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Milward de Azevedo Meiners MM, Araújo Cruz I, de Toledo MI. Adherence to antiretroviral therapy and viral suppression: Analysis of three periods between 2011 and 2017 at an HIV-AIDS center, Brazil. Front Pharmacol 2023; 14:1122018. [PMID: 37063259 PMCID: PMC10102605 DOI: 10.3389/fphar.2023.1122018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/14/2023] [Indexed: 04/03/2023] Open
Abstract
The increased effectiveness of antiretroviral therapy (ART) in the last 30 years is a scientific landmark, and viral suppression is directly associated with treatment adherence. The aim of this study was to compare the results of ART adherence and viral load suppression with the evolution of the protocols and other associated factors, in people living with HIV. A panel analysis of three descriptive longitudinal studies investigating ART adherence and viral load suppression was conducted in people with HIV treated at a drug dispensing unit in the Federal District. The studies were carried out during periods of 2011, 2013, and 2017, coinciding with the three different recommended treatment schemes for the country. Adherence was assessed using drug dispensing records. Viral load data were obtained from the Ministry of Healthʼs Laboratory Examination Information System. Analysis of the data of 522 individuals in the three periods showed sociodemographic differences such as a decline in the percentage of women (from 33% in period 1 to 4% in period 3) and an increase in the percentage of young people. ART adherence was higher in period 2 (tenofovir/lamivudine/efavirenz scheme). Viral load suppression was greater in period 3 (tenofovir/lamivudine/dolutegravir scheme). The relative detectable viral load risk was nearly two-fold higher (RR 1.83) in people living with HIV with less than 80% adherence when compared to those above 80%. With respect to the different schemes recommended in Brazil during the periods studied, ART containing dolutegravir was the most effective in achieving viral load suppression. By contrast, there was better ART adherence in the daily combined fixed dose consisting of tenofovir/lamivudine/efavirenz in tablet form. Adherence to ART above 80% seemed to be enough to promote an effective treatment in therapeutic schemes including efavirenz or dolutegravir.
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Affiliation(s)
- Micheline Marie Milward de Azevedo Meiners
- Programa de Pós-Graduação em Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Curso de Farmácia e Grupo de Pesquisa Acesso a Medicamentos e Uso Responsável (AMUR), Faculdade de Ceilândia, Universidade de Brasília, Brasília, Brazil
- *Correspondence: Micheline Marie Milward de Azevedo Meiners,
| | - Igor Araújo Cruz
- Programa de Pós-Graduação em Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
| | - Maria Inês de Toledo
- Programa de Pós-Graduação em Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
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2
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Moreira ATAD, Pinto CR, Lemos ACM, Assunção-Costa L, Souza GS, Martins Netto E. Evidence of the association between adherence to treatment and mortality among patients with COPD monitored at a public disease management program in Brazil. J Bras Pneumol 2021; 48:e20210120. [PMID: 34909924 PMCID: PMC8946558 DOI: 10.36416/1806-3756/e20210120] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/28/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the association between adherence to treatment and mortality among Chronic Obstructive Pulmonary Disease (COPD) patients treated in the Brazilian public health system. Methods This is cohort study of moderate-to-severe COPD patients monitored in a public pharmaceutical care-based Disease Management Program (DMP). All subjects who died one year after the beginning of the cohort were age-matched with those who remained alive at the end of the cohort period. Treatment adherence was measured through pharmacy records. Patients who received at least 90% of the prescribed doses were considered adherent to treatment. Results Of the 333 patients (52.8% age ≥ 65 years, 67.9% male), 67.3% were adherent to treatment (adherence rate, 87.2%). Mortality was associated with lack of adherence (p = 0.04), presence of symptoms (mMRC ≥ 2) and COPD treatment use. The death was associated with non-adherence, presence of symptoms and previous hospitalization. After adjustment, non-adherent patients to treatment were almost twice times likely to die compared to those adherents (Hazard Ratio (HR) 1.86; CI 1.16-2.98, p = 0.01). Conclusion Non-adherence to treatment was associated with higher mortality among moderate-to-severe COPD patients treated in the Brazilian public health system. Strategies to monitor and optimize adherence should be strengthened to reduce COPD-related mortality.
