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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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Oliveira HC, Hayashi D, Carvalho SDL, Barros RDCLD, Neves MLDS, Andrechuk CRS, Alexandre NMC, Ribeiro PAB, Rodrigues RCM. Quality of measurement properties of medication adherence instruments in cardiovascular diseases and type 2 diabetes mellitus: a systematic review and meta-analysis. Syst Rev 2023; 12:222. [PMID: 37993931 PMCID: PMC10664314 DOI: 10.1186/s13643-023-02340-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/29/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Medication adherence has a major impact on reducing mortality and healthcare costs related to the treatment of cardiovascular diseases and diabetes mellitus. Selecting the best patient-reported outcome measure (PROM) among the many available for this kind of patient is extremely important. This study aims to critically assess, compare and synthesize the quality of the measurement properties of patient-reported outcome measures to assess medication adherence among patients with cardiovascular diseases and/or type 2 diabetes mellitus. METHODS This review followed the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines and was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). The searches were performed in Web of Science, SCOPUS, PubMed, CINAHL, EMBASE, LILACS, PsycINFO, and ProQuest (gray literature). RESULTS A total of 110 records encompassing 27 different PROMs were included in the review. The included records were published between 1986 and 2023, most of which reported studies conducted in the United States and were published in English. None of the PROMs were classified in the category "a", thus being recommended for use due to the quality of its measurement properties. The PROMs that should not be recommended for use (category "c") are the MTA, GMAS, DMAS-7, MALMAS, ARMS-D, and 5-item questionnaire. The remaining PROMs, e.g., MMAS-8, SMAQ, MEDS, MNPS, ARMS-12, MGT, MTA-OA, MTA-Insulin, LMAS-14, MARS-5, A-14, ARMS-10, IADMAS, MAQ, MMAS-5, ProMAS, ARMS-7, 3-item questionnaire, AS, 12-item questionnaire, and Mascard were considered as having the potential to be recommended for use (category "b"). CONCLUSION None of the included PROMs met the criteria for being classified as trusted and recommended for use for patients with cardiovascular diseases and/or type 2 diabetes mellitus. However, 21 PROMs have the potential to be recommended for use, but further studies are needed to ensure their quality based on the COSMIN guideline for systematic reviews of PROMs. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019129109.
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Affiliation(s)
- Henrique Ceretta Oliveira
- CEPSchool of Nursing - University of Campinas (Unicamp), 126 Tessália Vieira de Camargo Street, Campinas, São Paulo, 13083-887, Brazil.
| | - Daisuke Hayashi
- CEPSchool of Nursing - University of Campinas (Unicamp), 126 Tessália Vieira de Camargo Street, Campinas, São Paulo, 13083-887, Brazil
| | - Samantha Dalbosco Lins Carvalho
- CEPSchool of Nursing - University of Campinas (Unicamp), 126 Tessália Vieira de Camargo Street, Campinas, São Paulo, 13083-887, Brazil
| | - Rita de Cássia Lopes de Barros
- CEPSchool of Nursing - University of Campinas (Unicamp), 126 Tessália Vieira de Camargo Street, Campinas, São Paulo, 13083-887, Brazil
| | - Mayza Luzia Dos Santos Neves
- CEPSchool of Nursing - University of Campinas (Unicamp), 126 Tessália Vieira de Camargo Street, Campinas, São Paulo, 13083-887, Brazil
| | - Carla Renata Silva Andrechuk
- CEPSchool of Nursing - University of Campinas (Unicamp), 126 Tessália Vieira de Camargo Street, Campinas, São Paulo, 13083-887, Brazil
| | - Neusa Maria Costa Alexandre
- CEPSchool of Nursing - University of Campinas (Unicamp), 126 Tessália Vieira de Camargo Street, Campinas, São Paulo, 13083-887, Brazil
| | - Paula Aver Bretanha Ribeiro
- Research Centre of the Montreal University Hospital (CRCHUM), 850 Rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
| | - Roberta Cunha Matheus Rodrigues
- CEPSchool of Nursing - University of Campinas (Unicamp), 126 Tessália Vieira de Camargo Street, Campinas, São Paulo, 13083-887, Brazil
