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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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Gargiulo P, Basile C, Galasso G, Bellino M, D'Elia D, Patti G, Bosco M, Prinetti M, Andò G, Campanella F, Taverna G, Calabrò P, Cesaro A, Fimiani F, Catalano A, Varbella F, Corleto A, Barillà F, Muscoli S, Musumeci G, Delnevo F, Giallauria F, Napoli R, Porto I, Polimeni A, Quarta R, Maloberti A, Merlini PA, De Luca L, Casu G, Brunetti ND, Crisci M, Paloscia L, Bilato C, Indolfi C, Marzano F, Fontanarosa S, Buonocore D, Parlati ALM, Nardi E, Prastaro M, Soricelli A, Salvatore M, Paolillo S, Perrone-Filardi P. Strike early-strike strong lipid-lowering strategy with PCSK9i in ACS patients. Real-world evidence from AT-TARGET-IT registry. Eur J Prev Cardiol 2024:zwae170. [PMID: 38788773 DOI: 10.1093/eurjpc/zwae170] [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: 02/21/2024] [Revised: 03/29/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024]
Abstract
AIMS No data are available on early initiation of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) in patients with acute coronary syndrome (ACS) in real-world. This study investigates the effects of PCSK9i started at time of ACS hospitalization on lipid control and major CV events in real-world. METHODS The lipid control outcome was the percentage of patients reaching the LDL-C target of < 55 mg/dL at first lipid control. The clinical outcome was the incidence of composite major CV events (all cause death, non-fatal MI, non-fatal stroke, and ischemia-driven revascularization) during follow-up in relation to quartiles of LDL-C at first lipid control. RESULTS We included 771 patients with ACS from AT-TARGET-IT registry, receiving PCSK9i prescription during hospitalization or at discharge. Median LDL-C was 137 mg/dL and decreased to 43 mg/dL at first lipid control. 527 (68.3%) patients achieved LDL-C target at the first lipid control at a median time of 37 days from hospitalization; of them, 404 (76.8%) were discharged on statin plus ezetimibe background therapy. Event curves through a median follow-up of 11 months across quartiles of LDL-C showed a stepwise lower risk of 4P-MACE, 3P-MACE, all-cause mortality, and ischemia-driven revascularization in lower quartile of LDL-C values at first lipid control (<23 mg/dL) and in patients reaching LDL-C <55 mg/dL. CONCLUSIONS Intensive and early lipid-lowering therapy using PCSK9i in patients with ACS (strike early strike strong strategy) is safe and effective in clinical practice and associated with a reduction of residual CV risk.
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Affiliation(s)
- Paola Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Christian Basile
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Debora D'Elia
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Giuseppe Patti
- Division of Cardiology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Manuel Bosco
- Division of Cardiology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Matteo Prinetti
- Division of Cardiology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Giuseppe Andò
- Department of Clinical and Experimental Medicine, University of Messina, AOU Policlinico "G. Martino", Messina, Italy
| | - Francesca Campanella
- Department of Clinical and Experimental Medicine, University of Messina, AOU Policlinico "G. Martino", Messina, Italy
| | - Giovanni Taverna
- Department of Clinical and Experimental Medicine, University of Messina, AOU Policlinico "G. Martino", Messina, Italy
| | - Paolo Calabrò
- Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli" and Divion of Cardiology, AORN "Sant' Anna e San Sebastiano", Caserta, Italy
| | - Arturo Cesaro
- Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli" and Divion of Cardiology, AORN "Sant' Anna e San Sebastiano", Caserta, Italy
| | - Fabio Fimiani
- Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli" and Divion of Cardiology, AORN "Sant' Anna e San Sebastiano", Caserta, Italy
| | - Angelo Catalano
- Cardiology Division Emergency Department, Eboli-Battipaglia-Roccadaspide, Maria SS Addolorata General Hospital, Eboli, Italy
| | - Ferdinando Varbella
- Division of Cardiology, Interventional Unit, Infermi Rivoli Hospital Rivoli, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Antonella Corleto
- Division of Cardiology, Interventional Unit, Infermi Rivoli Hospital Rivoli, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Francesco Barillà
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Saverio Muscoli
- Division of Cardiology, Fondazione Policlinico Tor Vergata, Rome, Italy
| | | | | | - Francesco Giallauria
- Department of Traslational Medical Sciences, Precision Medicine Unit, Federico II University, Naples, Italy
| | - Raffaele Napoli
- Department of Traslational Medical Sciences, Precision Medicine Unit, Federico II University, Naples, Italy
| | - Italo Porto
- Cardiovascular Disease Unit, Department of Internal Medicine (Di.M.I.), University of Genoa, Genoa, Italy and Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genoa, Italy
| | - Alberto Polimeni
- Division of Cardiology AOCS, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Cosenza, Italy
| | - Rossella Quarta
- Division of Cardiology AOCS, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Cosenza, Italy
| | - Alessandro Maloberti
- Cardiology 4, ASST GOM Niguarda, Milan, Italy and School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Piera Angelica Merlini
- Cardiology 4, ASST GOM Niguarda, Milan, Italy and School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Leonardo De Luca
- Department of Cardio-Thoracic and Vascular Medicine and Surgery, Division of Cardiology, S. Camillo-Forlanini, Rome, Italy
| | - Gavino Casu
- Department of Cardiology, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy and Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | | | - Mario Crisci
- Department of Cardiology, Division of Interventional Cardiology, Monaldi Hospital, Naples, Italy
| | | | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospitals, Arzignano, Vicenza, Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Federica Marzano
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Sara Fontanarosa
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Davide Buonocore
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | | | - Ermanno Nardi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Maria Prastaro
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Andrea Soricelli
- IRCCS Synlab SDN, Naples, Italy; Department of Motor Sciences and Healthiness, University of Naples Parthenope, Naples, Italy
| | | | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
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Scarton L, Nelson T, Yao Y, DeVaughan-Circles A, Legaspi AB, Donahoo WT, Segal R, Goins RT, Manson SM, Wilkie DJ. Association of Medication Adherence With HbA1c Control Among American Indian Adults With Type 2 Diabetes Using Tribal Health Services. Diabetes Care 2023; 46:1245-1251. [PMID: 37068266 PMCID: PMC10234744 DOI: 10.2337/dc22-1885] [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] [Received: 09/27/2022] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE To examine HbA1c levels and adherence to oral glucose-lowering medications and their association with future HbA1c levels among American Indian adults with type 2 diabetes (T2D) receiving medications at no cost from a tribal health care system. RESEARCH DESIGN AND METHODS Tribal citizens with T2D who used Choctaw Nation Health Services Authority (CNHSA) and Pharmacies and had HbA1c data during 2017-2018 were included in this study. Medication adherence (proportion of days covered [PDC] ≥0.80) was calculated using 2017 CNHSA electronic health record data. RESULTS Of the 74,000 tribal citizens living on tribal lands, 4,560 were eligible; 32% had HbA1c at or below target (≤7%), 36% were above target (>7 to ≤9%), and 32% were uncontrolled (>9%) in 2017. The percentage of patients with PDC ≥0.80 was 66% for those using biguanides, 72% for sulfonylureas, 75% for dipeptidyl peptidase 4 inhibitors, and 83% for sodium-glucose cotransporter 2 inhibitors. The proportion of patients with HbA1c at or below target increased slightly from 32% in 2017 to 42% in 2018. Higher average PDC in 2017 was associated with lower HbA1c levels in 2018 (β = -1.143; P < 0.001). CONCLUSIONS Medication adherence was higher than that found in previous studies using self-report methods in American Indian populations, although a smaller proportion of patients had HbA1c at or below target relative to U.S. adults with T2D. Medication adherence was associated with improved HbA1c levels for most oral glucose-lowering medication classes. Future studies of American Indians should use both longitudinal prescription data from both electronic health records and pharmacy refills.