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Affiliation(s)
- Aramís Tupiná Alcantara de Moreira
- Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador (BA) Brasil.,Departamento de Pneumologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador (BA) Brasil.,Diretoria de Assistência Farmacêutica, Secretaria da Saúde do Estado da Bahia, Salvador (BA) Brasil
| | - Charleston Ribeiro Pinto
- Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador (BA) Brasil.,Departamento de Pneumologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador (BA) Brasil.,Departamento de Ciências e Tecnologias, Faculdade de Farmácia, Universidade Estadual do Sudoeste da Bahia, Jequié (BA) Brasil.,Faculdade de Farmácia, Universidade Federal da Bahia, Salvador (BA) Brasil
| | - Antônio Carlos Moreira Lemos
- Departamento de Pneumologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador (BA) Brasil
| | | | | | - Eduardo Martins Netto
- Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador (BA) Brasil.,Laboratório de Pesquisa de Doenças Infecciosas, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador (BA) Brasil
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3
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Souza AF, Silva MRD, Santos JBD, Almeida AM, Acurcio FA, Alvares-Teodoro J. Medication adherence and persistence of psoriatic arthritis patients treated with biological therapy in a specialty pharmacy in Brazil: a prospective observational study. Pharm Pract (Granada) 2021; 19:2312. [PMID: 34221199 PMCID: PMC8216708 DOI: 10.18549/pharmpract.2021.2.2312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/02/2021] [Indexed: 01/12/2023] Open
Abstract
Background: Pharmaceutical services in Brazil provide access, supply, and rational use of
drugs for all population and an effort has been made to improve the quality
of these services. Biological drugs are high-cost drugs supplied in Brazil
that can inhibit disease progression and improve the quality of life of
psoriatic arthritis (PsA) patients. However, some patients did not achieve
therapeutic goals. Objective: To evaluate the medication adherence and persistence of PsA patients treated
with tumor necrosis factor inhibitors (anti-TNF) drugs and their associated
factors. Methods: A prospective observational study was performed at a single-specialty
pharmacy in Belo Horizonte, Brazil. Medication adherence, persistence, and
clinical outcomes were evaluated at 12 months of follow-up. Medication
persistence was historically compared to overall PsA patients treated in
Brazil. Associated factors were identified through log-binomial
regression. Results: One hundred ninety-seven PsA patients were included in the study, of whom 147
(74.6%) and 142 (72.1%) had medication adherence and
persistence, respectively. Patients treated with infliximab presented the
highest adherence (90.5%) and persistence rate (95.2%) in
comparison to patients treated with other drugs, except for adalimumab
versus infliximab for adherence outcome. All clinical measures significantly
improved in patients with medication adherence and persistence. Medication
persistence was higher for patients attended by specialty pharmacy than
other PsA patients in Brazil. The associated factors to higher medication
adherence were lower disease activity by BASDAI, being non-white race, and
intravenous drug use. The associated factors to higher medication
persistence were lower disease activity by Bath Ankylosing Spondylitis
Activity Index (BASDAI), intravenous drug use, non-use of corticoids and
non-steroidal anti-inflammatory drugs, and comorbidity. Conclusions: Patients with medication adherence and persistence had significant
improvements in clinical measures, functionality, and quality of life. High
medication adherence and persistence to biological therapy were observed and
associated with lesser disease activity at baseline. Also, medication
persistence to PsA patients attended in specialty pharmacy was higher than
the overall PsA population in Brazil, which indicates the importance of
pharmaceutical services to provide health care and promote the effectiveness
and safety of biological therapies.
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Affiliation(s)
- Ana F Souza
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais. Belo Horizonte, MG (Brazil).
| | - Michael R Da Silva
- PhD. Professor. Department of Pharmacy and Nutrition; Center for Exact, Natural and Health Sciences, Federal University of Espírito Santo, Alegre, ES (Brazil).
| | - Jéssica B Dos Santos
- PhD. Department of Pharmacy and Nutrition; Center for Exact, Natural and Health Sciences, Federal University of Espírito Santo, Alegre, ES (Brazil).
| | - Alessandra M Almeida
- PhD. Professor. Faculty of Medical Sciences of Minas Gerais. Belo Horizonte, MG (Brasil).
| | - Francisco A Acurcio
- PhD. Professor. Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais. Belo Horizonte, MG (Brazil).
| | - Juliana Alvares-Teodoro
- PhD. Professor. Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais. Belo Horizonte, MG (Brazil).
