An overview of the common methods used to measure treatment adherence

Real-world psoriasis treatment patterns and disease burden in Germany, with a focus on biologics and apremilast: data from a German statutory health insurance database

BACKGROUND

Psoriasis is a chronic, systemic, inflammatory skin disease, with increasing prevalence; however, few studies have reported real-world prescription patterns and healthcare burden.

OBJECTIVES

This retrospective, observational cohort study used statutory health insurance claims data (January 2014-December 2019) to estimate prevalence/incidence of moderate-to-severe psoriasis in Germany. Patient characteristics, treatment patterns/compliance, and healthcare resource utilization (HCRU)/costs were evaluated, focusing on apremilast and anti-interleukin (IL), and anti-tumor necrosis factor (TNF) biologics.

METHODS

The epidemiology population included adults with psoriasis; 1-year prevalence/incidence rates were extrapolated to the statutory health insurance population. The HCRU/costs population included adults with psoriasis and a first prescription for a drug of interest (index date). Baseline periods were 12 or 48 months before the index date, with 12‑month follow-up.

RESULTS

In 2019, the estimated psoriasis prevalence/incidence was 2,672.9 per 100,000 individuals/508.7 per 100,000 person-years. Of 2,809 patients in the HCRU/costs population, 3.6% (n = 101) received index drug apremilast, 10.2% (n = 287) anti-IL, 6.8% (n = 191) anti-TNF, and 79.4% (n = 2,230) traditional/other systemic therapy. Patients initiating apremilast were older and were more often biologic-naïve than those initiating anti-IL/TNF biologics. Twelve months after treatment initiation, drug adherence (medication possession rate >80%) and persistence (<60 days between prescriptions/no switch) were lower for apremilast vs. anti-IL and anti-TNF groups (24.8% vs. 59.6% and 53.9%; 36.6% vs. 66.9% and 57.6%, respectively). During a 12-month baseline period, psoriasis-related hospitalization was lower for apremilast vs. anti-IL and anti-TNF groups (4.95% vs. 15.68% and 14.14%) and higher during 12 months' follow-up (5.94% vs. 2.44% and 3.14%). Adjusted index drug costs during follow-up were €4,105, €3,498, and €13,777 higher for adalimumab, other anti-TNF and anti-IL biologics vs. apremilast, respectively, and the main driver for lower overall apremilast costs.

CONCLUSION

Given variation in treatment adherence/persistence, HCRU, and costs between apremilast and biologics, these findings could be key considerations during treatment selection.

Adherence and Persistence with Single-Inhaler Triple Therapy Among Patients with COPD Using Commercial and Medicare Advantage US Health Plan Claims Data

INTRODUCTION

Previously, adherence and persistence to treatment have been shown to improve outcomes among patients with chronic obstructive pulmonary disease (COPD). This study aimed to evaluate adherence and persistence to single-inhaler triple therapy with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI; one inhalation, once-daily) compared with budesonide/glycopyrrolate/formoterol fumarate (BUD/GLY/FOR; two inhalations, twice-daily) among patients with COPD in the USA.

METHODS

This retrospective weighted cohort study used claims data from the IQVIA PharMetrics® Plus Database from October 1, 2019 to March 31, 2023, to identify patients with COPD newly initiating FF/UMEC/VI or BUD/GLY/FOR. Index date was the first pharmacy claim for FF/UMEC/VI or BUD/GLY/FOR on or after October 1, 2020. The longest follow-up period was 12 months. Inverse probability of treatment weighting was used to balance baseline characteristics between cohorts. Adherence was measured as mean proportion of days covered (PDC); the proportion of patients with PDC ≥ 0.5 and PDC ≥ 0.8 was also assessed. Persistence was assessed as time to treatment discontinuation using Kaplan-Meier rates.

RESULTS

Overall, 8912 and 2685 patients were included in the FF/UMEC/VI and BUD/GLY/FOR cohorts, respectively. After weighting, mean age and proportion of patients with Medicare Advantage insurance was 64.62 years and 40.0% in the FF/UMEC/VI cohort and 63.96 years and 36.1% in the BUD/GLY/FOR cohort. At 6 months post-index, mean PDC was greater in the FF/UMEC/VI versus the BUD/GLY/FOR cohort (0.65 versus 0.59; P < 0.001). A significantly greater proportion of patients in the FF/UMEC/VI versus the BUD/GLY/FOR cohort had PDC ≥ 0.8 (45.6% versus 34.5%; P < 0.001) and PDC ≥ 0.5 (71.8% versus 64.3%; P < 0.001). Results were consistent at 12 months post-index. When a 30-day gap was used to define treatment discontinuation, the FF/UMEC/VI cohort had statistically significantly greater treatment persistence versus the BUD/GLY/FOR cohort at all time points.

CONCLUSION

In this study, patients initiating FF/UMEC/VI had significantly greater adherence and persistence to treatment than patients initiating BUD/GLY/FOR.

Capturing Real-World Rare Disease Patient Journeys: Are Current Methodologies Sufficient for Informed Healthcare Decisions?

RATIONALE

Despite growing emphasis among healthcare decision-makers on patient perspectives and real-world outcomes to inform care and access decisions, understanding of patient journey experiences in rare diseases remains limited due to data collection and evaluation challenges.

AIMS AND OBJECTIVES

This systematic literature review (SLR) assessed study designs, methodologies, and outcomes reported in real-world investigations of rare disease patient journeys.

METHODS

Searches in PubMed and Google Scholar targeted English-language publications and congress proceedings from 1 January 2014, to 30 April 2024, including rare disease patients, caregivers, or healthcare providers. Keywords included 'Journey', 'Path', or 'Odyssey'. Two reviewers independently assessed eligibility and abstracted data. Descriptive analyses and quality assessments were conducted.

RESULTS

Thirty-one studies met inclusion criteria, with 296,548 participants spanning over 600 rare diseases. Most studies used prospective observational (61%) and cross-sectional (26%) designs and were conducted in Europe (45%). Interviews (39%) and surveys (29%) were common methodologies. Patients (87%) were the primary research focus, compared to caregivers (32%) or providers (10%). The most studied journey stages were 'Pre-diagnosis/Screening' (97%) and 'Diagnosis' (84%), while 'Disease Awareness' (16%) and 'Treatment Adherence' (6%) were less common. Across 164 outcomes reported, frequent outcomes included 'Healthcare Resource Utilization' (94%), 'Symptoms' (74%), and 'Time-to-Diagnosis' (71%). Fewer studies reported 'Costs' (19%), 'Caregiver/Family Burden' (16%), and 'Productivity' (13%). Time-to-diagnosis averaged 11.8 years and a median of 6.1 years. All but one study (97%) was rated low or very low quality due to observational designs.

CONCLUSION

Most rare disease patient journey evidence focuses on 'Pre-diagnosis/Screening' and 'Diagnosis' stages using qualitative methods and surveys. While symptoms, time-to-diagnosis, and resource utilization were commonly reported, evidence gaps included treatment adherence, caregiver burden and productivity. Longitudinal assessments to collect real-world care and treatment burden outcomes, including caregiver perspectives, can enhance both clinician and policy decision-making for individuals living with rare diseases.

Suitability of Measures of Pharmacy-Based Medication Adherence for Routine Clinical Use Among Patients with Chronic Diseases: A Systematic Review

Purpose

To identify the suitability of pharmacy-based measures for determining medication adherence in routine clinical use.

Methods

Data were obtained through PubMed and Scopus databases up to December 2023 without publication year restrictions. This review included English studies on assessing medication adherence for hypertension, hyperlipidemia, asthma, chronic obstructive pulmonary disease, and diabetes, using pharmacy databases and providing full-text access. We investigated evidence quality utilizing the Newcastle-Ottawa Scale for non-randomized studies (cohort, case-control, and cross-sectional) and the Risk of Bias Assessment Tool for Non-randomized Studies-2 and JADAD scales for quasi-experiments and randomized control trials, respectively. We determined validity characteristics (completeness, accuracy, reliability, objectivity, continuous adherence history, non-intrusiveness, sensitivity, and specificity) and applicability (cost-effectiveness, ease of use, and interpretability) to evaluate the suitability of pharmacy-based medication adherence measures in clinical settings.

Results

This review retrieved 1513 studies, of which 74 met the inclusion criteria. All of the studies, which were published from 2000 to 2023 and mostly utilized a retrospective cohort design (n = 53), included 17.6 million patients. Of the 74 studies, 50 were conducted in the United States. Diabetes mellitus (n = 40) was the most prevalent disease, whereas the medication possession ratio (n = 46) and prescription days covered (n = 31) were the most prevalent pharmacy-based matrix. According to the results, 73 articles demonstrated validity characteristics, whereas 1 article lacked these characteristics. All 74 (100%) articles had applicability characteristics.

Conclusion

This systematic review demonstrates that pharmacy-based measures possess valid characteristics, including comprehensive, accurate, objective, reliable, and continuously updated adherence history records. These measures are designed to minimize disruption while offering high sensitivity and specificity. Furthermore, they are characterized by their practicality, being cost-effective, easy to implement, and easy to interpret. These findings suggest that pharmacy-based measures are potentially suitable to assess medication adherence for routine clinical use.

Identification of risk factors for suboptimal adherence in people living with HIV through measurement of medication possession ratio: a cross-sectional study

The most significant progress in addressing the HIV/AIDS epidemic has been the development of antiretroviral therapy (ART). However, ensuring a high degree of treatment adherence is necessary to prevent resistance and disease progression. We conducted a cross-sectional study to evaluate adherence to ART through the calculation of the medication possession ratio (MPR) and to identify risk factors for suboptimal adherence in a cohort of HIV-positive patients receiving care at a Colombian healthcare institution across 16 cities. Records of 12,145 users were analyzed, and a multivariate logistic regression model was performed, considering optimal adherence (MPR > =  95%) versus suboptimal adherence (MPR < 95%) as the reference. Suboptimal adherence to ART was identified in 29% of users. Residence region, presence of HIV-defining illnesses, chronic kidney disease (CKD), co-infections such as hepatitis C, tuberculosis, and sexually transmitted infections, treatment duration of more than 5 years, and non-suppressed viral load were identified as risk factors for non-adherence. This underscores the need to identify interventions for those vulnerable groups to minimize the likelihood of non-adherence and to intervene in care models focused on the medical needs of these patients.