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Affiliation(s)
- Lisa Scarton
- College of Nursing, University of Florida, Gainesville, FL
| | - Tarah Nelson
- College of Nursing, University of Florida, Gainesville, FL
| | - Yingwei Yao
- College of Nursing, University of Florida, Gainesville, FL
| | | | | | | | - Richard Segal
- College of Pharmacy, University of Florida, Gainesville, FL
| | - R. Turner Goins
- College of Health and Human Sciences, Western Carolina University, Cullowhee, NC
| | - Spero M. Manson
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
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Levin JS, Komanduri S, Whaley C. Association between hospital-physician vertical integration and medication adherence rates. Health Serv Res 2023; 58:356-364. [PMID: 36272112 PMCID: PMC10012217 DOI: 10.1111/1475-6773.14090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To test the association between vertical integration of primary care providers (PCPs) and adherence rates for anti-diabetics, renin angiotensin system antagonists (RASA), and statins. DATA SOURCES Medicare Part B outpatient fee-for-service claims and Medicare Part D event data from 2014 to 2017. STUDY DESIGN We estimated difference-in-differences regressions, comparing changes in adherence among patients with PCPs who converted from independent to integrated to changes among patients whose PCPs remained independent or integrated during the study period. To test for heterogenous impacts by patient demographics, we estimated triple difference regressions that included additional interaction terms by comorbidity rates, age group, and race/ethnicity. EXTRACTION METHODS We extracted Medicare claims for adults with continuous enrollment in Parts B and D during the study period. PRINCIPAL FINDINGS The proportion of patients who had a vertically integrated PCP increased by approximately 23% over the study period. Changes in adherence did not differ significantly between patients based on whether their PCP became integrated (Statins: 0.18, 95% CI -0.13, 0.49; RASA: -0.13, 95% CI -0.46, 0.19; Anti-Diabetics: -0.20, 95% CI -0.78, 0.38). Among patients with PCPs who became integrated, there were significant decreases in adherence for patients who were Black, Asian, Hispanic, or Native American, above 80 years old, and had greater comorbidities for all three classes. CONCLUSIONS While there were no average changes in adherence following vertical integration of PCPs, health equity worsened, with significant declines in adherence for Black, Asian, Hispanic, and Native American patients, patients over 80 years old, and patients with greater comorbidities. These findings suggest that integration may reduce clinicians' incentives to compete based on the quality of care delivered. Given the price increases associated with integration, integration may be a net welfare loss.
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Affiliation(s)
| | - Swad Komanduri
- RAND Health Care, RAND Corporation, Santa Monica, California, USA
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Adherence to Oral Antidiabetic Drugs in Patients with Type 2 Diabetes: Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12051981. [PMID: 36902770 PMCID: PMC10004070 DOI: 10.3390/jcm12051981] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Poor adherence to oral antidiabetic drugs (OADs) in patients with type 2 diabetes (T2D) can lead to therapy failure and risk of complications. The aim of this study was to produce an adherence proportion to OADs and estimate the association between good adherence and good glycemic control in patients with T2D. We searched in MEDLINE, Scopus, and CENTRAL databases to find observational studies on therapeutic adherence in OAD users. We calculated the proportion of adherent patients to the total number of participants for each study and pooled study-specific adherence proportions using random effect models with Freeman-Tukey transformation. We also calculated the odds ratio (OR) of having good glycemic control and good adherence and pooled study-specific OR with the generic inverse variance method. A total of 156 studies (10,041,928 patients) were included in the systematic review and meta-analysis. The pooled proportion of adherent patients was 54% (95% confidence interval, CI: 51-58%). We observed a significant association between good glycemic control and good adherence (OR: 1.33; 95% CI: 1.17-1.51). This study demonstrated that adherence to OADs in patients with T2D is sub-optimal. Improving therapeutic adherence through health-promoting programs and prescription of personalized therapies could be an effective strategy to reduce the risk of complications.