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4
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Vieira-Marques P, Almeida R, Teixeira JF, Valente J, Jácome C, Cachim A, Guedes R, Pereira A, Jacinto T, Fonseca JA. InspirerMundi-Remote Monitoring of Inhaled Medication Adherence through Objective Verification Based on Combined Image Processing Techniques. Methods Inf Med 2021; 60:e9-e19. [PMID: 33906260 PMCID: PMC8294936 DOI: 10.1055/s-0041-1726277] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background
The adherence to inhaled controller medications is of critical importance for achieving good clinical results in patients with chronic respiratory diseases. Self-management strategies can result in improved health outcomes and reduce unscheduled care and improve disease control. However, adherence assessment suffers from difficulties on attaining a high grade of trustworthiness given that patient self-reports of high-adherence rates are known to be unreliable.
Objective
Aiming to increase patient adherence to medication and allow for remote monitoring by health professionals, a mobile gamified application was developed where a therapeutic plan provides insight for creating a patient-oriented self-management system. To allow a reliable adherence measurement, the application includes a novel approach for objective verification of inhaler usage based on real-time video capture of the inhaler's dosage counters.
Methods
This approach uses template matching image processing techniques, an off-the-shelf machine learning framework, and was developed to be reusable within other applications. The proposed approach was validated by 24 participants with a set of 12 inhalers models.
Results
Performed tests resulted in the correct value identification for the dosage counter in 79% of the registration events with all inhalers and over 90% for the three most widely used inhalers in Portugal. These results show the potential of exploring mobile-embedded capabilities for acquiring additional evidence regarding inhaler adherence.
Conclusion
This system helps to bridge the gap between the patient and the health professional. By empowering the first with a tool for disease self-management and medication adherence and providing the later with additional relevant data, it paves the way to a better-informed disease management decision.
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Affiliation(s)
- Pedro Vieira-Marques
- CINTESIS-Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rute Almeida
- CINTESIS-Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, MEDCIDS, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - José Valente
- MEDIDA-Serviços em Medicina, EDucação, Investigação, Desenvolvimento e Avaliação, LDA, Porto, Portugal
| | - Cristina Jácome
- CINTESIS-Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, MEDCIDS, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Afonso Cachim
- Department of Community Medicine, MEDCIDS, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rui Guedes
- Department of Community Medicine, MEDCIDS, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Pereira
- CINTESIS-Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, MEDCIDS, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal.,Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - Tiago Jacinto
- CINTESIS-Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.,MEDIDA-Serviços em Medicina, EDucação, Investigação, Desenvolvimento e Avaliação, LDA, Porto, Portugal.,Department of Cardiovascular and Respiratory Sciences, Porto Health School, Polytechnic Institute of Porto, Porto, Portugal
| | - João A Fonseca
- CINTESIS-Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, MEDCIDS, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal.,MEDIDA-Serviços em Medicina, EDucação, Investigação, Desenvolvimento e Avaliação, LDA, Porto, Portugal.,Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
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5
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Jang Y, Jee D, Lee D, Choi NK, Bae S. Medication Adherence and Persistence of Open-Angle Glaucoma Patients in Korea: A Retrospective Study Using National Health Insurance Claims Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084106. [PMID: 33924601 PMCID: PMC8069643 DOI: 10.3390/ijerph18084106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/07/2021] [Accepted: 04/10/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to analyze medication adherence and persistence among open-angle glaucoma patients in Korea. A retrospective study was conducted using the Korean National Health Insurance (NHI) claims database from 2016 to 2019. Newly diagnosed open-angle glaucoma patients who were prescribed with the intraocular pressure (IOP)-lowering eyedrops were included. Adherence was measured using the medication possession ratio (MPR), and persistence was measured using the duration of therapy during the 24 month follow-up period. During the study period, 14,648 open-angle glaucoma patients were identified, and 3118 (21.3%) and 4481 patients (30.6%) were adherent to and persistent with their glaucoma treatment, respectively. The mean MPR was 48.8%, and the mean duration of therapy was 357.2 days. Logistic regression analysis showed that patients who are older, female, using prostaglandins as the index medication, and visiting secondary or tertiary hospitals were significantly associated with greater rates of adherence (odds ratio (OR) = 1.21, 1.12, 1.27, and 1.73, respectively) and persistence (OR = 1.11, 1.17, 1.16, 1.17, and 1.36, respectively) during the study period. Patients with open-angle glaucoma in Korea had substandard medication adherence and discontinued their treatment. Ophthalmologists should pay more attention to younger, male patients to improve adherence.