Use of mHealth Technology for Improving Exercise Adherence in Patients With Heart Failure: Systematic Review

BACKGROUND

The known and established benefits of exercise in patients with heart failure (HF) are often hampered by low exercise adherence. Mobile health (mHealth) technology provides opportunities to overcome barriers to exercise adherence in this population.

OBJECTIVE

This systematic review builds on prior research to (1) describe study characteristics of mHealth interventions for exercise adherence in HF including details of sample demographics, sample sizes, exercise programs, and theoretical frameworks; (2) summarize types of mHealth technology used to improve exercise adherence in patients with HF; (3) highlight how the term "adherence" was defined and how it was measured across mHealth studies and adherence achieved; and (4) highlight the effect of age, sex, race, New York Heart Association (NYHA) functional classification, and HF etiology (systolic vs diastolic) on exercise adherence.

METHODS

We searched for papers in PubMed, MEDLINE, and CINAHL databases and included studies published between January 1, 2015, and June 30, 2022. The risk of bias was analyzed.

RESULTS

In total, 8 studies (4 randomized controlled trials and 4 quasi-experimental trials) met our inclusion and exclusion criteria. A moderate to high risk of bias was noted in the studies. All studies included patients with HF in NYHA classification I-III, with sample sizes ranging from 12 to 81 and study durations lasting 4 to 26 weeks. Six studies had an equal distribution of male and female participants whose ages ranged between 53 and 73 years. Videoconferencing was used in 4 studies, while 4 studies used smartphone apps. Three studies using videoconferencing included an intervention that engaged participants in a group setting. A total of 1 study used a yoga program, 1 study used a walking program, 1 study combined jogging with walking, 1 study used a cycle ergometer, 2 studies combined walking with cycle ergometry, and 1 study used a stepper. Two studies incorporated resistance exercises in their program. Exercise programs varied, ranging between 3 and 5 days of exercise per week, with exercise sessions ranging from 30 to 60 minutes. The Borg rating of perceived exertion scale was mostly used to regulate exercise intensity, with 3 studies using heart rate monitoring using a Fitbit. Only 1 study implicitly mentions developing their intervention using a theoretical framework. Adherence was reported to the investigator-developed exercise programs. All studies were mostly feasibility or pilot studies, and the effect of age, sex, race, and NYHA classification on exercise adherence with the use of mHealth was not reported.

CONCLUSIONS

The results show some preliminary evidence of the feasibility of using mHealth technology for building exercise adherence in patients with HF; however, theoretically sound and fully powered studies, including studies on minoritized communities, are lacking. In addition, the sustainability of adherence beyond the intervention period is unknown.

Strategies for Effective Communication in Hypertension Management: Validation of Messages from a Mobile Application to Assist Hypertensive Older Adults in Adherence to Treatment, Nutrition and Physical Activity

BACKGROUND

Poor adherence to antihypertensive treatment is a common problem among elderly hypertensive patients and one of the leading causes of inadequate blood pressure control. In this sense, it is essential to improve strategies for effective communication in managing hypertension treatment for this group.

OBJECTIVE

This study aimed to validate the text messages of a mobile application to aid adherence to antihypertensive treatment, nutrition, and physical activity among older adults with hypertension treated in Brazilian public primary health care.

METHODS

This descriptive, methodological development study with a quantitative approach was carried out between March and August 2024.

RESULTS

A total of 27 messages were constructed and validated by 13 experts, and this stage was divided into two rounds. The Content Validity index and percentage of agreement were used in the validation process. The messages were developed using theory, national guidelines, validation, and expert review.

CONCLUSIONS

Text messages for adherence to antihypertensive treatment involving medication, nutrition, and physical activity have enormous potential with the target audience studied.

Exploring the association of adverse drug reactions with medication adherence and quality of life among hypertensive patients: a cross-sectional study

BACKGROUND

Effective hypertension management requires medication adherence to prevent complications. However, adverse drug reactions (ADRs) can undermine adherence and negatively affect patients' quality of life. Limited research has explored the association between ADRs, medication adherence, and health-related quality of life (HRQoL) in individuals with hypertension.

AIM

To investigate the association between ADRs, medication adherence, and HRQoL among patients with hypertension.

METHOD

A cross-sectional study using telephone interviews and medical record reviews was conducted in 11 primary care facilities in Indonesia. The causality of reported ADRs was assessed using the Naranjo algorithm, validated by a panel of experts in pharmacy practice and medication safety. The severity of ADRs was classified using the Hartwig scale. Adherence to antihypertensive drugs was estimated using the Medication Adherence Report Scale-5 (MARS-5). The EuroQoL EQ-5D-5L was used to measure HRQoL. The association between ADRs and medication adherence was assessed using multivariate logistic regression, while the association with HRQoL was evaluated through the Tobit regression model.

RESULTS

A total of 507 patients were included in this study. We found that 20.32% (n = 103) of the patients experienced ADRs, with the most commonly reported ADRs being polyuria and urgency, gastrointestinal symptoms, leg swelling, dizziness/hypotension, palpitations, and dry cough. The majority experienced mild ADRs (n = 75, 72.82%), while 27.18% (n = 28) had reactions of moderate severity. Experiencing ADRs was associated with reduced medication adherence (adjusted odds ratio (OR) 7.15, 95% CI 4.07-12.55) and decreased HRQoL (coefficient: - 0.037).

CONCLUSION

Patients experiencing ADRs were seven times more likely to be non-adherent to their medication regimen and reported a reduced quality of life compared to those without ADRs, placing them at a higher risk of suboptimal treatment outcomes. This finding highlights the need for additional monitoring and education for patients affected by ADRs, particularly through more frequent clinical and laboratory assessments, timely management of ADRs, and personalized education on the importance of adherence to prevent hypertension-related complications.

Intake Patterns and Experiences of Patients Using Direct Oral Anticoagulants Measured by Electronic Monitoring in Community Pharmacies

Purpose

Several international organizations advocate for monitoring of adherence to direct oral anticoagulants (DOACs), given the prevalent issue of suboptimal adherence to DOACs. The aim was to investigate intake patterns in patients on DOAC therapy by electronic monitoring of medication adherence in community pharmacies (using a Medication Event Monitoring System® (MEMS®)-device), and to assess patients' experiences with this device.

Patients and Methods

Patients using apixaban, rivaroxaban or edoxaban and visiting a community pharmacy, were included. Adherence was electronically monitored over a twelve-week period. Pharmacists conducted data readings from the electronic device at six and twelve weeks, and discussed these data with the patients. At the beginning and end of the study, patients completed a questionnaire about their expectations and experiences respectively.

Results

Eighty-nine patients were included and high taking adherence rates were observed (median adherence of 100% for once-daily dosed patients and 96.7% for twice-daily dosed patients), but more than half of the patients took at least one dose too late or skipped at least one dose, possibly resulting in temporarily reduced protection against thromboembolic events. Most patients who felt that their adherence had improved, believed this was due to the combination of the electronic device and the personal follow-up by the pharmacist. Although most patients stated that medication adherence is their own responsibility, they were grateful for the support they received from their community pharmacist.

Conclusion

High adherence rates were observed, but there was still room for improvement regarding intake moments. Positive experiences with an electronic device for medication adherence monitoring were reported.

ECLIPSES: Early initiation of sodium glucose cotransporter-2 inhibitors for cardiovascular protection in patients with type 2 diabetes following acute coronary syndrome and subsequent coronary artery bypass graft surgery

INTRODUCTION

There is a paucity of data evaluating early initiation of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients with diabetes following acute coronary syndrome (ACS) and coronary artery bypass graft surgery (CABG).

OBJECTIVES

To describe the efficacy and safety of SGLT2i initiated early after CABG in patients with type 2 diabetes who experienced ACS.

METHODS

This is a retrospective cohort study of patients with type 2 diabetes (T2DM) who experienced ACS and subsequent CABG with follow up at 3 and 12 months. Patients who filled a SGLT2i prescription within 14 days of discharge were allocated to the SGLT2i group and those who did not were included in the no SGLT2i group. The primary efficacy end point was first occurrence of a 4-point Major Adverse Cardiovascular Event (MACE), and the primary safety end point was a composite of hypoglycemia, hypotension, diabetic ketoacidosis, acute kidney injury, and urinary tract infection. Secondary end points included a comparative analysis of the primary outcome, 30-day readmission rates, and subgroup analyses of key populations.

RESULTS

A total of 1629 patients were included: 226 received a SGLT2i within 14 days of discharge and 1403 did not. At 12 months, 8.9% and 15.3% of patients experienced MACE in the SGLT2i and no SGLT2i groups, respectively (adjusted Hazard Ratio [aHR] 0.65, 95% confidence interval [CI] 0.41-1.04). The primary safety outcome occurred in 12.0% of the SGLT2i group and 19.1% of the no SGLT2i group at 12 months (aHR 0.68, 95% CI 0.45-1.01).

CONCLUSION

Early initiation of SGLT2i use was not associated with a reduction in MACE in patients with T2DM who experienced ACS and underwent subsequent CABG surgery. However, no apparent safety concerns were identified. Adequately powered trials are required to confirm this finding.

Current Insights on Treatment Adherence in Prevalent Dermatological Conditions and Strategies To Optimize Adherence Rates

Adherence to prescribed medication regimens is crucial for treatment efficacy and patient safety, but it remains a challenge in the medical field, particularly in dermatology, where adherence to prescribed treatments is being intensively evaluated and improved. This narrative review provides a comprehensive overview of adherence behaviors in dermatological diseases, including fungal skin infections, psoriasis, acne, atopic dermatitis, and chronic urticaria, aiming to update scientific information on adherence patterns and management strategies in these highly prevalent conditions. Furthermore, the importance of a holistic approach that integrates patient-centered and physician-centered strategies to optimize treatment outcomes and enhance adherence in dermatological care is highlighted. The role of technological advancements in promoting adherence is also discussed, with an emphasis on the potential for digital solutions to facilitate medication management. Future perspectives underscore the need for targeted interventions to address the multifaceted barriers to adherence, including treatment complexity, healthcare accessibility, and patient-provider communication. By addressing these challenges, healthcare providers can enhance patient satisfaction, improve therapeutic outcomes, and mitigate the adverse consequences of non-adherence in dermatological practice.

