Assessing the impact of prescribed medicines on health outcomes

Driving Efficiency Improvement (EI): Exploratory Analysis of a Centralised Model in New South Wales

Introduction

Public healthcare systems face rising demand coupled with reducing funding growth rates, necessitating ongoing approaches to efficiency improvement (EI). Centrally coordinated EI approaches l may support EI leaders, yet few such approaches exist internationally. This study provides evidence to inform system-wide EI by harnessing understanding of the perceptions, role demands and support requirements of key EI stakeholders in the centralised EI model implemented in New South Wales.

Methods

A purposive sample of key informants within NSW Health with responsibility for EI in their organisation were invited to participate. Semi-structured interviews were conducted, recorded and transcribed. A thematic analysis was undertaken using a theoretical deductive approach.

Results

Seventeen respondents participated who occupied EI leadership roles in metro (8) and rural (6) health services as well as non-clinical support (3) services. Four primary themes emerged on the perceptions and experiences of participants in 1. holding a unique skillset which enables them to undertake EI; 2. inheriting EI accountabilities as additional duties rather than holding dedicated EI roles; 3. the importance of senior support for EI success; and 4. feelings of isolation in undertaking EI. An additional underpinning theme that EI is not well conceptualized in public health systems also emerged, whereby EI planners felt that frontline staff generally do not consider efficiency as a component of their duties.

Conclusion

EI leaders provide points of authority, experience and influence across organisations within public health systems. This study finds that EI planners possess a unique skillset, can feel isolated both within their health organisation and within the broader public health system and believe that EI is poorly conceptualized amongst health staff. Centralised support for EI stakeholders across a public health system can promote knowledge sharing and capability development. Addressing the role and support requirements of key EI stakeholders is essential.

Determinants of medication non-adherence in Egyptian patients with systemic lupus erythematosus: Sharkia Governorate

The aim of the study was to identify the determinants of adherence to medication among Egyptian patients with SLE. A single-center cross-sectional study was conducted among Egyptian patients with SLE. Adherence to medication was measured via The Compliance Questionnaire for Rheumatology-19, and the patients were classified as non-adherers if they were taking <80% of their medication correctly. Predictors of adherence to SLE medication were determined by multiple logistic regressions. The mean age of participants was 30.9 ± 11.7 years. Females constituted 95% of all participants. Thirty-eight (%) were taking <80% of their medication correctly. On logistic regression analysis, the significant independent predictors of medication non-adherence were lower educational level (OR 5.6, 95% CI 2.1-7.3, P < 0.001), very low and low socioeconomic status (OR 2.6, 95% CI 1.6-4.3, P < 0.04), rural residency (OR 3.4, 95% CI 1.4-5, P < 0.01), more number of medications (OR 3.2, 95% CI 2.3-6.9, P < 0.01), and higher depressive symptoms (OR 3.7, 95% CI 1.4-10.2, P < 0.001). The adherence rate reported in this study was quite low. Appropriate adherence enhancing intervention strategies targeted at reducing pill load, minimizing depressive symptoms, and ensuring an uninterrupted access to free services regimen for patients with low socioeconomic status is strongly recommended. More attention should be given to SLE patients who live in rural regions.

Predictors of Medication Adherence in Patients with Rheumatoid Arthritis

Medication adherence is a significant problem in patients with rheumatoid arthritis (RA), a prevalent autoimmune disease. Due to the equivocal results reported in the research, consistent predictors of medication adherence in patients with RA are undetermined. A cross-sectional descriptive, predictive study of 108 patients with RA was used to: 1) describe self-reported medication adherence to disease modifying anti-rheumatic drugs (DMARDs); 2) compare demographic (age, residence, marital status, employment status, years of education, and ethnicity) and clinical (duration of disease and number of medications) factors of adherent and non-adherent individuals; and 3) determine the predictive power of demographic and clinical factors for DMARD adherence using various cut-points (research-based, mean, and median) on a validated, self-report scale measuring medication adherence. Independent samples t-tests, Chi square analyses, and logistic regression modeling were used to analyze these data. Approximately 90% of the individuals with RA reported adherence with their prescribed DMARD prescriptions. The only demographic and clinical difference between the adherent and non-adherent group was ethnicity (p=0.04); nonwhite individuals reported significantly less adherence with their prescribed DMARDs when compared to white individuals. Logistic regression models identified ethnicity (OR= 3.34-10.1; p< 0.05) and the number of medications taken (OR=1.7; p< 0.05) as predictors of medication non-adherence. These data provide evidence that ethnicity and taking an increased number of prescribed medications are independent predictors of medication adherence in patients with RA. These findings confirm the presence of a health disparity and an area where further research is needed to optimize patient outcomes.