherence. OBJECTIVE To measure asthma medication adherence in the 12 months after an asthma exacerbation and the influence of care type (specialist vs primary care provider) as well as social economic status on adherence. METHODS We measured portion of days covered (PDC) during the 12 months before and after an exacerbation in a cohort of patients with asthma who were aged 18 years and older. Subanalyses looked at PDC in those who had more than one exacerbation after the sentinel exacerbation, by type of care received (primary care, allergist or pulmonologist, or no care) during both periods and by socioeconomic status (SES), defined as the lower quartile of annual income for the group. RESULTS In a cohort of 1,697 patients, PDC improved significantly (from 0.44 to 0.53; P < .001) after an asthma exacerbation. Improvement in PDC was even greater (from 0.45 to 0.57; P < .001) if they had more than one exacerbation after the sentinel exacerbation. Being seen by a specialist after the exacerbation but not before it, resulted in the greatest improvement in PDC (0.17 mean change). Patients not seen by a specialist either before the exacerbation or after had a mean change of just 0.07. Those with a lower SES had an overall lower PDC before the exacerbation (0.37 vs 0.43) but saw a similar improvement in the PDC compared with those in a higher SES (0.09 vs 0.10). CONCLUSIONS An asthma exacerbation is associated with a significant and sustained effect on medication adherence.
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Affiliation(s)
- Peter J Cvietusa
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo; Department of Asthma, Allergy, and Immunology, Permanente Medical Group, Denver, Colo.
| | - Glenn K Goodrich
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo
| | - Diane K King
- Center for Behavioral Health Research and Services, Institute of Social and Economic Research, University of Alaska Anchorage, Anchorage, Alaska
| | - Bruce G Bender
- Center for Health Promotion, National Jewish Health, Denver, Colo
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Wei Q, Zhou J, Li H, Wang L, Wu Y, Ma A, Guan X. Medication adherence with fixed-dose versus free-equivalent combination therapies: Systematic review and meta-analysis. Front Pharmacol 2023; 14:1156081. [PMID: 37033611 PMCID: PMC10074603 DOI: 10.3389/fphar.2023.1156081] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
Objective: We conducted a large-scale meta-analysis and subgroup analysis to compare the effect of fixed-dose combination (FDC) therapy with that of free-equivalent combination (FEC) therapy on medication adherence. Methods: Studies published in Web of Science, PubMed, Cochrane Library, ScienceDirect, and Embase up to May 2022 were identified according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary assessed outcomes were the medication possession ratio (MPR) and proportion of days covered (PDC). We investigated the probability of being adherent to the prescribed treatment (MPR or PDC ≥80%) or the average estimate of these two parameters. Studies reporting such results were included in this meta-analysis. The summary measures were reported as the risk ratio (RR) and the weighted mean difference (MD) with 95% of confidence interval (CI) using the random-effects model of DerSimonian and Laird. The quality of the cohort studies was assessed using the Newcastle-Ottawa scale. Results: Of the 1,814 screened studies, 61 met the predefined inclusion criteria. The meta-analysis of the results showed that compared to FEC, FDC significantly improved the medication compliance of patients by 1.29 times (95% CI:1.23-1.35, p < 0.00001). I2 of 99% represent high heterogeneity across studies. The mean difference in medication adherence between FDC and FEC was 0.10 (95% CI: 0.06-0.14, p < 0.00001) with an I2 estimate of 100%. Subgroup analyses were performed for studies that reported adherence outcomes according to disease type, period of evaluation and compliance indicators. A sensitivity analysis was conducted to exclude the results of low-quality studies, as well as studies in which there was ambiguity in the method of calculating the estimator. Conclusion: Analysis of the assessed parameters for the intention-to-treat and subgroup populations suggests that FDC can improve adherence to treatment and its advantages over FEC may increase over time. Further research is needed to better understand how medical conditions affect the impact of reduced pill burden on adherence, particularly in diseases other than cardiovascular disease and type 2 diabetes mellitus.
