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Kassaw AT, Sendekie AK, Minyihun A, Gebresillassie BM. Medication regimen complexity and its impact on medication adherence in patients with multimorbidity at a comprehensive specialized hospital in Ethiopia. Front Med (Lausanne) 2024; 11:1369569. [PMID: 38860203 PMCID: PMC11163062 DOI: 10.3389/fmed.2024.1369569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/10/2024] [Indexed: 06/12/2024] Open
Abstract
Background Medication regimen complexity (MRC) is suspected to hinder medication adherence in patients with multiple illnesses. Despite this, the specific impact on Ethiopian patients with multimorbidity is unclear. This study assessed MRC and its impact on medication adherence in patients with multimorbidity. Methods A hospital-based cross-sectional study was conducted on patients with multimorbidity who had been followed at the University of Gondar Comprehensive and Specialized Hospital (UoGCSH), Ethiopia, from May to July 2021. Medication complexity was measured using the validated Medication Regimen Complexity Index (MRCI) tool, and the Adherence in Chronic Diseases Scale (ACDS) was used to measure medication adherence. Pearson's chi-square test was used to examine associations between MRCI levels and medication adherence. Ordinal logistic regression analysis was used to determine the impact of MRC and other associated variables on medication adherence. Statistical significance was determined using the adjusted odds ratio (AOR) at p-value <0.05 and its 95% confidence range. Results Out of 422 eligible patients, 416 (98.6%) were included in the study. The majority of participants (57.2%) were classified as having a high MRCI score with a mean (±SD) score of 9.7 (±3.4). Nearly half of the patients (49.3%) had low medication adherence. Patients with medium (AOR = 0.43, 95% CI: 0.04, 0.72) and higher (AOR = 0.31, 95% CI: 0.07, 0.79) MRCI levels had lower odds of medication adherence. In addition, monthly income (AOR = 4.59, 95% CI: 2.14, 9.83), follow-up durations (AOR = 2.31, 95% CI: 1.09, 4.86), number of medications (AOR = 0.63, 95% CI: 0.41, 0.97), and Charlson comorbidity index (CCI) (AOR = 0.36, 95% CI: 0.16, 0.83) were significantly associated with medication adherence. Conclusion Medication regimen complexity in patients with multimorbidity was found to be high and negatively impacted the levels of medication adherence. Healthcare providers and other stakeholders should seek interventions aimed at simplifying drug regimen complexity and improving adherence.
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Affiliation(s)
- Abebe Tarekegn Kassaw
- Department of Pharmacy, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Ashenafi Kibret Sendekie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Minyihun
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Begashaw Melaku Gebresillassie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
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Sucato V, Ortello A, Comparato F, Novo G, Galassi AR. Cholesterol-Lowering Strategies for Cardiovascular Disease Prevention: The Importance of Intensive Treatment and the Simplification of Medical Therapy. J Clin Med 2024; 13:1882. [PMID: 38610647 PMCID: PMC11012834 DOI: 10.3390/jcm13071882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/09/2024] [Accepted: 03/12/2024] [Indexed: 04/14/2024] Open
Abstract
Cardiovascular diseases (CVDs) are a leading global cause of mortality and are primarily driven by atherosclerotic coronary artery disease. Their pathogenesis involves multi-factorial mechanisms, among which low-density lipoprotein (LDL) plays a causative role. Recent ESC/EAS guidelines advocate for a shift toward new risk estimation algorithms that better emphasize non-fatal cardiovascular events, lifetime risk prediction, and tailored pharmacological approaches, including statin + ezetimibe and triple therapy, in specific cases. Intensive lipid-lowering therapy has been shown to be pivotal, especially in post-acute coronary events. Intracoronary imaging has revealed insights into the composition of plaque and demonstrated the significant regression that can be achieved through the use of statins such as rosuvastatin and atorvastatin. The positive effects of Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) inhibitors, particularly alirocumab and evolocumab, on plaque regression, have been demonstrated. Inclisiran, which targets PCSK9 gene expression, significantly reduces LDL cholesterol. The associated challenges include hesitancy to prescribe intensive regimens and limited treatment adherence, highlighting the need for pharmacological combinations to improve therapeutic outcomes.
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Affiliation(s)
- Vincenzo Sucato
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University Hospital Paolo Giaccone, University of Palermo, 90133 Palermo, Italy; (A.O.); (G.N.)
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Belachew EA, Netere AK, Sendekie AK. Medication regimen complexity and its impact on medication adherence and asthma control among patients with asthma in Ethiopian referral hospitals. Asthma Res Pract 2022; 8:7. [PMID: 36529750 PMCID: PMC9761953 DOI: 10.1186/s40733-022-00089-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Various studies have found that medication adherence is generally low among patients with asthma, and that the complexity of the regimen may be a potential factor. However, there is no information on the complexity of the regimen and its relationship to adherence and asthma outcomes in Ethiopian asthma patients. Therefore, this study assessed how complex medication regimens affected medication adherence and asthma control in patients with asthma. METHOD From February 1 to May 30, 2022, a multicenter cross-sectional study was conducted in three public referral hospitals in northwestern Ethiopia. The Medication Complexity Index (MRCI), a 65-item validated instrument, was used to represent the complexity of medication regimens The Medication Adherence Rating Scale for Asthma (MARS-A) was used to assess medication adherence, and the ACT was used to measure the level of asthma control. The association between predictor and outcome variables was determined using multivariable logistic regression analysis. P-values of < 0.05 were declared as a significant association. RESULT Patients with asthma (n = 396) who met the inclusion criteria were included in the final analysis. About 21.2% and 24.5% of the participants had high asthma-specific MRCI and patient-level MRCI, respectively. The majority (84.4%) of the participants did not adhere to their medication, and 71% of the participants were classified as having uncontrolled asthma. According to the result of the multivariable analysis, moving from a high asthma-specific MRCI to a moderate asthma MRCI enhances the likelihood of medication adherence by 2.51 times (AOR = 2.51, 95%CI: (1.27, 7.71). Likewise, patients who have low asthma MRCI were four times more likely to adhere to the medication compared with high asthma MRCI (AOR = 3.80, 95%CI: (2.0, 11.1). Similarly, patients having low patient-level MRCI were eight times more likely their asthma level had been controlled (AOR = 7.84, 95%CI: 1.46 to 21.3) and patients who had moderate patient-level MRCI were three times (AOR = 2.83, 95%CI: 1.05 to 8.25) more controlled asthma compared with patients who had high patient level MRCI. CONCLUSION The majority of asthma patients had low and moderate complexity of MRCI. Patients with low and moderate regimen complexity demonstrated high adherence and had well-controlled asthma. Therefore, future researchers should consider MRCI as one factor for adherence and asthma control levels.
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Affiliation(s)
- Eyayaw Ashete Belachew
- grid.59547.3a0000 0000 8539 4635Department of Clinical Pharmacy, School of Pharmacy,College of Medicine and Health Sciences, University of Gondar, 196 Gondar, Ethiopia
| | - Adeladlew Kassie Netere
- grid.59547.3a0000 0000 8539 4635Department of Clinical Pharmacy, School of Pharmacy,College of Medicine and Health Sciences, University of Gondar, 196 Gondar, Ethiopia
| | - Ashenafi Kibret Sendekie
- grid.59547.3a0000 0000 8539 4635Department of Clinical Pharmacy, School of Pharmacy,College of Medicine and Health Sciences, University of Gondar, 196 Gondar, Ethiopia
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Paranjpe R, Chen H, Johnson ML, Birtcher K, Serna O, Abughosh S. Adherence to Concomitant Diabetes, Hypertension, and Hyperlipidemia Treatments Among Elderly Patients. J Am Pharm Assoc (2003) 2022; 62:1351-1358. [DOI: 10.1016/j.japh.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/07/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
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Foley L, Larkin J, Lombard-Vance R, Murphy AW, Hynes L, Galvin E, Molloy GJ. Prevalence and predictors of medication non-adherence among people living with multimorbidity: a systematic review and meta-analysis. BMJ Open 2021; 11:e044987. [PMID: 34475141 PMCID: PMC8413882 DOI: 10.1136/bmjopen-2020-044987] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This systematic review aimed to describe medication non-adherence among people living with multimorbidity according to the current literature, and synthesise predictors of non-adherence in this population. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. PubMed, EMBASE, CINAHL and PsycINFO were searched for relevant articles published in English language between January 2009 and April 2019. Quantitative studies reporting medication non-adherence and/or predictors of non-adherence among people with two or more chronic conditions were included in the review. A meta-analysis was conducted with a subgroup of studies that used an inclusive definition of multimorbidity to recruit participants, rather than seeking people with specific conditions. Remaining studies reporting prevalence and predictors of non-adherence were narratively synthesised. RESULTS The database search produced 10 998 records and a further 75 were identified through other sources. Following full-text screening, 178 studies were included in the review. The range of reported non-adherence differed by measurement method, at 76.5% for self-report, 69.4% for pharmacy data, and 44.1% for electronic monitoring. A meta-analysis was conducted with eight studies (n=8949) that used an inclusive definition of multimorbidity to recruit participants. The pooled prevalence of non-adherence was 42.6% (95% CI: 34.0 - 51.3%, k=8, I2=97%, p<0.01). The overall range of non-adherence was 7.0%-83.5%. Frequently reported correlates of non-adherence included previous non-adherence and treatment-related beliefs. CONCLUSIONS The review identified a heterogeneous literature in terms of conditions studied, and definitions and measures of non-adherence used. Results suggest that future attempts to improve adherence among people with multimorbidity should determine for which conditions individuals require most support. The variable levels of medication non-adherence highlight the need for more attention to be paid by healthcare providers to the impact of multimorbidity on chronic disease self-management. PROSPERO REGISTRATION NUMBER CRD42019133849.