The impact of non-pharmacological interventions on adherence to medication and persistence in dyslipidaemia and hypertension: a systematic review

INTRODUCTION

Suboptimal medication adherence is common among patients with cardiovascular diseases. We sought evidence on non-pharmacological interventions used to support adherence for patients with hypertension and/or dyslipidemia.

METHODS

We searched MEDLINE, EMBASE, MEDLINE In-Process, ClinicalTrials.gov, EUCTR, and conference proceedings from July 2011 to July 2021 to identify trials evaluating effects of health education, phone reminders, or digital interventions on medication adherence or persistence of adult patients with hypertension and/or dyslipidemia. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool v2.

RESULTS

Of 64 studies, 62 used health education approaches (e.g. educational interviews, motivational meetings, advice from physicians, and mobile health content), 16 phone reminders (e.g. text reminders, electronic pill-box linked reminders, bi-directional text messaging), and 10 digital applications as interventions (e.g., various self-management applications). All studies assessed medication adherence; only two persistence. Overall, 30 studies (83%) assessing health education approaches alone and 25 (78%) combined with other strategies, 12 (75%) phone reminders and eight studies (80%) digital applications combined with other strategies reported improved medication adherence. Two studies assessing health education approaches reported improved persistence.

CONCLUSIONS

Our findings indicate non-pharmacological interventions may positively impact adherence. Therefore, 'beyond the pill' approaches could play a role in preventing cardiovascular diseases.

Adherence in young people living with juvenile arthritis: A systematic review

Objective

Juvenile idiopathic arthritis (JIA) is one of the leading causes of chronic pain in pediatric patients. Treatment regimens, which are critical to symptom management, can be burdensome, involving medication with potentially aversive side effects and exercise that can cause joint pain. Thus, it is important to examine the barriers and facilitators to adherence in JIA. While systematic reviews exist for rheumatic disease in adults, there has not yet been a synthesis of the literature examining adherence in JIA.

Methods

PsychINFO, PubMed and MEDLINE databases were systematically searched to identify qualitative and quantitative empirical studies that investigate adherence for JIA. Keywords included: patient compliance OR adherence OR persistence; youth OR children OR juvenile OR pediatric OR teen OR child OR adolescent; and rheumatoid arthritis OR idiopathic arthritis OR arthritis. Articles were excluded from the review if they involved non-human or adult samples, were non-experimental (e.g., practice recommendations), were not peer-reviewed, or were not written in English. After abstract selection, 32 articles were included in the analyses.

Results

Adherence to exercise regimens was consistently lower than adherence to medication. Researchers relied heavily on self-report of adherence, which suggests a need for additional research with more objective measures of adherence. Across studies, psychological treatment was not included, so adherence to this treatment component in JIA remains understudied.

Conclusions

Results suggest that future research should target devising and evaluating interventions to improve adherence to exercise and perhaps psychological treatment.

Implications for Impact

To facilitate adherence in JIA, behavioral health providers should focus on building a strong therapeutic alliance between provider and child, fostering positive coping skills in parents and children, and monitoring the parent-child relationship.

Knowledge and perception of mHealth medication adherence applications among pharmacists and pharmacy students in Jazan, Kingdom of Saudi Arabia

The advances in digital health, including mobile healthcare (mHealth) medication adherence applications (MApps), have been demonstrated to support medication adherence and improve health outcomes. This study aims to evaluate the knowledge and perception of the MApps among pharmacists and pharmacy students. An online cross-sectional survey was conducted among 223 pharmacists and pharmacy students in the Jazan region of Saudi Arabia between 1st and 30th April 2023. The survey collected information about the participants' socio-demographics, knowledge, and perception of the MApps. Among the 223 participants included in the study, 105 (47.1%) were pharmacists and 118 (52.9%) were pharmacy students. Most participants were females (72.6%) and aged 18-30 (70.4%). About half of the participants had poor knowledge of the MApps [pharmacists (48.0%) and students (42.0%)] and mainly encountered Medisafe (18.1%) or Pills (17.0%) MApps, respectively. Pharmacy students showed significantly higher knowledge of MApps (p = 0.048), especially the Pills (p = 0.022) than pharmacists. However, the pharmacists had significantly higher knowledge of MyMeds (p = 0.001) than pharmacy students. Most participants had a positive perception of the usefulness of the MApps (pharmacists, 79.0%; students 80.0%). Notably, over 85% of the participants expressed willingness to know and provide guidance on MApps, with over 50% willing to recommend it to the patients. There was no significant difference in perception between the pharmacists and pharmacy students (p>0.05). In conclusion, the study demonstrates limited knowledge with a positive perception of mHealth medication adherence applications among pharmacists and pharmacy students. Integrating digital adherence tools like the MApps into pharmacy training could significantly improve professional practice mHealth competencies, and optimize healthcare delivery and patient outcomes.

Non-adherence to cardiometabolic medication as assessed by LC-MS/MS in urine and its association with kidney and cardiovascular outcomes in type 2 diabetes mellitus

AIMS/HYPOTHESIS

Non-adherence to medication is a frequent barrier in the treatment of patients with type 2 diabetes mellitus, potentially limiting the effectiveness of evidence-based treatments. Previous studies have mostly relied on indirect adherence measures to analyse outcomes based on adherence. The aim of this study was to use LC-MS/MS in urine-a non-invasive, direct and objective measure-to assess non-adherence to cardiometabolic drugs and analyse its association with kidney and cardiovascular outcomes.

METHODS

This cohort study includes 1125 participants from the PROVALID study, which follows patients with type 2 diabetes mellitus at the primary care level. Baseline urine samples were tested for 79 cardiometabolic drugs and metabolites thereof via LC-MS/MS. An individual was classified as totally adherent if markers for all drugs were detected, partially non-adherent when at least one marker for one drug was detected, and totally non-adherent if no markers for any drugs were detected. Non-adherence was then analysed in the context of cardiovascular (composite of myocardial infarction, stroke and cardiovascular death) and kidney (composite of sustained 40% decline in eGFR, sustained progression of albuminuria, kidney replacement therapy and death from kidney failure) outcomes.

RESULTS

Of the participants, 56.3% were totally adherent, 42.0% were partially non-adherent, and 1.7% were totally non-adherent to screened cardiometabolic drugs. Adherence was highest to antiplatelet and glucose-lowering agents and lowest to lipid-lowering agents. Over a median (IQR) follow-up time of 5.10 (4.12-6.12) years, worse cardiovascular outcomes were observed with non-adherence to antiplatelet drugs (HR 10.13 [95% CI 3.06, 33.56]) and worse kidney outcomes were observed with non-adherence to antihypertensive drugs (HR 1.98 [95% CI 1.37, 2.86]).

CONCLUSIONS/INTERPRETATION

This analysis shows that non-adherence to cardiometabolic drug regimens is common in type 2 diabetes mellitus and negatively affects kidney and cardiovascular outcomes.

Technology-Based Strategy to Improve Medication Compliance Among Patients With Schizophrenia Spectrum Disorders

INTRODUCTION

 Non-compliance to medications remains a challenging problem in schizophrenia. Newer strategies with high feasibility and acceptability are always being researched. This study aimed to assess the effectiveness of technology-based intervention in improving medication compliance in individuals with schizophrenia.

METHOD

This was a prospective intervention study where participants were required to use the SuperMD smartphone application (Digital-Health Technologies Pte Ltd, Kuala Lumpur, Malaysia) for a month. A change in the Medication Adherence Rating Scale-Malay Translation (MARS-M) and Malay Translation of Drug Adherence Inventory-9 (MDAI-9) scores indicated a change in compliance and attitude to medication. Positive and Negative Syndrome Scale (PANSS) was used to assess change in symptoms and insight. Medication compliance was also obtained from the SuperMD application. Paired T-test was used to evaluate the significance of changes in mean scores of research variables over the study period. Wilcoxon signed-rank test was used to analyze the subscale of MDAI-9 and the change in PANSS score. The Kruskal-Wallis test was used to determine the effect of the change of insight on the level of compliance with medication.

RESULTS

There were 36 participants in this study. The results showed statistically significant improvement in compliance (0.65, p ≤ 0.01) but not in attitude towards medication (0.78, p = 0.065). There was also an improvement in PANNS score (-2.58, P ≤ 0.01). There was no significant change in insight (χ2(2) = 3.802, p = 0.15).  Conclusion:The use of technology-based strategies like SuperMD is effective in improving medication compliance for individuals with schizophrenia.

Using a Semiautomated Procedure (CleanADHdata.R Script) to Clean Electronic Adherence Monitoring Data: Tutorial

BACKGROUND

Patient adherence to medications can be assessed using interactive digital health technologies such as electronic monitors (EMs). Changes in treatment regimens and deviations from EM use over time must be characterized to establish the actual level of medication adherence.

OBJECTIVE

We developed the computer script CleanADHdata.R to clean raw EM adherence data, and this tutorial is a guide for users.

METHODS

In addition to raw EM data, we collected adherence start and stop monitoring dates and identified the prescribed regimens, the expected number of EM openings per day based on the prescribed regimen, EM use deviations, and patients' demographic data. The script formats the data longitudinally and calculates each day's medication implementation.

RESULTS

We provided a simulated data set for 10 patients, for which 15 EMs were used over a median period of 187 (IQR 135-342) days. The median patient implementation before and after EM raw data cleaning was 83.3% (IQR 71.5%-93.9%) and 97.3% (IQR 95.8%-97.6%), respectively (Δ+14%). This difference is substantial enough to consider EM data cleaning to be capable of avoiding data misinterpretation and providing a cleaned data set for the adherence analysis in terms of implementation and persistence.

CONCLUSIONS

The CleanADHdata.R script is a semiautomated procedure that increases standardization and reproducibility. This script has broader applicability within the realm of digital health, as it can be used to clean adherence data collected with diverse digital technologies.