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Gargiulo P, Basile C, Cesaro A, Marzano F, Buonocore D, Asile G, Abbate V, Vicidomini F, Paolillo S, Spaccarotella CAM, Catalano A, Spirito G, Merlini PA, Maloberti A, Iannuzzo G, Ciccone MM, Zito AP, Paloscia L, D'Alleva A, Varbella F, Corleto A, Brunetti ND, Corbo MD, Calabrò P, Indolfi C, Perrone-Filardi P. Efficacy, safety, adherence and persistence of PCSK9 inhibitors in clinical practice: A single country, multicenter, observational study (AT-TARGET-IT). Atherosclerosis 2023; 366:32-39. [PMID: 36696749 DOI: 10.1016/j.atherosclerosis.2023.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/17/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIMS Proprotein Convertase Subtilisin/Kexin type 9 inhibitors (PCSK9i) are recommended in patients at high and very-high cardiovascular (CV) risk, with documented atherosclerotic CV disease (ASCVD), and for very-high risk patients with familial hypercholesterolaemia not achieving LDL-cholesterol (LDL-C) goal while receiving maximally tolerated dose of lipid-lowering therapy (LLT). However, single country real-life data, reporting the use of PCSK9i in clinical practice, are limited. Therefore, we designed AT-TARGET-IT, an Italian, multicenter, observational registry on the use of PCSK9i in clinical practice. METHODS All data were recorded at the time of the first prescription and at the latest observation preceding inclusion in the study. RESULTS 798 patients were enrolled. The median reduction in LDL-C levels was 64.9%. After stratification for CV risk, 63.8% achieved LDL-C target; of them, 83.3% took LLTs at PCSK9i initiation and 16.7% did not. 760 patients (95.2%) showed high adherence to therapy, 13 (1.6%) partial adherence, and 25 (3.1%) poor adherence. At 6 months, 99.7% of patients enrolled in the study remained on therapy; there were 519 and 423 patients in the study with a follow-up of at least 12 and 18 months, respectively. Persistence in these groups was 98.1% and 97.5%, respectively. Overall, 3.5% of patients discontinued therapy. No differences in efficacy, adherence, and persistence were found between alirocumab and evolocumab. CONCLUSIONS PCSK9i are safe and effective in clinical practice, leading to very high adherence and persistence to therapy, and achievement of recommended LDL-C target in most patients, especially when used as combination therapy.
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Affiliation(s)
- Paola Gargiulo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Christian Basile
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Davide Buonocore
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Gaetano Asile
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Vincenza Abbate
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Francesca Vicidomini
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Angelo Catalano
- Cardiology Division Emergency Department, Roccadaspide Maria SS Addolorata General Hospital, Eboli, Italy
| | - Giulio Spirito
- Cardiology Division Emergency Department, Roccadaspide Maria SS Addolorata General Hospital, Eboli, Italy
| | | | - Alessandro Maloberti
- A. De Gasperis Cardio Center, ASST GOM Niguarda Ca' Granda, Milan, Italy; University of Milano-Bicocca, Milan, Italy
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Marco Matteo Ciccone
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Anna Paola Zito
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | | | | | | | | | - Maria Delia Corbo
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy
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Grzyb K, Meresińska M, Religioni U, Juszczyk G, Płaczek J, Neumann-Podczaska A, Szymański FM, Chełstowska B, Wieczorowska-Tobis K, Cofta S, Tobis S, Staszewski R, Vaillancourt R, Majewski R, Hernik J, Fehir Sola K, Blicharska E, Kaźmierczak J, Rutkowska E, Prygiel E, Skierska M, Nawara M, Korbiewska I, Krysiński J, Merks P. Implementation of the Patient Counselling Service at the Cancer Hospital in Radom, Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13642. [PMID: 36294222 PMCID: PMC9602852 DOI: 10.3390/ijerph192013642] [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: 09/01/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
Background: Non-adherence occurs in various groups of patients, including those with chronic diseases. One strategy to increase adherence among oncological patients is to individualise treatment and expand pharmaceutical care. Pharmaceutical labels that remind patients how they should take their medications are of great importance in this respect. Objective: The main objective of this study was to evaluate medication adherence in oncological patients, and to gather their opinions on the individual medication labelling system as an element of effective treatment. Methods: The study was conducted in 2021 among 82 patients of the oncological department of the Centre of Oncology in Radom. The research tool was a questionnaire consisting of personal data and two parts relating to the patient's disease and the medication labelling system. Results: Nearly half of the respondents reported that they forget to take medications and how they should take them. These problems increased with the age of the patient and the number of administered medications. Of the respondents, 89% stated that the labels with dosing information are helpful. Over 67% agreed that these labels should be affixed to all medications. Nearly 90% of the respondents believed the labels should be available in all pharmacies. Conclusions: Non-adherence is a common phenomenon among oncological patients. Pharmacists providing a labelling service for medicinal products can play a significant role in reducing this phenomenon.
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Affiliation(s)
- Katarzyna Grzyb
- Radom Oncology Center im, Bohaterów Radomskiego Czerwca 76′, 26-600 Radom, Poland
| | - Martyna Meresińska
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, 85-089 Bydgoszcz, Poland
| | - Urszula Religioni
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, Kleczewska 61/63, 01-826 Warsaw, Poland
| | - Grzegorz Juszczyk
- Department of Public Health, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Jakub Płaczek
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, 85-089 Bydgoszcz, Poland
| | | | - Filip M. Szymański
- Department of Civilization Diseases, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland
| | - Beata Chełstowska
- Department of Biochemistry and Laboratory Diagnostics, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland
| | - Katarzyna Wieczorowska-Tobis
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland
- Heliodor Swiecicki Clinical Hospital in Poznan, 60-355 Poznan, Poland
| | - Szczepan Cofta
- Heliodor Swiecicki Clinical Hospital in Poznan, 60-355 Poznan, Poland
- Department of Pulmonology, Allergology and Respiratory Oncology, Poznan University of Medical Sciences, 60-569 Poznan, Poland
| | - Sławomir Tobis
- Department of Pulmonology, Allergology and Respiratory Oncology, Poznan University of Medical Sciences, 60-569 Poznan, Poland
- Department of Occupational Therapy, Poznan University of Medical Sciences, 60-781 Poznan, Poland
| | - Rafał Staszewski
- Department of Hypertension, Angiology and Internal Medicine, Poznan University of Medical Sciences, 61-848 Poznań, Poland
| | - Regis Vaillancourt
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warszawa, Poland
| | - Rafał Majewski
- Radom Oncology Center im, Bohaterów Radomskiego Czerwca 76′, 26-600 Radom, Poland
| | - Justyna Hernik
- Radom Oncology Center im, Bohaterów Radomskiego Czerwca 76′, 26-600 Radom, Poland
| | | | - Eliza Blicharska
- Department of Analytical Chemistry, Medical University of Lublin, Chodźki 4a, 20-093 Lublin, Poland
| | | | - Ewa Rutkowska
- Radom Oncology Center im, Bohaterów Radomskiego Czerwca 76′, 26-600 Radom, Poland
| | - Elżbieta Prygiel