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Affiliation(s)
- Louise Foley
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - James Larkin
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Richard Lombard-Vance
- Department of Psychology, National University of Ireland Maynooth, Maynooth, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
- HRB Primary Care Clinical Trials Network Ireland, National University of Ireland Galway, Galway, Ireland
| | - Lisa Hynes
- Health Programmes, Croí Heart & Stroke Centre, Galway, Ireland
| | - Emer Galvin
- School of Pharmacy & Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gerard J Molloy
- School of Psychology, National University of Ireland Galway, Galway, Ireland
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Alefishat E, Jarab AS, Al-Qerem W, Abu-Zaytoun L. Factors Associated with Medication Non-Adherence in Patients with Dyslipidemia. Healthcare (Basel) 2021; 9:healthcare9070813. [PMID: 34203226 PMCID: PMC8305629 DOI: 10.3390/healthcare9070813] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 12/15/2022] Open
Abstract
Lack of medication adherence among patients with dyslipidemia negatively affects health-related outcomes. This study aims to evaluate medication adherence; we also aim to investigate the predictors of non-adherence among patients with dyslipidemia in Jordan. Medication adherence was evaluated in a total of 228 dyslipidemia patients. The Beliefs about Medicines Questionnaire was also used to assess patients' beliefs about medications. The majority of the current study participants (73.2%) reported non-adherence to the prescribed medications. There were significant negative associations between medication adherence and concerns of prescription drug use (B = -0.41, p-value < 0.01), duration of dyslipidemia (B = -0.22, p-value < 0.01), and the number of medications (B = -0.64, p-value < 0.01). Positive associations were found between medication adherence and the necessity of prescription drug use (B = 0.43, p-value < 0.01), taking statin and fibrate (B = 2.04, p-value < 0.01), and moderate-intensity statin (B = 2.34, p-value < 0.01). As for patients' beliefs about medications, the item "My medicine to lower my cholesterol disrupted my life" had the highest mean (3.50 ± 0.99). This study revealed a low adherence rate to medication among patients with dyslipidemia. It also demonstrates modifiable factors such as beliefs regarding perceived risk, medication harms, treatment duration, and the number of medications associated with poor adherence in patients with dyslipidemia.
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Affiliation(s)
- Eman Alefishat
- Department of Pharmacology, College of Medicine and Health Science, Khalifa University of Science and Technology, Abu Dhabi 127788, United Arab Emirates
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi 127788, United Arab Emirates
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman 11942, Jordan
- Correspondence: ; Tel.: +971-2-5018466
| | - Anan S. Jarab
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan; (A.S.J.); (L.A.-Z.)
| | - Walid Al-Qerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11733, Jordan;
| | - Lina Abu-Zaytoun
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan; (A.S.J.); (L.A.-Z.)
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Tsioufis K, Kreutz R, Sykara G, van Vugt J, Hassan T. Impact of single-pill combination therapy on adherence, blood pressure control, and clinical outcomes: a rapid evidence assessment of recent literature. J Hypertens 2021; 38:1016-1028. [PMID: 32371789 PMCID: PMC7253190 DOI: 10.1097/hjh.0000000000002381] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The 2018 European Society of Cardiology/European Society of Hypertension Guidelines for the management of arterial hypertension raised the need for evidence to support the use of single-pill combination (SPC) therapy in preference to free-dosed therapy for hypertension. This systematic rapid evidence assessment sought to determine if initiating SPC therapy improves adherence, blood pressure (BP) control and/or cardiovascular outcomes vs. initiation of free-dose combination therapy.
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Affiliation(s)
- Konstantinos Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Reinhold Kreutz
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - Georgia Sykara
- Medical Affairs, Pfizer Upjohn Hellas Ltd, Athens, Greece
| | - Joris van Vugt
- Medical Affairs, Pfizer Upjohn, Cappelle a/d Ijssel, The Netherlands
| | - Tarek Hassan
- Medical Affairs, Pfizer Upjohn, New York, New York, USA
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Endres K, Schiller E, Haen E. [Antihypertensive drugs in psychiatry : Prescription behavior and potential drug-drug interactions]. DER NERVENARZT 2021; 92:487-493. [PMID: 32986155 PMCID: PMC8087599 DOI: 10.1007/s00115-020-00996-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hintergrund Psychisch Kranke haben ein erhöhtes kardiovaskuläres Mortalitätsrisiko. Zur Prophylaxe und Therapie von Herz-Kreislauf-Erkrankungen werden insbesondere Antihypertensiva eingesetzt. In Kombination mit Psychopharmaka resultiert ein Interaktionspotenzial, wodurch das Erreichen therapeutischer Ziele beeinträchtigt werden kann. Ziel Das Verordnungsverhalten bei Antihypertensiva in psychiatrischen Kliniken und Praxen im deutschsprachigen Raum sowie das Interaktionspotenzial mit Psychopharmaka soll untersucht werden. Methoden Es erfolgte eine Auswertung der AGATE-„Stichtags“-Datenbank, welche anonym die Patientendaten Alter, Geschlecht, psychiatrische Hauptdiagnose sowie die verordneten Handelspräparate enthält. Die Auswertung der möglichen Interaktionen erfolgte mit PSIAC. Ergebnisse Zwischen 01.01.2012 und 31.12.2016 wiesen 27 % aller 21.980 erfassten Patienten eine Verordnung für mindestens ein Antihypertensivum auf, wobei der Anteil mit dem Alter auf 72 % bei den über 80-Jährigen anstieg. 48 % der antihypertensiv Behandelten erhielten eine blutdrucksenkende Monotherapie. Mit dem Alter stieg die Bedeutung der antihypertensiven Kombinationstherapie. Insgesamt wurden den Patienten im Median 7 Wirkstoffe verordnet, wodurch mathematisch 21 Interaktionen resultieren. Durch eine gleichzeitige Gabe von Psychopharmaka und Blutdrucksenkern kann es vor allem zu einem erhöhten Risiko für Hypotonie, unzureichende Blutdrucksenkung oder QTc-Zeitverlängerung kommen. Diskussion Antihypertensiva haben einen hohen Stellenwert bei der Behandlung psychiatrischer Patienten. Eine Interaktionsprüfung sollte durchgeführt werden, wenn die Pharmakotherapie ergänzt oder verändert werden soll. Allenfalls sollten Maßnahmen zur Verbesserung der Arzneimitteltherapiesicherheit erwogen werden.
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Affiliation(s)
- Katharina Endres
- Institut AGATE gGmbH Pentling, Pentling, Deutschland.
- Klinische Pharmakologie, Lehrstuhl für Pharmakologie und Toxikologie, Universität Regensburg, Universitätsstr. 31, 93053, Regensburg, Deutschland.
| | - Ernst Schiller
- Rechenzentrum, Universität Regensburg, Universitätsstr. 31, 93053, Regensburg, Deutschland
| | - Ekkehard Haen
- Institut AGATE gGmbH Pentling, Pentling, Deutschland
- Klinische Pharmakologie, Lehrstuhl für Pharmakologie und Toxikologie, Universität Regensburg, Universitätsstr. 31, 93053, Regensburg, Deutschland
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Cho J, Shin S, Jeong YM, Lee E, Lee E. The Effect of Regimen Frequency Simplification on Provider Order Generation: A Quasi-Experimental Study in a Korean Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084086. [PMID: 33924431 PMCID: PMC8070259 DOI: 10.3390/ijerph18084086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/31/2021] [Accepted: 04/09/2021] [Indexed: 11/16/2022]
Abstract
The multiplicity of dosing frequencies that are attached to medication orders poses a challenge to patients regarding adhering to their medication regimens and healthcare professionals in maximizing the efficiencies of health care service delivery. A multidisciplinary team project was performed to simplify medication regimens to improve the computerized physician order entry (CPOE) system to reduce the dosing frequencies for patients who were discharged from the hospital. A 36-month pre-test–post-test study was performed, including 12-month pre-intervention, 12-month intervention, and 12-month post-intervention periods. Two-pronged strategies, including regimen standardization and prioritization, were devised to evaluate the dosing frequencies and prescribing efficiency. The results showed that the standardized menu reduced the dosing frequencies from 4.3 ± 2.2 per day in the pre-intervention period to 3.5 ± 1.8 per day in the post-intervention period (p < 0.001). In addition, the proportion of patients taking medications five or more times per day decreased from 40.8% to 20.7% (p < 0.001). After prioritizing the CPOE dosing regimen, the number of pull-down options that were available reflected an improvement in the prescribing efficiency. Our findings indicate that concerted efforts in improving even a simple change on the CPOE screen via standardization and prioritization simplified the dosing frequencies for patients and improved the physicians’ prescribing process.