Effect of an in-hospital medication self-management intervention (SelfMED) on medication adherence in polypharmacy patients postdischarge: protocol of a pre-post intervention study

INTRODUCTION

Healthcare providers usually manage medication for patients during hospitalisation, although patients are expected to self-manage their medication after discharge. A lack of self-management competencies is found to be associated with low adherence levels and medication errors harming patients' health. Currently, patients seldom receive support or education in medication self-management. When self-management is allowed during hospitalisation, it is rarely provided using a structured, evidence-based format. Therefore, an in-hospital medication self-management intervention (ie, SelfMED) was developed based on current evidence. To date, empirical data demonstrating the effect of SelfMED on medication adherence are lacking. This study primarily aims to evaluate the effect of the SelfMED intervention on medication adherence 2 months postdischarge in polypharmacy patients, as compared with usual care.

METHODS AND ANALYSIS

A multicentre pre-post intervention study will be conducted. The study will start with a control phase investigating usual care (ie, medication management entirely provided by healthcare providers), followed by an intervention period, investigating the effects of the SelfMED intervention. SelfMED consists of multiple components: (1) a stepped assessment evaluating patients' eligibility for in-hospital medication self-management, (2) a monitoring system allowing healthcare providers to follow up medication management and detect problems and (3) a supportive tool providing healthcare providers with a resource to act on observed problems with medication self-management. Polymedicated patients recruited during the control and intervention periods will be monitored for 2 months postdischarge. A total of 225 participants with polypharmacy should be included in each group. Medication adherence 2 months postdischarge, measured by pill counts, will be the primary outcome. Secondary outcomes include self-management, medication knowledge, patient and staff satisfaction, perceived workload and healthcare service utilisation.

ETHICS AND DISSEMINATION

The ethics committee of the Antwerp University Hospital approved the study (reference no: B3002023000176). Study findings will be disseminated through peer-reviewed publications, conference presentations and summaries in layman's terms.

TRIAL REGISTRATION NUMBER

ISRCTN15132085.

Assessing the Efficacy of ChatGPT Versus Human Researchers in Identifying Relevant Studies on mHealth Interventions for Improving Medication Adherence in Patients With Ischemic Stroke When Conducting Systematic Reviews: Comparative Analysis

BACKGROUND

ChatGPT by OpenAI emerged as a potential tool for researchers, aiding in various aspects of research. One such application was the identification of relevant studies in systematic reviews. However, a comprehensive comparison of the efficacy of relevant study identification between human researchers and ChatGPT has not been conducted.

OBJECTIVE

This study aims to compare the efficacy of ChatGPT and human researchers in identifying relevant studies on medication adherence improvement using mobile health interventions in patients with ischemic stroke during systematic reviews.

METHODS

This study used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Four electronic databases, including CINAHL Plus with Full Text, Web of Science, PubMed, and MEDLINE, were searched to identify articles published from inception until 2023 using search terms based on MeSH (Medical Subject Headings) terms generated by human researchers versus ChatGPT. The authors independently screened the titles, abstracts, and full text of the studies identified through separate searches conducted by human researchers and ChatGPT. The comparison encompassed several aspects, including the ability to retrieve relevant studies, accuracy, efficiency, limitations, and challenges associated with each method.

RESULTS

A total of 6 articles identified through search terms generated by human researchers were included in the final analysis, of which 4 (67%) reported improvements in medication adherence after the intervention. However, 33% (2/6) of the included studies did not clearly state whether medication adherence improved after the intervention. A total of 10 studies were included based on search terms generated by ChatGPT, of which 6 (60%) overlapped with studies identified by human researchers. Regarding the impact of mobile health interventions on medication adherence, most included studies (8/10, 80%) based on search terms generated by ChatGPT reported improvements in medication adherence after the intervention. However, 20% (2/10) of the studies did not clearly state whether medication adherence improved after the intervention. The precision in accurately identifying relevant studies was higher in human researchers (0.86) than in ChatGPT (0.77). This is consistent with the percentage of relevance, where human researchers (9.8%) demonstrated a higher percentage of relevance than ChatGPT (3%). However, when considering the time required for both humans and ChatGPT to identify relevant studies, ChatGPT substantially outperformed human researchers as it took less time to identify relevant studies.

CONCLUSIONS

Our comparative analysis highlighted the strengths and limitations of both approaches. Ultimately, the choice between human researchers and ChatGPT depends on the specific requirements and objectives of each review, but the collaborative synergy of both approaches holds the potential to advance evidence-based research and decision-making in the health care field.

Arabic translation and cultural adaptation of Hill-Bone compliance to high blood pressure therapy scale

Background

Adherence to prescription medications is vital to the success of any treatment plan, especially for chronic health conditions, such as hypertension (HTN). Although there are different scales used in assessing adherence to prescription medications, most if not all, of those scales are not available in Arabic. The absence of essential assessment tools makes the appraisal of adherence to prescription medications very difficult for native Arabic speakers. Therefore, this study aimed to translate and validate the Hill-Bone Compliance to High Blood Pressure Therapy (CHBPT) scale, which is commonly used to assess adherence to antihypertensive medications, among a sample of Arabic-speaking patients with HTN.

Methods

This was a single-center cross-sectional study that took place at a university-affiliated hospital. It interviewed adult (≥18 years) patients with HTN who were visiting the primary care clinics between January and November 2020. Non-Arabic speakers, those under 18 years of age, individuals without a diagnosis of HTN, and patients without any previously filled prescription medications for HTN within the past three months were excluded. The forward-backward translation method was used after receiving permission from the originators of the questionnaire to translate their scale to Arabic. Test-retest and Cronbach alpha methods were used to assess the reliability. Principal component analysis with varimax rotation was used to examine the construct validity.

Results

One hundred and forty-one patients consented and participated in the study. Most of the patients were ≥ 50 years old (75 %), male (72 %), and had another chronic health condition besides HTN (99 %). The translated scale had good internal consistency (Cronbach alpha = 0.83) and reliability (intraclass correlation coefficient of 0.9). The Kaiser-Meyer-Oklin was 0.82 indicating adequate sampling to conduct factor analysis; hence, three factors (e.g., subscales) were extracted similar to the original scale. The mean scores for appointment keeping, medication taking, and reducing sodium intake subscales, as well as for the overall scale were 5.62 ± 1.39, 33.94 ± 3.87, 9.73 ± 2.1, and 49.29 ± 5.21, respectively.

Conclusion

The translated version of the Hill-Bone CHBPT scale has both good reliability and validity and will hopefully help healthcare providers assess and monitor HTN patients' adherence to their antihypertensive medication regimens. Multicenter studies should be conducted to verify the validity and reliability of the translated questionnaire among different Arabic-speaking patient populations with HTN.

A Multi-Component Intervention to Improve Therapeutic Adherence in Uncontrolled Hypertensive Patients Within the Primary Care Level: A Before-and-After Study

INTRODUCTION

Non-adherence to medication severely affects chronic disease control.

AIM

To assess whether a multi-component intervention implemented at the public primary care level in Argentina improves adherence to antihypertensive medication and helps to reduce blood pressure (BP) levels in uncontrolled hypertensive patients.

METHODS

A before-and-after study was conducted in five public primary care clinics located in the city of Almirante Brown, Argentina. One hundred and twenty-five uncontrolled hypertensive patients received a multi-component intervention based on the Chronic Care model and the 5As strategy (Ask, Advise, Agree, Assist, and Arrange). Medication possession ratio (MPR) and BP values were assessed before and after a 6-month period.

RESULTS

The follow-up rate was 96.8%. Main baseline characteristics were as follows, male: 44.8%, mean age: 57.1 years (± 8.1), exclusive public healthcare coverage: 83.5%, primary school level or less: 68.8%, and mean systolic/diastolic BP: 157.4 (± 13.6)/97.7 (± 8.2) mmHg. After implementing the intervention, a significant increase in the proportion of adequate adherence (MPR ≥ 80%) was observed, from 16.8% at baseline to 47.2% (p < 0.001). A significant reduction of 16.4 mmHg (CI 95%: 19.6, 13.1) was observed for systolic blood pressure (SBP) and 12.0 mmHg (CI 95%: 14.2, 9.9) for diastolic blood pressure (DBP) (p < 0.001). At 6 months, 51.2% of the population achieved blood pressure control (SBP < 140 mmHg and DBP < 90 mmHg).

CONCLUSIONS

The study intervention was associated with an increased adherence rate, achieving a significant reduction in BP values and reaching BP control in more than half of the population.

A Roadmap for Using Causal Inference and Machine Learning to Personalize Asthma Medication Selection

Inhaled corticosteroid (ICS) is a mainstay treatment for controlling asthma and preventing exacerbations in patients with persistent asthma. Many types of ICS drugs are used, either alone or in combination with other controller medications. Despite the widespread use of ICSs, asthma control remains suboptimal in many people with asthma. Suboptimal control leads to recurrent exacerbations, causes frequent ER visits and inpatient stays, and is due to multiple factors. One such factor is the inappropriate ICS choice for the patient. While many interventions targeting other factors exist, less attention is given to inappropriate ICS choice. Asthma is a heterogeneous disease with variable underlying inflammations and biomarkers. Up to 50% of people with asthma exhibit some degree of resistance or insensitivity to certain ICSs due to genetic variations in ICS metabolizing enzymes, leading to variable responses to ICSs. Yet, ICS choice, especially in the primary care setting, is often not tailored to the patient's characteristics. Instead, ICS choice is largely by trial and error and often dictated by insurance reimbursement, organizational prescribing policies, or cost, leading to a one-size-fits-all approach with many patients not achieving optimal control. There is a pressing need for a decision support tool that can predict an effective ICS at the point of care and guide providers to select the ICS that will most likely and quickly ease patient symptoms and improve asthma control. To date, no such tool exists. Predicting which patient will respond well to which ICS is the first step toward developing such a tool. However, no study has predicted ICS response, forming a gap. While the biologic heterogeneity of asthma is vast, few, if any, biomarkers and genotypes can be used to systematically profile all patients with asthma and predict ICS response. As endotyping or genotyping all patients is infeasible, readily available electronic health record data collected during clinical care offer a low-cost, reliable, and more holistic way to profile all patients. In this paper, we point out the need for developing a decision support tool to guide ICS selection and the gap in fulfilling the need. Then we outline an approach to close this gap via creating a machine learning model and applying causal inference to predict a patient's ICS response in the next year based on the patient's characteristics. The model uses electronic health record data to characterize all patients and extract patterns that could mirror endotype or genotype. This paper supplies a roadmap for future research, with the eventual goal of shifting asthma care from one-size-fits-all to personalized care, improve outcomes, and save health care resources.

