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Marshall MR, Curd S, Kennedy J, Khatri D, Lee S, Pireva K, Taule’alo O, Tiavale-Moore P, Wolley MJ, Ma TM, Kam AL, Suh JS, Aspden TJ. Structural Equation Modelling to Identify Psychometric Determinants of Medication Adherence in a Survey of Kidney Dialysis Patients. Patient Prefer Adherence 2024; 18:855-878. [PMID: 38645697 PMCID: PMC11032681 DOI: 10.2147/ppa.s454248] [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: 01/12/2024] [Accepted: 03/26/2024] [Indexed: 04/23/2024] Open
Abstract
Purpose Medication non-adherence in dialysis patients is associated with increased mortality and higher healthcare costs. We assessed whether medication adherence is influenced by specific psychometric constructs measuring beliefs about the necessity for medication and concerns about them. We also tested whether medication knowledge, health literacy, and illness perceptions influenced this relationship. Patients and Methods This study is based on data from a cross-sectional in-person questionnaire, administered to a random sample of all adult dialysis patients at a teaching hospital. The main outcome was self-assessed medication adherence (8-Item Morisky Medication Adherence Scale). The predictors were: concerns about medications and necessity for medication (Beliefs About Medication Questionnaire); health literacy; medication knowledge (Medication Knowledge Evaluation Tool); cognitive, emotional, and comprehensibility Illness perceptions (Brief Illness Perception Questionnaire). Path analysis was performed using structural equations in both covariance and variance-based models. Results Necessity for medication increased (standardized path coefficient [β] 0.30 [95% CI 0.05, 0.54]) and concerns about medication decreased (standardized β -0.33 [-0.57, -0.09]) medication adherence, explaining most of the variance in outcome (r2=0.95). Medication knowledge and cognitive illness perceptions had no effects on medication adherence, either directly or indirectly. Higher health literacy, greater illness comprehension, and a more positive emotional view of their illness had medium-to-large sized effects in increasing medication adherence. These were indirect rather and direct effects mediated by decreases in concerns about medications (standardized β respectively -0.40 [-0.63,-0.16], -0.60 [-0.85, -0.34], -0.33 [-0.52, -0.13]). Conclusion Interventions that reduce patients' concerns about their medications are likely to improve adherence, rather than interventions that increase patients' perceived necessity for medication. Improving patients' general health literacy and facilitating a better understanding and more positive perception of the illness can probably achieve this. Our study is potentially limited by a lack of generalizability outside of the population and setting in which it was conducted.
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Affiliation(s)
- Mark R Marshall
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Medicine, Tauranga Hospital, Hauora a Toi Bay of Plenty, Tauranga, New Zealand
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
| | - Samantha Curd
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Julia Kennedy
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dharni Khatri
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sophia Lee
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Krenare Pireva
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Olita Taule’alo
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Porsche Tiavale-Moore
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Martin J Wolley
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
- Endocrine Hypertension Research Centre, University of Queensland Frazer Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia
- Department of Nephrology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Tian M Ma
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
- Institute for Innovation + Improvement, North Shore Hospital, Auckland, New Zealand
| | - Angela L Kam
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
- Barts Health NHS Trust, London, UK
| | - Jun S Suh
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
| | - Trudi J Aspden
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Sumner J, Bundele A, Lim HW, Phan P, Motani M, Mukhopadhyay A. Developing an Artificial Intelligence-Driven Nudge Intervention to Improve Medication Adherence: A Human-Centred Design Approach. J Med Syst 2023; 48:3. [PMID: 38063940 PMCID: PMC10709244 DOI: 10.1007/s10916-023-02024-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023]
Abstract
To improve medication adherence, we co-developed a digital, artificial intelligence (AI)-driven nudge intervention with stakeholders (patients, providers, and technologists). We used a human-centred design approach to incorporate user needs in creating an AI-driven nudge tool. We report the findings of the first stage of a multi-phase project: understanding user needs and ideating solutions. We interviewed healthcare providers (n = 10) and patients (n = 10). Providers also rated example nudge interventions in a survey. Stakeholders felt the intervention could address existing deficits in medication adherence tracking and were optimistic about the solution. Participants identified flexibility of the intervention, including mode of delivery, intervention intensity, and the ability to stratify to user ability and needs, as critical success factors. Reminder nudges and provision of healthcare worker contact were rated highly by all. Conversely, patients perceived incentive-based nudges poorly. Finally, participants suggested that user burden could be minimised by leveraging existing software (rather than creating a new App) and simplifying or automating the data entry requirements where feasible. Stakeholder interviews generated in-depth data on the perspectives and requirements for the proposed solution. The participatory approach will enable us to incorporate user needs into the design and improve the utility of the intervention. Our findings show that an AI-driven nudge tool is an acceptable and appropriate solution, assuming it is flexible to user requirements.
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Affiliation(s)
- Jennifer Sumner
- Medical Affairs - Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore, Singapore.
| | - Anjali Bundele
- Medical Affairs - Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore, Singapore
| | - Hui Wen Lim
- Medical Affairs - Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore, Singapore
| | - Phillip Phan
- Johns Hopkins Carey Business School and the Department of Medicine, Baltimore, USA
| | - Mehul Motani
- Department of Electrical & Computer Engineering, National University of Singapore, Singapore, Singapore
| | - Amartya Mukhopadhyay
- Medical Affairs - Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Hennawi HA, Ashraf MT, Zohaib M, Khan MK, Khan IA, Muhammadzai HZU, Siddiqi A, Roomi S. Polypill Therapy in Cardiovascular Disease: A Meta-analysis of Randomized Controlled Trials. Curr Probl Cardiol 2023; 48:101735. [PMID: 37044270 DOI: 10.1016/j.cpcardiol.2023.101735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND The effectiveness of polypill therapy in the prevention and treatment of cardiovascular disorders is still unclear. This meta-analysis aimed to assess the efficacy of polypill therapy in reducing cardiovascular risk factors. METHODS We conducted a systematic search of PubMed, Cochrane CENTRAL, SCOPUS, and Google Scholar for randomized controlled trials (RCTs) that evaluated polypill therapy for cardiovascular diseases, hypertension, or dyslipidemia. We included 18 RCTs with a total of 20,463 participants in our analysis. Pooled effect estimates were reported as Odds ratios (ORs) with a 95% confidence interval (CI) using a random-effects model. RESULTS Polypill therapy was associated with a statistically significant reduction in systolic blood pressure (SBP) [OR: -0.33, 95% CI (-0.64, -0.03); P-value= 0.03], diastolic blood pressure (DBP) [OR: -0.70, 95% CI (-1.20, -0.21); P-value= 0.005], and total cholesterol level [OR: -1.25, 95% CI (-1.82, -0.68); P-value < 0.0001]. Polypill therapy also showed improved adherence [OR 2.18, 95% CI (1.47, 3.24); P-value= 0.0001]. However, there was no statistically significant benefit in the reduction of all-cause mortality, major cardiovascular events, and LDL-c levels. CONCLUSIONS The use of polypill therapy is associated with a statistically significant reduction in SBP, DBP, and total cholesterol levels, as well as improved adherence. Further research is needed to determine its impact on hard clinical outcomes such as mortality and major cardiovascular events.
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Affiliation(s)
- Hussam Al Hennawi
- Department of Internal Medicine, Jefferson Abington Hospital, Abington, Pennsylvania, USA.
| | - Muhammad Talal Ashraf
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Zohaib
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Ibrahim Ahmed Khan
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Ali Siddiqi
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Sohaib Roomi
- Department of Internal Medicine, Jefferson Abington Hospital, Abington, Pennsylvania, USA
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Zhou TT, Wang R, Gu SJ, Xie LL, Zhao QH, Xiao MZ, Chen YL. Effectiveness of Mobile Medical Apps in Ensuring Medication Safety Among Patients With Chronic Diseases: Systematic Review and Meta-analysis. JMIR Mhealth Uhealth 2022; 10:e39819. [PMID: 36413386 PMCID: PMC9727690 DOI: 10.2196/39819] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/22/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Along with the rapid growth of the global aging society, the mobile and health digital market has expanded greatly. Countless mobile medical apps (mmApps) have sprung up in the internet market, aiming to help patients with chronic diseases achieve medication safety. OBJECTIVE Based on the medication safety action plans proposed by the World Health Organization, we aimed to explore the effectiveness of mmApps in ensuring the medication safety of patients with chronic diseases, including whether mmApps can improve the willingness to report adverse drug events (ADEs), improve patients' medication adherence, and reduce medication errors. We hoped to verify our hypothesis through a systematic review and meta-analysis. METHODS The meta-analysis was performed in strict accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and included literature searched from 7 databases-PubMed, Web Of Science, Embase, CINAHL, China National Knowledge Infrastructure, Wanfang, and SinoMed. The publication time was limited to the time of database establishment to April 30, 2022. Studies were screened based on inclusion and exclusion criteria. The data extracted included authors, years of publication, countries or regions, participants' characteristics, intervention groups, and control groups, among others. Our quality assessment followed the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions, Version 6.3. RevMan 5.2 software (Cochrane Collaboration) was used to analyze the statistical data, and a sensitivity analysis was performed to assess data stability. The degree of stability was calculated by using a different statistical method and excluding large-sample studies from the analysis. RESULTS We included 8 studies from 5 countries (China, the United States, France, Canada, and Spain) that were published from January 1, 2014, to December 31, 2021. The total number of participants was 1355, and we analyzed the characteristics of included studies, each app's features, the risk of bias, and quality. The results showed that mmApps could increase ADE reporting willingness (relative risk [RR] 2.59, 95% CI 1.26-5.30; P=.009) and significantly improve medication adherence (RR 1.17, 95% CI 1.04-1.31; P=.007), but they had little effect on reducing medication errors (RR 1.54, 95% CI 0.33-7.29; P=.58). CONCLUSIONS We analyzed the following three merits of mmApps, with regard to facilitating the willingness to report ADEs: mmApps facilitate more communication between patients and physicians, patients attach more importance to ADE reporting, and the processing of results is transparent. The use of mmApps improved medication adherence among patients with chronic diseases by conveying medical solutions, providing educational support, tracking medications, and allowing for remote consultations. Finally, we found 3 potential reasons for why our medication error results differed from those of other studies. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42022322072; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=322072.