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Affiliation(s)
- Jungwon Cho
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (J.C.); (S.S.); (E.L.)
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Korea
| | - Sangmi Shin
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (J.C.); (S.S.); (E.L.)
| | - Young Mi Jeong
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (J.C.); (S.S.); (E.L.)
- Correspondence: (Y.M.J.); (E.L.)
| | - Eunsook Lee
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (J.C.); (S.S.); (E.L.)
| | - Euni Lee
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (J.C.); (S.S.); (E.L.)
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Korea
- Correspondence: (Y.M.J.); (E.L.)
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Foley L, Larkin J, Lombard-Vance R, Murphy AW, Molloy GJ. Prevalence and predictors of medication non-adherence among patients with multimorbidity: A systematic review protocol. HRB Open Res 2021; 2:29. [PMID: 32296748 PMCID: PMC7140769 DOI: 10.12688/hrbopenres.12961.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 01/23/2023] Open
Abstract
Introduction: Patients with multimorbidity are expected to adhere to complex medication regimens in order to manage their multiple chronic conditions. It has been reported the likelihood of adherence decreases as patients are prescribed more medications. Much medication adherence research to date is dominated by a single-disease focus, which is at odds with the rising prevalence of multimorbidity and may artificially underestimate the complexity of managing chronic illness. This review aims to describe the prevalence of medication non-adherence among patients with multimorbidity, and to identify potential predictors of non-adherence in this population. Methods: A systematic review will be conducted and reported according to PRISMA guidelines. PubMed, EMBASE, CINAHL and PsycINFO will be searched using a predefined search strategy from 2009–2019. Quantitative studies will be considered eligible for review if prevalence of medication non-adherence among adults with two or more chronic conditions is reported. Studies will be included in the review if available in English full text. Titles and abstracts will be screened by single review, with 20% of screening cross-checked by a second reviewer. Full-text articles will be screened by two independent reviewers, noting reasons for exclusions. Data extraction will be performed using a predefined extraction form. Quality and risk of bias assessment will be conducted using criteria for observational studies outlined by Sanderson et al. (2007). A narrative synthesis and, if feasible, meta-analysis will be conducted. Discussion: By exploring medication non-adherence from a multimorbidity perspective, the review aims to inform an evidence base for intervention development which accounts for the rising prevalence of patients with multiple chronic conditions. Study registration: The systematic review is prospectively registered in PROSPERO (
CRD42019133849); registered on 12 June 2019.
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Affiliation(s)
- Louise Foley
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
| | - James Larkin
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Andrew W Murphy
- Discipline of General Practice, National University of Ireland, Galway, Galway, Ireland.,HRB Primary Care Clinical Trials Network Ireland, National University of Ireland, Galway, Galway, Ireland
| | - Gerard J Molloy
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
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A Gap in Post-Stroke Blood Pressure Target Attainment at Entry to Cardiac Rehabilitation. Can J Neurol Sci 2020; 48:487-495. [PMID: 33059775 DOI: 10.1017/cjn.2020.231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Recurrent events account for approximately one-third of all strokes and are associated with greater disability and mortality than first-time strokes. Blood pressure (BP) is the most important modifiable risk factor. Objectives were to determine the proportion of post-stroke patients enrolled in cardiac rehabilitation (CR) meeting systolic and diastolic BP (SBP/DBP) targets and to determine correlates of meeting these targets. METHODS A retrospective study of 1,804 consecutively enrolled post-stroke patients in a CR program was conducted. Baseline data (database records 2006-2017) included demographics, anthropometrics, clinical/medication history, and resting BP. Multivariate analyses determined predictors of achieving BP targets. RESULTS Mean age was 64.1 ± 12.7 years, median days from stroke 210 (IQR 392), with most patients being male (70.6%; n = 1273), overweight (66.8%; n = 1196), and 64.2% diagnosed with hypertension (n = 1159), and 11.8% (n = 213) with sleep apnea. A mean of 1.69 ± 1.2 antihypertensives were prescribed, with 26% (n = 469) of patients prescribed 3-4 antihypertensives. SBP target was met by 71% (n = 1281) of patients, 83.3% (n = 1502) met DBP target, and 64.3% (n = 1160) met both targets. Correlates of meeting SBP target were not having diabetes, younger age, fewer prescribed antihypertensives, and more recent program entry. Correlates of meeting DBP target were not having diabetes, older age, fewer prescribed antihypertensives, and more recent stroke. CONCLUSIONS Up to one-third of patients were not meeting BP targets. Patients with diabetes, and those prescribed multiple antihypertensives are at greater risk for poorly controlled SBP and DBP. Reasons for poor BP control such as untreated sleep apnea and medication non-adherence need to be investigated.
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Abstract
OBJECTIVE Medication non-adherence is a widespread problem and has been known to be associated with worse health outcomes and increased healthcare costs. Although many measures of adherence have been developed, their usage is not consistent across studies. Furthermore, statistical methods for analyzing adherence measures have not been rigorously evaluated. METHODS Using Proportion of Days Covered (PDC), a commonly used adherence measure, we examine the variability inherent to study inclusion criteria and several variations of the PDC calculation method using a motivating data example. We illustrated via sensitivity analyses the potential for flawed inference when modeling PDC as an outcome measure. We also performed simulation studies to investigate the statistical properties of three statistical models: logistic regression, negative binomial, and ordinal logistic regression models. RESULTS Our sensitivity analysis showed that parameter estimates can vary greatly depending on the rules for determining the study end date in calculating PDC, or the minimum number of fills in defining the cohort. In simulation studies, logistic regression had lower power than ordinal logistic and negative binomial regression models. Naivete to treatment was an important predictor of adherence and omitting it from statistical models can lead to inflated type I errors. CONCLUSIONS We discourage dichotomizing adherence data as it results in low power. The negative binomial model offers advantages in modeling adherence data, as it avoids the problematic use of a ratio in regression models. The ordinal logistic regression is robust to distributional assumptions with greater power, but naivete to treatment should be adjusted to reserve type I error rate. We also provide a recommendation for defining the observation window in calculating PDC.
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Affiliation(s)
- Josh DeClercq
- Vanderbilt University Medical Center, Department of Biostatistics, Nashville, TN, USA
| | - Leena Choi
- Vanderbilt University Medical Center, Department of Biostatistics, Nashville, TN, USA
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Elnaem MH, Irwan NA, Abubakar U, Syed Sulaiman SA, Elrggal ME, Cheema E. Impact of Medication Regimen Simplification on Medication Adherence and Clinical Outcomes in Patients with Long-Term Medical Conditions. Patient Prefer Adherence 2020; 14:2135-2145. [PMID: 33173282 PMCID: PMC7646472 DOI: 10.2147/ppa.s268499] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 09/01/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND This study aims to identify interventions used to reduce medication regimen complexity and to assess their impact on medication adherence and clinical outcomes. METHODS A literature search was conducted using pre-defined search terms in three scientific databases, including ScienceDirect, ProQuest and MEDLINE. Original research articles published in English between 2009 and 2020 that assessed the impact of medication regimen simplification on medication adherence in patients with long-term medical conditions were eligible for inclusion. Review articles, meta-analysis studies and conference proceedings were excluded. Data charting was done in an iterative process using a study-specific extraction form. RESULTS Of the 684 studies identified through initial searches, 17 studies were included in the review. Nine studies involved simplification of medication regimen related to HIV, while three studies focused on patients with diabetes with or without coronary artery disease. The remaining five studies included medications used among elderly patients or medications related to hypertension, psychiatric disorders, glaucoma and kidney diseases. Three medication regimen simplification strategies were identified; fixed-dose combination (n = 7), once-daily dosing (n = 4) and the combination of both fixed-dose and once-daily dosing (n = 6). Overall, most of the regimen simplification strategies (14 out of 17) were found to be useful in improving medication adherence. There was no assessment of clinical outcomes in four out of 17 studies. Furthermore, more than half of the studies that assessed clinical outcomes did not show any additional impact on clinical outcomes. CONCLUSION The findings suggest that there was an equal utilization of the three main approaches of regimen simplifications; fixed-dose combination, once-daily dosing and a combination of both. Overall, most of the regimen simplification strategies were found to be effective in improving medication adherence. However, the associated improvement in medication adherence did not extend to improvement in the clinical outcomes.