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Affiliation(s)
- Yunjeong Jang
- College of Pharmacy, Ewha Womans University, Seoul 03760, Korea;
| | - Donghyun Jee
- St. Vincent’s Hospital, College of Medicine, The Catholic University, Seoul 16247, Korea;
| | - Donghwan Lee
- Department of Statistics, Ewha Womans University, Seoul 03760, Korea;
| | - Nam-Kyong Choi
- Department of Health Convergence, Ewha Womans University, Seoul 03760, Korea;
| | - SeungJin Bae
- College of Pharmacy, Ewha Womans University, Seoul 03760, Korea;
- Correspondence: ; Tel.: +82-2-3277-3056
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Shafrir A, Shauly-Aharonov M, Katz LH, Paltiel O, Pickman Y, Ackerman Z. The Association between Serum Vitamin D Levels and Helicobacter pylori Presence and Eradication. Nutrients 2021; 13:nu13010278. [PMID: 33478000 PMCID: PMC7835846 DOI: 10.3390/nu13010278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 12/12/2022] Open
Abstract
Background: The success of Helicobacter pylori (H. pylori) eradication depends on several host and treatment factors. Serum vitamin D levels may be associated with H. pylori infection and eradication rates. We investigated the association between vitamin D and H. pylori infection and eradication, using a large electronic database based on medical records from a population-based health maintenance organization. Methods: Data regarding adults who underwent H. pylori testing and had vitamin D measurements within one month of H. pylori testing were collected. H. pylori infection was ascertained using urea breath or stool antigen tests. A negative H. pylori test following a positive result implied eradication. Multivariate regression models were constructed to assess associations between H. pylori infection, eradication, and vitamin D. Results: Among 150,483 members who underwent H. pylori testing from 2009 to 2018, 27,077 (18%) had vitamin D measurements. Vitamin D levels were inversely associated with H. pylori infection, p < 0.001. The odds of a positive H. pylori test were 31% higher among patients with vitamin D levels <20 ng/mL, compared with those with levels ≥20 ng/mL (OR 1.31, 99% CI 1.22–1.4, p < 0.001). Purchase of vitamin D supplements was associated with a negative subsequent H. pylori test (p < 0.001). Mean vitamin D levels were moderately higher in those with successful vs. failed H. pylori eradication (19.34 ± 9.55 vs. 18.64 ± 9.61, p < 0.001). Conclusions: Vitamin D levels are associated with H. pylori infection. Increased vitamin D levels are associated with successful H. pylori eradication. Vitamin D may have a role in H. pylori eradication.
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Affiliation(s)
- Asher Shafrir
- Division of Medicine, Meuhedet Health Services, Tel Aviv 6203854, Israel
- Hadassah Medical Center, The Department of Gastroenterology, Faculty of Medicine, Ein Karem Campus, Hebrew University of Jerusalem, P.O. Box 12249, Jerusalem 9112102, Israel;
- Correspondence: ; Tel.: +972-2677-7547; Fax: +972-2642-0338
| | - Michal Shauly-Aharonov
- The Jerusalem College of Technology, P.O. Box 16031, Jerusalem 91160, Israel;
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel;
| | - Lior H. Katz
- Hadassah Medical Center, The Department of Gastroenterology, Faculty of Medicine, Ein Karem Campus, Hebrew University of Jerusalem, P.O. Box 12249, Jerusalem 9112102, Israel;
| | - Ora Paltiel
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel;
- Hadassah Medical Center, Department of Hematology, Faculty of Medicine, Ein Karem Campus, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | | | - Zvi Ackerman
- Hadassah Medical Center, Department of Medicine, Faculty of Medicine, Mount Scopus Campus, Hebrew University of Jerusalem, P.O. Box 24035, Jerusalem 91240, Israel;
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Kardas P, Aguilar-Palacio I, Almada M, Cahir C, Costa E, Giardini A, Malo S, Massot Mesquida M, Menditto E, Midão L, Parra-Calderón CL, Pepiol Salom E, Vrijens B. The Need to Develop Standard Measures of Patient Adherence for Big Data: Viewpoint. J Med Internet Res 2020; 22:e18150. [PMID: 32663138 PMCID: PMC7484771 DOI: 10.2196/18150] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/26/2020] [Accepted: 06/22/2020] [Indexed: 12/18/2022] Open
Abstract
Despite half a century of dedicated studies, medication adherence remains far from perfect, with many patients not taking their medications as prescribed. The magnitude of this problem is rising, jeopardizing the effectiveness of evidence-based therapies. An important reason for this is the unprecedented demographic change at the beginning of the 21st century. Aging leads to multimorbidity and complex therapeutic regimens that create a fertile ground for nonadherence. As this scenario is a global problem, it needs a worldwide answer. Could this answer be provided, given the new opportunities created by the digitization of health care? Daily, health-related information is being collected in electronic health records, pharmacy dispensing databases, health insurance systems, and national health system records. These big data repositories offer a unique chance to study adherence both retrospectively and prospectively at the population level, as well as its related factors. In order to make full use of this opportunity, there is a need to develop standardized measures of adherence, which can be applied globally to big data and will inform scientific research, clinical practice, and public health. These standardized measures may also enable a better understanding of the relationship between adherence and clinical outcomes, and allow for fair benchmarking of the effectiveness and cost-effectiveness of adherence-targeting interventions. Unfortunately, despite this obvious need, such standards are still lacking. Therefore, the aim of this paper is to call for a consensus on global standards for measuring adherence with big data. More specifically, sound standards of formatting and analyzing big data are needed in order to assess, uniformly present, and compare patterns of medication adherence across studies. Wide use of these standards may improve adherence and make health care systems more effective and sustainable.