- Radom Oncology Center im, Bohaterów Radomskiego Czerwca 76′, 26-600 Radom, Poland
| | - Monika Skierska
- Radom Oncology Center im, Bohaterów Radomskiego Czerwca 76′, 26-600 Radom, Poland
| | - Monika Nawara
- Radom Oncology Center im, Bohaterów Radomskiego Czerwca 76′, 26-600 Radom, Poland
| | - Izabela Korbiewska
- Rehabilitation Faculty of Medical Sciences, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland
| | - Jerzy Krysiński
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, 85-089 Bydgoszcz, Poland
| | - Piotr Merks
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warszawa, Poland
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8
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Orozco‐Beltrán D, Cinza‐Sanjurjo S, Escribano‐Serrano J, López‐Simarro F, Fernández G, Gómez García A, Ferreira de Campos K, Cedenilla Horcajuelo M. Adherence, control of cardiometabolic factors and therapeutic inertia in patients with type 2 diabetes in the primary care setting. Endocrinol Diabetes Metab 2022; 5:e00320. [PMID: 34964310 PMCID: PMC8917867 DOI: 10.1002/edm2.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/03/2021] [Accepted: 12/11/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction Studies on treatment adherence to glucose‐lowering drugs among patients with type 2 diabetes (T2D) including concomitant treatment for other cardiovascular risk factors are scarce. We aimed to estimate the prevalence of good adherence to all medications used to control diabetes, hypertension and dyslipidemia and to analyse cardiometabolic control and its associated factors in T2D patients in the primary care (PC) setting. Methods Observational, retrospective study conducted in adult patients with T2D who were followed in the PC setting in Spain. Patients were classified as adherent in a particular category if the summary of the proportion of days covered (PDC) for a particular medication category was ≥80% and were considered globally adherent if the PDC was ≥80% for each of the 3 medication categories. Results A total of 457 evaluable patients were recruited, among which 321 patients (70.3%, 95% CI 65.8 to 74.4) were adherent to the three drug categories. The proportion of patients controlled for the 3 cardiometabolic risk factors was 31% according to the contemporary clinical practice guideline criteria, 58% according to investigator judgment and 36% when the objective for HbA1c was individualized. In a multivariate analysis, presenting comorbidities was associated with a lower likelihood of showing adequate control of dyslipidemia (odds ratio [OR] 0.25, 95% CI, 0.16–0.40) and the three cardiometabolic factors as a whole (OR 0.43, 95% CI 0.26–0.70). In a post hoc analysis, therapeutic inertia was found to be greater for dyslipidemia and hypertension than for T2D. Conclusions Despite a relatively high adherence to all medications for treating diabetes, hypertension and dyslipidemia in patients with T2D in the PC setting in Spain, the control of cardiometabolic risk factors as a whole is far from optimal. This could be related, at least in part, to the high frequency of comorbidity of these patients.
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Affiliation(s)
- Domingo Orozco‐Beltrán
- Medicina de Familia Departamento de Medicina Clínica Universidad Miguel Hernandez San Juan de Alicante Spain
| | | | | | - Flora López‐Simarro
- Medicina de Familia ABS Martorell Urbano. Institut Català de la Salut Martorell Spain
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Joho AA. Using the Health Belief Model to Explain the Patient's Compliance to Anti-hypertensive Treatment in Three District Hospitals - Dar Es Salaam, Tanzania: A Cross Section Study. East Afr Health Res J 2021; 5:50-58. [PMID: 34308245 PMCID: PMC8291213 DOI: 10.24248/eahrj.v5i1.651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 05/06/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Hypertension remains a public-health challenge globally. Its prevention, early detection, proper and adequate treatment and control should be given high consideration to prevent occurrence of cardiovascular disease and stroke. This study is guided by the Health Belief Model (HBM) to investigate the influence of treatment compliance using HBM constructs among elderly hypertensive patients in 3 regional hospitals in Dar es Salaam, Tanzania. METHODS An analytical cross-sectional study was conducted in 3 region hospitals in Dar es Salaam from April to May 2012. The study included patients who were on antihypertensive medications. Simple Random Sampling was used to enrol the study participants. Data was collected using structured questionnaire. Data was analysed using SPSS version 20. Linear Multiple Regression analysis was performed to identify variables which are strongest predictor of treatment compliance among variables of the Health belief Model. RESULTS A total of 135 participants were enrolled of whom 56% were compliant to hypertensive treatment. Multivariate analysis indicated significant model fit for the data (F=11.19 and P value <.001). The amount of variance in treatment compliance that was explained by the predictors was 30.3% (R2=0.303) with perceived barrier being the strongest predictor of treatment compliance (β=-0.477; p< .001). Other predictor variables were not statistically associated with treatment compliance. CONCLUSION The study showed that 56% of study participants had hypertensive treatment compliance and perceived barrier to treatment was the strongest predictor. Innovative strategy on improving patients' perception of barrier to treatment is recommended in order to improve treatment compliance.
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Affiliation(s)
- Angelina Alphonce Joho
- School of Nursing and Public Health, Department of Clinical Nursing, University of Dodoma, Tanzania
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10
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Molecular response to imatinib in patients with chronic myeloid leukemia in Tanzania. Blood Adv 2021; 5:1403-1411. [PMID: 33666650 DOI: 10.1182/bloodadvances.2020002973] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/19/2021] [Indexed: 01/02/2023] Open
Abstract
Imatinib is the mainstay of treatment of patients with chronic myeloid leukemia (CML) in Tanzania. Monitoring molecular response to therapy by real-time polymerase chain reaction at defined milestones is necessary for early detection of treatment failure. However, this assay is not routinely performed in Tanzania; therefore, the depth of molecular response among patients with CML is not known. A total of 158 patients with previously diagnosed CML who received imatinib treatment were recruited from January 2019 and followed up through October 2020 at Ocean Road Cancer Institute. Information was obtained at the time of diagnosis and follow-up. Blood samples were collected in EDTA tubes to measure the BCR/ABL ratio on the Gene Xpert system for molecular response determination. The median age of the 158 adult patients was 45 years (range, 18-86). By reference to established treatment milestones, only 37 (23.4%) achieved optimal molecular response. Signs of advanced-stage disease, in particular the need for red cell transfusions before diagnosis (adjusted odds ratio [AOR], 3.4; 95% CI, 1.32-9.17) and cytopenias (AOR, 2.26; 95% CI, 1.03-4.96) necessitating drug interruptions were statistically validated predictors of treatment failure on multivariate, multinomial logistic regression. Patient survival at the 22-month follow-up was lowest, with 78.6% (95% CI, 69.4-85.4) in the failure-to-respond category and highest in patients achieving optimal response 97.0% (95% CI, 80.9-99.6). In summary, the majority of patients with CML treated with imatinib in Tanzania do not obtain deep molecular response. This outcome can be attributed to late diagnosis, the development of cytopenias requiring multiple drug interruptions, and poor adherence to treatment.