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Affiliation(s)
- Qiran Wei
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
- Center for Pharmacoeconomics and Outcomes Research of China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Jiting Zhou
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
- Center for Pharmacoeconomics and Outcomes Research of China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Hongchao Li
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
- Center for Pharmacoeconomics and Outcomes Research of China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Luying Wang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
- Center for Pharmacoeconomics and Outcomes Research of China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Yao Wu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
- Center for Pharmacoeconomics and Outcomes Research of China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Aixia Ma
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
- Center for Pharmacoeconomics and Outcomes Research of China Pharmaceutical University, Nanjing, Jiangsu, China
- *Correspondence: Aixia Ma, ; Xin Guan,
| | - Xin Guan
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
- Center for Pharmacoeconomics and Outcomes Research of China Pharmaceutical University, Nanjing, Jiangsu, China
- *Correspondence: Aixia Ma, ; Xin Guan,
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Fleshner NE, Alibhai SMH, Connelly KA, Martins I, Eigl BJ, Lukka H, Aprikian A. Adherence to oral hormonal therapy in advanced prostate cancer: a scoping review. Ther Adv Med Oncol 2023; 15:17588359231152845. [PMID: 37007631 PMCID: PMC10064469 DOI: 10.1177/17588359231152845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/09/2023] [Indexed: 03/31/2023] Open
Abstract
Background: Orally administrated agents play a key role in the management of prostate cancer, providing a convenient and cost-effective treatment option for patients. However, they are also associated with adherence issues which can compromise therapeutic outcomes. This scoping review identifies and summarizes data on adherence to oral hormonal therapy in advanced prostate cancer and discusses associated factors and strategies for improving adherence. Methods: PubMed (inception to 27 January 2022) and conference databases (2020–2021) were searched to identify English language reports of real-world and clinical trial data on adherence to oral hormonal therapy in prostate cancer using the key search terms ‘prostate cancer’ AND ‘adherence’ AND ‘oral therapy’ OR respective aliases. Results: Most adherence outcome data were based on the use of androgen receptor pathway inhibitors in metastatic castration-resistant prostate cancer (mCRPC). Self-reported and observer-reported adherence data were used. The most common observer-reported measure, medication possession ratio, showed that the vast majority of patients were in possession of their medication, although proportion of days covered and persistence rates were considerably lower, raising the question whether patients were consistently receiving their treatment. Study follow-up for adherence was generally around 6 months up to 1 year. Studies also indicate that persistence may drop further with longer follow-up, especially in the non-mCRPC setting, which may be a concern when years of therapy are required. Conclusions: Oral hormonal therapy plays an important role in the treatment of advanced prostate cancer. Data on adherence to oral hormonal therapies in prostate cancer were generally of low quality, with high heterogeneity and inconsistent reporting across studies. Short study follow-up for adherence and focus on medication possession rates may further limit relevance of available data, especially in settings that require long-term treatment. Additional research is required to comprehensively assess adherence.
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Affiliation(s)
| | | | - Kim A. Connelly
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Toronto, ON, Canada
| | | | - Bernhard J. Eigl
- BC Cancer Vancouver, University of British Columbia, Vancouver, BC, Canada
| | - Himu Lukka
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Armen Aprikian
- McGill University Health Centre, McGill University, Montreal, QC, Canada
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47
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Bruthans J, Berger J, Šoltés J, Michálek P. Using the national electronic prescription system to determine the primary non-adherence to medication in the Czech Republic. Front Pharmacol 2023; 14:1128457. [PMID: 37033608 PMCID: PMC10073447 DOI: 10.3389/fphar.2023.1128457] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
The primary medication non-adherence occurs when a patient does not collect his or her newly prescribed medication. Various studies give estimates that this occurs between 0.2 percent and 74 percent. Recently, this topic has been researched by analyzing data in national electronic prescription systems. The database of the Czech electronic prescription system was used to obtain the number of all prescriptions issued and collected in 2021 for fifty particular substances (associated with six medication groups). Additionally, a similar query was performed with an additional criterion that the same substance had not been prescribed within the last 365 days. The data were obtained separately in five age categories. The total number of prescriptions analyzed in this study was over 21 million, which represents almost 30 percent of all prescriptions issued in the Czech Republic in 2021. The primary medication non-adherence in the selected substances was 4.56 percent, which negatively correlates (rxy = 0.707) with the age of a patient. There is a higher primary non-adherence in the Psychoanaleptics and Lipid modifying medication groups than in the whole studied sample (p < 0.05). Lipid-modifying medication group and several other particular substances showed a larger difference between primary non-adherence and overall non-adherence, indicating issues in the initiation of these drugs. The results of our study are following earlier studies with similar methodologies from other countries. However, the difference between primary non-adherence and overall non-adherence had not been observed in other studies before. The electronic prescription system proved to be a valuable tool for conducting this type of research.