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Bentley S, Morgan L, Exall E, Arbuckle R, Rossom RC, Roche N, Khunti K, Higgins V, Piercy J. Qualitative Interviews to Support Development and Cognitive Debriefing of the Adelphi Adherence Questionnaire (ADAQ©): A Patient-Reported Measure of Medication Adherence Developed for Use in a Range of Diseases, Treatment Modalities, and Countries. Patient Prefer Adherence 2022; 16:2579-2592. [PMID: 36133076 PMCID: PMC9484566 DOI: 10.2147/ppa.s358046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The Adelphi Adherence Questionnaire (ADAQ©) is a newly developed generic patient-reported outcome (PRO) assessment of medication adherence. The aim was to assess its content validity by conducting cognitive debriefing (CD) interviews with patients prescribed medication(s) of various treatment modalities in a range of therapy areas. MATERIALS AND METHODS Targeted literature/instrument review and concept elicitation interviews informed development of the ADAQ©. CD interviews were conducted with 57 adults from the United States of America (USA; n = 21), Spain (n = 18), and Germany (n = 18) who prescribed medication for hypertension, diabetes, depression, schizophrenia, asthma, multiple myeloma, psoriasis, and/or multiple sclerosis. Interviews were conducted in two rounds to explore the relevance and understanding of the item wording, instructions, recall period and response options. Verbatim transcripts were analysed in ATLAS.Ti using thematic analysis. Three expert clinicians provided guidance throughout the study. RESULTS ADAQ© items/instructions were well understood and relevant to participants. Key modifications following round 1 included revising instructions to refer to current medication(s) for one condition to reduce cognitive burden, removing two items with lower relevance (specifically those assessing running out of medication and social discouragement), and adding a response option for participants to indicate if they had stopped taking a medication. Minor wording modifications were made following round 2. Subgroup differences in item relevance were explored based on clinical characteristics. Cost of medication was more relevant amongst US participants. CONCLUSION Content validity of the ADAQ© was confirmed in demographically and clinically diverse participants. Psychometric properties of the ADAQ© will be explored in future studies.
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Affiliation(s)
- Sarah Bentley
- Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, UK
| | - Lucy Morgan
- Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, UK
| | - Elizabeth Exall
- Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, UK
| | - Rob Arbuckle
- Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, UK
- Correspondence: Rob Arbuckle, Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, UK, Tel +44 7720 880884, Email
| | - Rebecca C Rossom
- HealthPartners Institute, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Nicholas Roche
- Respiratory Medicine, Cochin Hospital, APHP Centre University Paris Cité, Institut Cochin (UMR1016), Paris, France
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester University, Leicester, UK
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Tegegn HG, Wark S, Tursan d’Espaignet E, Spark MJ. Measurement Properties of Patient-Reported Outcome Measures for Medication Adherence in Cardiovascular Disease: A COSMIN Systematic Review. Clin Drug Investig 2022; 42:879-908. [PMID: 36180813 PMCID: PMC9617955 DOI: 10.1007/s40261-022-01199-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Several medication adherence patient-reported outcome measures (MA-PROMs) are available for use in patients with cardiovascular disease (CVD); however, little evidence is available on the most suitable MA-PROM to measure medication adherence in patients with CVD. The aim of this systematic review is to synthesise the measurement properties of MA-PROMs for patients with CVD and identify the most suitable MA-PROM for use in clinical practice or future research in patients with CVD. METHODS An electronic search of nine databases (PubMed, MEDLINE, CINAHL, ProQuest Health and Medicine, Cochrane Library, PsychInfo, Scopus, Embase, and Web of Science) was conducted to identify studies that have reported on at least one of the measurement properties of MA-PROMs in patients with CVD. The methodological quality of the studies included in the systematic review was evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. RESULTS A total of 40 MA-PROMs were identified in the 84 included studies. This review found there is a lack of moderate-to-high quality evidence of sufficient content validity for all MA-PROMs for patients with