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Affiliation(s)
- Mohamed Hassan Elnaem
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
- Quality Use of Medicines Research Group, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Nor Afifah Irwan
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Usman Abubakar
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Syed Azhar Syed Sulaiman
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Mahmoud E Elrggal
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Ejaz Cheema
- School of Pharmacy, University of Birmingham, Edgbaston, BirminghamB15 2TT, UK
- Correspondence: Ejaz Cheema School of Pharmacy, University of Birmingham, Edgbaston, BirminghamB15 2TT, UKTel +44-121-4146845 Email
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Foley L, Larkin J, Lombard-Vance R, Murphy AW, Molloy GJ. Prevalence and predictors of medication non-adherence among patients with multimorbidity: A systematic review protocol. HRB Open Res 2019; 2:29. [DOI: 10.12688/hrbopenres.12961.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2019] [Indexed: 01/19/2023] Open
Abstract
Introduction: Patients with multimorbidity are expected to adhere to complex medication regimens in order to manage their multiple chronic conditions. It has been reported the likelihood of adherence decreases as patients are prescribed more medications. Much medication adherence research to date is dominated by a single-disease focus, which is at odds with the rising prevalence of multimorbidity and may artificially underestimate the complexity of managing chronic illness. This review aims to describe the prevalence of medication non-adherence among patients with multimorbidity, and to identify potential predictors of non-adherence in this population. Methods: A systematic review will be conducted and reported according to PRISMA guidelines. PubMed, EMBASE, CINAHL and PsycINFO will be searched using a predefined search strategy from 2009–2019. Quantitative studies will be considered eligible for review if prevalence of medication non-adherence among adults with two or more chronic conditions is reported. Studies will be included in the review if available in English full text. Titles and abstracts will be screened by single review, with 20% of screening cross-checked by a second reviewer. Full-text articles will be screened by two independent reviewers, noting reasons for exclusions. Data extraction will be performed using a predefined extraction form. Quality and risk of bias assessment will be conducted using criteria for observational studies outlined by Sanderson et al. (2007). A narrative synthesis and, if feasible, meta-analysis will be conducted. Discussion: By exploring medication non-adherence from a multimorbidity perspective, the review aims to inform an evidence base for intervention development which accounts for the rising prevalence of patients with multiple chronic conditions. Study registration: The systematic review is prospectively registered in PROSPERO (CRD42019133849); registered on 12 June 2019.
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Alfian SD, Pradipta IS, Hak E, Denig P. A systematic review finds inconsistency in the measures used to estimate adherence and persistence to multiple cardiometabolic medications. J Clin Epidemiol 2019; 108:44-53. [DOI: 10.1016/j.jclinepi.2018.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/15/2018] [Accepted: 12/05/2018] [Indexed: 02/08/2023]
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Incidence, predictors, and outcomes of DAPT disruption due to non-compliance vs. bleeding after PCI: insights from the PARIS Registry. Clin Res Cardiol 2019; 108:643-650. [DOI: 10.1007/s00392-018-1392-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/05/2018] [Indexed: 12/20/2022]
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Xu K, Liu LM, Farazi PA, Wang H, Rochling FA, Watanabe-Galloway S, Zhang JJ. Adherence and perceived barriers to oral antiviral therapy for chronic hepatitis B. Glob Health Action 2018; 11:1433987. [PMID: 29447614 PMCID: PMC5827725 DOI: 10.1080/16549716.2018.1433987] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: Globally, of the 248 million people chronically infected with the hepatitis B virus (HBV), 74 million reside in China. Five oral nucleot(s)ide analogs (NUCs) have been approved for the treatment of chronic hepatitis B (CHB) in China. Objectives: The aims of this study were to determine rates of adherence to NUC therapy in patients with CHB, to identify the self-perceived barriers to adherence, and to examine the factors associated with adherence. Methods: Questionnaire-based interviews were administered among Chinese patients with CHB at hepatology clinics of a tertiary hospital in the city of Wuhan, China. Adults aged 18 years or older prescribed with NUCs were recruited and interviewed to complete a 27-item questionnaire in a private setting, and adherence was measured using the Morisky Medication Adherence Scale (MMAS-8). Results: Among 369 participants, only 16.5% had high adherence (score of 8), 32.2% had medium adherence (score of 6 to <8), and 51.2% were measured with low adherence (score of <6). A logistic regression model was used to determine the factors associated with medication adherence. Significant predictors of high adherence consisted of urban residency, non-cirrhotic status, not using prescribed pills other than HBV medications, and reminders from family members. The five most common reasons for skipping NUCs were that medication(s) are expensive (48.7%), forgetfulness (45.1%), have experienced or worry about potential side effects (19.8%), do not want others to know about my medication(s) usage (18.5%), and ran out of pills and do not have time to refill (15.9%). Conclusions: This study revealed that adherence rates to oral antiviral therapy were far from optimal. This finding should generate public attention, and it would be beneficial for interventional programs to target Chinese patients from rural regions, as well as patients with low socioeconomic status, cirrhosis, and taking multiple medications.
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Affiliation(s)
- Kerui Xu
- a Department of Epidemiology, College of Public Health , University of Nebraska Medical Center , Omaha , NE , USA
| | - Li-Ming Liu
- b Department of Hepatology , Hubei Third People's Hospital , Wuhan , Hubei , China
| | - Paraskevi A Farazi
- a Department of Epidemiology, College of Public Health , University of Nebraska Medical Center , Omaha , NE , USA
| | - Hongmei Wang
- c Department of Health Services Research & Administration, College of Public Health , University of Nebraska Medical Center , Omaha , NE , USA
| | - Fedja A Rochling
- d Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine , University of Nebraska Medical Center , Omaha , NE , USA
| | - Shinobu Watanabe-Galloway
- a Department of Epidemiology, College of Public Health , University of Nebraska Medical Center , Omaha , NE , USA
| | - Jian-Jun Zhang
- b Department of Hepatology , Hubei Third People's Hospital , Wuhan , Hubei , China
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Range JT, LaFontaine PR, Ryder PT, Polston M. Factors Associated With Adherence to Statin Medications of Patients Enrolled in a Self-insured University Health Plan. Clin Ther 2018; 40:1692-1700. [PMID: 30231972 DOI: 10.1016/j.clinthera.2018.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/03/2018] [Accepted: 08/17/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to examine the association of patient and prescription factors with statin adherence of patients enrolled a self-insured university health plan. METHODS We conducted a retrospective, longitudinal analysis of pharmacy claims data from a self-insured university for those enrollees prescribed a statin during a 38-month period (2009-2012). Adherence was calculated as the portion of days covered and was defined as portion of days covered ≥80%. To be included in the study, patients had to have ≥2 statin claims and be continuously enrolled in the plan. A logistic regression model was constructed to identify longitudinal predictors of adherence. In addition, a Cox proportional hazards model was run to examine predictors of adherence during 1year of statin therapy. FINDINGS There were 222 patients in the study. These 222 patients generated a total of 3,349 statin claims. With a mean (SD) observation period of 970 (346.5) days, those patients taking statin medications had a mean adherence rate of 54.5%. Adherent and nonadherent patients were similar regardless of statin switching and inferred household income. However, those patients with greater adherence levels were older, more likely to be male, had previous statin exposure, paid higher mean copayments, and were more likely to use mail order as their delivery channel. In logistic regression, older age (odds ratio [OR] = 1.07, P = 0.001), male sex (OR = 1.79, P = 0.047), and the use of mail order (OR = 3.07, P = 0.002) were significantly associated with adherence. Of the original 222 patients, 200 patients completed 1 full year of therapy. In a subsequent Cox proportional hazards analysis, the retail delivery channel (hazard ratio = 1.904, P = 0.025) was associated with higher risk for nonadherence during a 1-year period. IMPLICATIONS Despite the benefits associated with statin medications, adherence remains a challenge for certain groups of patients, including patients who are female, younger patients, and patients who use retail pharmacies (vs mail order) when filling their prescriptions. Health care professionals and employers, especially those employers who are self-insured, would be well served in developing adherence interventions aimed at these specific populations.
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Affiliation(s)
- Jason T Range
- Butler University College of Pharmacy and Health Sciences, Indianapolis, Indiana.
| | - Patrick R LaFontaine
- Butler University College of Pharmacy and Health Sciences, Indianapolis, Indiana
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Zidan A, Awaisu A, El-Hajj MS, Al-Abdulla SA, Figueroa DCR, Kheir N. Medication-Related Burden among Patients with Chronic Disease Conditions: Perspectives of Patients Attending Non-Communicable Disease Clinics in a Primary Healthcare Setting in Qatar. PHARMACY 2018; 6:pharmacy6030085. [PMID: 30104554 PMCID: PMC6165107 DOI: 10.3390/pharmacy6030085] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/30/2018] [Accepted: 08/08/2018] [Indexed: 11/16/2022] Open
Abstract
This study aimed to assess perceived medication-related burden among patients with multiple non-communicable diseases (NCDs) and to investigate the association between perceived burden and adherence to medication therapy. Using a cross-sectional study in three primary care clinics in Qatar, medication-related burden was measured using the Living with Medicines Questionnaire (LMQ) among adults with diabetes, with or without other comorbidities. Adherence was measured using the Adherence to Refills and Medications Scale (ARMS). Two hundred and ninety-three eligible patients participated in the study. The majority of them reported experiencing minimal (66.8%) to moderate (24.1%) medication-related burden. There was a significant positive correlation between the scores of the LMQ (medication-related burden) and ARMS (medication adherence), rs (253) = 0.317, p < 0.0005.
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Affiliation(s)
- Amani Zidan
- College of Pharmacy, Qatar University, Doha 2713, Qatar.
| | - Ahmed Awaisu
- College of Pharmacy, Qatar University, Doha 2713, Qatar.
| | | | | | | | - Nadir Kheir
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1010, New Zealand.