Evaluation of methods measuring medication adherence in patients with polypharmacy: a longitudinal and patient perspective

PURPOSE

To explore patients' willingness to have medication adherence measured using different methods and evaluate the feasibility and validity of their combination (i.e., pill counts, a medication diary and a questionnaire assessing adherence two months post-discharge).

METHODS

(1) A cross-sectional evaluation of the willingness of patients with polypharmacy to have their medication adherence measured post-discharge. (2) Medication adherence was monitored during two months using pill counts based on preserved medication packages and a diary in which patients registered their adherence-related problems. During a home visit, the Probabilistic Medication Adherence Scale (ProMAS) and a questionnaire on feasibility were administered.

RESULTS

A total of 144 participants completed the questionnaire at discharge. The majority was willing to communicate truthfully about their adherence (97%) and to share adherence-related information with healthcare providers (99%). More participants were willing to preserve medication packages (76%) than to complete a medication diary (67%) during two months. Most participants reported that preserving medication packages (91%), completing the diary (99%) and the ProMAS (99%) were no effort to them. According to the majority of participants (60%), pill counts most accurately reflected medication adherence, followed by the diary (39%) and ProMAS (1%). Medication adherence measured by pill counts correlated significantly with ProMAS scores, but not with the number of diary-reported problems. However, adherence measured by the medication diary and ProMAS correlated significantly.

CONCLUSION

Combining tools for measuring adherence seems feasible and can provide insight into the accordance of patients' actual medication use with their prescribed regimen, but also into problems contributing to non-adherence.

Patient-reported preferences in eHealth-based cardiac rehabilitation: A qualitative investigation of behavior change techniques, barriers and facilitators

Background

Cardiac rehabilitation (CR) reduces recurrent cardiac events and mortality in patients with cardiovascular diseases (CVD). Innovative eHealth methods can facilitate CR uptake and effectiveness by addressing barriers associated with clinic-based rehabilitation. Tailoring eHealth-based CR to patient preferences is needed to further enhance CR.

Purpose

To identify preferred behavior change techniques (BCTs) as well as barriers and facilitators for the different health behaviors targeted in eHealth-based CR among patients who have been referred to CR.

Methods

Thirty-nine patients were interviewed in nine focus groups in The Netherlands, Germany, and Spain. A thematic analysis, using a combined deductive and inductive approach to coding, was conducted to identify BCTs and barriers and facilitators to behavior change. Behaviors under investigation included physical activity, medication adherence, eating a cardiac healthy-diet, stress reduction and smoking cessation.

Results

The perceived helpfulness of BCTs depended on the specific behavior targeted. Common barriers were negative emotional state and physical limitations. A desire to feel physically or mentally well and having experienced a cardiac life event were the most common facilitators across health behaviors. Specific BCTs, barriers and facilitators were found for each of the health behavior.

Conclusions

Behavior change techniques that patients preferred for each health behavior targeted in eHealth-based CR were identified. A negative emotional state, experiencing a life event, and improving physical functioning are important barriers and facilitators in multiple behaviors targeted in eHealth-based CR programs. Additional tailoring of interventions to patient preferences for BCTs and patient-specific barriers and facilitators per health behavior could lead to further improvement of eHealth-based CR.

Relationship between self-efficacy and adherence to antiretroviral therapy in HIV/AIDS patients: An analytical cross-sectional study in southern Iran

Background and Aims

The human immunodeficiency virus (HIV) infection, also known as acquired immunodeficiency syndrome (AIDS), is spreading rapidly in the world, especially in developing countries, and is considered a serious health threat. This study aimed to assess the relationship of adherence antiretroviral therapy (ART) and self-efficacy among people living with HIV.

Methods

This cross-sectional study was conducted in March-July 2022 at the Center for Behavioral Diseases in Bandar Abbas. A total number of 208 HIV patients treated with ART entered the study after voluntarily signing an informed letter of consent. The data collection instrument was the adherence to ART questionnaire with the six subscales and the General Self-Efficacy Scale-17 (GSE-17) general self-efficacy questionnaire. Multivariate regression analysis was used to test the relationship among the variables.

Results

The participants' mean age was 41.7 ± 8.2 years. Self-efficacy was positively correlated with adherence ART. With every one score of increased self-efficacy, MA increased for 0.85 score (p < 0.001) and medical challenges have the strongest correlation (r = 0.27) with self-efficacy. The multivariable regression analysis showed that moderate and high socioeconomic status (SES) each improved MA for 18 and 22 units, respectively, compared to poor SES. Alcohol consumption reduced MA for 11 units.

Conclusion

This study proved the positive relationship of self-efficacy in adherence to ART in HIV patients. The insights offered by this research can help develop a systematic and effective intervention to promote MA in HIV patients. SES and alcohol consumption significantly affect MA.

Adherence to Medications in Patients with Ischaemic Heart Disease in Oman

Objectives

This study aimed to evaluate the level of adherence to medication among patients with ischaemic heart disease (IHD) in Oman and assess the related factors.

Methods

This cross-sectional questionnaire-based study among patients with IHD attending the outpatient clinic at Sultan Qaboos University Hospital, Muscat, Oman, was performed between January and December 2021.

Results

A total of 105 patients (mean age = 49.9 ± 11.1 years, 78.1% male) were recruited. Most of the patients (80%) reported taking the medications by themselves; 77 (73.3%) patients said that over the preceding 2 weeks, they had missed at least 3 doses of their medication. The reasons for missing the medications included forgetting (100%), having to take too many tablets (57%), feeling that the tablets are not effective (48%) and having to take the tablets too often each day (23%). The factors responsible for patients failing to take medications could not be identified.

Conclusion

Medication adherence was low among patients with IHD in Oman, with high pill burden being the most common reason for non-adherence. Physicians must bear this in mind when reviewing patients.

Intake reminders are effective in enhancing adherence to direct oral anticoagulants in stroke patients: a randomised cross-over trial (MAAESTRO study)

BACKGROUND

Direct oral anticoagulants (DOAC) effectively prevent recurrent ischaemic events in atrial fibrillation (AF) patients with recent stroke. However, excellent adherence to DOAC is mandatory to guarantee sufficient anticoagulation as the effect quickly subsides.

AIM

To investigate the effect of intake reminders on adherence to DOAC.

METHODS

MAAESTRO was a randomised, cross-over study in DOAC-treated AF patients hospitalised for ischaemic stroke. Adherence was measured by electronic monitoring for 12 months. After an observational phase, patients were randomised to obtain an intake reminder either in the first or the second half of the subsequent 6-month interventional phase. The primary outcome was 100%-timing adherence. Secondary outcomes were 100%-taking adherence, and overall timing and taking adherence. We analysed adherence outcomes using McNemar's test or mixed-effects logistic models.

RESULTS

Between January 2018 and March 2022, 130 stroke patients were included, of whom 42 dropped out before randomisation. Analysis was performed with 84 patients (mean age: 76.5 years, 39.3% women). A 100%-timing adherence was observed in 10 patients who were using the reminder, and in zero patients without reminder (p = 0.002). The reminder significantly improved adherence to DOAC, with study participants having 2.7-fold increased odds to achieve an alternative threshold of 90%-timing adherence (OR 2.65; 95% CI 1.05-6.69; p = 0.039). A similar effect was observed for 90%-taking adherence (OR 3.06; 95% CI 1.20-7.80; p = 0.019). Overall timing and taking adherence increased significantly when using the reminder (OR 1.70; 95% CI 1.55-1.86, p < 0.01; and OR 1.67; 95% CI 1.52-1.84; p < 0.01).

CONCLUSION

Intake reminders increased adherence to DOAC in patients with stroke attributable to atrial fibrillation.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT03344146.

A systematic review of approaches to improve medication adherence in homeless adults with psychiatric disorders

Introduction

Medication non-adherence is a significant problem among homeless individuals with psychiatric disorders in the United States. We conducted a systematic review to identify strategies to improve psychiatric medication adherence among homeless individuals with psychiatric disorders, including substance use disorders.

Methods

We searched seven databases (MEDLINE, Embase, PsychInfo, Scopus, Web of Science, CDSR, and CENTRAL) and screened 664 studies by title and abstract followed by full-text review. Our inclusion criteria were studies that: involved an intervention for homeless adults with psychiatric disorders, reported a quantitative outcome of medication adherence, and were published in English in a peer-reviewed journal. We rated the relative effectiveness of strategies described in each study using a self-designed scale.

Results

Eleven peer-reviewed studies met criteria for inclusion in this review. Within these studies, there were seven different approaches to improve medication adherence in this population. Three studies were randomized controlled trials (RCTs) and the remaining were observational studies. Outpatient interventions included Assertive Community Treatment, Cell Phone-Assisted Monitoring, Customized Adherence Enhancement plus Long-Acting Injectable Medications, and Homeless-Designated Pharmacy Clinics. Residential, shelter-based, and inpatient interventions included use of the Housing First model, Modified Therapeutic Communities, and Homeless-Designated Inpatient Care. The approaches described in four of the eleven studies were rated as scoring a 3 or higher on a 5-point scale of effectiveness in improving medication adherence; none received 5 points.

Discussion

The interventions with the strongest evidence for improving medication adherence in this population were Assertive Community Treatment, Customized Adherence Enhancement plus Long-Acting Injectable Medications, and Housing First. Overall, studies on this topic required more rigor and focus on medication adherence as an outcome in this population. This review highlights several promising strategies and the need for larger RCTs to determine effective and diverse ways to improve medication adherence among homeless adults with psychiatric disorders.