CVDs. Only eight MA-PROMs were classified in COSMIN recommendation category A. They exhibited sufficient content validity with very low-quality evidence, and moderate-to-high quality evidence for sufficient internal consistency. The 28 MA-PROMs that meet the requirements for COSMIN recommendation category 'B' require further validation studies. Four MA-PROMs including Hill-Bone Compliance Medication Scale (HBMS), the five-item Medication Adherence Report Scale (MARS-5), Maastricht Utrecht Adherence in Hypertension (MUAH), and MUAH-16 have insufficient results with high quality evidence for at least one measurement property and consequently are not recommended for use in patients with CVD. Two MA-PROMs (Adherence to Refills and Medications Scale [ARMS] and ARMS-7) are comprehensive and have moderate to high quality evidence for four sufficient measurement properties. CONCLUSION From the eight MA-PROMs in COSMIN recommendation category A, ARMS and ARMS-7 were selected as the most suitable MA-PROMs for use in patients with CVD. They are the most comprehensive with be best quality evidence to support their use in clinical practice and research.
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Affiliation(s)
- Henok G. Tegegn
- School of Rural Medicine, University of New England, Armidale, 2351 Australia ,Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Stuart Wark
- School of Rural Medicine, University of New England, Armidale, 2351 Australia
| | - Edouard Tursan d’Espaignet
- School of Rural Medicine, University of New England, Armidale, 2351 Australia ,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW 2300 Australia
| | - M. Joy Spark
- School of Rural Medicine, University of New England, Armidale, 2351 Australia
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Shiyanbola OO, Maurer MA, Virrueta N, Walbrandt Pigarelli DL, Huang YM, Unni EJ, Smith PD. Feasibility of a Randomized Controlled Mixed Methods Trial to Address Health Literacy, Beliefs, Medication Adherence, and Self-Efficacy (ADHERE) in a Clinical Pharmacist-Led Clinic. Patient Prefer Adherence 2022; 16:679-696. [PMID: 35300357 PMCID: PMC8922467 DOI: 10.2147/ppa.s349258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/12/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To assess the feasibility and acceptability of a health literacy-psychosocial support intervention - ADHERE and explore changes in glycemic values and medication adherence. PATIENTS AND METHODS Thirty-one participants with hemoglobin A1c (HbA1c) ≥ 8% were randomly allocated to control (usual care) or intervention groups (receiving usual care plus a 6-session pharmacist-led intervention focusing on the modifiable psychosocial factors that may influence medication adherence). Feasibility metrics evaluated recruitment, retention, and intervention adherence. Questionnaires were administered to collect psychosocial factors and self-reported medication adherence at baseline, the end of the intervention, 3 months, and 6 months post intervention. HbA1c values were extracted from electronic medical records. Repeated measures analysis of variance was used to compare differences in mean outcomes between the control and intervention groups. To assess intervention acceptability, eleven individuals participated in semi-structured interviews about their intervention experiences. Qualitative content analysis was used for analyzing the interviews. RESULTS Thirty participants completed the study. Overall, the findings support the feasibility of the intervention. There were significant differences in HbA1c values. Participants in the intervention group had lower A1C (8.3 ± 1.4) than in the control group (9.2 ± 1.3) at the time of 6-month follow-up (p = 0.003). In addition, the participants in the intervention group showed improved HbA1c at 6-month follow-up (8.3 ± 1.4), compared to baseline (9.4 ± 1.5, p = 0.011) and after 6-session intervention (8.9 ± 1.6, p = 0.046). However, there were no significant differences in medication adherence between groups over time. Qualitative themes suggest participants liked the intervention and perceived the additional support from the pharmacist as beneficial. CONCLUSION A pharmacist-led intervention to provide additional health literacy-psychosocial support may contribute to long-term improvements in HbA1c. Equipping pharmacists with patient-specific diabetes medication adherence information and building in additional follow-up support for patients may improve patient health outcomes.