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Giorgino F, Penfornis A, Pechtner V, Gentilella R, Corcos A. Adherence to antihyperglycemic medications and glucagon-like peptide 1-receptor agonists in type 2 diabetes: clinical consequences and strategies for improvement. Patient Prefer Adherence 2018; 12:707-719. [PMID: 29765207 PMCID: PMC5944456 DOI: 10.2147/ppa.s151736] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Adherence to antihyperglycemic medications is often suboptimal in patients with type 2 diabetes, and this can contribute to poor glycemic control, increased hospitalization, and the development of diabetic complications. Reported adherence rates to antihyperglycemics vary widely among studies, and this may be related to differences in methodology for measuring adherence, patient populations, and other factors. Poor adherence may occur regardless of the specific regimen used and whether therapy is oral or injectable, and can be especially common in chronic, asymptomatic conditions, such as type 2 diabetes. More convenient drug-administration regimens and advances in formulations and delivery devices are among strategies shown to improve adherence to antihyperglycemic therapy, especially for injectable therapy. This is exemplified by technological developments made in the drug class of glucagon-like peptide 1-receptor agonists, which are a focus of this narrative review. Dulaglutide, albiglutide, and prolonged-release exenatide have an extended duration of action and can be administered once weekly, whereas such agents as liraglutide require once-daily administration. The convenience of once-weekly versus once-daily administration is associated with better adherence in real-world studies involving this class of agent. Moreover, provision of a user-friendly delivery device has been shown to overcome initial resistance to injectable therapy among patients with type 2 diabetes. This suggests that recent innovations in drug formulation (eg, ready-to-use formulations) and delivery systems (eg, single-dose prefilled pens and hidden, ready-attached needles) may be instrumental in encouraging patient acceptance. For physicians who aim to improve their patients' adherence to antihyperglycemic medications, it is thus important to consider the patient's therapeutic experience (treatment frequency, drug formulation, delivery device). Better adherence, powered by recent technological advances in the delivery of glucagon-like peptide 1-receptor agonists, may thus lead to improved clinical outcomes in type 2 diabetes.
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Affiliation(s)
- Francesco Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Alfred Penfornis
- Service d’Endocrinologie, Diabétologie, et Maladies Métaboliques, Centre Hospitalier Sud-Francilien de Corbeil-Essonnes, Université Paris-Sud, Orsay, France
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21
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Atzema CL, Yu B, Schull MJ, Jackevicius CA, Ivers NM, Lee DS, Rochon P, Austin PC. Physician follow-up and long-term use of evidence-based medication for patients with hypertension who were discharged from an emergency department: a prospective cohort study. CMAJ Open 2018; 6:E151-E161. [PMID: 29615439 PMCID: PMC7869658 DOI: 10.9778/cmajo.20170119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND More than 25% of the population has hypertension. The number of patients seeking care for hypertension in emergency departments has increased by more than 60% in the last decade, with less than 10% of these patients subsequently admitted to hospital. Managing physicians recommend early follow-up to patients who are discharged from the emergency department, but there is a paucity of literature assessing the impact or timing of follow-up on patient outcomes. METHODS Using a population-based cohort design, we included patients more than 65 years of age who were discharged from an Ontario emergency department with a primary diagnosis of hypertension between 2007 and 2014. We identified 2 cohorts: an incident cohort, and a cohort in which patients were on no more than 1 class of evidence-based antihypertensive medication at the time of presentation. Using logistic regression, we assessed the association of early follow-up care (within 7 d) and basic care (8-30 d), compared with no care within 30 days, on patient use of a new evidence-based antihypertensive medication 1 year later. RESULTS Our study included 2088 patients with a new diagnosis of hypertension (the first cohort), and 6420 patients in the second cohort. Of patients with new diagnoses, 48.2% and 30.2% obtained early and basic follow-up care, respectively, compared with 50.0% and 30.9% of patients in the second cohort. Compared with patients without follow-up care within 30 days, the adjusted odds of filling an evidence-based antihypertensive medication prescription 1 year later in the incident group were 2.36 (95% confidence interval [CI] 1.86-2.99) for those who received early care, and 2.00 (95% CI 1.55-2.58) for those who received basic care. The adjusted odds in the second cohort were 2.12 (95% CI 1.84-2.43) and 1.96 (95% CI 1.69-2.27), respectively. INTERPRETATION Early follow-up care after leaving an emergency department with a diagnosis of hypertension was associated with improved long-term use of evidence-based antihypertensive medication. As patients increasingly present to the emergency department for hypertension, a formal, timely follow-up care system could improve patient use of evidence-based antihypertensive medication.
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Affiliation(s)
- Clare L Atzema
- Affiliations: Institute for Clinical Evaluative Sciences (Atzema, Yu, Schull, Jackevicius, Ivers, Lee, Rochon, Austin), Toronto, Ont.; Division of Emergency Medicine (Atzema, Schull) and Cardiology (Lee), the Department of Medicine, Department of Family and Community Medicine (Ivers), and the Institute for Health Policy, Management and Evaluation (Atzema, Schull, Jackevicius, Ivers, Lee, Rochon, Austin), University of Toronto, Toronto, Ont.; Sunnybrook Health Sciences Centre (Atzema, Schull, Tu, Austin), Women's College Hospital (Ivers, Rochon), University Health Network (Jackevicius, Lee), Toronto, Ont.; Western University of Health Sciences, Pomona, Calif., and the Veteran's Affairs Greater Los Angeles Healthcare System (Jackevicius), Los Angeles, Calif
| | - Bing Yu
- Affiliations: Institute for Clinical Evaluative Sciences (Atzema, Yu, Schull, Jackevicius, Ivers, Lee, Rochon, Austin), Toronto, Ont.; Division of Emergency Medicine (Atzema, Schull) and Cardiology (Lee), the Department of Medicine, Department of Family and Community Medicine (Ivers), and the Institute for Health Policy, Management and Evaluation (Atzema, Schull, Jackevicius, Ivers, Lee, Rochon, Austin), University of Toronto, Toronto, Ont.; Sunnybrook Health Sciences Centre (Atzema, Schull, Tu, Austin), Women's College Hospital (Ivers, Rochon), University Health Network (Jackevicius, Lee), Toronto, Ont.; Western University of Health Sciences, Pomona, Calif., and the Veteran's Affairs Greater Los Angeles Healthcare System (Jackevicius), Los Angeles, Calif
| | - Michael J Schull
- Affiliations: Institute for Clinical Evaluative Sciences (Atzema, Yu, Schull, Jackevicius, Ivers, Lee, Rochon, Austin), Toronto, Ont.; Division of Emergency Medicine (Atzema, Schull) and Cardiology (Lee), the Department of Medicine, Department of Family and Community Medicine (Ivers), and the Institute for Health Policy, Management and Evaluation (Atzema, Schull, Jackevicius, Ivers, Lee, Rochon, Austin), University of Toronto, Toronto, Ont.; Sunnybrook Health Sciences Centre (Atzema, Schull, Tu, Austin), Women's College Hospital (Ivers, Rochon), University Health Network (Jackevicius, Lee), Toronto, Ont.; Western University of Health Sciences, Pomona, Calif., and the Veteran's Affairs Greater Los Angeles Healthcare System (Jackevicius), Los Angeles, Calif
| | - Cynthia A Jackevicius
- Affiliations: Institute for Clinical Evaluative Sciences (Atzema, Yu, Schull, Jackevicius, Ivers, Lee, Rochon, Austin), Toronto, Ont.; Division of Emergency Medicine (Atzema, Schull) and Cardiology (Lee), the Department of Medicine, Department of Family and Community Medicine (Ivers), and the Institute for Health Policy, Management and Evaluation (Atzema, Schull, Jackevicius, Ivers, Lee, Rochon, Austin), University of Toronto, Toronto, Ont.; Sunnybrook Health Sciences Centre (Atzema, Schull, Tu, Austin), Women's College Hospital (Ivers, Rochon), University Health Network (Jackevicius, Lee), Toronto, Ont.; Western University of Health Sciences, Pomona, Calif., and the Veteran's Affairs Greater Los Angeles Healthcare System (Jackevicius), Los Angeles, Calif
| | - Noah M Ivers
- Affiliations: Institute for Clinical Evaluative Sciences (Atzema, Yu, Schull, Jackevicius, Ivers, Lee, Rochon, Austin), Toronto, Ont.; Division of Emergency Medicine (Atzema, Schull) and Cardiology (Lee), the Department of Medicine, Department of Family and Community Medicine (Ivers), and the Institute for Health Policy, Management and Evaluation (Atzema, Schull, Jackevicius, Ivers, Lee, Rochon, Austin), University of Toronto, Toronto, Ont.; Sunnybrook Health Sciences Centre (Atzema, Schull, Tu, Austin), Women's College Hospital (Ivers, Rochon), University Health Network (Jackevicius, Lee), Toronto, Ont.; Western University of Health Sciences, Pomona, Calif., and the Veteran's Affairs Greater Los Angeles Healthcare System (Jackevicius), Los Angeles, Calif