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Chen J, Kao CY, He X, Fan L, Jackson JA, Juneja R. Treatment Patterns, Adherence, and Persistence Associated With Human Regular U-500 Insulin: A Real-World Evidence Study. Diabetes Spectr 2020; 33:264-272. [PMID: 32848348 PMCID: PMC7428667 DOI: 10.2337/ds19-0060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE | Human regular U-500 insulin (U-500R) is concentrated insulin with basal and prandial activity that can be used as insulin monotherapy. The goal of this study was to better understand treatment patterns (total daily dose [TDD] and concomitant medications), adherence, and persistence in real-world patients treated with U-500R. DESIGN AND METHODS | We selected patients from the Truven Health MarketScan database who initiated U-500R between 2010 and 2013. We collected data for three periods: pre-index (12 months before initiation), post-index (12 months after initiation or until a gap of ≥60 days in U-500R claims), and follow-up (12 months after post-index). Data were analyzed using descriptive statistics and a regression model as appropriate. RESULTS | We identified 1,582 patients who met the selection criteria. The median TDD of U-500R during the post-index period was 333 units/day, with 70.0% of patients using 300-400 units/day. During the post-index period, 74.1% of patients had U-500R claims that did not overlap with prescriptions for other insulins, interpreted as U-500R monotherapy. Among patients with ≥1 U-500R fill in the post-index period (n = 1,208), 54.4% had a medication possession ratio (MPR, a measure of adherence) ≥80%. Although 849 patients had a gap of ≥60 days in U-500R claims in the post-index period, 602 of those resumed U-500R in the follow-up period. Of the 733 patients who had no gap in U-500R claims in the post-index period, 286 had a gap of ≥60 days in claims in year 2, and 447 continued with U-500R treatment beyond 2 years. CONCLUSION | These results demonstrate that U-500R was commonly used as insulin monotherapy, with a median TDD >300 units/day. Compared with published, relevant studies of other insulins, U-500R showed similar or greater adherence and persistence rates. These new data may help guide clinical decision-making when choosing insulin therapy for patients requiring high doses of insulin.
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Affiliation(s)
| | | | | | - Ludi Fan
- Eli Lilly and Company, Indianapolis, IN
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12
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Blakeston S, Harper G, Zabala Mancebo J. Identifying the drivers of patients' reliance on short-acting β2-agonists in asthma. J Asthma 2020; 58:1094-1101. [PMID: 32469667 DOI: 10.1080/02770903.2020.1761382] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND One of the most commonly observed asthma treatment patterns is the underuse of inhaled corticosteroid (ICS) maintenance therapy when patients are not experiencing symptoms, and the predominant use of short-acting β2-agonists (SABAs) when patients are experiencing symptoms. This multinational study investigated the current beliefs and behaviors related to reliance on reliever inhalers among asthma patients, and the reasons why patients may not adhere to their recommended maintenance controller treatment. METHODS This was a qualitative research study, in which 80 patients with asthma who were receiving reliever therapy (i.e. SABAs) were interviewed, in-depth, for 60 min. The interview questions focused on the patients' experience of living with asthma and their inhaled treatment regimens. RESULTS The key insights identified in the interviews were (a) patients had a strong emotional attachment to SABA relievers driven by their efficacy and success in quickly alleviating asthma symptoms, with the reliever also becoming an emotional support; (b) patients typically did not understand that the frequent use of SABAs indicates poor asthma control; (c) patients had a misperception of ICS, which could lead to a delay in escalation and poor adherence; and (d) severe exacerbations improve adherence to ICS, but only temporarily in many cases. CONCLUSION This study confirmed the poor level of control patients have over their asthma, and how this affects their lifestyle and daily activities. Our results also confirmed that the patients' perception of both the disease and treatment plays a key role in SABA reliance and ICS underuse.
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Cea-Calvo L, Marín-Jiménez I, de Toro J, Fuster-RuizdeApodaca MJ, Fernández G, Sánchez-Vega N, Orozco-Beltrán D. Association between non-adherence behaviors, patients' experience with healthcare and beliefs in medications: a survey of patients with different chronic conditions. Curr Med Res Opin 2020; 36:293-300. [PMID: 31580168 DOI: 10.1080/03007995.2019.1676539] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective: The objective of the current work was to assess the frequency of non-adherence behaviors and potential association with patients' experience with healthcare and beliefs in medicines self-reported by patients with four different chronic conditions.Methods: Patients responded anonymously to a survey comprising five non-adherence behaviors (based on physician and patient input), an assessment of patients' experience with healthcare using the validated Instrument to Evaluate the EXperience of PAtients with Chronic diseases (IEXPAC), and a validated Spanish version of the Beliefs about Medicines Questionnaire (BMQ). Associations of non-adherence behavior were analyzed using logistic regression models.Results: Of 1530 respondents, 53.1% reported ≥1 non-adherence behavior. Non-adherence rates were 59.8% in diabetes mellitus (DM), 56.0% in rheumatic disease, 55.6% in inflammatory bowel disease, and 42.8% in human immunodeficiency virus (HIV) infection patients (p < .001). IEXPAC and BMQ scores were higher in adherent vs. non-adherent patients. In multivariate analysis, non-adherence behavior was strongly associated with lower overall BMQ, lower BMQ Necessity scores and higher BMQ Concerns scores (p < .001 for all), and with a lower IEXPAC self-management score (p = .007), but not with the overall IEXPAC score. Non-adherence was more frequent in DM patients compared with HIV infection patients (p < .001).Conclusions: Patients' beliefs in medicines-a lower perception for the necessity of medication, and higher concerns in taking medication-and low patient self-management experience score were associated with non-adherence behavior. These are modifiable aspects that need to be addressed to increase medication adherence in chronic disease.