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Affiliation(s)
- Olayinka O Shiyanbola
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin- Madison, Madison, WI, USA
- Correspondence: Olayinka O Shiyanbola, Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, 777 Highland Avenue, Madison, WI, 53705, USA, Tel +1 608 890 2091, Email
| | - Martha A Maurer
- Sonderegger Research Center, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Natasha Virrueta
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin- Madison, Madison, WI, USA
| | | | - Yen-Ming Huang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Elizabeth J Unni
- Department of Social, Behavioral, and Administrative Sciences, Touro College of Pharmacy, New York, NY, USA
| | - Paul D Smith
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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Wells J, Crilly P, Kayyali R. A Systematic Analysis of Reviews Exploring the Scope, Validity, and Reporting of Patient-Reported Outcomes Measures of Medication Adherence in Type 2 Diabetes. Patient Prefer Adherence 2022; 16:1941-1954. [PMID: 35958891 PMCID: PMC9359520 DOI: 10.2147/ppa.s375745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Non-adherence to medicines is estimated to cost billions to healthcare providers across the US and Europe each year. Addressing medication adherence (MA) can be challenging. Patient-reported outcome measures (PROMs) have been developed to collect self-reported data on MA, among other behaviours. Despite the myriad PROMs available and their widespread implementation in research, there is little commentary or standardization on the way they are reported, or their validity assessed. This review aims to provide a comprehensive analysis of systematic reviews (SRs) that report PROMs of MA with a focus on type 2 diabetes to explore PROM reporting and validity. MATERIALS AND METHODS A literature search was conducted using the following databases: PubMed, EMBASE, CINAHL, Cochrane, and Web of Science. SRs reporting on PROMs related to MA behaviour in patients living with type 2 diabetes were included. Any SR published in English prior to December 2021 was included. Abstract and title screening were performed prior to full-text review by two independent researchers with discrepancies managed by a third. Protocols and SRs reporting on paediatric populations were excluded. RESULTS A total of 19 eligible SRs that included 241 unique PROM studies were captured from the initial 2074 records that were identified. Data were captured across a 30-year scope, with roughly half (47.4%, n=9/19) of the SRs published in the last 5 years. In total, 104 unique PROMs were identified. Inclusion of non-validated PROMs was identified in 63.2% (n=12/19) of the included SRs, and reporting issues were identified in 47.3% of studies (n=114/241). A lower journal impact factor was significantly associated with a higher prevalence of validity issues (r=0.44, p=0.04). CONCLUSION There are a broad range of available PROMs; however, they have been reported inconsistently in the literature, often lacking significant evidence with respect to validity criteria. Standardization of reporting and assessments of validity may help to address this.