| | - Douglas S Lee
- Affiliations: Institute for Clinical Evaluative Sciences (Atzema, Yu, Schull, Jackevicius, Ivers, Lee, Rochon, Austin), Toronto, Ont.; Division of Emergency Medicine (Atzema, Schull) and Cardiology (Lee), the Department of Medicine, Department of Family and Community Medicine (Ivers), and the Institute for Health Policy, Management and Evaluation (Atzema, Schull, Jackevicius, Ivers, Lee, Rochon, Austin), University of Toronto, Toronto, Ont.; Sunnybrook Health Sciences Centre (Atzema, Schull, Tu, Austin), Women's College Hospital (Ivers, Rochon), University Health Network (Jackevicius, Lee), Toronto, Ont.; Western University of Health Sciences, Pomona, Calif., and the Veteran's Affairs Greater Los Angeles Healthcare System (Jackevicius), Los Angeles, Calif
| | - Paula Rochon
- Affiliations: Institute for Clinical Evaluative Sciences (Atzema, Yu, Schull, Jackevicius, Ivers, Lee, Rochon, Austin), Toronto, Ont.; Division of Emergency Medicine (Atzema, Schull) and Cardiology (Lee), the Department of Medicine, Department of Family and Community Medicine (Ivers), and the Institute for Health Policy, Management and Evaluation (Atzema, Schull, Jackevicius, Ivers, Lee, Rochon, Austin), University of Toronto, Toronto, Ont.; Sunnybrook Health Sciences Centre (Atzema, Schull, Tu, Austin), Women's College Hospital (Ivers, Rochon), University Health Network (Jackevicius, Lee), Toronto, Ont.; Western University of Health Sciences, Pomona, Calif., and the Veteran's Affairs Greater Los Angeles Healthcare System (Jackevicius), Los Angeles, Calif
| | - Peter C Austin
- Affiliations: Institute for Clinical Evaluative Sciences (Atzema, Yu, Schull, Jackevicius, Ivers, Lee, Rochon, Austin), Toronto, Ont.; Division of Emergency Medicine (Atzema, Schull) and Cardiology (Lee), the Department of Medicine, Department of Family and Community Medicine (Ivers), and the Institute for Health Policy, Management and Evaluation (Atzema, Schull, Jackevicius, Ivers, Lee, Rochon, Austin), University of Toronto, Toronto, Ont.; Sunnybrook Health Sciences Centre (Atzema, Schull, Tu, Austin), Women's College Hospital (Ivers, Rochon), University Health Network (Jackevicius, Lee), Toronto, Ont.; Western University of Health Sciences, Pomona, Calif., and the Veteran's Affairs Greater Los Angeles Healthcare System (Jackevicius), Los Angeles, Calif
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Schaffer AL, Buckley NA, Pearson SA. Who benefits from fixed-dose combinations? Two-year statin adherence trajectories in initiators of combined amlodipine/atorvastatin therapy. Pharmacoepidemiol Drug Saf 2017; 26:1465-1473. [DOI: 10.1002/pds.4342] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/17/2017] [Accepted: 10/01/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Andrea L. Schaffer
- Centre for Big Data Research in Health; University of New South Wales; Sydney Australia
| | | | - Sallie-Anne Pearson
- Centre for Big Data Research in Health; University of New South Wales; Sydney Australia
- Menzies Centre for Health Policy; University of Sydney; Camperdown Australia
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Sav A, Salehi A, Mair FS, McMillan SS. Measuring the burden of treatment for chronic disease: implications of a scoping review of the literature. BMC Med Res Methodol 2017; 17:140. [PMID: 28899342 PMCID: PMC5596495 DOI: 10.1186/s12874-017-0411-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/31/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although there has been growing research on the burden of treatment, the current state of evidence on measuring this concept is unknown. This scoping review aimed to provide an overview of the current state of knowledge as well as clear recommendations for future research, within the context of chronic disease. METHODS Four health-based databases, Scopus, CINAHL, Medline, and PsychInfo, were comprehensively searched for peer-reviewed articles published between the periods of 2000-2016. Titles and abstracts were independently read by two authors. All discrepancies between the authors were resolved by a third author. Data was extracted using a standardized proforma and a comparison analysis was used in order to explore the key treatment burden measures and categorize them into three groups. RESULTS Database searching identified 1458 potential papers. After removal of duplications, and irrelevant articles by title, 1102 abstracts remained. An additional 22 papers were added via snowball searching. In the end, 101 full papers were included in the review. A large number of the studies involved quantitative measures and conceptualizations of treatment burden (n = 64; 63.4%), and were conducted in North America (n = 49; 48.5%). There was significant variation in how the treatment burden experienced by those with chronic disease was operationalized and measured. CONCLUSION Despite significant work, there is still much ground to cover to comprehensively measure treatment burden for chronic disease. Greater qualitative focus, more research with cultural and minority populations, a larger emphasis on longitudinal studies and the consideration of the potential effects of "identity" on treatment burden, should be considered.
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Affiliation(s)
- Adem Sav
- School of Allied Health, Australian Catholic University, Banyo, Queensland, Australia. .,, PO Box 456, Virginia, 4014, Australia.
| | - Asiyeh Salehi
- Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, QLD, Australia
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Sara S McMillan
- Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, QLD, Australia
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Mantel Ä, Holmqvist M, Jernberg T, Wållberg-Jonsson S, Askling J. Long-term outcomes and secondary prevention after acute coronary events in patients with rheumatoid arthritis. Ann Rheum Dis 2017; 76:2017-2024. [DOI: 10.1136/annrheumdis-2017-211608] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/14/2017] [Accepted: 07/19/2017] [Indexed: 11/04/2022]
Abstract
ObjectivesPatients with rheumatoid arthritis (RA) are at increased risk of acute coronary syndrome (ACS) and suffer from poorer short-term outcomes after ACS. The aims of this study were to assess long-term outcomes in patients with RA with ACS compared with non-RA patients with ACS, and to investigate whether the use of secondary preventive drugs could explain any differences in ACS outcome.MethodsWe performed a cohort study based on 1135 patients with RA and 3184 non-RA patients who all developed an incident ACS between 2007 and 2010. We assessed 1-year and overall relative risks for ACS recurrence and mortality, as well as prescriptions of standard of care secondary preventive drugs.ResultsThe risk of ACS recurrence, and of mortality, was increased in RA, both at 1 year after adjusting for baseline comorbidities (HR=1.30(95% CI 1.04 to 1.62) and 1.38(95% CI 1.20 to 1.59), respectively) and throughout the complete (mean 2 years) follow-up (HR=1.27(95% CI 1.06 to 1.52) and 1.50(95% CI 1.34 to 1.68), respectively). Among certain subgroups of ACS, there was a tendency of lower usage of statins, whereas there were no apparent differences in others. The increased rates of ACS recurrence and mortality remained in subgroup analyses of individuals whose prescription pattern indicated both adequate initiation and persistence to secondary preventive treatments.ConclusionsPatients with RA suffer from an increased risk of ACS recurrence and of death following ACS compared with general population, which in the present study could not readily be explained by differences in usage of secondary preventive drugs.
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Nagai N, Tani H, Suzuki T, Ikai S, Gerretsen P, Mimura M, Uchida H. Patients' Knowledge about Prescribed Antipsychotics and Medication Adherence in Schizophrenia: A Cross-Sectional Survey. PHARMACOPSYCHIATRY 2017; 50:264-269. [PMID: 28675911 DOI: 10.1055/s-0043-113828] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction Data on the knowledge about antipsychotic medications prescribed in patients with schizophrenia are very limited. Moreover, it remains unclear how patients' knowledge about prescribed antipsychotics affects medication adherence. Methods ighty-one Japanese outpatients with schizophrenia according to the International Classification of Diseases, 10th edition, were included. Patients' knowledge of the primary antipsychotics prescribed to them in terms of therapeutic effects, type, and implicated neurotransmitters was assessed with a multiple-choice questionnaire developed for this study. Medication possession ratios (MPRs) were compared between patients who answered correctly and those who did not in each category. Results The percentages of subjects who answered correctly regarding antipsychotic effects, type, and implicated neurotransmitters were low at 30.9%, 30.9%, and 7.4%, respectively. No differences were found in MPRs between subjects who answered correctly and those who did not. Discussion Our preliminary results indicate that patients lack knowledge about their antipsychotic medications. More concerning, they suggest that knowledge about prescribed antipsychotics may not directly translate into actual medication adherence in patients with schizophrenia.