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Affiliation(s)
- Luis Cea-Calvo
- Medical Affairs Department, Merck Sharp & Dohme Spain, Madrid, Spain
| | - Ignacio Marín-Jiménez
- IBD Unit, Gastroenterology Department, Clinical Research Institute Gregorio Marañón (IiSGM), Gregorio Marañón University Hospital, Madrid, Spain
| | - Javier de Toro
- Rheumatology Department, A Coruña University Hospital, A Coruña, Spain
| | | | - Gonzalo Fernández
- Medical Affairs Department, Merck Sharp & Dohme Spain, Madrid, Spain
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14
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Fernandez-Lazaro CI, García-González JM, Adams DP, Fernandez-Lazaro D, Mielgo-Ayuso J, Caballero-Garcia A, Moreno Racionero F, Córdova A, Miron-Canelo JA. Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross-sectional study. BMC FAMILY PRACTICE 2019; 20:132. [PMID: 31521114 PMCID: PMC6744672 DOI: 10.1186/s12875-019-1019-3] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/30/2019] [Indexed: 12/11/2022]
Abstract
Background Adherence to treatment, a public health issue, is of particular importance in chronic disease therapies. Primary care practices offer ideal venues for the effective care and management of these conditions. The aim of this study is to assess adherence to treatment and related-factors among patients with chronic conditions in primary care settings. Methods A cross-sectional study was conducted among 299 adult patients with ≥1 chronic condition(s) and prescribed medication in primary healthcare centers of Spain. The Morisky-Green-Levine questionnaire was used to assess medication adherence via face-to-face interviews. Crude and adjusted multivariable logistic regression models were used to analyze factors associated with adherence using the Multidimensional Model proposed by the World Health Organization — social and economic, healthcare team and system-related, condition-related, therapy-related, and patient-related factors. Results The proportion of adherent patients to treatment was 55.5%. Older age (adjusted odds ratio 1.31 per 10-year increment, 95% CI 1.01–1.70), lower number of pharmacies used for medication refills (0.65, 95% CI 0.47–0.90), having received complete treatment information (3.89, 95% CI 2.09–7.21), having adequate knowledge about medication regimen (4.17, 95% CI 2.23–7.80), and self-perception of a good quality of life (2.17, 95% CI 1.18–4.02) were independent factors associated with adherence. Conclusions Adherence to treatment for chronic conditions remained low in primary care. Optimal achievement of appropriate levels of adherence through tailored multifaceted interventions will require attention to the multidimensional factors found in this study, particularly those related to patients’ education and their information needs. Electronic supplementary material The online version of this article (10.1186/s12875-019-1019-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cesar I Fernandez-Lazaro
- Department of Biomedical and Diagnostic Sciences, School of Medicine, University of Salamanca, Calle Alfonso X el Sabio s/n, 37007, Salamanca, Spain. .,Department of Preventive Medicine and Public Health, School of Medicine, IDISNA, University of Navarra, Pamplona, Spain.
| | | | - David P Adams
- Dual Enrollment Program, Point University-Savannah Campus, Savannah, GA, USA
| | - Diego Fernandez-Lazaro
- Department of Cell Biology, Histology and Pharmacology, University of Valladolid, Soria, Spain
| | - Juan Mielgo-Ayuso
- Department of Biochemistry, Molecular Biology and Physiology, Faculty of Physical Therapy, University of Valladolid, Soria, Spain
| | | | | | - Alfredo Córdova
- Department of Biochemistry, Molecular Biology and Physiology, Faculty of Physical Therapy, University of Valladolid, Soria, Spain
| | - Jose A Miron-Canelo
- Department of Biomedical and Diagnostic Sciences, School of Medicine, University of Salamanca, Calle Alfonso X el Sabio s/n, 37007, Salamanca, Spain
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15
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Farley JF, Kumar A, Urick BY. Measuring Adherence: A Proof of Concept Study for Multiple Medications for Chronic Conditions in Alternative Payment Models. PHARMACY 2019; 7:pharmacy7030081. [PMID: 31269735 PMCID: PMC6789652 DOI: 10.3390/pharmacy7030081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 02/04/2023] Open
Abstract
Adherence to renin angiotensin system antagonists (RASA), non-insulin diabetes medications (NIDM) and statins has been included in the Medicare Star Ratings program since 2012. The long-term use of these measures emphasizes adherence to a limited number of chronic medications and may present opportunities for Part D plan sponsors to misuse the measures to influence their Medicare Part D Star Rating. It also does not capture the adherence needs of high-risk patients with multiple chronic conditions. The objective of this study was to describe the development of a new measure to capture adherence to multiple medications for chronic conditions (MMCC). The MMCC measure captures adherence to 71 different therapeutic categories of medication and was constructed using North Carolina Medicaid prescription claims data from 2015 to 2017. This measure was validated against the existing RASA, NIDM and statin adherence measures. This new measure was highly correlated with Star Rating measures, captured a greater number of eligible patients than these existing measures and had a lower proportion of patients meet the adherence threshold than the existing Star Ratings adherence measures. There is an opportunity to develop new measures, which include adherence to multiple medications in populations with multiple chronic conditions.
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Affiliation(s)
- Joel F Farley
- Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Arun Kumar
- Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| | - Benjamin Y Urick
- Center for Medication Optimization, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
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Pons-Faudoa FP, Ballerini A, Sakamoto J, Grattoni A. Advanced implantable drug delivery technologies: transforming the clinical landscape of therapeutics for chronic diseases. Biomed Microdevices 2019; 21:47. [PMID: 31104136 PMCID: PMC7161312 DOI: 10.1007/s10544-019-0389-6] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Chronic diseases account for the majority of all deaths worldwide, and their prevalence is expected to escalate in the next 10 years. Because chronic disorders require long-term therapy, the healthcare system must address the needs of an increasing number of patients. The use of new drug administration routes, specifically implantable drug delivery devices, has the potential to reduce treatment-monitoring clinical visits and follow-ups with healthcare providers. Also, implantable drug delivery devices can be designed to maintain drug concentrations in the therapeutic window to achieve controlled, continuous release of therapeutics over extended periods, eliminating the risk of patient non-compliance to oral treatment. A higher local drug concentration can be achieved if the device is implanted in the affected tissue, reducing systemic adverse side effects and decreasing the challenges and discomfort of parenteral treatment. Although implantable drug delivery devices have existed for some time, interest in their therapeutic potential is growing, with a global market expected to reach over $12 billion USD by 2018. This review discusses implantable drug delivery technologies in an advanced stage of development or in clinical use and focuses on the state-of-the-art of reservoir-based implants including pumps, electromechanical systems, and polymers, sites of implantation and side effects, and deployment in developing countries.