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Affiliation(s)
- Joshua Wells
- Department of Pharmacy, Kingston University, Kingston, UK
| | - Philip Crilly
- Department of Pharmacy, Kingston University, Kingston, UK
| | - Reem Kayyali
- Department of Pharmacy, Kingston University, Kingston, UK
- Correspondence: Reem Kayyali, Department of Pharmacy, Kingston University, Penrhyn Road, Kingston, KT1 2EE, UK, Tel/Fax +44 208 417 2561, Email
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Murali KM, Mullan J, Roodenrys S, Cheikh Hassan HI, Lonergan MA. Exploring the Agreement Between Self-Reported Medication Adherence and Pharmacy Refill-Based Measures in Patients with Kidney Disease. Patient Prefer Adherence 2022; 16:3465-3477. [PMID: 36605331 PMCID: PMC9809402 DOI: 10.2147/ppa.s388060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 12/13/2022] [Indexed: 01/01/2023] Open
Abstract
AIM To assess the quantitative and categorical agreement between two methods of measuring medication adherence: pharmacy refill-based medication possession rates and self-reported medication adherence scale. BACKGROUND Categorisation of adherence metrics using empirical cut-off scores can lead to misclassification, which can be overcome by expressing adherence as a continuous variable. Pharmacy refill-based adherence can be reported as actual rates, but the validity of expressing self-reported medication adherence scores as a continuous variable to reflect adherence is unknown and its quantitative agreement with refill-based adherence rates untested. METHODS Patients with kidney disease, including dialysis patients, from Illawarra Shoalhaven region of New South Wales, Australia were recruited between January 2015 and June 2016 to this cross-sectional study. Medication adherence was assessed using the self-reported Morisky Medication Adherence Scale (MMAS) and two pharmacy refill-based measures, Medication Possession Ratio (MPR) and Proportion of Days Covered (PDC) for antihypertensives and cardiometabolic drugs. Categorical and quantitative agreement between self-reported adherence and pharmacy refill-based adherence were assessed using tests of trend, analysis of covariance (ANCOVA), Cohen's kappa and Bland-Altman analysis. RESULTS We recruited 113 patients. There was a significant declining trend of MPR (p < 0.001) and PDC (<0.001 for antihypertensives, p = 0.004 for cardiometabolic) scores among categories with worsening MMAS adherence. Adjusted ANCOVA showed significant association between self-report and pharmacy refill-based adherence (p < 0.001). Weighted Cohen's kappa statistics showed fair agreement between the self-report and pharmacy refill-based categories. Bland-Altman's analysis showed less than 5% of cases were outside the limits of agreement (-0.36 to 0.27) and the bias for MMAS was negative (-0.05 to -0.09), indicating MMAS did not overestimate adherence. CONCLUSION There is modest agreement between pharmacy refill-based measures and self-report MMAS measures when assessed categorically or quantitatively. Assessing adherence as a continuous variable should be considered to overcome the challenges associated with categorization of adherence based on arbitrary thresholds.
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Affiliation(s)
- Karumathil M Murali
- Department of Nephrology, Wollongong Hospital, Wollongong, NSW, Australia
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- Correspondence: Karumathil M Murali, Department of Nephrology, Wollongong Hospital, Wollongong, NSW, 2500, Australia, Tel +61 2 42952800, Fax +61 2 4295 2916, Email
| | - Judy Mullan
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Steven Roodenrys
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Hicham I Cheikh Hassan
- Department of Nephrology, Wollongong Hospital, Wollongong, NSW, Australia
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Maureen A Lonergan
- Department of Nephrology, Wollongong Hospital, Wollongong, NSW, Australia
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Spencer JC, Reeve BB, Troester MA, Wheeler SB. Factors Associated with Endocrine Therapy Non-Adherence in Breast Cancer Survivors. Psychooncology 2020; 29:647-654. [PMID: 32048400 DOI: 10.1002/pon.5289] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/29/2019] [Accepted: 11/11/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND For women with hormone receptor positive breast cancer, long-term endocrine therapy (ET) can greatly reduce the risk of recurrence, yet adherence is low- particularly among traditionally underserved populations. METHODS The Carolina Breast Cancer Study oversampled Black and young women (<50 years of age). Participants answered an ET-specific medication adherence questionnaire assessing reasons for non-adherence. We used principal factor analysis to identify latent factors describing ET non-adherence. We then performed multivariable regression to determine clinical and demographic characteristics associated with each ET non-adherence factor. RESULTS 1,231 women were included in analysis, 59% reported at least one barrier to ET adherence. We identified three latent factors which we defined as: habit - challenges developing medication-taking behavior; tradeoffs - high perceived side effect burden and medication safety concerns; and resource barriers - challenges related to cost or accessibility. Older age (50+) was associated with less reporting of habit (Adjusted Risk Ratio (aRR) 0.54[95% CI: 0.43-0.69] and resource barriers (aRR 0.66[0.43-0.997]), but was not associated with tradeoff barriers. Medicaid-insured women were more likely than privately-insured to report tradeoff (aRR:1.53 [1.10-2.13]) or resource barriers (aRR:4.43[2.49-6.57]). Black race was associated with increased reporting of all factors (habit: aRR 1.29[1.09-1.53]; tradeoffs: 1.32[1.09-1.60], resources: 1.65[1.18-2.30]). CONCLUSION Barriers to ET adherence were described by three distinct factors, and strongly associated with sociodemographic characteristics. Barriers to ET adherence appear inadequately addressed for younger, Black, and publicly-insured breast cancer survivors. These findings underscore the importance of developing multi-faceted, patient-centered interventions that address a diverse range of barriers to ET adherence.