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Affiliation(s)
- Nobuhiro Nagai
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hideaki Tani
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Takefumi Suzuki
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Inokashira Hospital, Tokyo, Japan
| | - Saeko Ikai
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Philip Gerretsen
- Multimodal Imaging Group - Research Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada
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Howell EH, Senapati A, Hsich E, Gorodeski EZ. Medication self-management skills and cognitive impairment in older adults hospitalized for heart failure: A cross-sectional study. SAGE Open Med 2017; 5:2050312117700301. [PMID: 28540048 PMCID: PMC5433792 DOI: 10.1177/2050312117700301] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 02/15/2017] [Indexed: 01/07/2023] Open
Abstract
Background: Cognitive impairment is highly prevalent among older adults (aged ≥65 years) hospitalized for heart failure and has been associated with poor outcomes. Poor medication self-management skills have been associated with poor outcomes in this population as well. The presence and extent of an association between cognitive impairment and poor medication self-management skills in this population has not been clearly defined. Objective: We assessed the cognition of consecutive older adults hospitalized for heart failure, in relation to their medication self-management skills. Methods: We conducted a cross-sectional study of older adults (aged ≥65 years) who were hospitalized for heart failure and were being discharged home. Prior to discharge, we assessed cognition using the Mini-Cog. We also tested patients’ ability to read a pill bottle label, open a pill bottle safety cap, and allocate mock pills to a pill box. Pill allocation performance was assessed quantitatively (counts of errors of omission and commission) and qualitatively (patterns suggestive of knowledge-based mistakes, rule-based mistakes, or skill-based slips). Results: Of 55 participants, 22% were found to have cognitive impairment. Patients with cognitive impairment tended to be older as compared to those without cognitive impairment (mean age = 81 vs 76 years, p = NS). Patients with cognitive impairment had a higher prevalence of inability to read pill bottle label (prevalence ratio = 5.8, 95% confidence interval = 3.2–10.5, p = 0.001) and inability to open pill bottle safety cap (prevalence ratio = 3.3, 95% confidence interval = 1.3–8.4, p = 0.03). While most patients (65%) had pill-allocation errors regardless of cognition, those patients with cognitive impairment tended to have more errors of omission (mean number of errors = 48 vs 23, p = 0.006), as well as more knowledge-based mistakes (75% vs 40%, p = 0.03). Conclusion: There is an association between cognitive impairment and poor medication self-management skills. Medication taking failures due to poor medication self-management skills may be part of the pathway linking cognitive impairment to poor post-discharge outcomes among patients with heart failure transitioning from hospital to home.
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Affiliation(s)
- Erik H Howell
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Alpana Senapati
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Eileen Hsich
- Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eiran Z Gorodeski
- Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.,Center for Connected Care, Cleveland Clinic, Cleveland, OH, USA
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Johnson LA. Factors influencing oral adherence: qualitative metasummary and triangulation with quantitative evidence. Clin J Oncol Nurs 2017; 19:6-30. [PMID: 26030389 DOI: 10.1188/15.s1.cjon.6-30] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Concern about adherence to oral agents among patients with cancer has grown as more oral agents are being used for cancer treatment. Knowledge of common factors that facilitate or inhibit adherence to oral medication regimens can be beneficial to clinicians in identifying patients at risk for nonadherence, in planning care to address barriers to adherence, and in educating patients about ways to improve adherence. OBJECTIVES The focus of this review is to synthesize the evidence about factors that influence adherence and identify implications for practice. METHODS Literature was searched via PubMed and CINAHL®. Evidence regarding factors influencing adherence was synthesized using a metasummary of qualitative research and triangulated with findings from quantitative research. FINDINGS Forty-four factors influencing adherence were identified from 159 research studies of patients with and without cancer. Factors associated with adherence in oncology and non-oncology cases included provider relations, side effects, forgetfulness, beliefs about medication necessity, establishing routines for taking medication, social support, ability to fit medications in lifestyle, cost, and medication knowledge. Among patients with cancer, depression and negative expectations of results also were shown to have a negative relationship to adherence.
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Borrego Y, Gómez-Fernández E, Jiménez R, Cantudo R, Almeida-González CV, Morillo R. Predictors of primary non-adherence to concomitant chronic treatment in HIV-infected patients with antiretroviral therapy. Eur J Hosp Pharm 2017; 25:127-131. [PMID: 31157006 DOI: 10.1136/ejhpharm-2016-001000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 11/21/2016] [Accepted: 01/16/2017] [Indexed: 12/28/2022] Open
Abstract
Objectives To identify the independent risk factors of primary non-adherence to chronic concomitant treatment in HIV-positive patients, and to measure primary and secondary non-adherence rates to chronic treatments, and secondary non-adherence to antiretroviral therapy and the prevalence of concomitant chronic diseases. Methods We conducted a retrospective study that included HIV-infected patients with antiretroviral treatmentwho attended the pharmaceutical care office between January and December 2012. The dependent variable was primary non-adherence to concomitant prescription drugs for chronic diseases. To know the predictors of concomitant primary non-adherence, we performed a univariate analysis and a multivariate binary logistic regression model to identify the independent predictors of primary non-adherence to co-medication. Results Out of 598 patients analysed, 333 patients had a new co-medication prescribed during the studied period. The number of comorbidities per patient was 2.3 and the patients were treated with an average of 3.4 drugs. The rates of primary and secondary non-adherence to co-medication were 8.4% and 44.4%, respectively. The co-occurrence of primary and secondary non-adherence was 24.9%. The number of comorbidities (p=0.001) and co-medications (p=0.001) was significantly higher in patients who had primary non-adherence to co-medication. Furthermore, there was a statistically significant relationship between primary non-adherence and patients treated with psychotropic drugs (p=0.03). The multivariate analysis showed the independent predictor of primary non-adherence to co-medication was the number of co-medications (p<0.001). Conclusion One-third of new concomitant medications prescribed to HIV-positive patients were never filled from the pharmacy. The number of co-medications was identified as a predictor of primary non-adherence to chronic concomitant treatment in HIV-infected population.
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Affiliation(s)
- Yolanda Borrego
- Department of Pharmacy, Hospital Universitario Nuestra Señora de Valme, Seville, Spain
| | | | - Rocío Jiménez
- Department of Pharmacy, Hospital Universitario Nuestra Señora de Valme, Seville, Spain
| | - Rosa Cantudo
- Department of Pharmacy, Hospital Universitario Nuestra Señora de Valme, Seville, Spain
| | | | - Ramón Morillo
- Department of Pharmacy, Hospital Universitario Nuestra Señora de Valme, Seville, Spain
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Kim HJ, Kim E, Min KB, Min JY. Blood pressure and lipid target adherence in Korean patients receiving angiotensin II receptor blockers/statin regimens. Curr Med Res Opin 2017; 33:385-390. [PMID: 27819152 DOI: 10.1080/03007995.2016.1257982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Hypertension and dyslipidemia are important cardiovascular risk factors. Simultaneously controlling blood pressure (BP) and lipid levels is effective in preventing cardiovascular events and premature death. This study investigated the association between adherence to angiotensin II receptor blocker (ARB)/statin regimens and BP or low density lipoprotein-cholesterol (LDL-C) target attainment in Korean patients with concomitant hypertension and dyslipidemia. METHODS In this retrospective, multicenter study, we collected case report forms (CRFs) of hypertensive patients with concomitant dyslipidemia who were prescribed an ARB/statin regimen between 1 April 2014 and 31 March 2015 from 51 outpatient clinics. A total of 672 and 609 patients were eventually included for statistical analyses of BP and LDL-C, respectively. Adherence was measured by medication possession ratio (MPR) for 6 months following the index date. RESULTS The overall rates of attaining BP and LDL-C targets were 75.6% and 81.1%, respectively. The mean value of MPR for patients attaining target BP or LDL-C was significantly higher than that for those not attaining target BP or LDL-C. After adjustment for all covariates, increases in the quartiles of MPR were significantly associated with an increased probability of attaining target BP or LDL-C in all models (all p-trend <0.05). Attaining of BP control was significantly higher in quartiles 3 and 4 of MPR (MPR >0.95) than the lowest MPR (quartile 1), whereas attaining LDL-C target was associated with quartile 4 of MPR (MPR >0.97). CONCLUSION We identified a strong correlation between medication adherence and BP or LDL-C target achievement in Korean patients with concomitant hypertension and dyslipidemia. The adherence for reaching targets could be different between BP and LDL-C levels.
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Affiliation(s)
- Hyun-Jin Kim
- a Institute of Health and Environment, School of Public Health , Seoul National University , Seoul , Korea
| | - Eugene Kim
- b School of Public Health , Seoul National University , Seoul , Korea
| | - Kyoung-Bok Min
- c Department of Preventive Medicine, College of Medicine , Seoul National University , Seoul , Korea
| | - Jin-Young Min
- a Institute of Health and Environment, School of Public Health , Seoul National University , Seoul , Korea
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Packard KA, Hilleman DE. Adherence to therapies for secondary prevention of cardiovascular disease: a focus on aspirin. Cardiovasc Ther 2016; 34:415-422. [DOI: 10.1111/1755-5922.12211] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Kathleen A. Packard
- Department of Pharmacy Practice; Creighton University School of Pharmacy and Health Professions; Omaha NE USA
| | - Daniel E. Hilleman
- Department of Pharmacy Practice; Creighton University School of Pharmacy and Health Professions; Omaha NE USA
- The Cardiac Center of Creighton University School of Medicine; Omaha NE USA
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Bjerkeli PJ, Jönsson AK, Lesén E, Mårdby AC, Sundell KA. Refill Adherence in Relation to Substitution and the Use of Multiple Medications: A Nationwide Population Based Study on New ACE-Inhibitor Users. PLoS One 2016; 11:e0155465. [PMID: 27192203 PMCID: PMC4871506 DOI: 10.1371/journal.pone.0155465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 04/29/2016] [Indexed: 11/18/2022] Open
Abstract
Objective Generic substitution has contributed to economic savings but switching products may affect patient adherence, particularly among those using multiple medications. The aim was to analyse if use of multiple medications influenced the association between switching products and refill adherence to angiotensin-converting-enzyme (ACE) inhibitors in Sweden. Study Design and Setting New users of ACE-inhibitors, starting between 1 July 2006 and 30 June 2007, were identified in the Swedish Prescribed Drug Register. Refill adherence was assessed using the continuous measure of medication acquisition (CMA) and analysed with linear regression and analysis of covariance. Results The study population included 42735 individuals whereof 51.2% were exposed to switching ACE-inhibitor and 39.6% used multiple medications. Refill adherence was higher among those exposed to switching products than those not, but did not vary depending on the use of multiple medications or among those not. Refill adherence varied with age, educational level, household income, country of birth, previous hospitalisation and previous cardiovascular diagnosis. Conclusion The results indicate a positive association between refill adherence and switching products, mainly due to generic substitution, among new users of ACE-inhibitors in Sweden. This association was independent of use of multiple medications.