The feasibility of self-performing measurements of peripheral oxygen saturation and respiratory exercises in home-isolated COVID-19 patients-a single-arm prospective trial

BACKGROUND

COVID-19 is a highly contagious disease where isolation of infected individuals is deemed warranted. If possible, home isolation is preferred over hospitalization. This implies a need for methods of observation that can ensure the safety of these patients. Preventive treatment methods that can both decrease the probability for development of critical disease and hopefully decrease the need for hospitalization would be an added benefit. This was a single-arm prospective pilot study performed to assess the feasibility of performing self-measurements of SpO2 and respiratory exercises in at-home isolated COVID-19 patients.

METHOD

A total of 40 ambulant SARS-CoV-2-positive individuals in home isolation were followed up for a period of 14 days. At baseline, they were equipped with a pulse oximeter, PEF meter, a project diary to note all measurements, and simple instructions on how to perform respiratory exercises. No other contact was made, but participants were instructed to contact the hospital based on given criteria for blood oxygenation levels and dyspnea severity and to return study equipment and the project diary at the end of study.

RESULTS

During the follow-up period, 35 participants (87.5%) recorded daily SpO2 measurements, and 12 (30%) adhered to daily respiratory exercises as instructed. Four participants (10%) were admitted to hospital during the follow-up period. Five participants terminated follow-up prematurely.

CONCLUSIONS

Performing self-measurements of SpO2 during home isolation due to COVID-19 infection is feasible. The feasibility of performing respiratory exercises in ambulant patients is questionable and may require more motivational interventions to increase adherence.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04647747.

Can temporal self-regulation theory and its constructs predict medication adherence? A systematic review and meta-analysis

The relationships between temporal self-regulation theory (TST) constructs (intention, behavioural prepotency and self-regulatory capacity) and medication adherence should be established before further applying the theory to adherence. Searches of PsychINFO, Medline, EMBASE, CINAHL and Web of Science were conducted in 2019 (updated November 2021). Studies had to be original quantitative research, assessed the relationship between one of the constructs and adherence in one illness, and used an adult population. The risk of bias was assessed using the NHLBI Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Three meta-analyses were conducted using R. Moderation analyses were also conducted. A total of 57 articles (60 studies) with 13,995 participants were included, with 7 studies included in more than one analysis. Results identified significant correlations between intention (r = .369, [95% CI: .25, .48]), behavioural prepotency (r = .332, [95% CI: .18, .48]), self-regulatory capacity (r = .213, [95% CI: .10, .32]) and adherence. There was some evidence of publication bias and no significant moderators. No studies explored the interactions in the theory, so whilst the constructs adequately predict adherence, future research should apply the theory to adherence in a specific illness to assess these relationships. Pre-registered on Prospero: CRD42019141395.

How Pharmacogenomics Informs and Influences the Medication Experience

Both pharmacogenomics (PGx) and the medication experience (MedXp) share a common purpose for their use, which is to optimally tailor medications to each unique individual. The former pursues this aim by using an individual's genetic makeup, while the latter considers the subjective experience of medication-taking in one's life. The different ways by which these fields of study pursue their shared aim have resulted in relatively little understanding of their relationship when utilized in care processes to produce health outcomes. This commentary explores this gap and identifies implications for future research that can help close it to improve person-centered care.

Adherence to ketogenic diet in lifestyle interventions in adults with overweight or obesity and type 2 diabetes: a scoping review

BACKGROUND/OBJECTIVES

Despite the evidence supporting the efficacy of the ketogenic diet (KD) on weight and type 2 diabetes (T2D) management, adherence to the KD is challenging. Additionally, no studies have reported changes in PA among individuals with overweight/obesity and T2D who have followed KD. We mapped out the methods used to assess adherence to the KD and level of physical activity (PA) in lifestyle interventions for weight and T2D management in individuals with overweight/obesity and T2D and compared levels of KD adherence and PA in these interventions.

METHODS

Articles published between January 2005 and March 2022 were searched in MEDLINE, CINAHL, and Scopus. Studies that included KD in lifestyle interventions for adults with T2D and overweight/obesity and measured ketone levels were included.

RESULTS

The eleven included studies comprised eight randomized controlled trials. They mainly used self-reported measures to evaluate adherence to the KD and level of PA. We found studies reported higher carbohydrate intake and lower fat intake than the KD regimen. Great inconsistencies were found among studies on the measurement and reporting of ketone and PA levels.

CONCLUSION

Our results demonstrated the need to develop intervention strategies to improve adherence to the KD, as well as the necessity of developing standardized diet and PA assessment tools to establish a stronger evidence base for including KD in lifestyle interventions for weight and T2D management among adults with overweight/obesity and T2D.

Antihypertensive Medication Adherence and Cardiovascular Outcomes in Patients With Cancer: A Nationwide Population-Based Cohort Study

Background Hypertension is an important cause of morbidity, which predisposes patients to major cardiovascular events and mortality. The aim of this study was to explore the association between adherence to antihypertensive medication and clinical outcomes in adult patients with cancer. Methods and Results Using the 2002 to 2013 Korean National Health Insurance Service-National Sample Cohort, we extracted adult patients with cancer treated with antihypertensive medications. Based on the medication possession ratio value, participants were divided into 3 groups: good (medication possession ratio ≥0.8), moderate (0.5≤ medication possession ratio <0.8), and poor (medication possession ratio <0.5) adherence groups. The primary outcomes were overall and cardiovascular mortality. The secondary outcome was cardiovascular events requiring hospitalization due to major cardiovascular diseases. Among 19 246 patients with cancer with concomitant hypertension, 66.4% were in the nonadherence group (26.3% were moderate and 40.0% were poor adherence group). Over a median of 8.4 years of follow-up, 2752 deaths and 6057 cardiovascular events occurred. Compared with the good adherence group, the moderate and poor adherence groups had a 1.85-fold and 2.19-fold increased risk for overall mortality, and 1.72-fold and 1.71-fold elevated risk for cardiovascular mortality, respectively, after adjustment for possible confounders. Furthermore, the moderate and poor adherence groups had a 1.33-fold and 1.34-fold elevated risk of new-onset cardiovascular events, respectively. These trends were consistent across cardiovascular event subtypes. Conclusions Nonadherence to antihypertensive medication was common in patients with cancer and was associated with worse clinical outcomes in adult patients with cancer with hypertension. More attention should be paid to improving adherence to antihypertensive medication among patients with cancer.

Using group based trajectory modeling for assessing medication adherence to nintedanib among idiopathic pulmonary fibrosis patients

BACKGROUND AND OBJECTIVE

Adherence to antifibrotic medications has been evaluated in a few studies using annual proportion of days covered (PDC), a common adherence metric. However, PDC alone cannot identify and distinguish between different patterns of adherence over time, which can be accomplished using group-based trajectory models (GBTM) of monthly PDC. The objective is to assess nintedanib adherence trajectories using GBTM and identify characteristics of patients within each trajectory group.

METHODS

Individuals with idiopathic pulmonary fibrosis (IPF) who initiated nintedanib during 10/1/2014-12/31/2018 were identified in 100% Medicare claims and enrollment data. The sample consisted of community-dwelling older adults (≥ 66 years) with continuous coverage in Medicare Parts A, B and D for one year before (baseline) and after (follow-up) initiating nintedanib. A series of GBTMs of adherence was estimated to identify the best-fitting specification. Patients were then grouped based on their estimated adherence trajectories. Associations between baseline patient characteristics, including demographics, comorbidities, and health care use, and group membership probabilities were quantified as odds ratios using fractional multinomial logit modeling.

RESULTS

Among the 1,798 patients initiating nintedanib, mean age was 75.4 years, 61.1% were male, and 91.1% were non-Hispanic white. The best-fitting GBTM had five adherence trajectory groups: high adherence (43.1%), moderate adherence (11.9%), high-then-poor adherence (10.4%), delayed-poor adherence (13.2%), and early-poor adherence (21.5%). The principal factors associated with higher odds of being in at least one of the poor-adherence groups were older age, female sex, race and ethnicity other than non-Hispanic white, and number of medications during baseline.

CONCLUSIONS

GBTM identified distinct patterns of nintedanib adherence for the IPF patient cohort. Identifying adherence trajectory groups and understanding the characteristics of their members provide more actionable information to personalize interventions than conventional metrics of medication adherence.

Real-world treatment patterns in patients with nontuberculous mycobacterial lung disease in the Netherlands based on medication dispensing data

PURPOSE

Real-world data on antibiotic management of nontuberculous mycobacterial lung disease (NTM-LD) is limited for many countries. This study aimed to evaluate real-world treatment practices of NTM-LD in the Netherlands using medication dispensing data.

METHODS

A retrospective longitudinal real-world study was conducted using IQVIA's Dutch pharmaceutical dispensing database. The data are collected monthly and include approximately 70% of all outpatient prescriptions in the Netherlands. Patients initiated on specific NTM-LD treatment regimens between October 2015 and September 2020 were included. The main areas of investigation were initial treatment regimens, persistence on treatment, treatment switching, treatment compliance in terms of medication possession rate (MPR) and restarts of treatment.

RESULTS

The database included 465 unique patients initiated on triple- or dual-drug regimens for the treatment of NTM-LD. Treatment switches were common and occurred approximately 1.6 per quarter throughout the treatment period. The average MPR of patients initiated on triple-drug therapy was 90%. The median time on therapy for these patients was 119 days; after six months and one year, 47% and 20% of the patients, respectively, were still on antibiotic therapy. Of 187 patients initiated on triple-drug therapy, 33 (18%) patients restarted antibiotic therapy after the initial treatment had been stopped.

CONCLUSION

When on therapy, patients were compliant with the NTM-LD treatment; however, many patients stopped their therapy prematurely, treatment switches often occurred, and part of patients had to restart their therapy after a longer treatment gap. NTM-LD management should be improved through greater guideline adherence and appropriate involvement of expert centers.