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Affiliation(s)
- Jennifer C Spencer
- Department of Health Policy and Management, University of North Carolina at Chapel Hill
| | - Bryce B Reeve
- Department of Population Health Sciences, Duke University School of Medicine.,Duke Cancer Institute, Duke University School of Medicine
| | | | - Stephanie B Wheeler
- Department of Health Policy and Management, University of North Carolina at Chapel Hill.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
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Peipert JD, Badawy SM, Baik SH, Oswald LB, Efficace F, Garcia SF, Mroczek DK, Wolf M, Kaiser K, Yanez B, Cella D. Development of the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) Medication Adherence Scale (PMAS). Patient Prefer Adherence 2020; 14:971-983. [PMID: 32606615 PMCID: PMC7293395 DOI: 10.2147/ppa.s249079] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/12/2020] [Indexed: 12/11/2022] Open
Abstract
Poor medication adherence is associated with reduced drug effectiveness, poor health-related quality of life, increased morbidity and mortality, and increased healthcare utilization and cost. Including the patient's voice is essential in understanding barriers to adherence. Useful patient-reported adherence measures are brief, inexpensive, non-invasive; can indicate barriers to adherence; and can be incorporated in electronic health records. The NIH Patient-Reported Outcomes Measurement Information System (PROMIS®) includes high-quality, freely available patient-reported measures covering many important constructs in patient-centered research but does not include a medication adherence measure. To fill this gap, we developed the PROMIS Medication Adherence Scale (PMAS) using the rigorous PROMIS instrument development guidelines. To develop the PMAS, we first conducted a review of the reviews, which enabled us to identify content areas relevant to medication adherence behavior. Then, we conducted qualitative research to elicit patients' views of and experiences with medication adherence. This process identified the following important content areas to guide item writing: extent medication is taken, knowledge of medication regimen, beliefs about medication, remembering to take medication, skipping due to side effects, skipping due to feeling better, and cost of medications. Based on the results of these activities, we wrote items and aimed to retain 1-2 items per content area. The final item set included 9 total adherence items, which were then refined through intensive comprehension and translatability review, as well as cognitive interviews. Future steps include testing the PMAS's validity.