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Affiliation(s)
- Ting Ting Zhou
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Wang
- Hepatobiliary Surgery, The Second Affliated Hospital of Chongqing Medical University, Chongqing, China
| | - Si Jia Gu
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Ling Xie
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qing Hua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ming Zhao Xiao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Lu Chen
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Sosa Liprandi Á, Baranchuk A, López-Santi R, Wyss F, Piskorz D, Puente A, Ponte-Negretti CI, Muñera-Echeverri A, Piñeiro DJ. El control de la hipertensión arterial, una asignatura pendiente. Rev Panam Salud Publica 2022; 46:e147. [PMID: 36133428 PMCID: PMC9484329 DOI: 10.26633/rpsp.2022.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022] Open
Abstract
El adecuado diagnóstico, tratamiento y control de la hipertensión arterial (HTA) continúa siendo una asignatura pendiente en nuestro intento de reducir la incidencia de mortalidad cardiovascular prematura y discapacidades, siendo esta una realidad a nivel mundial y particularmente cierta en la región de las Américas. A pesar de contar con adecuados algoritmos diagnósticos y eficientes esquemas de tratamiento, la brecha entre el conocimiento médico y la realidad nos muestra la gran dificultad para que nuestras recomendaciones sean adoptadas por nuestros pacientes. La adherencia representa un gran desafío y la adecuada comprensión de sus dimensiones resulta básico al momento de diseñar estrategias para mejorar el control de la HTA. Es claro que disponer y diseminar información adecuada es una parte de la solución, pero no menos importante son las acciones que garanticen su implementación. Es por lo que damos la bienvenida a guías de práctica clínica que intenten abordar esta problemática. La reciente publicación de guía de la Organización Mundial de la Salud en hipertensión arterial es un claro ejemplo de este tipo de iniciativas. Los programas de implementación posiblemente sean uno de los mayores desafíos de la medicina contemporánea. El desarrollo de intervenciones multimodales en el primer nivel de atención con el objetivo de mejorar su capacidad resolutiva y promover el desarrollo de redes integradas de servicios de salud, impresiona ser el camino mas adecuado para alcanzar niveles adecuados de control de la HTA. Estamos convencidos del importante rol que nuestras sociedades científicas tienen con estas iniciativas dando apoyo, soporte y articulando la interacción con los diferentes actores involucrados.
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Affiliation(s)
| | | | | | - Fernando Wyss
- Servicios y Tecnología Cardiovascular, Cardiosolutions, Ciudad de Guatemala, Guatemala
| | | | - Adriana Puente
- Centro Medico Nacional 20 de noviembre, ISSSTE, Ciudad de México, México
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6
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Mobile medical applications’ state quo and underlying barriers: review of literature †. FRONTIERS OF NURSING 2022. [DOI: 10.2478/fon-2022-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Objective
To explore the current development and challenges regarding mobile medical applications (mmAPPs), so as to provide reference for application function elevation and quality improvement.
Methods
We retrieved literature databases like Web of Science, PubMed, China National Knowledge Infrastructure, Wanfang, China Biomedical Network, time limit was from January 1, 2010 to December 31, 2021, and restricted to the Chinese or English language.
Results
This study concluded with the following six aspects: Domestic and foreign development of mmAPP, reminder function, barriers and challenges (low quality; slow update rate; lack of standard evaluation tool or criterion), privacy and safety concerns, adverse drug event report state (low report rate-related reasons, different countries’ report policies), and current hindrances in the progression (economic worries; personal education level; acceptance and study of technology; rural districts, and low-income countries).
Conclusions
We should focus on the application's quality elevation rather than quantity, pay more attention to patients’ adverse drug event reports, privacy and safety, and place emphasis on rural districts and low-income countries.
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Jahangiri R, Rezapour A, Malekzadeh R, Olyaeemanesh A, Roshandel G, Motevalian SA. Cost-effectiveness of fixed-dose combination pill (Polypill) in primary and secondary prevention of cardiovascular disease: A systematic literature review. PLoS One 2022; 17:e0271908. [PMID: 35901100 PMCID: PMC9333258 DOI: 10.1371/journal.pone.0271908] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 07/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND A significant proportion of cardiovascular disease (CVD) morbidity and mortality could be prevented via the population-based and cost-effective interventions. A fixed-dose combination treatment is known as the polypill for the primary and secondary prevention of CVD has come up in recent years. PURPOSE In order to provide recommendations for future economic evaluations, this systematic review aimed to review and assess the quality of published evidence on the cost-effectiveness of polypill in primary and secondary prevention of CVD, to identify the key drivers that impact the cost-effectiveness. METHODS A systematic review of literature, following the PRISMA guidelines, was undertaken in the electronic databases. Two researchers identified the relevant studies according to inclusion and exclusion criteria. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to quality assessment of included studies. ICERs value adjusted to 2020 United States Dollar using consumer price index (CPI) and purchasing power parity (PPP). Finally, data were summarized via a narrative synthesis. RESULTS In total, 24 articles were identified based on the determined inclusion criteria. All studies met more than 50% of the CHEERS criteria. Adjusted incremental cost-effectiveness ratios varied from 24$ to 31000$(2020 US dollar) among the studies. The polypill resulted in the improved adherence and quality of life, at a price equal to or lower than multiple monotherapies. This price is typically below the commonly accepted thresholds or cost saving in both, primary and secondary prevention of CVD. The main identified cost-effectiveness drivers were the polypill price, adherence, age, CVD risk, and drug combination. CONCLUSIONS This systematic review found that the polypill seemed to be a cost-effective intervention in primary and secondary prevention of CVD. However, it is necessary to conduct more economic evaluation studies based on the long-term clinical trials with large populations. Also, studies should consider how the polypill interacts with other primary and secondary preventive strategies as a complementary health strategy.
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Affiliation(s)
- Reza Jahangiri
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Malekzadeh
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Olyaeemanesh
- National Institute for Health Research & Health Equity Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Seyed Abbas Motevalian
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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8
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Rao S, Jamal Siddiqi T, Khan MS, Michos ED, Navar AM, Wang TJ, Greene SJ, Prabhakaran D, Khera A, Pandey A. Association of polypill therapy with cardiovascular outcomes, mortality, and adherence: A systematic review and meta-analysis of randomized controlled trials. Prog Cardiovasc Dis 2022; 73:48-55. [PMID: 35114251 PMCID: PMC10535365 DOI: 10.1016/j.pcad.2022.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 02/07/2023]
Abstract
Prior studies have reported improvements in population-level risk factor burden and cardiovascular disease (CVD) outcomes using polypills for CVD risk reduction. However, a comprehensive assessment of the impact of polypills on CVD outcomes, mortality, adherence, and side effects across different settings has not previously been reported. We performed a systematic review and meta-analysis of randomized controlled trials examining the association between polypill therapy and CVD outcomes published before February 2021. The primary outcome of interest was the risk of major adverse CVD events (MACE). Risk ratios for dichotomous outcomes were converted to log RR and pooled using a generic inverse variance weighted random-effects model. Data for continuous outcomes were pooled using random-effects modeling and presented as mean differences with 95% CIs. Eight studies representing 25,584 patients were included for analysis. In the overall pooled analysis, the use of polypills was associated with a non-significant reduction in the risk of MACE (RR: 0.85; 95% CI: 0.70-1.02) and significant reductions in the risk of all-cause mortality (RR: 0.90; 95% CI: 0.81-1.00). The reductions in the risk of MACE with polypill use varied by baseline risk and nature of the study population (primary prevention vs. secondary prevention), with the most significant risk reduction among lower-risk cohorts, including within primary prevention populations [RR 0.70 (0.62, 0.79)]. Among measures of CVD risk factors, modest but significant reductions were observed for systolic and diastolic blood pressure [systolic: mean difference 1.99 mmHg (95% CI: -3.07 to -0.91); diastolic: mean difference 1.30 mmHg (95% CI: -2.42 to -0.19), but not for levels of total or low-density lipoprotein-cholesterol. Use of the polypill strategy significantly improved drug adherence (RR: 1.31; 95% CI: 1.11-1.55) with no association between polypill use and rates of adverse events or drug discontinuation. The use of polypill formulations is associated with significant reductions in CVD risk factors and the risk of all-cause mortality and MACE, particularly in the low-risk and primary prevention population.
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Affiliation(s)
- Shreya Rao
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Tariq Jamal Siddiqi
- Division of Cardiology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, United States of America
| | - Muhammad Shahzeb Khan
- Division of Cardiology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, United States of America
| | - Erin D Michos
- Division of Cardiology, Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Ann Marie Navar
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Thomas J Wang
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Stephen J Greene
- Division of Cardiology, Duke University Medical Center, Durham, NC, United States of America
| | | | - Amit Khera
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States of America.
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9
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Smith TW. Intimate Relationships and Coronary Heart Disease: Implications for Risk, Prevention, and Patient Management. Curr Cardiol Rep 2022; 24:761-774. [PMID: 35380384 PMCID: PMC8981884 DOI: 10.1007/s11886-022-01695-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Research and clinical services addressing psychosocial aspects of coronary heart disease (CHD) typically emphasize individuals, focusing less on the context of intimate relationships such as marriage and similar partnerships. This review describes current evidence regarding the role of intimate relationships in the development, course, and management of CHD. RECENT FINDINGS Having an intimate partner is associated with reduced risk of incident CHD and a better prognosis among patients, but strain (e.g., conflict) and disruption (i.e., separation, divorce) in these relationships are associated with increased risk and poor outcomes. These associations likely reflect mechanisms involving health behavior and the physiological effects of emotion and stress. Importantly, many other well-established psychosocial risk and protective factors (e.g., low SES, job stress, depression, and optimism) are strongly related to the quality of intimate relationships, and these associations likely contribute to the effects of those other psychosocial factors. For better or worse, intimate partners can also affect the outcome of efforts to alter health behaviors (physical activity, diet, smoking, and medication adherence) central in the prevention and management CHD. Intimate partners also influence-and are influenced by-stressful aspects of acute coronary crises and longer-term patient adjustment and management. Evidence on each of these roles of intimate relationships in CHD is considerable, but direct demonstrations of the value of couple assessments and interventions are limited, although preliminary research is promising. Research needed to close this gap must also address issues of diversity, disparities, and inequity that have strong parallels in CHD and intimate relationships.
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Affiliation(s)
- Timothy W Smith
- Department of Psychology, University of Utah, Salt Lake City, UT, USA.
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10
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Alomari A, Alananzeh I, Lord H, Abdulla Al-Lenjawi B, Fernandez R. Medication Adherence Rate in Arab Patients With Cardiovascular Disease: A Systematic Review. J Transcult Nurs 2022; 33:632-641. [PMID: 35583032 DOI: 10.1177/10436596221095851] [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: 11/17/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is one of the most common chronic illnesses in the Eastern Mediterranean. There have been few studies on medication adherence in Arab patients with CVD. AIM To investigate the rates and the reasons for medication adherence in Arab patients with CVD. METHODOLOGY The Joanna Briggs Institute methodology for prevalence systematic reviews was used. MEDLINE, EMCARE, CINAHL, Scopus, Science Direct, PsychINFO, and the Cochrane Central Register of Controlled Trials were searched. RESULTS Thirteen quantitative studies on medication adherence in Arab adult CVD patients were included.Pooled data from nine studies demonstrated that 53.2% (95% confidence interval = [51.2%, 55.1%]) of patients were adherent to their medications. Reasons for nonadherence to medication include personal factors, understanding, and complexity of treatment regimes, medication knowledge and structural barriers. CONCLUSION Medication adherence appears to have a social gradient, and families should be actively involved in future strategies to increase medication adherence.