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Affiliation(s)
- Fernanda P Pons-Faudoa
- Department of Nanomedicine, Houston Methodist Research Institute, 6670 Bertner Avenue, Houston, TX, 77030, USA
- School of Medicine and Health Sciences, Tecnologico de Monterrey, Avenida Eugenio Garza Sada 2501, 64849, Monterrey, NL, Mexico
| | - Andrea Ballerini
- Department of Nanomedicine, Houston Methodist Research Institute, 6670 Bertner Avenue, Houston, TX, 77030, USA
- Department of Oncology and Onco-Hematology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Jason Sakamoto
- Department of Nanomedicine, Houston Methodist Research Institute, 6670 Bertner Avenue, Houston, TX, 77030, USA
| | - Alessandro Grattoni
- Department of Nanomedicine, Houston Methodist Research Institute, 6670 Bertner Avenue, Houston, TX, 77030, USA.
- Department of Surgery, Houston Methodist Hospital, 6550 Fannin Street, Houston, TX, 77030, USA.
- Department of Radiation Oncology, Houston Methodist Hospital, 6550 Fannin Street, Houston, TX, 77030, USA.
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Abstract
Pharmacy data reveal that 70% of patients were missing one or more days worth of drops out of five. Adopting approaches to behavior change and management skills used for people with diabetes may provide insight to improve self-management of glaucoma. Every person who is diagnosed with a chronic health condition such as glaucoma has unique life circumstances that may present barriers to behavior change. An accurate diagnosis and a treatment plan are useless if patients do not use their prescribed eye drops. Active listening and effective communication can result in persons who are more engaged in their self-care behaviors. Collaborative communication using person-centered and strengths-based messages could help eye care providers identify challenges and concerns for people with glaucoma who are experiencing inconsistencies with their eye drops. In an atmosphere where patients can discuss their challenges with treatment recommendations without judgment or fear, they are more likely to trust their provider and therefore share their situation openly and honestly. This is accomplished by choosing language that communicates mutually-agreed-upon self-management goals and addresses and strengthens individual and clinical outcomes. The eye care professional is then seen by the patient as a resource who can empathize when setbacks occur and reinforce the patient's self-management goals. Open-ended questions and tell-ask-tell approaches for identifying barriers to care are keys to more effective communication and trusting relationships. This includes recognizing that glaucoma is associated with increased rates of anxiety or depression that may be an overlooked barrier to self-management. By adopting language recommendations from diabetes care and education, eye care practitioners may be better equipped to help people with glaucoma improve their self-care.
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Gaspar FW, Zaidel CS, Dewa CS. Rates and Determinants of Use of Pharmacotherapy and Psychotherapy by Patients With Major Depressive Disorder. Psychiatr Serv 2019; 70:262-270. [PMID: 30630402 DOI: 10.1176/appi.ps.201800275] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Rates and determinants of pharmacological and psychotherapy use were assessed after a major depressive disorder diagnosis. METHODS In a retrospective claims study that included 2007-2016 records from the IBM MarketScan research databases, use of pharmacotherapy and psychotherapy was tracked in a population of 24,579 patients with a diagnosis of major depressive disorder. Univariate and multiple variable analyses were used to identify determinants of antidepressant adherence (proportion of days covered ≥.8) and intensive psychotherapy at the beginning of treatment (at least four psychotherapy visits in the first 4 weeks after initiating psychotherapy). RESULTS In the 12 months following a diagnosis of major depressive disorder, most individuals received pharmacotherapy or psychotherapy (94.7%), and unimodal therapy was more common (58.5%) than bimodal therapy (36.2%). When antidepressants were initiated (N=13,524), 41.7% and 32.0% of patients were adherent in the acute and continuation phases, respectively. Initial antidepressant dosages were outside guideline recommendations for 34.5% of patients prescribed these medications. When psychotherapy was initiated, the median number of visits in the year after a patient's diagnosis was seven. Most patients (54.7%) did not continue to receive either antidepressant or psychotherapy treatment after month 5 following their diagnosis. A shorter time from diagnosis to treatment and a lower percentage of treatment costs paid by the patient were associated with increased antidepressant adherence and intensive psychotherapy use. CONCLUSIONS Findings indicate that treatment guideline recommendations are not followed for a large proportion of patients with major depressive disorder and that improvement is needed in multiple areas to enhance effective treatment.
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Affiliation(s)
- Fraser W Gaspar
- MDGuidelines at ReedGroup, Ltd., Westminster, Colorado (Gaspar, Zaidel); Department of Psychiatry and Behavioral Sciences, University of California, Davis (Dewa)
| | - Catherine S Zaidel
- MDGuidelines at ReedGroup, Ltd., Westminster, Colorado (Gaspar, Zaidel); Department of Psychiatry and Behavioral Sciences, University of California, Davis (Dewa)
| | - Carolyn S Dewa
- MDGuidelines at ReedGroup, Ltd., Westminster, Colorado (Gaspar, Zaidel); Department of Psychiatry and Behavioral Sciences, University of California, Davis (Dewa)
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Ganguly R, Tian Y, Kong SX, Hersloev M, Hobbs T, Smolarz BG, Ramasamy A, Haase CL, Weng W. Persistence of newer anti-obesity medications in a real-world setting. Diabetes Res Clin Pract 2018; 143:348-356. [PMID: 30009937 DOI: 10.1016/j.diabres.2018.07.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 07/09/2018] [Indexed: 11/18/2022]
Abstract
AIMS Evaluate real-world data on persistence with anti-obesity medications (AOMs) and explore associated patient factors. METHODS Truven Health MarketScan® data were analyzed to evaluate utilization of AOMs approved for long-term use between 4/2015 and 3/2016. Kaplan-Meier survival analyses were used to evaluate treatment persistence. A multivariate analysis was performed to identify associations between persistence and relevant factors. RESULTS In total, 26,522 adult patients were identified as newly prescribed naltrexone/bupropion (44.0%, mean age 47.1, 80.5% female), lorcaserin (24.8%, 48.5, 79.3%), phentermine/topiramate extended release (15.8%, 46.7, 82.2%) or liraglutide 3.0 mg (15.4%, 46.9, 72.4%). At 6 months, 41.8% of patients were still on liraglutide 3.0 mg, compared to 15.9% lorcaserin (p < 0.001), 18.1% naltrexone/bupropion (p < 0.001), and 27.3% phentermine/topiramate (p < 0.001). After adjusting for baseline factors, patients on liraglutide 3.0 mg had significantly lower risk of discontinuation compared to those on lorcaserin (HR = 0.46, p < 0.0001), naltrexone/bupropion (HR = 0.48, p < 0.0001), and phentermine/topiramate (HR = 0.64, p < 0.0001) over the course of follow-up (mean follow-up duration, 342-427 days). Older age, male gender, having hyperlipidemia, and no prior phentermine use were associated with higher persistence. Over 95% of study patients had commercial insurance. CONCLUSIONS In a real-world setting, patients on liraglutide 3.0 mg had the highest persistence rate of the four AOMs studied.