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Affiliation(s)
- Przemyslaw Kardas
- Department of Family Medicine, Medical University of Lodz, Lodz, Poland
| | - Isabel Aguilar-Palacio
- Preventive Medicine and Public Health Department, Zaragoza University, Zaragoza, Spain.,Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Marta Almada
- UCIBIO REQUIMTE, ICBAS, Porto4Ageing - Competences Center on Active and Healthy Ageing, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Caitriona Cahir
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elisio Costa
- UCIBIO REQUIMTE, ICBAS, Porto4Ageing - Competences Center on Active and Healthy Ageing, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Anna Giardini
- IT Department, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Sara Malo
- Preventive Medicine and Public Health Department, Zaragoza University, Zaragoza, Spain.,Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Mireia Massot Mesquida
- Servei d'Atenció Primària Vallès Occidental, Institut Català de la Salut, Barcelona, Spain
| | - Enrica Menditto
- CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy.,Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Luís Midão
- UCIBIO REQUIMTE, ICBAS, Porto4Ageing - Competences Center on Active and Healthy Ageing, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Carlos Luis Parra-Calderón
- Group of Research and Innovation in Biomedical Informatics, Biomedical Engineering and Health Economy, Institute of Biomedicine of Seville, IBiS / Virgen del Rocío University Hospital / CSIC / University of Seville, Seville, Spain
| | - Enrique Pepiol Salom
- International Commitee, Muy Ilustre Colegio Oficial de Farmacéuticos, Valencia, Spain
| | - Bernard Vrijens
- AARDEX Group, Seraing, Belgium.,Liège University, Liège, Belgium
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8
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Cui B, Dong Z, Zhao M, Li S, Xiao H, Liu Z, Yan X. Analysis of Adherence to Antihypertensive Drugs in Chinese Patients with Hypertension: A Retrospective Analysis Using the China Health Insurance Association Database. Patient Prefer Adherence 2020; 14:1195-1204. [PMID: 32764892 PMCID: PMC7373416 DOI: 10.2147/ppa.s243665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 05/24/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To analyze the adherence to antihypertensive drugs in Chinese patients with hypertension and the factors associated with the drug adherence. METHODS The data for this analysis were obtained from the 2014 China Health Insurance Association (CHIRA) database. The study included 64,576 patients aged ≥18 years who were prescribed one of the seven antihypertensive drugs included in the study in their first prescription in 2014 and were observed for ≥180 days. The medicine possession ratio (MPR) was calculated and taken as the measure of treatment adherence. MPR values <0.3, 0.3 to <0.5, 0.5 to <0.8, and ≥0.8 were considered treatment adherence very low, low, intermediate, and high, respectively. Descriptive statistics were used to present baseline data and treatment adherence rate. Multiple regression models were used to determine independent factors which can affect the treatment adherence rate. P-value <0.05 was considered significant. RESULTS Among the study antihypertensive drugs, amlodipine (33.98%), metoprolol (25.04%), and nifedipine (17.15%) were the frequently prescribed drugs. Nifedipine controlled release tablet had the highest MPR (0.61), followed by valsartan (0.53), valsartan/amlodipine fixed-dose combination (0.50), indapamide (0.40), and amlodipine (0.39), whereas benazepril (0.27) and metoprolol (0.19) had the lowest MPR. Higher reimbursement ratio, regular tertiary hospitals visits, lower age, and lower daily medical cost positively affected treatment adherence, whereas longer duration of illness and higher daily average cost affected treatment adherence negatively. CONCLUSION Our study assessed that prescribing more cost-effective, long-acting antihypertensive drugs, and raising the reimbursement ratio were associated with a better treatment adherence in Chinese patients with hypertension.