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Affiliation(s)
| | | | - Heidi Lord
- South Eastern Sydney Local Health District, Kogarah, New South Wales, Australia
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11
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Horne BD, Muhlestein JB, Lappé DL, May HT, Le VT, Bair TL, Babcock D, Bride D, Knowlton KU, Anderson JL. Behavioral Nudges as Patient Decision Support for Medication Adherence: The ENCOURAGE Randomized Controlled Trial. Am Heart J 2022; 244:125-134. [PMID: 34798073 DOI: 10.1016/j.ahj.2021.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 11/04/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Medication adherence is generally low and challenging to address because patient actions control healthcare delivery outside of medical environments. Behavioral nudging changes clinician behavior, but nudging patient decision-making requires further testing. This trial evaluated whether behavioral nudges can increase statin adherence, measured as the proportion of days covered (PDC). METHODS In a 12-month parallel-group, unblinded, randomized controlled trial, adult patients in Intermountain Healthcare cardiology clinics were enrolled. Inclusion required an indication for statins and membership in SelectHealth insurance. Subjects were randomized 1:1 to control or nudges. Nudge content, timing, frequency, and delivery route were personalized by CareCentra using machine learning of subject motivations and abilities from psychographic assessment, demographics, social determinants, and the Intermountain Mortality Risk Score. PDC calculation used SelectHealth claims data. RESULTS Among 182 subjects, age averaged 63.2±8.5 years, 25.8% were female, baseline LDL-C was 82.5±32.7 mg/dL, and 93.4% had coronary disease. Characteristics were balanced between nudge (n = 89) and control arms (n = 93). The statin PDC was greater at 12 months in the nudge group (PDC: 0.742±0.318) compared to controls (PDC: 0.639±0.358, P = 0.042). Adherent subjects (PDC ≥80%) were more concentrated in the nudge group (66.3% vs controls: 50.5%, P = 0.036) while a composite of death, myocardial infarction, stroke, and revascularization was non-significant (nudges: 6.7% vs control: 10.8%, P = 0.44). CONCLUSIONS Persuasive behavioral nudges driven by artificial intelligence resulted in a clinically important increase in statin adherence in general cardiology patients. This precision patient decision support utilized computerized nudge design and delivery with minimal on-going human input.
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Affiliation(s)
- Benjamin D Horne
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA.
| | - Joseph B Muhlestein
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA; Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Donald L Lappé
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA; Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Heidi T May
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA
| | - Viet T Le
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA; Rocky Mountain University of Health Professions, Provo, Utah, USA
| | - Tami L Bair
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA
| | - Daniel Babcock
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA
| | - Daniel Bride
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA
| | - Kirk U Knowlton
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA; Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Jeffrey L Anderson
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA; Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
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Fitilev SB, Vozzhaev AV, Klyuev DA, Shkrebniova II, Shindryaeva NN, Saakova LN, Shkirando YV. Effects of Pharmacy Care Program on medication adherence in outpatients with stable coronary artery disease: a randomized controlled study. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2021-3069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To assess the effects of the Pharmacy Care Program on medication adherence in outpatients with stable coronary artery disease (SCAD).Material and methods. An open randomized controlled study was conducted in primary care clinic over the period of 2019-2020. All subjects (n=126) were randomized at visit 1 into the multifaceted intervention group (n=63) or control group (n=63) and invited 12 months after to visit 2. Patients of intervention group were included into the Pharmacy Care Program, which consisted of the following components: pharmacist-led counseling, provision of education materials and 7-day pillbox, weekly SMS-reminders. Medication adherence was measured initially and at the end of the study period by means of eight-item Morisky Medication Adherence Scale (MMAS-8) and Self-Efficacy for Appropriate Medication Use Scale (SEAMS).Results. The implementation of the Pharmacy Care Program improved medication adherence in SCAD outpatients with MMAS-8 median score of 7,0-8,0 (p<0,001) and SEAMS median score of 35,0-36,0 (p=0,017). In the control group, no changes (p=0,123) in MMAS-8 score were revealed, while SEAMS score decreased from 35,0 down to 34,5 (p=0,003). The reduction in systolic blood pressure (p=0,049) and risk of urgent hospital admission (OR=0,28; 95% CI, 0,08-0,99; p=0,041) was registered in the intervention group in contrast to the control group over the 12-month period.Conclusion. The multicomponent intervention within the Pharmacy Care Program contributed to an increase in the adherence to pharmacotherapy of outpatients with stable CAD.
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Affiliation(s)
- S. B. Fitilev
- Peoples’ Friendship University of Russia; City Polyclinic № 2
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13
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Neville HL, Mann K, Killen J, Callaghan M. Pharmacist Intervention to Improve Medication Adherence in Patients with Acute Coronary Syndrome: The PRIMA-ACS Study. Can J Hosp Pharm 2021; 74:350-360. [PMID: 34602623 DOI: 10.4212/cjhp.v74i4.3198] [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: 11/10/2022]
Abstract
Background Despite ample evidence of benefit, adherence to secondary prevention medication therapy after acute coronary syndrome (ACS) is often suboptimal. Hospital pharmacists are uniquely positioned to improve adherence by providing medication education at discharge. Objective To determine whether a standardized counselling intervention at hospital discharge significantly improved patients' adherence to cardiovascular medications following ACS. Methods This single-centre, prospective, nonrandomized comparative study enrolled patients with a primary diagnosis of ACS (January 2014 to July 2015). Patients who received standardized discharge counselling from a clinical pharmacist were compared with patients who did not receive counselling. At 30 days and 1 year after discharge, follow-up patient surveys were conducted and community pharmacy refill data were obtained. Adherence was assessed using pharmacy refill data and patient self-reporting for 5 targeted medications: acetylsalicylic acid, P2Y purinoceptor 12 (P2Y12) inhibitors, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, β-blockers, and statins. Thirty-day and 1-year medication utilization, cardiovascular readmission rates, and all-cause mortality were also assessed. Results Of the 259 patients enrolled, 88 (34.0%) received discharge counselling. Medication data were obtained for 253 patients (97.7%) at 30 days and 242 patients (93.4%) at 1 year. At 1 year after discharge, there were no statistically significant differences between patients who did and did not receive counselling in terms of rates of nonadherence (11.9% versus 18.4%, p = 0.19), cardiovascular readmission (17.6% versus 22.3%, p = 0.42), and all-cause mortality (3.4% versus 4.2%, p > 0.99). Overall medication nonadherence was 2.8% (7/253) at 30 days and 16.1% (39/242) at 1 year. Conclusions Discharge medication counselling provided by hospital pharmacists after ACS was not associated with significantly better medication adherence at 1 year. Higher-quality evidence is needed to determine the most effective and practical interventions to ensure that patients adhere to their medication regimens and achieve positive outcomes after ACS.
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Affiliation(s)
- Heather L Neville
- , BScPharm, MSc, FCSHP, is with Nova Scotia Health, Halifax, Nova Scotia
| | - Kelsey Mann
- , BScPharm, was, at the time of this study, with Nova Scotia Health, Halifax, Nova Scotia
| | - Jessica Killen
- , BScPharm, ACPR, is with Nova Scotia Health, Halifax, Nova Scotia
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14
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Saki M, Najmi S, Gholami M, Ebrahimzadeh F, Pour FJ. The effect of patient-centered education in adherence to the treatment regimen in patients with coronary artery disease. JOURNAL OF VASCULAR NURSING 2021; 40:28-34. [DOI: 10.1016/j.jvn.2021.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/26/2021] [Accepted: 10/02/2021] [Indexed: 11/27/2022]
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15
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Schwaab B, Bjarnason-Wehrens B, Meng K, Albus C, Salzwedel A, Schmid JP, Benzer W, Metz M, Jensen K, Rauch B, Bönner G, Brzoska P, Buhr-Schinner H, Charrier A, Cordes C, Dörr G, Eichler S, Exner AK, Fromm B, Gielen S, Glatz J, Gohlke H, Grilli M, Gysan D, Härtel U, Hahmann H, Herrmann-Lingen C, Karger G, Karoff M, Kiwus U, Knoglinger E, Krusch CW, Langheim E, Mann J, Max R, Metzendorf MI, Nebel R, Niebauer J, Predel HG, Preßler A, Razum O, Reiss N, Saure D, von Schacky C, Schütt M, Schultz K, Skoda EM, Steube D, Streibelt M, Stüttgen M, Stüttgen M, Teufel M, Tschanz H, Völler H, Vogel H, Westphal R. Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 2. J Clin Med 2021; 10:jcm10143071. [PMID: 34300237 PMCID: PMC8306118 DOI: 10.3390/jcm10143071] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 02/08/2023] Open
Abstract
Background: Scientific guidelines have been developed to update and harmonize exercise based cardiac rehabilitation (ebCR) in German speaking countries. Key recommendations for ebCR indications have recently been published in part 1 of this journal. The present part 2 updates the evidence with respect to contents and delivery of ebCR in clinical practice, focusing on exercise training (ET), psychological interventions (PI), patient education (PE). In addition, special patients’ groups and new developments, such as telemedical (Tele) or home-based ebCR, are discussed as well. Methods: Generation of evidence and search of literature have been described in part 1. Results: Well documented evidence confirms the prognostic significance of ET in patients with coronary artery disease. Positive clinical effects of ET are described in patients with congestive heart failure, heart valve surgery or intervention, adults with congenital heart disease, and peripheral arterial disease. Specific recommendations for risk stratification and adequate exercise prescription for continuous-, interval-, and strength training are given in detail. PI when added to ebCR did not show significant positive effects in general. There was a positive trend towards reduction in depressive symptoms for “distress management” and “lifestyle changes”. PE is able to increase patients’ knowledge and motivation, as well as behavior changes, regarding physical activity, dietary habits, and smoking cessation. The evidence for distinct ebCR programs in special patients’ groups is less clear. Studies on Tele-CR predominantly included low-risk patients. Hence, it is questionable, whether clinical results derived from studies in conventional ebCR may be transferred to Tele-CR. Conclusions: ET is the cornerstone of ebCR. Additional PI should be included, adjusted to the needs of the individual patient. PE is able to promote patients self-management, empowerment, and motivation. Diversity-sensitive structures should be established to interact with the needs of special patient groups and gender issues. Tele-CR should be further investigated as a valuable tool to implement ebCR more widely and effectively.
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Affiliation(s)
- Bernhard Schwaab
- Curschmann Klinik, D-23669 Timmendorfer Strand, Germany
- Medizinische Fakultät, Universität zu Lübeck, D-23562 Lübeck, Germany
- Correspondence:
| | - Birna Bjarnason-Wehrens
- Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport- and Exercise Medicine, German Sportuniversity Cologne, D-50933 Köln, Germany; (B.B.-W.); (H.-G.P.)
| | - Karin Meng
- Institute for Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, D-97080 Würzburg, Germany;
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital, D-50937 Köln, Germany;
| | - Annett Salzwedel
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); or (H.V.)
| | | | | | - Matthes Metz
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.M.); (K.J.); (D.S.)