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Affiliation(s)
- Jan Bruthans
- Department of Anesthesiology and Intensive Care, General Teaching Hospital, Prague, Czechia
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University, Prague, Czechia
- *Correspondence: Jan Bruthans,
| | - Jiří Berger
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Ján Šoltés
- Department of Anesthesiology and Intensive Care, General Teaching Hospital, Prague, Czechia
| | - Pavel Michálek
- Department of Anesthesiology and Intensive Care, General Teaching Hospital, Prague, Czechia
- Department of Anaesthesia, Antrim Area Hospital, Antrim, United Kingdom
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48
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Neuner JM, Fergestrom N, Pezzin LE, Laud PW, Ruddy KJ, Winn AN. Medication delivery factors and adjuvant endocrine therapy adherence in breast cancer. Breast Cancer Res Treat 2023; 197:223-233. [PMID: 36357711 DOI: 10.1007/s10549-022-06704-2] [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: 04/29/2022] [Accepted: 07/31/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE Over 50% of breast cancer patients prescribed a 5-year course of daily oral adjuvant endocrine therapy (ET) are nonadherent. We investigated the role of costs and cancer medication delivery mode and other medication delivery factors on adherence. METHODS We conducted a retrospective cohort study of commercially insured and Medicare advantage patients with newly diagnosed breast cancer in 2007-2015 who initiated ET. We examined the association between 12-month ET adherence (proportion of days covered by fills ≥ 0.80) and ET copayments, 90-day prescription refill use, mail order pharmacy use, number of pharmacies, and synchronization of medications. We used regression models to estimate nonadherence risk ratios adjusted for demographics (age, income, race, urbanicity), comorbidities, total medications, primary cancer treatments, and generic AI availability. Sensitivity analyses were conducted using alternative specifications for independent variables. RESULTS Mail order users had higher adherence in both commercial and Medicare-insured cohorts. Commercially insured patients who used mail order were more likely to be adherent if they had low copayments (< $5) and 90-day prescription refills. For commercially insured patients who used local pharmacies, use of one pharmacy and better synchronized refills were also associated with adherence. Among Medicare patients who used mail order pharmacies, only low copayments were associated with adherence, while among Medicare patients using local pharmacies both low copayments and 90-day prescriptions were associated with ET adherence. CONCLUSION Out-of-pocket costs, medication delivery mode, and other pharmacy-related medication delivery factors are associated with adherence to breast cancer ET. Future work should investigate whether interventions aimed at streamlining medication delivery could improve adherence for breast cancer patients.
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Affiliation(s)
- Joan M Neuner
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. .,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Nicole Fergestrom
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Liliana E Pezzin
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Purushottam W Laud
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kathryn J Ruddy
- The Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Aaron N Winn
- School of Pharmacy, Medical College of Wisconsin, Milwaukee, WI, USA
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Saukkosalmi P, Kankaanranta H, Vähätalo I, Sillanmäki L, Sumanen M. Defined daily dose definition in medication adherence assessment in asthma. Eur Clin Respir J 2023; 10:2207335. [PMID: 37139181 PMCID: PMC10150619 DOI: 10.1080/20018525.2023.2207335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Adherence to inhaled corticosteroids (ICS) has been described as poor. In adherence studies, if the actual prescribed dosing is not available, generic defined daily doses (DDD) are applied instead when assessing adherence. We evaluated asthma patients' adherence in a large prospective follow-up survey. We also analysed whether World Health Organization (WHO) and Global Initiative for Asthma (GINA) reference doses give different results. The current study was cross-sectional and included respondents attending to HeSSup follow-up questionnaire in 2012. Altogether 1,141 of 12,854 adult participants answered positively to the question about having asthma. According to the Finnish Social Insurance Institutions' medication register, 686 of them had purchased ICS medication during 2011. DDDs for ICS by WHO as well as medium doses from GINA report were used as reference doses to evaluate adherence. To estimate adherence to ICS, the proportion of days covered (PDC) over one year was calculated for every patient. If the lower limit of GINA medium ICS dose was used as a reference, 65% of the patients were adherent (PDC ≥ 80%). Use of WHO's DDD as reference halved the proportion of adherent patients. Adherence was higher among those using a combination inhaler of corticosteroid and long-acting β2-agonist compared to those using steroid only inhalers. Use of WHO's daily defined doses as reference values may lead to underestimation of adherence to inhaled corticosteroids. Thus, attention should be paid when choosing the reference doses for the evaluation of adherence to inhaled corticosteroids in asthma.
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Affiliation(s)
- Päivi Saukkosalmi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Regional State Administrative Agency for Southern Finland, Hämeenlinna, Finland
| | - Hannu Kankaanranta
- Faculty of Medicine and Health Technology, Tampere University Respiratory Research Group, Tampere, Finland
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
- Department of Internal Medicine, Krefting Research Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Iida Vähätalo
- Faculty of Medicine and Health Technology, Tampere University Respiratory Research Group, Tampere, Finland
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Lauri Sillanmäki
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Markku Sumanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- CONTACT Markku Sumanen Faculty of Medicine and Health Technology, Tampere University, TampereFIN-33014, Finland
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50
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA. 1. Improving Care and Promoting Health in Populations: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S10-S18. [PMID: 36507639 PMCID: PMC9810463 DOI: 10.2337/dc23-s001] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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