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Affiliation(s)
- Bin Cui
- School of Public Health, Peking University, Beijing100191, People’s Republic of China
| | - Zhaohui Dong
- Human Resources and Social Security, Chinese Academy of Labour and Social Security, Beijing, 100029, People’s Republic of China
| | - Mengmeng Zhao
- School of Pharmaceutical Science and Technology, School of Pharmacy, Tianjin University, Tianjin, 300072, People’s Republic of China
| | - Shanshan Li
- Medical Affairs, Bayer Healthcare Company Limited (China), Beijing, 100020, People’s Republic of China
| | - Hua Xiao
- Medical Affairs, Bayer Healthcare Company Limited (China), Beijing, 100020, People’s Republic of China
| | - Zhitao Liu
- Medical Affairs, Bayer Healthcare Company Limited (China), Beijing, 100020, People’s Republic of China
| | - Xiaowei Yan
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of China
- Correspondence: Xiaowei Yan Peking Union Medical College Hospital, Beijing100730, People’s Republic of China Email
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Jácome C, Pereira AM, Almeida R, Ferreira-Magalhaes M, Couto M, Araujo L, Pereira M, Correia MA, Loureiro CC, Catarata MJ, Maia Santos L, Pereira J, Ramos B, Lopes C, Mendes A, Cidrais Rodrigues JC, Oliveira G, Aguiar AP, Afonso I, Carvalho J, Arrobas A, Coutinho Costa J, Dias J, Todo Bom A, Azevedo J, Ribeiro C, Alves M, Leiria Pinto P, Neuparth N, Palhinha A, Gaspar Marques J, Pinto N, Martins P, Todo Bom F, Alvarenga Santos M, Gomes Costa A, Silva Neto A, Santalha M, Lozoya C, Santos N, Silva D, Vasconcelos MJ, Taborda-Barata L, Carvalhal C, Teixeira MF, Alves RR, Moreira AS, Sofia Pinto C, Morais Silva P, Alves C, Câmara R, Coelho D, Bordalo D, Fernandes RM, Ferreira R, Menezes F, Gomes R, Calix MJ, Marques A, Cardoso J, Emiliano M, Gerardo R, Nunes C, Câmara R, Ferreira JA, Carvalho A, Freitas P, Correia R, Fonseca JA. Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts. BMJ Open 2019; 9:e031732. [PMID: 31699737 PMCID: PMC6858182 DOI: 10.1136/bmjopen-2019-031732] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE We aimed to compare patient's and physician's ratings of inhaled medication adherence and to identify predictors of patient-physician discordance. DESIGN Baseline data from two prospective multicentre observational studies. SETTING 29 allergy, pulmonology and paediatric secondary care outpatient clinics in Portugal. PARTICIPANTS 395 patients (≥13 years old) with persistent asthma. MEASURES Data on demographics, patient-physician relationship, upper airway control, asthma control, asthma treatment, forced expiratory volume in one second (FEV1) and healthcare use were collected. Patients and physicians independently assessed adherence to inhaled controller medication during the previous week using a 100 mm Visual Analogue Scale (VAS). Discordance was defined as classification in distinct VAS categories (low 0-50; medium 51-80; high 81-100) or as an absolute difference in VAS scores ≥10 mm. Correlation between patients' and physicians' VAS scores/categories was explored. A multinomial logistic regression identified the predictors of physician overestimation and underestimation. RESULTS High inhaler adherence was reported both by patients (median (percentile 25 to percentile 75) 85 (65-95) mm; 53% VAS>80) and by physicians (84 (68-95) mm; 53% VAS>80). Correlation between patient and physician VAS scores was moderate (rs=0.580; p<0.001). Discordance occurred in 56% of cases: in 28% physicians overestimated adherence and in 27% underestimated. Low adherence as assessed by the physician (OR=27.35 (9.85 to 75.95)), FEV1 ≥80% (OR=2.59 (1.08 to 6.20)) and a first appointment (OR=5.63 (1.24 to 25.56)) were predictors of underestimation. An uncontrolled asthma (OR=2.33 (1.25 to 4.34)), uncontrolled upper airway disease (OR=2.86 (1.35 to 6.04)) and prescription of short-acting beta-agonists alone (OR=3.05 (1.15 to 8.08)) were associated with overestimation. Medium adherence as assessed by the physician was significantly associated with higher risk of discordance, both for overestimation and underestimation of adherence (OR=14.50 (6.04 to 34.81); OR=2.21 (1.07 to 4.58)), while having a written action plan decreased the likelihood of discordance (OR=0.25 (0.12 to 0.52); OR=0.41 (0.22 to 0.78)) (R2=44%). CONCLUSION Although both patients and physicians report high inhaler adherence, discordance occurred in half of cases. Implementation of objective adherence measures and effective communication are needed to improve patient-physician agreement.