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.M.); (K.J.); (D.S.)
| | - Bernhard Rauch
- Institut für Herzinfarktforschung Ludwigshafen, IHF, D-67063 Ludwigshafen am Rhein, Germany;
- Zentrum für ambulante Rehabilitation, ZAR Trier GmbH, D-54292 Trier, Germany
| | - Gerd Bönner
- Medizinische Fakultät, Albert-Ludwigs-Universität zu Freiburg, D-79104 Freiburg, Germany;
| | - Patrick Brzoska
- Fakultät für Gesundheit, Universität Witten/Herdecke, Lehrstuhl für Versorgungsforschung, D-58448 Witten, Germany;
| | | | | | - Carsten Cordes
- Gollwitzer-Meier-Klinik, D-32545 Bad Oeynhausen, Germany;
| | - Gesine Dörr
- Alexianer St. Josefs-Krankenhaus Potsdam, D-14472 Potsdam, Germany;
| | - Sarah Eichler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); or (H.V.)
| | - Anne-Kathrin Exner
- Klinikum Lippe GmbH, Standort Detmold, D-32756 Detmold, Germany; (A.-K.E.); (S.G.)
| | - Bernd Fromm
- REHA-Klinik Sigmund Weil, D-76669 Bad Schönborn, Germany;
| | - Stephan Gielen
- Klinikum Lippe GmbH, Standort Detmold, D-32756 Detmold, Germany; (A.-K.E.); (S.G.)
| | - Johannes Glatz
- Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany; (J.G.); (E.L.)
| | - Helmut Gohlke
- Private Practice, D-79282 Ballrechten-Dottingen, Germany;
| | - Maurizio Grilli
- Library Department, University Medical Centre Mannheim, D-68167 Mannheim, Germany;
| | - Detlef Gysan
- Department für Humanmedizin, Private Universität Witten/Herdecke GmbH, D-58455 Witten, Germany;
| | - Ursula Härtel
- LMU München, Institut für Medizinische Psychologie, D-80336 München, Germany;
| | | | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, D-37075 Göttingen, Germany;
| | | | | | | | | | | | - Eike Langheim
- Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany; (J.G.); (E.L.)
| | | | - Regina Max
- Zentrum für Rheumatologie, Drs. Dornacher/Schmitt/Max/Lutz, D-69115 Heidelberg, Germany;
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Medical Faculty of the Heinrich-Heine University, D-40225 Düsseldorf, Germany;
| | - Roland Nebel
- Hermann-Albrecht-Klinik METTNAU, Reha-Einrichtungen der Stadt Radolfzell, D-7385 Radolfzell, Germany;
| | - Josef Niebauer
- Universitätsinstitut für Präventive und Rehabilitative Sportmedizin, Uniklinikum Salzburg, Paracelsus Medizinische Privatuniversität, A-5020 Salzburg, Austria;
| | - Hans-Georg Predel
- Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport- and Exercise Medicine, German Sportuniversity Cologne, D-50933 Köln, Germany; (B.B.-W.); (H.-G.P.)
| | - Axel Preßler
- Privatpraxis für Kardiologie, Sportmedizin, Prävention, Rehabilitation, D-81675 München, Germany;
| | - Oliver Razum
- Epidemiologie und International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, D-33615 Bielefeld, Germany;
| | - Nils Reiss
- Schüchtermann-Schiller’sche Kliniken, D-49214 Bad Rothenfelde, Germany;
| | - Daniel Saure
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.M.); (K.J.); (D.S.)
| | | | - Morten Schütt
- Diabetologische Schwerpunktpraxis, D-23552 Lübeck, Germany;
| | - Konrad Schultz
- Klinik Bad Reichenhall, Zentrum für Rehabilitation, Pneumologie und Orthopädie, D-83435 Bad Reichenhall, Germany;
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, University of Duisburg-Essen, D-45147 Essen, Germany; (E.-M.S.); (M.T.)
| | | | - Marco Streibelt
- Department for Rehabilitation Research, German Federal Pension Insurance, D-10704 Berlin, Germany;
| | | | | | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, University of Duisburg-Essen, D-45147 Essen, Germany; (E.-M.S.); (M.T.)
| | | | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); or (H.V.)
- Klinik am See, D-15562 Rüdersdorf, Germany
| | - Heiner Vogel
- Abteilung für Medizinische Psychologie und Psychotherapie, Medizinische Soziologie und Rehabilitationswissenschaften, Universität Würzburg, D-97070 Würzburg, Germany;
| | - Ronja Westphal
- Herzzentrum Segeberger Kliniken, D-23795 Bad Segeberg, Germany;
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Shah G, Erickson JL, Luxenburg J, Hu B, Reali-Sorrell M, Lovelace R, Pfoh E, Kobaivanova N, Brateanu A. Impact on patients' compliance with medication using prepacked blisters for multidrug medical therapy: I-COMPLY Study. Am J Health Syst Pharm 2021; 78:1713-1719. [PMID: 33950184 DOI: 10.1093/ajhp/zxab193] [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: 11/12/2022] Open
Abstract
PURPOSE Studies have supported the use of packaging interventions such as pillboxes or blister packs to improve medication adherence but have not evaluated the efficacy of these interventions in a population of low socioeconomic status. The aim of this study was to assess the effect of home-delivered pill packs on medication adherence in a low-income Black American population with Medicaid insurance. METHODS This study was an open-label, randomized, controlled trial. The patient population studied included 80 patients followed by primary care physicians at the Cleveland Clinic. Patients were randomized to a study group who received delivery of their multidrug medical therapy, defined as a minimum of 4 medications daily, in prepackaged blisters or a control group who obtained their prescriptions from their routine pharmacy. RESULTS The primary analysis compared the mean percentage of missed pills between the 2 groups using t-test analysis. The percentage of missed pills in the study group was significantly lower than in the control group (mean [SD]: 3.7% [6.0%] vs 17.4% [16.6%] missed daily pills; P < 0.001). The number of daily missed doses was also significantly lower in the study group (0.3 [0.5] vs 0.7 [0.6]; P = 0.002). Patients were on a mean of 8.1 (SD, 2.3) and 8.1 (SD, 2.6) medications in the study and control groups, respectively (P = 0.96). CONCLUSION Delivery of prepackaged medications in a low-income Black American community was demonstrated to improve medication adherence. The use of prepackaged blisters for medication home delivery is a model that can be utilized on a larger scale for patients on multidrug medical therapy.
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Affiliation(s)
- Gautam Shah
- Regional Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Bo Hu
- Department of Quantitative Health Science, Cleveland Clinic, Cleveland, OH, USA
| | | | - Rita Lovelace
- Department of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Elizabeth Pfoh
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA
| | | | - Andrei Brateanu
- Department of Medicine, Cleveland Clinic, Cleveland, OH, USA
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17
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Zafeiropoulos S, Farmakis I, Kartas A, Arvanitaki A, Pagiantza A, Boulmpou A, Tampaki A, Kosmidis D, Nevras V, Markidis E, Papadimitriou I, Vlachou A, Arvanitakis K, Miyara SJ, Ziakas A, Molmenti EP, Kassimis G, Zanos S, Karvounis H, Giannakoulas G. Reinforcing adherence to lipid-lowering therapy after an acute coronary syndrome: A pragmatic randomized controlled trial. Atherosclerosis 2021; 323:37-43. [PMID: 33780749 DOI: 10.1016/j.atherosclerosis.2021.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/13/2021] [Accepted: 03/10/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS Achieving the low-density lipoprotein cholesterol (LDL-C) goal following an acute coronary syndrome (ACS) is a milestone often missed due to suboptimal adherence to secondary prevention treatments. Whether improved adherence could result in reduced LDL-C levels is unclear. We aimed to evaluate whether an educational-motivational intervention increases long-term lipid-lowering therapy (LLT) adherence and LDL-C goal attainment rate among post-ACS patients. METHODS IDEAL-LDL was a parallel, two-arm, single-center, pragmatic, investigator-initiated randomized controlled trial. Hospitalized patients for ACS were randomized to a physician-led integrated intervention consisting of an educational session at baseline, followed by regular motivational interviewing phone sessions or usual care. Co-primary outcomes were the LLT adherence (measured by Proportion of Days Covered (PDC); good adherence defined as PDC>80%), and LDL-C goal (<70 mg/dl or 50% reduction from baseline) achievement rate at one year. RESULTS In total, 360 patients (mean age 62 years, 81% male) were randomized. Overall, good adherence was positively associated with LDL-C goal achievement rate at one year. Median PDC was higher in the intervention group than the control group [0.92 (IQR, 0.82-1.00) vs. 0.86 (0.62-0.98); p = 0.03] while the intervention group had increased odds of good adherence (odds ratio: 1.76 (95% confidence interval 1.02 to 2.62; p = 0.04). However, neither the LDL-C goal achievement rate (49.6% in the intervention vs. 44.9% in the control group; p = 0.49) nor clinical outcomes differed significantly between the two groups. CONCLUSIONS Α multifaceted intervention improved LLT adherence in post-ACS patients without a significant difference in LDL-C goal attainment.
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Affiliation(s)
- Stefanos Zafeiropoulos
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Elmezzi Graduate School of Molecular Medicine and Feinstein Institutes for Medical Research at Northwell Health, Manhasset, NY, USA
| | - Ioannis Farmakis
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Kartas
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandra Arvanitaki
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster, Germany
| | - Areti Pagiantza
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Internal Medicine, Serres General Hospital, Serres, Greece
| | - Aristi Boulmpou
- 3rd Department of Cardiology, Ippokrateion University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athina Tampaki
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Diamantis Kosmidis
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassileios Nevras
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleftherios Markidis
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Papadimitriou
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Vlachou
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Arvanitakis
- Laboratory of Biomathematics, University of Thessaly, School of Medicine, Papakyriazi 22, Building "Katsigra", Larissa, Greece
| | - Santiago J Miyara
- Elmezzi Graduate School of Molecular Medicine and Feinstein Institutes for Medical Research at Northwell Health, Manhasset, NY, USA
| | - Antonios Ziakas
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ernesto P Molmenti
- Department of Surgery, North Shore University Hospital, Manhasset, NY, USA
| | - George Kassimis
- 2nd Department of Cardiology, Ippokrateion University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Haralambos Karvounis
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Giannakoulas
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Zhou X, Yuan Y, Wang Z, Zhang K, Fan W, Zhang Y, Ma P. Effect of continuous nursing on angina attack and quality of life in patients with coronary artery disease: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24536. [PMID: 33592907 PMCID: PMC7870225 DOI: 10.1097/md.0000000000024536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Coronary Artery Disease is an ischemic or necrotic heart disease caused by myocardial hypoxia caused by coronary artery stenosis or occlusion. The main symptoms are heart failure and recurrent angina pectoris. Continuous nursing refers to the nursing mode from in-hospital nursing to out-of-hospital nursing, including guiding patients' follow-up treatment and lifestyle, which can effectively improve the quality of life in patients with Coronary Artery Disease and reduce the number of angina attacks. The study implemented in this program will systematically evaluate the efficacy and safety of continuous nursing intervention on an angina attack and quality of life in Coronary Artery Disease, and provide evidence-based basis for clinical application of continuous nursing intervention in Coronary Artery Disease. METHOD The 2 researchers search the databases of China Knowledge Network, VP Information Chinese Journal Service Platform, PubMed, Embase, the Cochrane Library and Web of Science. From the establishment of the database in December 2020, all the randomized controlled trials on continuous nursing intervention for Coronary Artery Disease are collected. The relevant data are extracted and the quality is evaluated. meta-analysis is performed on the included literature using Stata15.0 software. RESULT In this study, the efficacy and safety of continuous nursing intervention on Coronary Artery Disease are evaluated by Seattle angina questionnaire and other indicators. CONCLUSION This study will provide reliable evidence for the clinical application of nursing intervention in Coronary Artery Disease. ETHICS AND DISSEMINATION Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/7QRKV.