Supervised administration of primaquine may enhance adherence to radical cure for P. vivax malaria in India

The Plasmodium vivax lifecycle encompasses a dormant liver-stage known as 'hypnozoite' which serves as silent reservoirs of malaria, reactivation of which results in recurring episodes of relapse with varying periodicity. This contributes to continuous transmission of malaria unamenable to control methods. The prevention of relapse requires a "radical cure" by a hypnozoitcidal drug. Primaquine (PQ) has been the recommended radical cure for this malaria. However, adherence to 14 days PQ treatment remains poor. India accounts for majority of P. vivax burden globally. However, PQ administration is not supervised in the current national programme. Supervised administration of drugs ensures compliance and improves drug regime success rate. Trials across different countries have established the effectiveness of directly observed therapy (DOT) for prevention of relapses. As India aims to eliminate malaria by 2030, it is prudent to consider DOT to ensure complete treatment of the malaria affected populations. Therefore, we recommend that the Indian malaria control programme may consider DOT of primaquine for treatment of vivax malaria. The supervised administration would entail additional direct and indirect costs but will ensure complete treatment and hence minimize the probability of relapses. This will help the country in achieving the goal of malaria elimination.

Interventions from pregnancy to two years after birth for parents experiencing complex post-traumatic stress disorder and/or with childhood experience of maltreatment

BACKGROUND

Acceptable, effective and feasible support strategies (interventions) for parents experiencing complex post-traumatic stress disorder (CPTSD) symptoms or with a history of childhood maltreatment may offer an opportunity to support parental recovery, reduce the risk of intergenerational transmission of trauma and improve life-course trajectories for children and future generations. However, evidence relating to the effect of interventions has not been synthesised to provide a comprehensive review of available support strategies. This evidence synthesis is critical to inform further research, practice and policy approaches in this emerging area.

OBJECTIVES

To assess the effects of interventions provided to support parents who were experiencing CPTSD symptoms or who had experienced childhood maltreatment (or both), on parenting capacity and parental psychological or socio-emotional wellbeing.

SEARCH METHODS

In October 2021 we searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers, together with checking references and contacting experts to identify additional studies.

SELECTION CRITERIA

All variants of randomised controlled trials (RCTs) comparing any intervention delivered in the perinatal period designed to support parents experiencing CPTSD symptoms or with a history of childhood maltreatment (or both), to any active or inactive control. Primary outcomes were parental psychological or socio-emotional wellbeing and parenting capacity between pregnancy and up to two years postpartum.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed the eligibility of trials for inclusion, extracted data using a pre-designed data extraction form, and assessed risk of bias and certainty of evidence. We contacted study authors for additional information as required. We analysed continuous data using mean difference (MD) for outcomes using a single measure, and standardised mean difference (SMD) for outcomes using multiple measures, and risk ratios (RR) for dichotomous data. All data are presented with 95% confidence intervals (CIs). We undertook meta-analyses using random-effects models.

MAIN RESULTS

We included evidence from 1925 participants in 15 RCTs that investigated the effect of 17 interventions. All included studies were published after 2005. Interventions included seven parenting interventions, eight psychological interventions and two service system approaches. The studies were funded by major research councils, government departments and philanthropic/charitable organisations. All evidence was of low or very low certainty. Parenting interventions Evidence was very uncertain from a study (33 participants) assessing the effects of a parenting intervention compared to attention control on trauma-related symptoms, and psychological wellbeing symptoms (postpartum depression), in mothers who had experienced childhood maltreatment and were experiencing current parenting risk factors. Evidence suggested that parenting interventions may improve parent-child relationships slightly compared to usual service provision (SMD 0.45, 95% CI -0.06 to 0.96; I2 = 60%; 2 studies, 153 participants; low-certainty evidence). There may be little or no difference between parenting interventions and usual perinatal service in parenting skills including nurturance, supportive presence and reciprocity (SMD 0.25, 95% CI -0.07 to 0.58; I2 = 0%; 4 studies, 149 participants; low-certainty evidence). No studies assessed the effects of parenting interventions on parents' substance use, relationship quality or self-harm. Psychological interventions Psychological interventions may result in little or no difference in trauma-related symptoms compared to usual care (SMD -0.05, 95% CI -0.40 to 0.31; I2 = 39%; 4 studies, 247 participants; low-certainty evidence). Psychological interventions may make little or no difference compared to usual care to depression symptom severity (8 studies, 507 participants, low-certainty evidence, SMD -0.34, 95% CI -0.66 to -0.03; I2 = 63%). An interpersonally focused cognitive behavioural analysis system of psychotherapy may slightly increase the number of pregnant women who quit smoking compared to usual smoking cessation therapy and prenatal care (189 participants, low-certainty evidence). A psychological intervention may slightly improve parents' relationship quality compared to usual care (1 study, 67 participants, low-certainty evidence). Benefits for parent-child relationships were very uncertain (26 participants, very low-certainty evidence), while there may be a slight improvement in parenting skills compared to usual care (66 participants, low-certainty evidence). No studies assessed the effects of psychological interventions on parents' self-harm. Service system approaches One service system approach assessed the effect of a financial empowerment education programme, with and without trauma-informed peer support, compared to usual care for parents with low incomes. The interventions increased depression slightly (52 participants, low-certainty evidence). No studies assessed the effects of service system interventions on parents' trauma-related symptoms, substance use, relationship quality, self-harm, parent-child relationships or parenting skills.

AUTHORS' CONCLUSIONS

There is currently a lack of high-quality evidence regarding the effectiveness of interventions to improve parenting capacity or parental psychological or socio-emotional wellbeing in parents experiencing CPTSD symptoms or who have experienced childhood maltreatment (or both). This lack of methodological rigour and high risk of bias made it difficult to interpret the findings of this review. Overall, results suggest that parenting interventions may slightly improve parent-child relationships but have a small, unimportant effect on parenting skills. Psychological interventions may help some women stop smoking in pregnancy, and may have small benefits on parents' relationships and parenting skills. A financial empowerment programme may slightly worsen depression symptoms. While potential beneficial effects were small, the importance of a positive effect in a small number of parents must be considered when making treatment and care decisions. There is a need for further high-quality research into effective strategies for this population.

A systematic literature review to evaluate extended dosing intervals in the pharmacological management of acromegaly

PURPOSE

This systematic literature review investigated whether extended dosing intervals (EDIs) of pharmacological acromegaly treatments reduce patient burden and costs compared with standard dosing, while maintaining effectiveness.

METHODS

MEDLINE/Embase/the Cochrane Library (2001-June 2021) and key congresses (2018-2021) were searched and identified systematic literature review bibliographies reviewed. Included publications reported on efficacy/effectiveness, safety and tolerability, health-related quality of life (HRQoL), and patient-reported and economic outcomes in longitudinal/cross-sectional studies in adults with acromegaly. Interventions included EDIs of pegvisomant, cabergoline, and somatostatin receptor ligands (SRLs): lanreotide autogel/depot (LAN), octreotide long-acting release (OCT), pasireotide long-acting release (PAS), and oral octreotide; no comparator was required.

RESULTS

In total, 35 publications reported on 27 studies: 3 pegvisomant monotherapy, 11 pegvisomant combination therapy with SRLs, 9 LAN, and 4 OCT; no studies reported on cabergoline, PAS, or oral octreotide at EDIs. Maintenance of normal insulin-like growth factor I (IGF-I) was observed in ≥ 70% of patients with LAN (1 study), OCT (1 study), and pegvisomant monotherapy (1 study). Achievement of normal IGF-I was observed in ≥ 70% of patients with LAN (3 studies) and pegvisomant in combination with SRLs (4 studies). Safety profiles were similar across EDI and standard regimens. Patients preferred and were satisfied with EDIs. HRQoL was maintained and cost savings were provided with EDIs versus standard regimens.

CONCLUSIONS

Clinical efficacy/effectiveness, safety, and HRQoL outcomes in adults with acromegaly were similar and costs lower with EDIs versus standard regimens. Physicians may consider acromegaly treatment at EDIs, especially for patients with good disease control.

Impact of the First SARS-CoV-2 Lockdown on Adherence to Biological Treatment in Patients with Immune-Mediated Inflammatory Diseases in the Netherlands

PURPOSE

During the SARS-CoV-2 pandemic, national and international societies have recommended continuing biological agents in patients with immune-mediated inflammatory diseases (IMID) in the absence of SARS-CoV-2 symptoms. However, adherence to biological treatment might decrease, because these recommendations contradict patients' beliefs. Especially an increased concern about side effects could have influenced the adherence to biological treatment during the first lockdown. The primary objective was to investigate the impact of the first SARS-CoV-2 lockdown on adherence to biological treatment in IMID patients.

PATIENTS AND METHODS

In this prospective cohort study, IMID patients who received a biological agent before and during the first SARS-CoV-2 lockdown (March 2020- June 2020) were included. Patients were excluded if they did not complete the medication adherence report scale-5 (MARS-5) questionnaire at ≥1 visit before the lockdown and ≥1 visit during the lockdown. Adherence to biological treatment was measured with the MARS-5 and Medication Possession Ratio (MPR).

RESULTS

We included 157 IMID patients. The percentage of adherent patients, defined as MARS-5 score >21, was significantly lower during the lockdown compared to the period before the lockdown (88.5% vs 84.1%, p<0.001). Additionally, the overall percentage of adherent patients during the lockdown based on the MPR ≥90% was significantly lower compared to adherence based upon the MARS-5 (65.1% vs 84.1%, p<0.001).

CONCLUSION

This study showed that the first SARS-CoV-2 lockdown negatively impacts adherence to biological treatment in IMID patients. Therefore, treating physicians should be aware of this problem to minimize the potential harmful effects of non-adherence.

Virological failure among people living with HIV receiving second-line antiretroviral therapy in Pune, India

BACKGROUND

The number of people receiving second-line antiretroviral therapy (ART) has increased as global access to ART has expanded. Data on the burden and factors associated with second-line ART virologic failure (VF) from India remain limited.

METHODS

We conducted cross-sectional viral load (VL) testing among adults (≥ 18 years) who were registered at a publicly funded ART center in western India between 2014 and 2015 and had received second-line ART for at least 6 months. Sociodemographic and clinical characteristics were abstracted from routinely collected programmatic data. Logistic regression evaluated factors associated with VF (defined as VL > 1000 copies/mL).