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Affiliation(s)
- Cristina Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | - Ana Margarida Pereira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
- Immunoalergology, CUF-Porto Hospital and Institute, Porto, Portugal
| | - Rute Almeida
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | - Manuel Ferreira-Magalhaes
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Mariana Couto
- Immunoalergology, CUF-Porto Hospital and Institute, Porto, Portugal
| | - Luís Araujo
- Immunoalergology, CUF-Porto Hospital and Institute, Porto, Portugal
| | - Mariana Pereira
- MEDIDA - Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal
| | | | - Cláudia Chaves Loureiro
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Maria Joana Catarata
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Lília Maia Santos
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - João Pereira
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Bárbara Ramos
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Cristina Lopes
- Unidade de Imunoalergologia, Unidade Local de Saúde de Matosinhos EPE, Senhora da Hora, Portugal
- Imunologia Básica e Clínica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Ana Mendes
- Serviço de Imunoalergologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte EPE, Lisboa, Portugal
| | | | - Georgeta Oliveira
- Serviço de Pediatria, Unidade Local de Saúde de Matosinhos EPE, Senhora da Hora, Portugal
| | - Ana Paula Aguiar
- Serviço de Pediatria, Unidade Local de Saúde de Matosinhos EPE, Senhora da Hora, Portugal
| | - Ivete Afonso
- Serviço de Pediatria, Unidade Local de Saúde de Matosinhos EPE, Senhora da Hora, Portugal
| | - Joana Carvalho
- Serviço de Pediatria, Unidade Local de Saúde de Matosinhos EPE, Senhora da Hora, Portugal
| | - Ana Arrobas
- Serviço de Pneumologia B, Hospital Geral, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - José Coutinho Costa
- Serviço de Pneumologia B, Hospital Geral, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Joana Dias
- Serviço de Pneumologia B, Hospital Geral, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Ana Todo Bom
- Serviço de Imunoalergologia, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - João Azevedo
- Serviço de Imunoalergologia, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Carmelita Ribeiro
- Serviço de Imunoalergologia, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Marta Alves
- Serviço de Imunoalergologia, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Paula Leiria Pinto
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| | - Nuno Neuparth
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
- Pathophysiology, CEDOC, Integrated Pathophysiological Mechanisms Research Group, Nova Medical School, Lisboa, Portugal
| | - Ana Palhinha
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| | - João Gaspar Marques
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| | - Nicole Pinto
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| | - Pedro Martins
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
- Pathophysiology, CEDOC, Integrated Pathophysiological Mechanisms Research Group, Nova Medical School, Lisboa, Portugal
| | - Filipa Todo Bom
- Serviço de Pneumologia, Hospital Beatriz Ângelo, Loures, Portugal
| | | | | | | | - Marta Santalha
- Serviço de Pediatria, Hospital da Senhora da Oliveira, Guimaraes, Portugal
| | - Carlos Lozoya
- Serviço de Imunoalergologia, Hospital Amato Lusitano, Castelo Branco, Portugal
| | - Natacha Santos
- Serviço de Imunoalergologia, Centro Hospitalar do Algarve EPE, Faro, Portugal
| | - Diana Silva
- Serviço de Imunoalergologia, Hospital São João, Porto, Portugal
| | | | - Luís Taborda-Barata
- University of Beira Interior, CICS - Health Sciences Research Centre; NuESA - Environment & Health Study Group, Faculty of Health Sciences, Covilha, Portugal
- Cova da Beira University Hospital Centre, Department of Allergy & Clinical Immunology, Covilhã, Portugal
| | - Célia Carvalhal
- Cova da Beira University Hospital Centre, Department of Allergy & Clinical Immunology, Covilhã, Portugal
| | - Maria Fernanda Teixeira
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Rodrigo Rodrigues Alves
- Unidade de Imunoalergologia, Hospital do Divino Espirito Santo de Ponta Delgada EPE, Ponta Delgada, Portugal
| | - Ana Sofia Moreira