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Affiliation(s)
| | | | | | - Ke Zhang
- Pingdingshan University, Pingdingshan
| | | | - Yawei Zhang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Pu Ma
- The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan Province, China
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Anderson LJ, Nuckols TK, Coles C, Le MM, Schnipper JL, Shane R, Jackevicius C, Lee J, Pevnick JM. A systematic overview of systematic reviews evaluating medication adherence interventions. Am J Health Syst Pharm 2020; 77:138-147. [PMID: 31901098 DOI: 10.1093/ajhp/zxz284] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To systematically summarize evidence from multiple systematic reviews (SRs) examining interventions addressing medication nonadherence and to discern differences in effectiveness by intervention, patient, and study characteristics. SUMMARY MEDLINE, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects were searched for papers published from January 2004 to February 2017. English-language SRs examining benefits of medication adherence interventions were eligible. Inclusion was limited to adult patients prescribed medication for 1 of the following disease conditions: diabetes and prediabetes, heart conditions, hypertension and prehypertension, stroke, and cognitive impairment. Non-disease-specific SRs that considered medication adherence interventions for older adults, adults with chronic illness, and adults with known medication adherence problems were also included. Two researchers independently screened titles, abstracts, and full-text articles. They then extracted key variables from eligible SRs, reconciling discrepancies via discussion. A MeaSurement Tool to Assess systematic Reviews (AMSTAR) was used to assess SRs; those with scores below 8 were excluded. Conclusions regarding intervention effectiveness were extracted. Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methodology was applied to assess evidence quality. RESULTS Of 390 SRs, 25 met the inclusion criteria and assessed adherence as a primary outcome. Intervention types most consistently found to be effective were dose simplification, patient education, electronic reminders to patients, and reduced patient cost sharing or incentives. Of 50 conclusions drawn by the SRs, the underlying evidence was low or very low quality for 45 SRs. CONCLUSION Despite an abundance of primary studies and despite only examining high-quality SRs, the vast majority of primary studies supporting SR authors' conclusions were of low or very low quality. Nonetheless, health system leaders seeking to improve medication adherence should prioritize interventions that have been studied and found to be effective at improving patient adherence, including dose simplification, education, reminders, and financial incentives.
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Affiliation(s)
- Laura J Anderson
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Teryl K Nuckols
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Courtney Coles
- Department of Health Policy and Management, Johnathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
| | - Michael M Le
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Jeff L Schnipper
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Rita Shane
- Department of Pharmacy, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Cynthia Jackevicius
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, VA Greater Los Angeles Healthcare System, Los Angeles, CA, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada, and University Health Network, Toronto, Canada
| | - Joshua Lee
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Joshua M Pevnick
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
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20
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Ayorinde AA, Williams I, Mannion R, Song F, Skrybant M, Lilford RJ, Chen YF. Publication and related bias in quantitative health services and delivery research: a multimethod study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Bias in the publication and reporting of research findings (referred to as publication and related bias here) poses a major threat in evidence synthesis and evidence-based decision-making. Although this bias has been well documented in clinical research, little is known about its occurrence and magnitude in health services and delivery research.
Objectives
To obtain empirical evidence on publication and related bias in quantitative health services and delivery research; to examine current practice in detecting/mitigating this bias in health services and delivery research systematic reviews; and to explore stakeholders’ perception and experiences concerning such bias.
Methods
The project included five distinct but interrelated work packages. Work package 1 was a systematic review of empirical and methodological studies. Work package 2 involved a survey (meta-epidemiological study) of randomly selected systematic reviews of health services and delivery research topics (n = 200) to evaluate current practice in the assessment of publication and outcome reporting bias during evidence synthesis. Work package 3 included four case studies to explore the applicability of statistical methods for detecting such bias in health services and delivery research. In work package 4 we followed up four cohorts of health services and delivery research studies (total n = 300) to ascertain their publication status, and examined whether publication status was associated with statistical significance or perceived ‘positivity’ of study findings. Work package 5 involved key informant interviews with diverse health services and delivery research stakeholders (n = 24), and a focus group discussion with patient and service user representatives (n = 8).
Results
We identified only four studies that set out to investigate publication and related bias in health services and delivery research in work package 1. Three of these studies focused on health informatics research and one concerned health economics. All four studies reported evidence of the existence of this bias, but had methodological weaknesses. We also identified three health services and delivery research systematic reviews in which findings were compared between published and grey/unpublished literature. These reviews found that the quality and volume of evidence and effect estimates sometimes differed significantly between published and unpublished literature. Work package 2 showed low prevalence of considering/assessing publication (43%) and outcome reporting (17%) bias in health services and delivery research systematic reviews. The prevalence was lower among reviews of associations than among reviews of interventions. The case studies in work package 3 highlighted limitations in current methods for detecting these biases due to heterogeneity and potential confounders. Follow-up of health services and delivery research cohorts in work package 4 showed positive association between publication status and having statistically significant or positive findings. Diverse views concerning publication and related bias and insights into how features of health services and delivery research might influence its occurrence were uncovered through the interviews with health services and delivery research stakeholders and focus group discussion conducted in work package 5.
Conclusions
This study provided prima facie evidence on publication and related bias in quantitative health services and delivery research. This bias does appear to exist, but its prevalence and impact may vary depending on study characteristics, such as study design, and motivation for conducting the evaluation. Emphasis on methodological novelty and focus beyond summative assessments may mitigate/lessen the risk of such bias in health services and delivery research. Methodological and epistemological diversity in health services and delivery research and changing landscape in research publication need to be considered when interpreting the evidence. Collection of further empirical evidence and exploration of optimal health services and delivery research practice are required.
Study registration
This study is registered as PROSPERO CRD42016052333 and CRD42016052366.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 33. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Abimbola A Ayorinde
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Iestyn Williams
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Russell Mannion
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Fujian Song
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Magdalena Skrybant
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Richard J Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Yen-Fu Chen
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Maidment ID, Lawson S, Wong G, Booth A, Watson A, McKeown J, Zaman H, Mullan J, Bailey S. Medication management in older people: the MEMORABLE realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [PMID: 32579319 DOI: 10.3310/hsdr08260] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background
The number and proportion of older people in the UK are increasing, as are multimorbidity (potentially reducing quality of life) and polypharmacy (increasing the risk of adverse drug events). Together, these complex factors are challenging for older people, informal carers, and health and care practitioners.
Objectives
MEMORABLE (MEdication Management in Older people: Realist Approaches Based on Literature and Evaluation) aimed to understand how medication management works and propose improvements.
Design
A realist approach informed three work packages, combining a realist review of secondary data with a realist evaluation of primary interview data, in a theory-driven, causal analysis.
Setting
The setting was in the community.
Participants
Older people, informal carers, and health and care practitioners.
Interventions
Studies relating to medication management and to reviewing and reconciling medications; and realist-informed interviews.
Main outcome measures
Not applicable.
Data sources
MEDLINE, CINAHL (Cumulative Index of Nursing and Allied Health Literature) and EMBASE were searched (all searched from January 2009 to July 2017; searched on 1 August 2017). Supplementary articles were identified by the Research Team. Data were also obtained through interviews.
Review methods
Searches of electronic databases were supplemented by citation-tracking for explanatory contributions, as well as accessing topic-relevant grey literature. Following RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) guidelines, articles were screened and iteratively analysed with interview data, to generate theory-informed (normalisation process theory) explanations.
Results
Developing a framework to explain medication management as a complex intervention across five stages: identifying problem (Stage 1), starting, changing or stopping medications (Stage 3) and continuing to take medications (Stage 4), where older people, sometimes with informal carers, make individual decisions and follow routines that fit medication management into their day-to-day lives, engendering a sense of control. In getting diagnosis and/or medications (Stage 2) and reviewing/reconciling medications (Stage 5), older people and practitioners share decision-making in time-limited contacts: involving four steps – sense-making, relationships, action and reflection/monitoring (normalisation process theory); and conceptualising burden – through a detailed analysis of Stage 5, generating a theoretical framework and identifying five burden types amendable to mitigation: ambiguity, concealment, unfamiliarity, fragmentation and exclusion. Proposing interventions: risk identification – a simple way of identifying older people and informal carers who are not coping, at risk and who need appropriate help and support; and individualised information – a short, personalised record and reference point, co-produced and shared by older people, informal carers and practitioners that addresses the experience of living with multimorbidities and polypharmacy.
Limitations
Few studies directly address the complexity of medication management as a process and how it works. Limitations included, having identified the overall complexity, the need to focus the analysis on reviewing/reconciling medications (Stage 5), the exclusion of non-English-language literature, the focus on non-institutionalised populations and the broad definition of older people.
Conclusions
MEMORABLE explored the complexity of medication management. It highlighted the way interpersonal stages in the medication management process, notably reviewing/reconciling medications, contribute to the mitigation of burdens that are often hidden.
Future work
Co-produced studies to scope and trial the two proposed interventions; studies to extend the detailed understanding of medication management, linked to burden mitigation; and a study to clarify the medication management outcomes wanted by older people, informal carers and practitioners.
Study registration
This study is registered as PROSPERO CRD42016043506.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 26. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ian D Maidment
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Sally Lawson
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anne Watson
- Medicines Management Department, West Heath Hospital, Birmingham Community Healthcare NHS Trust, West Heath, UK
| | - Jane McKeown
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - Hadar Zaman
- Bradford School of Pharmacy, School of Life Sciences, University of Bradford, Bradford, UK
| | - Judy Mullan
- Australian Health Services Research Institute (AHSRI), University of Wollongong, Wollongong, NSW, Australia
| | - Sylvia Bailey
- Patient and public involvement representative, School of Life and Health Sciences, Aston University, Birmingham, UK
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Bermon A, Uribe-Rodríguez AF, Pérez-Rivero PF, Prieto-Merino D, Cáceres Rivera DI, Guio E, Atkins L, Horne R, Murray E, Serrano Díaz NC, Free C, Perel P, Casas JP. Evaluation of the efficacy and safety of text messages targeting adherence to cardiovascular medications in secondary prevention: the txt2heart Colombia randomised controlled trial protocol. BMJ Open 2019; 9:e028017. [PMID: 31818831 PMCID: PMC6924706 DOI: 10.1136/bmjopen-2018-028017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Anti-platelet therapy, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, beta-blockers and statins are cost-effective in patients with atherosclerotic cardiovascular diseases (ASCVD) for reducing the risk of ASCVD events. Unfortunately, there is abundant evidence that adherence to these cardiovascular medications is far from ideal. A recent Cochrane review showed a potential beneficial effect of Short Message Service (SMS) interventions on adherence to medication in ASCVD patients. METHODS AND ANALYSIS The txt2heart study is a pragmatic randomised single-blind controlled trial. The objective is to evaluate the efficacy and safety of an intervention with SMS messages delivered by mobile phones to improve adherence to cardiovascular medications in patients with ASCVD. The intervention consists of behavioural techniques delivered via SMS. The primary outcome is change in blood serum low-density lipoprotein cholesterol levels as an indicator of adherence to statins. Secondary outcomes will include systolic blood pressure as an indicator of adherence to blood-lowering therapies and heart rate as an indicator of adherence to beta-blockers, urine levels of 11-dehydrothromboxane B2, self-reported adherence to cardiovascular medications and rates of cardiovascular death or hospitalisation due to cardiovascular disease. ETHICS AND DISSEMINATION The study will be performed in compliance with the protocol, regulatory requirements, Good Clinical Practice and ethical principles of the Declaration of Helsinki. The Ethics Committee of Fundación Cardiovascular de Colombia evaluated and approved the trial. The txt2heart Colombia trial aims to provide robust evidence to evaluate whether SMS messages delivered through mobile telephones change the behaviour of Colombian patients who have suffered a cardiovascular event. Trial results will be presented to the local health authorities, and if the intervention is effective and safe, we hope this strategy will be implemented quickly because of its low cost and wide-reaching impact on the population. TRIAL REGISTRATION NUMBER NCT03098186.