RESULTS

Among 400 participants, median age was 40 years (IQR 34-44), 71% (285/400) were male, and 15% (59/400) had VF. Relative to participants without VF, those with VF had lower median CD4 counts (230 vs 406 cells/mm³, p < 0.0001), lower weight at first-line failure (49 vs 52 kg, p = 0.003), were more likely to have an opportunistic infection (17% vs 3%, p < 0.0001) and less likely to have optimal ART adherence (71% vs 87%, p = 0.005). In multivariable analysis, VF was associated with opportunistic infection (aOR, 4.84; 95% CI, 1.77-13.24), lower CD4 count (aOR 4.15; 95% CI, 1.98-8.71) and lower weight at first-line failure (aOR, 2.67; 95% CI, 1.33-5.34).

CONCLUSIONS

We found second-line VF in about a sixth of participants in our setting, which was associated with nearly fivefold increased odds in the context of opportunistic infection. Weight could be a useful clinical indicator for second-line VF.

Game-based health education to improve ART adherence of newly diagnosed young people with HIV: protocol for a stepped-wedge design randomized controlled trial

BACKGROUND

Antiretroviral therapy (ART) is one of the most effective ways for HIV-infected to treat AIDS. However, it is difficult to start ART among young people those newly diagnosed HIV-infection in China, and their adherence to ART is poor. We have designed an AIDS educational game called AIDS Fighter · Health Defense, which could improve the AIDS-related knowledge and has the potential to improve AIDS prevention ability of young students. In this study, AIDS Fighter · Health Defense will be used with newly diagnosed young people with HIV to evaluate the education effect of the game in improving ART adherence.

DESIGN

A stepped-wedge design randomized controlled trial will be conducted to confirm the education effect of AIDS Fighter · Health Defense on improving ART adherence of newly diagnosed young people with HIV, and to verify when to start game-based health education could be more effective for newly diagnosed young people with HIV.

METHODS

Participants will receive AIDS education from health workers and start ART when diagnosed with HIV and assigned into four groups randomly. The first step group to the fourth step group will receive AIDS Fighter · Health Defense in turn at the star of ART, one week, one month and three months after the start of ART. The primary outcomes are medication adherence, CD4( +) T cell count, and HIV viral load. The secondary outcomes are ART-related knowledge, ART-related skills, psychological resilience, and self-discrimination. Assessments will be completed before the intervention and one week, first month, and third month of the intervention, and then a one-year follow-up evaluation will be conducted after the intervention.

DISCUSSION

AIDS Fighter · Health Defense may be an effective approach to help newly diagnosed young people with HIV to improve ART adherence. A stepped-wedge design randomized controlled trial of this study may find the optimal time of AIDS education to improve ART adherence of newly diagnosed young people with HIV.

REGISTRATION NUMBER

Chinese Clinical Trial Registry: ChiCTR2200059766, registered 11 May 2022. http://www.chictr.org.cn/showproj.aspx?proj=169420.

Sociodemographic, clinical and pharmacological factors influencing early readmission in mental health settings

Early readmissions (between 24 hours and 30 days after discharge) can be disruptive for psychiatric patients and their families.

Assessing adherence to medications: Is there a difference between a subjective method and an objective method, or between using them concurrently?

Background

Patients' adherence to medication can be assessed by several subjective or objective methods. The Global Initiative for Asthma (GINA) has recommended the use of both measures simultaneously.

Objective

To assess patients' adherence to medication using a subjective or an objective method separately, and via using a combination of both methods. As well as identifying the degree of agreement between the two methods.

Methods

Participants who met the study inclusion criteria completed the Adherence to Asthma Medication Questionnaire (AAMQ). A retrospective audit was conducted in order to extract pharmacy refill records for the previous twelve months. The patients' pharmacy refill records were expressed using the Medication Possession Ratio (MPR). Data were analyzed using the Statistical Package for Social Science. The degree of agreement was determined by Cohen's kappa coefficient (κ).

Results

In terms of the difference in the ability of each method to identify non-adherent patients, a higher percentage of non-adherent patients were identified using the self-reported AAMQ (61.4%) compared to the pharmacy refill records (34.3%). When both methods, in combination, were used to assess adherence, the percentage of non-adherent patients was 80.0%, which is higher than each method when used separately. Twenty percent of the patients were considered adherent on both assessment methods, while 15.7% were considered non-adherent via both methods. Consequently, the AAMQ and pharmacy refill records agreed on 35.7% of the patients. The degree of agreement analysis showed a low correlation between the two methods.

Conclusion

The combination strategy resulted in a higher percentage of non-adherent patients, compared to using a subjective (the AAMQ) or an objective (the pharmacy refill records) method. The GINA guideline proposition may be supported by the present study's findings.

A Systematic Review of Independent and Chain Pharmacies Effects on Medication Adherence

As the last step in the care pathway, pharmacies can significantly impact a patient’s medication adherence and the success of treatment. The potential impact of patient’s pharmacy choice on their medication adherence has yet to be established. This study aims to review the impact a pharmacies ownership model, either independent or chain, has on its users’ medication adherence. As a generalisation, independent pharmacies offer a more personal service and chain pharmacies offer medications at lower prices. A keyword search of EMBASE and MEDLINE databases in March 2022 identified 410 studies, of which 5 were deemed to meet our inclusion criteria. The studies mostly took place in North America, measured medication adherence using pharmacy records over a 12-month period. This review was unable to substantiate a difference in the rate of medication adherence between the users of independent and chain pharmacies. However, those with a lower income, greater medication burden, and increased age appeared to use an independent pharmacy more than a chain pharmacy and to have greater medication adherence when doing so. Establishing the differences in service provision between types of pharmacies and why people choose a pharmacy to frequent should be a focus of future research.

Detecting Medication-Taking Gestures Using Machine Learning and Accelerometer Data Collected Via Smartwatch Technology: A Feasibility Study (Preprint)

BACKGROUND

Medication adherence is a global public health challenge, as only approximately 50% of people adhere to their medication regimens. Medication reminders have shown promising results in terms of promoting medication adherence. However, practical mechanisms to determine whether a medication has been taken or not, once people are reminded, remain elusive. Emerging smartwatch technology may more objectively, unobtrusively, and automatically detect medication taking than currently available methods.

OBJECTIVE

This study aimed to examine the feasibility of detecting natural medication-taking gestures using smartwatches.

METHODS

A convenience sample (N=28) was recruited using the snowball sampling method. During data collection, each participant recorded at least 5 protocol-guided (scripted) medication-taking events and at least 10 natural instances of medication-taking events per day for 5 days. Using a smartwatch, the accelerometer data were recorded for each session at a sampling rate of 25 Hz. The raw recordings were scrutinized by a team member to validate the accuracy of the self-reports. The validated data were used to train an artificial neural network (ANN) to detect a medication-taking event. The training and testing data included previously recorded accelerometer data from smoking, eating, and jogging activities in addition to the medication-taking data recorded in this study. The accuracy of the model to identify medication taking was evaluated by comparing the ANN's output with the actual output.

RESULTS

Most (n=20, 71%) of the 28 study participants were college students and aged 20 to 56 years. Most individuals were Asian (n=12, 43%) or White (n=12, 43%), single (n=24, 86%), and right-hand dominant (n=23, 82%). In total, 2800 medication-taking gestures (n=1400, 50% natural plus n=1400, 50% scripted gestures) were used to train the network. During the testing session, 560 natural medication-taking events that were not previously presented to the ANN were used to assess the network. The accuracy, precision, and recall were calculated to confirm the performance of the network. The trained ANN exhibited an average true-positive and true-negative performance of 96.5% and 94.5%, respectively. The network exhibited <5% error in the incorrect classification of medication-taking gestures.

CONCLUSIONS

Smartwatch technology may provide an accurate, nonintrusive means of monitoring complex human behaviors such as natural medication-taking gestures. Future research is warranted to evaluate the efficacy of using modern sensing devices and machine learning algorithms to monitor medication-taking behavior and improve medication adherence.

Patient Support Program and Healthcare Resource Utilization in Patients Using Clean Intermittent Catheterization for Bladder Management

The primary purpose of this study was to evaluate the impact of a patient-centered, chronic care self-management support program of clean intermittent catheterization (CIC) on emergency department (ED) visits and hospitalizations within the first 30 days of starting CIC. Secondary research objectives were to compare reuse of catheters, adherence to healthcare provider–instructed frequency of CIC, and reasons for nonadherence.

Medication Adherence among Patients with Chronic Diseases in Saudi Arabia

Introduction: The management of chronic illnesses commonly includes a long-term pharmacological approach. Although these medications effectively control disease, their full benefits are often not realized because approximately 50% of patients do not take their medications as prescribed. Medication adherence has become a big concern to clinicians and healthcare systems in Saudi Arabia and worldwide because of growing evidence associating nonadherence with adverse outcomes and higher costs of care. Despite it being a well-recognized problem, few studies have investigated medication adherence in Saudi Arabia. Therefore, this study aims to gain a better perspective on medication adherence among patients with chronic diseases in Saudi Arabia. Method: A questionnaire-based cross-sectional study was conducted among patients with chronic diseases in the Makkah region, Saudi Arabia, from 1 May to 31 July 2021. Patients aged 18 years and above who were taking prescribed or over-the-counter medications were included. Descriptive statistics were used to describe the participants’ characteristics, and categorical variables were reported as frequencies and percentages. A Chi-square test was used to test the relations between variables. Results: In total, 239 participants were included in the study. Females represented 62% of the participants. In terms of the history of chronic diseases, 44% had hypertension, 40% had diabetes mellitus, 21% had heart diseases and 9% had asthma. Nearly half (49%) of participants did not follow up regularly with a primary healthcare center and 42% said that they had forgotten to take their medications in the past. However, most of the participants (78%) stated that they took their medicine as instructed by their doctor or pharmacist, and 61% took their medications on time. The majority of participants (85%) said that the pharmacist explained the method of using the medications and the instructions for use, while 30% thought that the medications they took were too much. In regard to the reasons for medication nonadherence, having no specific reasons for medication nonadherence was the most common cause for nonadherence in our study. The relationship between patients taking medications as instructed by a healthcare provider (the doctor or pharmacist) and the healthcare provider giving clear instructions to patients about medication use was significant (p < 0.001). Conclusions: Failure to adhere is a significant problem that not only affects the patient but also the healthcare system. Additional research is needed to monitor medication adherence and identify factors contributing to this problem to provide successful strategies to improve medication adherence in Saudi Arabia.