- Unidade de Imunoalergologia, Hospital do Divino Espirito Santo de Ponta Delgada EPE, Ponta Delgada, Portugal
| | - Cláudia Sofia Pinto
- Serviço de Pneumologia, Centro Hospitalar de Trás-os-montes e Alto Douro EPE, Vila Real, Portugal
| | | | - Carlos Alves
- Serviço de Pneumologia, Centro Hospitalar Barreiro Montijo EPE, Barreiro, Portugal
| | - Raquel Câmara
- Serviço de Pneumologia, Centro Hospitalar Barreiro Montijo EPE, Barreiro, Portugal
| | - Didina Coelho
- Serviço de Pneumologia, Centro Hospitalar Barreiro Montijo EPE, Barreiro, Portugal
| | - Diana Bordalo
- Serviço de Pediatria, Centro Hospitalar do Médio Ave EPE, Santo Tirso, Portugal
| | - Ricardo M Fernandes
- Pediatrics, Hospital de Santa Maria, Lisbon, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, University of Lisbon Medical Faculty, Lisboa, Portugal
| | | | - Fernando Menezes
- Serviço de Pneumologia, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Ricardo Gomes
- Serviço de Pneumologia, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Maria José Calix
- Serviço de Pediatria, Centro Hospitalar Tondela Viseu EPE, Viseu, Portugal
| | - Ana Marques
- Serviço de Pediatria, Centro Hospitalar Tondela Viseu EPE, Viseu, Portugal
| | - João Cardoso
- Pneumology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
- NOVA Medical School, Lisbon, Portugal
| | | | - Rita Gerardo
- Pneumology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Carlos Nunes
- Imunoalergologia, Centro de Imunoalergologia do Algarve, Portimão, Portugal
| | - Rita Câmara
- Serviço de Imunoalergologia, Serviço de Saúde da Região Autónoma da Madeira, Funchal, Portugal
| | - José Alberto Ferreira
- Serviço de Imunoalergologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Aurora Carvalho
- Serviço de Imunoalergologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Paulo Freitas
- Bloco operatório, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ricardo Correia
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), University of Porto Faculty of Medicine, Porto, Portugal
| | - Joao A Fonseca
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
- Immunoalergology, CUF-Porto Hospital and Institute, Porto, Portugal
- MEDIDA - Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), University of Porto Faculty of Medicine, Porto, Portugal
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Kharjul MD, Cameron C, Braund R. Using the Pharmaceutical Collection Database to identify patient adherence to oral hypoglycaemic medicines. J Prim Health Care 2019; 11:265-274. [DOI: 10.1071/hc19017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
ABSTRACT INTRODUCTIONPoor adherence to oral hypoglycaemic medicines is a key contributor to therapy failure and sub-optimal glycaemic control among people with type 2 diabetes. It is unclear how commonly non-adherence to oral hypoglycaemics occurs in the general population. This information is essential to design and implement local adherence strategies. AIMThis study aimed to determine levels of sub-optimal adherence and identify patient groups who may need additional adherence support. METHODSThe dispensing data of 340,283 patients from one District Health Board was obtained from the Pharmaceutical Collection Database for the period 2008–15. Of these, 12,405 patients received oral hypoglycaemic therapy during the study period. The proportion of days covered (PDC) was calculated for patients with complete data and a PDC value of ≥80% was used to indicate sufficient adherence. Patient demographics (gender, ethnicity, age, socioeconomic status) and therapy type (mono- or combination) were described. RESULTSOverall, 54.5% of the patients were found to have a PDC of <80% and so were considered non-adherent. Non-adherence was significantly higher in patients receiving combination oral hypoglycaemic therapy than monotherapy; in male patients; in New Zealand Māori patients; and in patients with higher socioeconomic deprivation. DISCUSSIONIn the study region, non-adherence to oral hypoglycaemic medicines was significant and widespread. Identification of such patients is important so that strategies to enhance adherence can be implemented. Prescribers need to be encouraged to optimise monotherapy before the addition of another oral hypoglycaemic, and adherence support services should be offered not only to older patients.
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