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Affiliation(s)
- Anderson Bermon
- Research, Fundacion Cardiovascular de Colombia, Floridablanca, Santander, Colombia
- Epidemiology and Biostatistics, CES University, Medellín, Colombia
| | - Ana Fernanda Uribe-Rodríguez
- Faculty of Psychology, Universidad Pontificia Bolivariana - Seccional Bucaramanga, Floridablanca, Santander, Colombia
| | - Paula Fernanda Pérez-Rivero
- Faculty of Psychology, Universidad Pontificia Bolivariana - Seccional Bucaramanga, Floridablanca, Santander, Colombia
| | - David Prieto-Merino
- EPH LSHTM, London School of Hygiene and Tropical Medicine, London, UK
- Applied Statistical Methods in Medical Research Group, Universidad Católica San Antonio de Murcia, Murcia, Spain
| | | | - Elizabeth Guio
- Metabolism and Genoma Laboratory, Fundacion Cardiovascular de Colombia, Floridablanca, Santander, Colombia
| | - Louise Atkins
- University College London Research Department of Epidemiology and Public Health, London, UK
| | - Robert Horne
- University College London School of Pharmacy, London, UK
| | - Elizabeth Murray
- University College London Research Department of Primary Care and Population Health, London, UK
| | | | - Caroline Free
- EPH LSHTM, London School of Hygiene and Tropical Medicine, London, UK
| | - Pablo Perel
- EPH LSHTM, London School of Hygiene and Tropical Medicine, London, UK
| | - Juan P Casas
- Research, Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, Massachusetts, USA
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23
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Zhao YY, Dang FP, Zhai TT, Li HJ, Wang RJ, Ren JJ. The effect of text message reminders on medication adherence among patients with coronary heart disease: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e18353. [PMID: 31876709 PMCID: PMC6946488 DOI: 10.1097/md.0000000000018353] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To determine the effectiveness of text message reminders (TMR) on medication adherence (MA) and to investigate the effects of TMR on clinical outcomes. METHODS The PubMed, Cochrane library, EMbase, and China Biology Medicine databases were searched for randomized-controlled trials with TMR as the intervention for patients with coronary heart disease. Two reviewers independently extracted data and assessed the risk of bias. Meta-analysis was conducted using Stata 15.0 software. RESULTS In total, 1678 patients in 6 trials were included. Compared with the control group, the MA was 2.85 times greater among the intervention group (RR [relative risk] 2.85; 95% confidence interval [CI] 1.07-7.58). TMR reduced systolic blood pressure (BP) (weighted mean difference) = -6.51; 95% CI -9.79 to -3.23), cholesterol (standard mean difference = -0.26; 95% CI -0.4 to -0.12) and increased the number of patients with BP <140/90 mm Hg (RR 1.39; 95% CI 1.26-1.54). CONCLUSION TMR significantly promoted MA and reduced systolic BP, cholesterol level, and body mass index, but had no effect on mortality, diastolic BP, or lipoproteins. However, substantial heterogeneity existed in our analyses.
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Affiliation(s)
| | - Fang-Ping Dang
- School of Nursing of Lanzhou University, Gansu, Lanzhou, China
| | - Tian-Tian Zhai
- School of Nursing of Lanzhou University, Gansu, Lanzhou, China
| | - Hui-Ju Li
- School of Nursing of Lanzhou University, Gansu, Lanzhou, China
| | - Rui-Juan Wang
- School of Nursing of Lanzhou University, Gansu, Lanzhou, China
| | - Jing-Jie Ren
- School of Nursing of Lanzhou University, Gansu, Lanzhou, China
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24
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Santo K, Singleton A, Chow CK, Redfern J. Evaluating Reach, Acceptability, Utility, and Engagement with An App-Based Intervention to Improve Medication Adherence in Patients with Coronary Heart Disease in the MedApp-CHD Study: A Mixed-Methods Evaluation. Med Sci (Basel) 2019; 7:medsci7060068. [PMID: 31167489 PMCID: PMC6631463 DOI: 10.3390/medsci7060068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/27/2019] [Accepted: 05/31/2019] [Indexed: 12/03/2022] Open
Abstract
Objective: The aim of this study was to assess the reach, acceptability, utility, and engagement with the apps that were used in the MEDication reminder APPlications (apps) to improve medication adherence in Coronary Heart Disease (MedApp-CHD) study, a randomised clinical trial to improve medication adherence, using a mixed-methods approach. Methods: The MedApp-CHD study randomised 163 patients with coronary heart disease (CHD) to one of three groups: (i) usual care (n = 56), (ii) a basic medication reminder app (n = 54), or (iii) an advanced medication reminder app (n = 53). For this mixed-methods evaluation, the data sources included patient screening logs, feedback questionnaires collected at three-month follow-up, focus groups discussions, and analytical data from the app software. Results: Ninety-four percent (98/104) of participants who received a medication reminder app completed the three-month feedback questionnaire and 15 participated in the focus group discussions. The themes that were identified included that participants (i) found the medication reminders useful in reminding them to take the medications on the correct time every day, (ii) liked having the medication list as an easily-accessible record of medications’ names and dosages, (iii) reported being likely to continue to use the apps after the study completion, (iv) would be likely to recommend the apps to their family and friends, and (v) those who used the clinical measurements feature found it useful as a tool to track and graph the blood pressure and glucose levels over time (especially those with diabetes and/or hypertension). In addition, analytical data from the app software demonstrated that the participants used the medication-related features more than the clinical measurements feature. Furthermore, data from the patient screening logs showed that the main reason for exclusion, other than not meeting the CHD criteria, was not having a suitable smartphone, and those that were excluded for this reason were older and had a higher proportion of females than those enrolled in the study. Conclusion: This study provides important insights regarding the features that are most useful in apps that aim to improve medication adherence. This mixed-methods evaluation suggests that, currently, young male patients with CHD are more likely to use such apps, that the apps were well-accepted and useful in reminding the patients to take the medications, and that the patients were engaged in regularly using the apps.
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Affiliation(s)
- Karla Santo
- Westmead Applied Research Centre, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2145, Australia.
- The George Institute for Global Health, Sydney, NSW 2050, Australia.
| | - Anna Singleton
- Westmead Applied Research Centre, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2145, Australia.
| | - Clara K Chow
- Westmead Applied Research Centre, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2145, Australia.
- The George Institute for Global Health, Sydney, NSW 2050, Australia.
- Westmead Hospital, Cardiology Department, Sydney, NSW 2145, Australia.
| | - Julie Redfern
- Westmead Applied Research Centre, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2145, Australia.
- The George Institute for Global Health, Sydney, NSW 2050, Australia.
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25
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Sosa-Liprandi Á, Sosa Liprandi MI, Alexánderson E, Avezum Á, Lanas F, López-Jaramillo JP, Martínez F, Ponte-Negretti N CI, Wyss F, González Juanatey JR, Perel P. Clinical Impact of the Polypill for Cardiovascular Prevention in Latin America: A Consensus Statement of the Inter-American Society of Cardiology. Glob Heart 2018; 14:3-16.e1. [PMID: 30502220 DOI: 10.1016/j.gheart.2018.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/20/2018] [Accepted: 10/16/2018] [Indexed: 01/22/2023] Open
Abstract
The burden of cardiovascular diseases (CVD) is increasing, particularly in low-middle-income countries such as most of Latin America. This region presents specific socioeconomic characteristics, generating a high incidence of CVD despite efforts to control the problem. A consensus statement has been developed by Inter-American Society of Cardiology with the aim of answering some important questions related to CVD in this region and the role of the polypill in cardiovascular (CV) prevention as an intervention to address these issues. A multidisciplinary team composed of Latin American experts in the prevention of CVD was convened by the Inter-American Society of Cardiology and participated in the process and the formulation of statements. To characterize the prevailing situation in Latin American countries, we describe the most significant CV risk factors in the region. The barriers that impair the use of CV essential medications are also reviewed. The role of therapeutic adherence in CV prevention and how the polypill emerges as an effective strategy for optimizing adherence, accessibility, and affordability in the treatment of CVDs are discussed in detail. Clinical scenarios in which the polypill could represent an effective intervention in primary and secondary CV prevention are described. This initiative is expected to help professionals involved in the management of CVD and public health policymakers develop optimal strategies for the management of CVDs.
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Affiliation(s)
| | | | - Erick Alexánderson
- Department of Physiology, Faculty of Medicine, Universidad Nacional Autónoma de México, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Álvaro Avezum
- Instituto Dante Pazzanese de Cardiología, Saõ Paulo, Brazil
| | | | - José Patricio López-Jaramillo
- Clínica Fundación Oftalmologica de Santander/Clínica Carlos Ardila Lulle, Bucaramanga, Colombia; Eugenio Espejo Faculty of Health Sciences, Universidad Tecnológica Equinoccial, Quito, Ecuador
| | | | | | - Fernando Wyss
- Servicios y Tecnología Cardiovascular de Guatemala S.A., CARDIOSOLUTIONS, Guatemala, Guatemala
| | | | - Pablo Perel
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Al-Ganmi AHA, Perry L, Gholizadeh L, Alotaibi AM. Behaviour change interventions to improve medication adherence in patients with cardiac disease: Protocol for a mixed methods study including a pilot randomised controlled trial. Collegian 2018. [DOI: 10.1016/j.colegn.2017.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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27
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Selak V, Webster R, Stepien S, Bullen C, Patel A, Thom S, Arroll B, Bots ML, Brown A, Crengle S, Dorairaj P, Elley CR, Grobbee DE, Harwood M, Hillis GS, Laba TL, Neal B, Peiris D, Rafter N, Reid C, Stanton A, Tonkin A, Usherwood T, Wadham A, Rodgers A. Reaching cardiovascular prevention guideline targets with a polypill-based approach: a meta-analysis of randomised clinical trials. Heart 2018; 105:42-48. [DOI: 10.1136/heartjnl-2018-313108] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 05/17/2018] [Accepted: 05/24/2018] [Indexed: 01/11/2023] Open
Abstract
ObjectiveThe aim of this study was to determine the effect of polypill-based care on the achievement of 2016 European Society of Cardiology (ESC) guideline targets for blood pressure (BP), low-density lipoprotein (LDL) cholesterol and antiplatelet therapy.MethodsWe conducted an individual participant data meta-analysis of three randomised clinical trials that compared a strategy using a polypill containing aspirin, statin and antihypertensive therapy with usual care in patients with a prior cardiovascular disease (CVD) event or who were at high risk of their first event. Overall, the trials included 3140 patients from Australia, England, India, Ireland, the Netherlands and New Zealand (75% male, mean age 62 years and 76% with a prior CVD event). The primary outcome for this study was the proportion of people achieving ESC guideline targets for BP, LDL and antiplatelet therapy.ResultsThose randomised to polypill-based care were more likely than those receiving usual care to achieve recommended targets for BP (62% vs 58%, risk ratio (RR) 1.08, 95% CI 1.02 to 1.15), LDL (39% vs 34%, RR 1.13, 95% CI 1.02 to 1.25) and all three targets for BP, LDL and adherence to antiplatelet therapy (the latter only applicable to those with a prior CVD event) simultaneously (24% vs 19%, RR 1.27, 95% CI 1.10 to 1.47) at 12 months. There was no difference between groups in antiplatelet adherence (96% vs 96%, RR 1.00, 95% CI 0.98 to 1.01). There was heterogeneity by baseline treatment intensity such that treatment effects increased with the fewer the number of treatments being taken at baseline: for patients taking 3, 2 and 0–1 treatment modalities the RRs for reaching all three guideline goals simultaneously were 1.10 (95% CI 0.94 to 1.30, 22% vs 20%), 1.62 (95% CI 1.09 to 2.42, 27% vs 17%) and 3.07 (95% CI 1.77 to 5.33, 35% vs 11%), respectively.ConclusionsPolypill-based therapy significantly improved the achievement of all three ESC targets for BP, LDL and antiplatelet therapy compared with usual care, particularly among those undertreated at baseline.