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Affiliation(s)
- John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Correspondence: John Devin Peipert Email
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Sharon H Baik
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Laura B Oswald
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Fabio Efficace
- Italian Group for Adult Hematologic Disease (GIMEMA), Health Outcomes Research Unit, Rome, Italy
| | - Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniel K Mroczek
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael Wolf
- Department of Medicine, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Karen Kaiser
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Shiyanbola OO, Walbrandt Pigarelli DL, Unni EJ, Smith PD, Maurer MA, Huang YM. Design and rationale of a mixed methods randomized control trial: ADdressing Health literacy, bEliefs, adheRence and self-Efficacy (ADHERE) program to improve diabetes outcomes. Contemp Clin Trials Commun 2019; 14:100326. [PMID: 30705995 PMCID: PMC6348197 DOI: 10.1016/j.conctc.2019.100326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/09/2019] [Accepted: 01/12/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Improving medication adherence is one of the most effective approaches to improving the health outcomes of patients with diabetes. To date, enhancing diabetes medication adherence has occurred by improving diabetes-related knowledge. Unfortunately, behavior change often does not follow knowledge change. Enhancing communication between patients and healthcare professionals through addressing health literacy-related psychosocial attributes is critical. OBJECTIVE Examine whether a patient-centered intervention augmenting usual care with a health literacy-psychosocial support intervention will improve medication adherence for patients with diabetes, compared to usual care. METHODS This study is a randomized controlled trial with an intervention mixed methods design. Fifty participants being enrolled are English-speaking, 18-80 years old with diagnosed diabetes, take at least one diabetes medication, have low diabetes medication adherence (proportion of days covered less than 80% or based on clinical notes), and have poor diabetes control (hemoglobin A1c of ≥8%). Participants will be allocated to either a control group receiving usual care (n = 25) or an intervention group (n = 25) receiving usual care and a 6-session intervention focusing on the modifiable psychosocial factors that may influence medication adherence. A questionnaire will be administered at baseline and at the end of the intervention to all participants to assess the effectiveness of the intervention. Fifteen participants from the intervention group will be interviewed to explore participants' experiences and perceptions of the intervention processes and outcomes. CONCLUSIONS The trial will examine if a patient-centered intervention that addresses patients' health literacy and focuses on modifiable psychosocial factors will improve medication adherence among patients with diabetes.
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Affiliation(s)
- Olayinka O. Shiyanbola
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, WI, USA
| | | | - Elizabeth J. Unni
- Department of Pharmaceutical Sciences, College of Pharmacy, Roseman University of Health Sciences, Utah, USA
| | - Paul D. Smith
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, WI, USA
| | - Martha A. Maurer
- Sonderegger Research Center, School of Pharmacy, University of Wisconsin-Madison, WI, USA
| | - Yen-Ming Huang
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, WI, USA
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Wheeler SB, Spencer J, Pinheiro LC, Murphy CC, Earp JA, Carey L, Olshan A, Tse CK, Bell ME, Weinberger M, Reeder-Hayes KE. Endocrine Therapy Nonadherence and Discontinuation in Black and White Women. J Natl Cancer Inst 2019; 111:498-508. [PMID: 30239824 PMCID: PMC6510227 DOI: 10.1093/jnci/djy136] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 06/08/2018] [Accepted: 07/10/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Differential use of endocrine therapy (ET) by race may contribute to breast cancer outcome disparities, but racial differences in ET behaviors are poorly understood. METHODS Women aged 20-74 years with a first primary, stage I-III, hormone receptor-positive (HR+) breast cancer were included. At 2 years postdiagnosis, we assessed nonadherence, defined as not taking ET every day or missing more than two pills in the past 14 days, discontinuation, and a composite measure of underuse, defined as either missing pills or discontinuing completely. Using logistic regression, we evaluated the relationship between race and nonadherence, discontinuation, and overall underuse in unadjusted, clinically adjusted, and socioeconomically adjusted models. RESULTS A total of 1280 women were included; 43.2% self-identified as black. Compared to white women, black women more often reported nonadherence (13.7% vs 5.2%) but not discontinuation (10.0% vs 10.7%). Black women also more often reported the following: hot flashes, night sweats, breast sensitivity, and joint pain; believing that their recurrence risk would not change if they stopped ET; forgetting to take ET; and cost-related barriers. In multivariable analysis, black race remained statistically significantly associated with nonadherence after adjusting for clinical characteristics (adjusted odds ratio = 2.72, 95% confidence interval = 1.75 to 4.24) and after adding socioeconomic to clinical characteristics (adjusted odds ratio = 2.44, 95% confidence interval = 1.50 to 3.97) but was not independently associated with discontinuation after adjustment. Low recurrence risk perception and lack of a shared decision making were strongly predictive of ET underuse across races. CONCLUSIONS Our results highlight important racial differences in ET-adherence behaviors, perceptions of benefits/harms, and shared decision making that may be targeted with culturally tailored interventions.