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Affiliation(s)
- Rahul Ganguly
- Novo Nordisk, Inc., 800 Scudders Mill Rd, Plainsboro, NJ, USA
| | - Ye Tian
- Novo Nordisk, Inc., 800 Scudders Mill Rd, Plainsboro, NJ, USA
| | - Sheldon X Kong
- Novo Nordisk, Inc., 800 Scudders Mill Rd, Plainsboro, NJ, USA
| | - Malene Hersloev
- Novo Nordisk, Inc., 800 Scudders Mill Rd, Plainsboro, NJ, USA
| | - Todd Hobbs
- Novo Nordisk, Inc., 800 Scudders Mill Rd, Plainsboro, NJ, USA
| | | | | | | | - Wayne Weng
- Novo Nordisk, Inc., 800 Scudders Mill Rd, Plainsboro, NJ, USA.
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A Review of Medication Adherence Monitoring Technologies. APPLIED SYSTEM INNOVATION 2018. [DOI: 10.3390/asi1020014] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Tilea I, Petra D, Voidazan S, Ardeleanu E, Varga A. Treatment adherence among adult hypertensive patients: a cross-sectional retrospective study in primary care in Romania. Patient Prefer Adherence 2018; 12:625-635. [PMID: 29731610 PMCID: PMC5923249 DOI: 10.2147/ppa.s162965] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE This study was performed to elucidate the level of adherence to antihypertensive treatment in adult subjects attending a family medicine clinic in a city in central Romania. PATIENTS AND METHODS A cross-sectional, retrospective study was performed on a cohort of hypertensive adults. A total of 525 participants were selected from 1,714 adults attending a single urban family medicine practice. Assessment of adherence to therapy was performed by a chart review of prescription and clinical records over a 4-year study period. RESULTS The results showed that 69.8% of the patients had high adherence (>80% with therapy); 20.3% had medium adherence (20%-79%); and 9.9% had low adherence (<20%). A positive association was found (p = 0.01) between low adherence and male gender. A significant positive association (p = 0.02) was found between total cardiovascular risk and level of adherence. We found that 54.7% of the high adherence subjects had well-controlled blood pressure, and chronic kidney disease was associated with high adherence to therapy (p = 0.03). Antihypertensive regimens administered as fixed-dose combinations were positively associated with high adherence (p = 0.001). Subjects who had their antihypertensive regimen adjusted to a new drug class during the study period showed enhanced adherence compared to subjects treated with an unchanged regimen (p = 0.001). CONCLUSION This is the first published study assessing adherence to antihypertensive therapy in family medicine practice in Romania. It presented data derived from a primarily urban setting and targeted a geographical area where the prevalence of hypertension has increased continuously. Female gender, age, presence of cardiovascular risk factors, defined cardiovascular disease, chronic renal impairment, and good control of hypertension were positively associated with high adherence. The results provide insights to guide further strategies to improve adherence and indirect methods for blood pressure management strategies.
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Affiliation(s)
- Ioan Tilea
- Department M3-Internal Medicine, Family Medicine Discipline, Faculty of Medicine, University of Medicine and Pharmacy, Tirgu Mures, Mures, Romania
| | - Dorina Petra
- Department M3-Internal Medicine, Family Medicine Discipline, Faculty of Medicine, University of Medicine and Pharmacy, Tirgu Mures, Mures, Romania
- Correspondence: Dorina Petra, Department M3-Internal Medicine, Family Medicine Discipline, Faculty of Medicine, University of Medicine and Pharmacy, 38, Gheorghe Marinescu Street, Tirgu Mures 540319, Mures, Romania, Tel +40 740 19 4122, Fax +40 265 21 1011, Email
| | - Septimiu Voidazan
- Department M2-Functional and Complementary Sciences, Epidemiology Discipline, Faculty of Medicine, University of Medicine and Pharmacy, Tirgu Mures, Mures, Romania
| | - Elena Ardeleanu
- Department XVI-Balneology, Medical Rehabilitation and Rheumatology, Family Medicine Discipline, Faculty of Medicine, University of Medicine and Pharmacy, Timisoara, Timis, Romania
| | - Andreea Varga
- Department M3-Internal Medicine, Family Medicine Discipline, Faculty of Medicine, University of Medicine and Pharmacy, Tirgu Mures, Mures, Romania
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Pan J, Lei T, Hu B, Li Q. Post-discharge evaluation of medication adherence and knowledge of hypertension among hypertensive stroke patients in northwestern China. Patient Prefer Adherence 2017; 11:1915-1922. [PMID: 29200832 PMCID: PMC5700759 DOI: 10.2147/ppa.s147605] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The aims of this study were to assess the knowledge of hypertension (HTN) and investigate risk factors associated with medication adherence among hypertensive stroke patients after discharge in northwestern China. PATIENTS AND METHODS A cross-sectional study involving 440 Chinese hypertensive stroke patients was conducted in a tertiary hospital in Xi'an, China. Data were collected by telephone interviews and patients' medical records. RESULTS It was found that 35.23% of patients were compliant with their antihypertensive drug treatments, and 42.95%, 52.27% and 4.77% of patients had poor, moderate and adequate knowledge of HTN, respectively. Gender, blood pressure (BP) categories, BP monitoring and HTN knowledge were independently associated with antihypertensive medication adherence. CONCLUSION The medication adherence among hypertensive stroke patients in northwestern China was poor. Knowledge of HTN was suboptimal. More attention and effective strategies should be designed to the factors affecting medication adherence. As knowledge positively affects medication adherence, clinical pharmacists should play an important role in patients' medication education.
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Affiliation(s)
- Jingjing Pan
- Department of Pharmacy
- Correspondence: Jingjing Pan, Department of Pharmacy, Xi’an Fourth Hospital, 21 JieFang Road, 710004 Xi’an, People’s Republic of China, Tel +86 029 8748 0635 ext 029, Email
| | - Tao Lei
- Department of Neurology, Xi’an Fourth Hospital, Xi’an, People’s Republic of China
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