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Nguyen T, Nguyen TH, Nguyen PT, Tran HT, Nguyen NV, Nguyen HQ, Ha BN, Pham TT, Taxis K. Pharmacist-Led Intervention to Enhance Medication Adherence in Patients With Acute Coronary Syndrome in Vietnam: A Randomized Controlled Trial. Front Pharmacol 2018; 9:656. [PMID: 29977205 PMCID: PMC6021484 DOI: 10.3389/fphar.2018.00656] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/31/2018] [Indexed: 11/21/2022] Open
Abstract
Background: Patient adherence to cardioprotective medications improves outcomes of acute coronary syndrome (ACS), but few adherence-enhancing interventions have been tested in low-income and middle-income countries. Objectives: We aimed to assess whether a pharmacist-led intervention enhances medication adherence in patients with ACS and reduces mortality and hospital readmission. Methods: We conducted a randomized controlled trial in Vietnam. Patients with ACS were recruited, randomized to the intervention or usual care prior to discharge, and followed 3 months after discharge. Intervention patients received educational and behavioral interventions by a pharmacist. Primary outcome was the proportion of adherent patients 1 month after discharge. Adherence was a combined measure of self-reported adherence (the 8–item Morisky Medication Adherence Scale) and obtaining repeat prescriptions on time. Secondary outcomes were (1) the proportion of patients adherent to medication; (2) rates of mortality and hospital readmission; and (3) change in quality of life from baseline assessed with the European Quality of Life Questionnaire – 5 Dimensions – 3 Levels at 3 months after discharge. Logistic regression was used to analyze data. Registration: ClinicalTrials.gov (NCT02787941). Results: Overall, 166 patients (87 control, 79 intervention) were included (mean age 61.2 years, 73% male). In the analysis excluding patients from the intervention group who did not receive the intervention and excluding all patients who withdrew, were lost to follow-up, died or were readmitted to hospital, a greater proportion of patients were adherent in the intervention compared with the control at 1 month (90.0% vs. 76.5%; adjusted OR = 2.77; 95% CI, 1.01–7.62) and at 3 months after discharge (90.2% vs. 77.0%; adjusted OR = 3.68; 95% CI, 1.14–11.88). There was no significant difference in median change of EQ-5D-3L index values between intervention and control [0.000 (0.000; 0.275) vs. 0.234 (0.000; 0.379); p = 0.081]. Rates of mortality, readmission, or both were 0.8, 10.3, or 11.1%, respectively; with no significant differences between the 2 groups. Conclusion: Pharmacist-led interventions increased patient adherence to medication regimens by over 13% in the first 3 months after ACS hospital discharge, but not quality of life, mortality and readmission. These results are promising but should be tested in other settings prior to broader dissemination.
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Affiliation(s)
- Thang Nguyen
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Thao H Nguyen
- Department of Clinical Pharmacy, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Phu T Nguyen
- Department of Clinical Pharmacy, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Ha T Tran
- Department of Clinical Pharmacy, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Ngoc V Nguyen
- Department of Clinical Pharmacy, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Hoa Q Nguyen
- Department of Clinical Pharmacy, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Ban N Ha
- Heart Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tam T Pham
- Faculty of Public Health, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Katja Taxis
- Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
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Fuller RH, Perel P, Navarro-Ruan T, Nieuwlaat R, Haynes RB, Huffman MD. Improving medication adherence in patients with cardiovascular disease: a systematic review. Heart 2018; 104:1238-1243. [DOI: 10.1136/heartjnl-2017-312571] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 02/08/2018] [Accepted: 02/09/2018] [Indexed: 11/04/2022] Open
Abstract
ObjectiveTo evaluate and compare the effect of interventions for improving adherence to medications for atherosclerotic cardiovascular disease (ASCVD) secondary prevention.MethodsWe extracted eligible trials from a 2014 Cochrane systematic review on adherence for any condition. We updated the search from CENTRAL, Medline, Embase, PsycINFO, CINAHL, Sociological Abstracts and trial registers through November 2016. Study reports needed to be from a randomised controlled trial, incorporate participants identified as having ASCVD and interventions aimed at improving adherence to medicines for secondary prevention of ASCVD and measure both adherence and a clinical outcome. Two reviewers independently determined the eligibility of studies, extracted data and conducted a narrative synthesis.ResultsWe identified 17 trials (n=17 448 participants). Most trials had high risk of bias in at least one domain. The intervention group adherence rates ranged from 44%to99% and the comparator group adherence rates ranged from 13% to 96%. Three distinct interventions reported improvements in both adherence and clinical outcomes: short message service (65% vs 13% of participants with high adherence in the intervention vs control group), a fixed-dose combination pill (86% vs 65% adherence, risk ratio of being adherent, 1.33; 95% CI 1.26 to 1.41) and a community health worker-based intervention (97% in the intervention group compared with 92% in the control group; OR=2.62, 95% CI 1.32 to 5.19).ConclusionsWe identified three interventions that demonstrated improvements in adherence and clinical outcomes. Ongoing, longer-term trials will help determine whether short-term changes in adherence can be maintained and lead to differences in clinical events.
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Östbring MJ, Eriksson T, Petersson G, Hellström L. Motivational Interviewing and Medication Review in Coronary Heart Disease (MIMeRiC): Protocol for a Randomized Controlled Trial Investigating Effects on Clinical Outcomes, Adherence, and Quality of Life. JMIR Res Protoc 2018; 7:e57. [PMID: 29463490 PMCID: PMC5840476 DOI: 10.2196/resprot.8659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/15/2017] [Accepted: 12/16/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Preventive treatment goals for blood pressure and cholesterol levels continue to be unmet for many coronary patients. The effect of drug treatment depends on both its appropriateness and the patients' adherence to the treatment regimen. There is a need for adherence interventions that have a measurable effect on clinical outcomes. OBJECTIVE This study aims to evaluate the effects on treatment goals of an intervention designed to improve patient adherence and treatment quality in secondary prevention of coronary heart disease. A protocol for the prespecified process evaluation of the trial is published separately. METHODS The Motivational Interviewing and Medication Review in Coronary heart disease (MIMeRiC) trial is a prospective, randomized, outcomes-blinded trial designed to compare individualized follow-up by a clinical pharmacist using motivational interviewing (MI) and medication review with standard follow-up. Patients were randomized to 2 groups after stratification according to their beliefs about medicines. After standard follow-up at the cardiology clinic, patients in the intervention group are seen individually by a clinical pharmacist 2 to 5 times as required over 7 months, at the clinic. The pharmacist reviews each patient's medication and uses MI to manage any problems with prescribing and adherence. The primary study outcome is the proportion of patients who have reached the treatment goal for low-density lipoprotein cholesterol by 12 months after discharge. Secondary outcomes are the effects on patient adherence, systolic blood pressure, disease-specific quality of life, and health care use. RESULTS The protocol for this study was approved by the Regional Ethics Committee, Linköping, in 2013. Enrollment started in October 2013 and ended in December 2016 when 417 patients had been included. Follow-up data collection will conclude in March 2018. Publication of the primary and secondary outcome results from the MIMeRiC trial is anticipated in 2019. CONCLUSIONS The MIMeRiC trial will assess the effectiveness of an intervention involving medication reviews and individualized support. The results will inform the continued development of support for this large group of patients who use preventive medicines for lifelong treatment. The design of this adherence intervention is based on a theoretical framework and is the first trial of an intervention that uses beliefs about medicines to individualize the intervention protocol. TRIAL REGISTRATION ClinicalTrials.gov NCT02102503; https://clinicaltrials.gov/ct2/show/NCT02102503 (Archived by WebCite at http://www.webcitation.org/6x7iUDohy).
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Affiliation(s)
- Malin Johansson Östbring
- Pharmaceutical Department, Kalmar County Council, Kalmar, Sweden.,eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Tommy Eriksson
- Department of Biomedical Science, Malmö University, Malmö, Sweden.,Department of Clinical and Molecular Medicine, Norweigan University of Sciences and Technology, Trondheim, Norway
| | - Göran Petersson
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Lina Hellström
- Pharmaceutical Department, Kalmar County Council, Kalmar, Sweden
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31
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Chow CK, Thiagalingam A, Santo K, Kok C, Thakkar J, Stepien S, Billot L, Jan S, Joshi R, Hillis GS, Brieger D, Chew DP, Rådholm K, Atherton JJ, Bhindi R, Collins N, Coverdale S, Hamilton-Craig C, Kangaharan N, Maiorana A, McGrady M, Shetty P, Thompson P, Rogers A, Redfern J. TEXT messages to improve MEDication adherence and Secondary prevention (TEXTMEDS) after acute coronary syndrome: a randomised clinical trial protocol. BMJ Open 2018; 8:e019463. [PMID: 29374674 PMCID: PMC5829769 DOI: 10.1136/bmjopen-2017-019463] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Identifying simple, low-cost and scalable means of supporting lifestyle change and medication adherence for patients following a cardiovascular (CV) event is important. OBJECTIVE The TEXTMEDS (TEXT messages to improve MEDication adherence and Secondary prevention) study aims to investigate whether a cardiac education and support programme sent via mobile phone text message improves medication adherence and risk factor levels in patients following an acute coronary syndrome (ACS). STUDY DESIGN A single-blind, multicentre, randomised clinical trial of 1400 patients after an ACS with 12 months follow-up. The intervention group will receive multiple weekly text messages that provide information, motivation, support to adhere to medications, quit smoking (if relevant) and recommendations for healthy diet and exercise. The primary endpoint is the percentage of patients who are adherent to cardioprotective medications and the key secondary outcomes are mean systolic blood pressure (BP) and low-density lipoprotein cholesterol. Secondary outcomes will also include total cholesterol, mean diastolic BP, the percentage of participants who are adherent to each cardioprotective medication class, the percentage of participants who achieve target levels of CV risk factors, major vascular events, hospital readmissions and all-cause mortality. The study will be augmented by formal economic and process evaluations to assess acceptability, utility and cost-effectiveness. SUMMARY The study will provide multicentre randomised trial evidence of the effects of a text message-based programme on cardioprotective medication adherence and levels of CV risk factors. ETHICS AND DISSEMINATION Primary ethics approval was received from Western Sydney Local Health District Human Research Ethics Committee (HREC2012/12/4.1 (3648) AU RED HREC/13/WMEAD/15). Results will be disseminated via peer-reviewed publications and presentations at international conferences. TRIAL REGISTRATION NUMBER ACTRN12613000793718; Pre-results.