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Affiliation(s)
- Stephanie B Wheeler
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jennifer Spencer
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Laura C Pinheiro
- Division of General Internal Medicine, Weill Cornell Medical College, New York, NY
| | - Caitlin C Murphy
- Division of Epidemiology, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jo Anne Earp
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lisa Carey
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrew Olshan
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Chiu Kit Tse
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mary E Bell
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Morris Weinberger
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Katherine E Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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12
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Lessa F, Caccavo F, Curtis S, Ouimet-Rathé S, Lemgruber A. Strengthening and implementing health technology assessment and the decision-making process in the Region of the Americas. Rev Panam Salud Publica 2017; 41:e165. [PMID: 31384277 PMCID: PMC6650625 DOI: 10.26633/rpsp.2017.165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 08/01/2017] [Indexed: 01/18/2023] Open
Abstract
Objective. Health technology assessment (HTA) has been adopted by countries in order to
improve allocative efficiency in their health systems. This study aimed to
describe and analyze the HTA decision-making process in the Region of the
Americas. Methods. A literature review was done to better understand the HTA situation in the
Region. Also, in 2014 and 2015, individuals responsible for conducting HTA
in countries of the Americas were identified and received a questionnaire on
HTA and the decision-making process. Results. A total of 46 questionnaire responses were obtained, from 30 countries. The
respondents were similar in terms of their institutions, main funding
sources, and technology types assessed. Of the 46 respondents, 23 (50%) work
for their respective ministry of health. Also, 36 (78%) undertake and/or
coordinate HTA through coverage and reimbursement/pricing decisions and
other HTA-related activities, while 24 (52%) use HTA for emerging
technologies. While some countries in the Region have created formal HTA
units, there is a weak link between the HTA process and decision-making.
Most of the countries with recognized HTA institutions are members of the
Health Technology Assessment Network of the Americas (RedETSA). Despite the
advances in the Region overall, most countries in Central America and the
Caribbean are still at the early stages of implementing HTA to support
decision-making. Conclusions. Many countries in the Americas have benefited from the exchange and
capacity-building opportunities within RedETSA. However, there are still
many challenges to overcome in the Region in terms of the discussion and
creation of HTA-related policies.
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Affiliation(s)
- Fernanda Lessa
- Medicines and Health Technologies Unit Pan American Health Organization/World Health Organization Washington, D.C. United States of America Medicines and Health Technologies Unit, Pan American Health Organization/World Health Organization, Washington, D.C., United States of America
| | - Francisco Caccavo
- Medicines and Health Technologies Unit Pan American Health Organization/World Health Organization Washington, D.C. United States of America Medicines and Health Technologies Unit, Pan American Health Organization/World Health Organization, Washington, D.C., United States of America
| | - Stephanie Curtis
- Medicines and Health Technologies Unit Pan American Health Organization/World Health Organization Washington, D.C. United States of America Medicines and Health Technologies Unit, Pan American Health Organization/World Health Organization, Washington, D.C., United States of America
| | - Stéphanie Ouimet-Rathé
- Medicines and Health Technologies Unit Pan American Health Organization/World Health Organization Washington, D.C. United States of America Medicines and Health Technologies Unit, Pan American Health Organization/World Health Organization, Washington, D.C., United States of America
| | - Alexandre Lemgruber
- Medicines and Health Technologies Unit Pan American Health Organization/World Health Organization Washington, D.C. United States of America Medicines and Health Technologies Unit, Pan American Health Organization/World Health Organization, Washington, D.C., United States of America
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