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Affiliation(s)
- Clara K Chow
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Aravinda Thiagalingam
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Karla Santo
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Cindy Kok
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jay Thakkar
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sandrine Stepien
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Laurent Billot
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen Jan
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Rohina Joshi
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Graham S Hillis
- Department of Cardiology, School of Medicine and Pharmacology, University of Western Australia, Royal Perth Hospital, Perth, WA, Australia
| | - David Brieger
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Derek P Chew
- Department of Cardiology, Flinders University, Adelaide, Australia
| | - Karin Rådholm
- Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Faculty of Health Sciences, Department of Local Care West, County Council of Östergötland, Linköping University, Linköping, Sweden
| | - John J Atherton
- Department of Cardiology, Royal Brisbane and Women's Hospital and University of Queensland School of Medicine, Brisbane, QLD, Australia
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Nicholas Collins
- Deaprtment of Cardiology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Steven Coverdale
- Department of Cardiology, Sunshine Coast University Hospital, Birtinya, QLD, Australia
| | - Christian Hamilton-Craig
- Department of Cardiology, The Prince Charles Hospital and University of Queensland, Brisbane, QLD, Australia
| | - Nadarajah Kangaharan
- Department of Cardiology, Royal Darwin Hospital, Darwin, NT, Australia
- Department of Cardiology, Alice Springs Hospital, Alice Springs, NT, Australia
| | - Andrew Maiorana
- School of Physiotherapy and Exercise Science, Curtin University and Fiona Stanley Hospital, Perth, WA, Australia
| | - Michelle McGrady
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Pratap Shetty
- Department of Cardiology, Wollongong Hospital, Wollongong, NSW, Australia
| | - Peter Thompson
- Department of Cardiology, Sir Charles Gairdner Hospital, Pert, WA, Australia
| | - Anthony Rogers
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Julie Redfern
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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Crawshaw J, Auyeung V, Ashworth L, Norton S, Weinman J. Healthcare provider-led interventions to support medication adherence following ACS: a meta-analysis. Open Heart 2017; 4:e000685. [PMID: 29344366 PMCID: PMC5761293 DOI: 10.1136/openhrt-2017-000685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/09/2017] [Accepted: 11/07/2017] [Indexed: 01/01/2023] Open
Abstract
We conducted a systematic review and meta-analysis to determine the effectiveness of healthcare provider-led (HCPs) interventions to support medication adherence in patients with acute coronary syndrome (ACS). A systematic search of Cochrane Library, Medline, EMBASE, PsycINFO, Web of Science, IPA, CINAHL, ASSIA, OpenGrey, EthOS, WorldCat and PQDT was undertaken. Interventions were deemed eligible if they included adult ACS patients, were HCP-led, measured medication adherence and randomised participants to parallel groups. Intervention content was coded using the Behaviour Change Technique (BCT) Taxonomy and data were pooled for analysis using random-effects models. Our search identified 8870 records, of which 27 were eligible (23 primary studies). A meta-analysis (n=9735) revealed HCP-led interventions increased the odds of medication adherence by 54% compared to control interventions (k=23, OR 1.54, 95% CI 1.26 to 1.88, I2=57.5%). After removing outliers, there was a 41% increase in the odds of medication adherence with moderate heterogeneity (k=21, OR 1.41, 95% CI 1.21 to 1.65, I2=35.3%). Interventions that included phone contact yielded (k=12, OR 1.63, 95% CI 1.25 to 2.12, I2=32.0%) a larger effect compared to those delivered exclusively in person. A total of 32/93 BCTs were identified across interventions (mean=4.7, SD=2.2) with 'information about health consequences' (BCT 5.1) (19/23) the most common. HCP-led interventions for ACS patients appear to have a small positive impact on medication adherence. While we were able to identify BCTs among interventions, data were insufficient to determine the impact of particular BCTs on study effectiveness. PROSPERO registration number CRD42016037706.
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Affiliation(s)
- Jacob Crawshaw
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Vivian Auyeung
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Lucy Ashworth
- School of Health Sciences, City University of London, London, UK
| | - Sam Norton
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - John Weinman
- Institute of Pharmaceutical Science, King's College London, London, UK
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Santo K, Chow CK, Thiagalingam A, Rogers K, Chalmers J, Redfern J. MEDication reminder APPs to improve medication adherence in Coronary Heart Disease (MedApp-CHD) Study: a randomised controlled trial protocol. BMJ Open 2017; 7:e017540. [PMID: 28993388 PMCID: PMC5640083 DOI: 10.1136/bmjopen-2017-017540] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION The growing number of smartphone health applications available in the app stores makes these apps a promising tool to help reduce the global problem of non-adherence to long-term medications. However, to date, there is limited evidence that available medication reminder apps are effective. This study aims to determine the impact of medication reminder apps on adherence to cardiovascular medication when compared with usual care for people with coronary heart disease (CHD) and to determine whether an advanced app compared with a basic app is associated with higher adherence. METHODS AND ANALYSIS Randomised controlled trial with follow-up at 3 months to evaluate the feasibility and effectiveness of medication reminder apps on medication adherence compared with usual care. An estimated sample size of 156 patients with CHD will be randomised to one of three groups (usual care group, basic medication reminder app group and advanced medication reminder app group). The usual care group will receive standard care for CHD with no access to a medication reminder app. The basic medication reminder app group will have access to a medication reminder app with a basic feature of providing simple daily reminders with no interactivity. The advanced medication reminder app group will have access to a medication reminder app with additional interactive and customisable features. The primary outcome is medication adherence measured by the eight-item Morisky Medication Adherence Scale at 3 months. Secondary outcomes include clinical measurements of blood pressure and cholesterol levels, and medication knowledge. A process evaluation will also be performed to assess the feasibility of the intervention by evaluating the acceptability, utility and engagement with the apps. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Western Sydney Local Health Network Human Research Ethics Committee (AU/RED/HREC/1/WMEAD/3). Study findings will be disseminated via usual scientific forums. TRIAL REGISTRATION NUMBER ACTRN12616000661471; Pre-results.
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Affiliation(s)
- Karla Santo
- Cardiovascular Division, The George Institute for Global Health, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Clara K Chow
- Cardiovascular Division, The George Institute for Global Health, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Aravinda Thiagalingam
- Sydney Medical School, University of Sydney, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Cardio-respiratory Division, Westmead Institute for Medical Research, Sydney, Australia
| | - Kris Rogers
- Statistics Division, The George Institute for Global Health, Sydney, Australia
| | - John Chalmers
- Sydney Medical School, University of Sydney, Sydney, Australia
- Professorial Unit, The George Institute for Global Health, Sydney, Australia
| | - Julie Redfern
- Cardiovascular Division, The George Institute for Global Health, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
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35
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Causes of death in atrial fibrillation: Challenges and opportunities. Trends Cardiovasc Med 2017; 27:494-503. [PMID: 28602539 DOI: 10.1016/j.tcm.2017.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 04/28/2017] [Accepted: 05/02/2017] [Indexed: 11/20/2022]
Abstract
Atrial fibrillation (AF) is an age-related arrhythmia associated with several co-morbidities and significant mortality. Most AF patients are in need of anticoagulation due to increased risk of stroke. Despite anticoagulation, AF patients still have a significant risk of death (about 5%/y). Approximately half of deaths in AF are due to heart-related causes (i.e., sudden death, heart failure, and myocardial infarction), one-third of deaths are due to non-vascular causes (i.e., cancer, respiratory diseases, and infections) and the remaining AF patients die from stroke or hemorrhage (about 6% each), or other causes. This review describes current situations related to causes of death in AF, the challenges in the management of AF (e.g., frequent presence of cardiovascular risk factors and co-morbidities, physicians adherence to clinical guidelines and patients adherence to cardiovascular medications in AF) as well as the opportunities for intervention.
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Lapatto-Reiniluoto O, Sinisalo J, Roine R. The problem with non-adherence arising from medical practices. Eur J Prev Cardiol 2017; 24:1093-1094. [PMID: 28345367 DOI: 10.1177/2047487317702045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Outi Lapatto-Reiniluoto
- 1 Department of Clinical Pharmacology, Helsinki University Hospital and University of Helsinki, Finland
| | - Juha Sinisalo
- 2 Heart and Lung Centre, Helsinki University Hospital and University of Helsinki, Finland
| | - Risto Roine
- 3 Research Centre for Comparative Effectiveness and Patient safety (RECEPS), University of Eastern Finland, Finland.,4 Administration, University of Helsinki and Helsinki University Hospital, Finland
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Huffman MD, Xavier D, Perel P. Uses of polypills for cardiovascular disease and evidence to date. Lancet 2017; 389:1055-1065. [PMID: 28290995 DOI: 10.1016/s0140-6736(17)30553-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/12/2017] [Accepted: 02/13/2017] [Indexed: 12/11/2022]
Abstract
Polypills have been approved in more than 30 countries, but worldwide experience with and availability of polypills remain limited, unlike fixed-dose combinations in other diseases such as HIV, tuberculosis, and malaria. In this Series review, we aim to propose a guide for the use of polypills in future research and clinical activities and to synthesise contemporary evidence supporting the use of polypills for prevention of atherosclerosis. Polypill uses can be categorised by population and indication, both of which influence the balance between benefits and risks. Populations include secondary prevention, high-risk primary prevention based on formal risk assessment, and primary prevention based on single risk factor measurement, such as age, also known as mass treatment. For each population, potential indications are initiation, step-up of current drug therapy, and straight substitution of individual drug components. We summarise efficacy and safety results from 13 polypill trials (9059 participants) done in 32 countries. Polypills improve adherence, are generally well tolerated, and reduce risk factor levels, although heterogeneity limits the certainty of the effect on risk factors. Trials published to date have not been designed to detect differences in clinical outcomes, and thus no significant differences between polypill and comparator groups have been reported. Polypill therapy could be one of the most scalable strategies to reduce the risk of premature mortality from atherosclerosis by 25% by 2025 by improving medication adherence and access, but further trial data and clinical experience will be useful to determine how polypills can best be implemented to achieve this goal.
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Affiliation(s)
- Mark D Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Denis Xavier
- Department of Pharmacology and Division of Clinical Research, St John's Medical College and Research Institute, St John's National Academy of Health Sciences, Bangalore, India
| | - Pablo Perel
- Centre for Global Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Multidimensional factors affecting medication adherence among community-dwelling older adults: a structural-equation-modeling approach. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0764-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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