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Affiliation(s)
- Pernilla J. Bjerkeli
- Nordic School of Public Health, Gothenburg, Sweden
- Unit for Social Epidemiology, Clinical Research Centre, Faculty of Medicine, Lund University, Lund, Sweden
- * E-mail:
| | - Anna K. Jönsson
- Department of Forensic Genetics and Forensic Toxicology, National Board Forensic Medicine, Linköping, Sweden
| | - Eva Lesén
- Nordic Health Economics AB, Gothenburg, Sweden
| | - Ann-Charlotte Mårdby
- Research and Development, Sahlgrenska University Hospital, Gothenburg, Sweden
- Section for Epidemiology and Social Medicine, Department of Public Health and Community Medicine at Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Karolina Andersson Sundell
- Section for Epidemiology and Social Medicine, Department of Public Health and Community Medicine at Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Amara W, Antoniou S. Benefits of once-daily dosing with non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J Suppl 2016; 18:D1-D6. [DOI: 10.1093/eurheartj/suv062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lipska KJ, Krumholz H, Soones T, Lee SJ. Polypharmacy in the Aging Patient: A Review of Glycemic Control in Older Adults With Type 2 Diabetes. JAMA 2016; 315:1034-45. [PMID: 26954412 PMCID: PMC4823136 DOI: 10.1001/jama.2016.0299] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE There is substantial uncertainty about optimal glycemic control in older adults with type 2 diabetes mellitus. OBSERVATIONS Four large randomized clinical trials (RCTs), ranging in size from 1791 to 11,440 patients, provide the majority of the evidence used to guide diabetes therapy. Most RCTs of intensive vs standard glycemic control excluded adults older than 80 years, used surrogate end points to evaluate microvascular outcomes and provided limited data on which subgroups are most likely to benefit or be harmed by specific therapies. Available data from randomized clinical trials suggest that intensive glycemic control does not reduce major macrovascular events in older adults for at least 10 years. Furthermore, intensive glycemic control does not lead to improved patient-centered microvascular outcomes for at least 8 years. Data from randomized clinical trials consistently suggest that intensive glycemic control immediately increases the risk of severe hypoglycemia 1.5- to 3-fold. Based on these data and observational studies, for the majority of adults older than 65 years, the harms associated with a hemoglobin A1c (HbA1c) target lower than 7.5% or higher than 9% are likely to outweigh the benefits. However, the optimal target depends on patient factors, medications used to reach the target, life expectancy, and patient preferences about treatment. If only medications with low treatment burden and hypoglycemia risk (such as metformin) are required, a lower HbA1c target may be appropriate. If patients strongly prefer to avoid injections or frequent fingerstick monitoring, a higher HbA1c target that obviates the need for insulin may be appropriate. CONCLUSIONS AND RELEVANCE High-quality evidence about glycemic treatment in older adults is lacking. Optimal decisions need to be made collaboratively with patients, incorporating the likelihood of benefits and harms and patient preferences about treatment and treatment burden. For the majority of older adults, an HbA1c target between 7.5% and 9% will maximize benefits and minimize harms.
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Affiliation(s)
- Kasia J Lipska
- Department of Internal Medicine, Section of Endocrinology, Yale School of Medicine, New Haven, Connecticut
| | - Harlan Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut3Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, New Haven, Connecticut4Department of
| | - Tacara Soones
- Department of Geriatrics and Palliative Medicine; Icahn School of Medicine at Mount Sinai; New York
| | - Sei J Lee
- Division of Geriatrics, Department of Medicine, University of California, San Francisco7San Francisco VA Medical Center, California
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Levi M, Pasqua A, Cricelli I, Cricelli C, Piccinni C, Parretti D, Lapi F. Patient Adherence to Olmesartan/Amlodipine Combinations: Fixed Versus Extemporaneous Combinations. J Manag Care Spec Pharm 2016; 22:255-62. [PMID: 27003555 PMCID: PMC10398216 DOI: 10.18553/jmcp.2016.22.3.255] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Lack of adherence to prescribed therapies is often a cause of suboptimal blood pressure control in patients with hypertension. To enhance patients' adherence to treatment, fixed-dose combinations of active substances with complementary mechanisms of action have been developed. An angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker (ARB) is often combined with a calcium channel blocker. Olmesartan is the most used ARB in combination therapy. In Italy, in September 2011, a fixed-dose combination of olmesartan/amlodipine (olmesartan/amlodipine 20/5 mg, 40/5 mg, or 40/10 mg) was introduced to treat patients with hypertension for whom control of blood pressure is not reached with either olmesartan or amlodipine alone. Prior research on adherence to olmesartan/amlodipine combinations was carried out in local contexts (e.g., claims databases of Italian regions or local health authorities), and/or it was limited by the fact that adherence was assessed against monotherapies already known for their low compliance profile, such as diuretics. OBJECTIVE To compare adherence with olmesartan/amlodipine fixed-dose combination (FDC) and extemporaneous combination in primary care in Italy. METHODS A nationwide, population-based study was conducted by using the Health Search IMS Health Longitudinal Patient Database. Patients aged > 17 years, affected by hypertension and treated with the FDC or extemporaneous combination of olmesartan/amlodipine, were identified. Adherence to these 2 therapeutic regimens was estimated by calculating the proportion of days covered (PDC). Patients were classified into 3 levels of adherence: high (PDC ≥ 80%), intermediate (PDC = 40%-79%), or low (PDC < 40%). RESULTS In the 6-month follow-up, FDC showed higher adherence compared with an extemporaneous combination (55.1% vs. 15.9%, P < 0.001). This difference was confirmed in a multivariable logistic regression model clustered on patient identifier (odds ratio = 6.65; 95% CI = 3.10-14.26; P < 0.001). The proportion of patients adherent to FDC varied from 60.4% for the 40/5 mg formulation to 47.5% for the 40/10 mg formulation. CONCLUSIONS These findings suggest that higher adherence may be achieved with FDCs than with extemporaneous combinations. To improve the degree of adherence, general practitioners may consider prescribing fixed combinations of antihypertensive agents as soon as monotherapies fail to achieve the expected therapeutic objective.
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Affiliation(s)
- Miriam Levi
- Research Fellow, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alessandro Pasqua
- Chief Statistician, Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Iacopo Cricelli
- General Director, Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Claudio Cricelli
- President, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Carlo Piccinni
- Postdoctoral Researcher, Department of Medical and Surgical Sciences−Pharmacology Unit, University of Bologna, Bologna, Italy
| | - Damiano Parretti
- General Practitioner, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Francesco Lapi
- Research Director, Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
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Kuecker CM, Vivian EM. Patient considerations in type 2 diabetes - role of combination dapagliflozin-metformin XR. Diabetes Metab Syndr Obes 2016; 9:25-35. [PMID: 26966383 PMCID: PMC4770010 DOI: 10.2147/dmso.s81565] [Citation(s) in RCA: 6] [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] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The purpose of this review article is to provide guidance to health care providers regarding the use of dapagliflozin-metformin XR (extended release) as a therapeutic option for the treatment of patients with type 2 diabetes mellitus (T2DM). METHODS The PubMed database was searched through August 2015 to identify clinical trials and meta-analyses evaluating the use of the sodium-glucose cotransporter type 2 inhibitor dapagliflozin administered as monotherapy or in combination with metformin. RESULTS Fourteen studies were included for this review, six of which evaluated dapagliflozin in combination with metformin, one of which evaluated dapagliflozin monotherapy, and four of which evaluated dapagliflozin as an add-on therapy to other antidiabetic agents. The combination of dapagliflozin and metformin resulted in an A1C decrease of up to 2%, weight loss of 2-3 kg, and modest systolic blood pressure decrease of 3-5 mmHg. However, long-term effects on cancer and cardiovascular health are still being investigated. Providing patients with a fixed-dose combination therapy such as dapagliflozin-metformin XR can increase medication adherence and patient satisfaction, and improve glycemic control. Dapagliflozin-metformin XR is ideal because it can be administered orally once a day, is associated with a low risk of hypoglycemia, and provides the added benefit of weight reduction and modest blood pressure lowering. CONCLUSION The unique combined mechanism of action and favorable efficacy and safety profile of dapagliflozin-metformin XR support consideration of this fixed-dose combination as a treatment option for patients with T2DM.
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Affiliation(s)
- Catherine M Kuecker
- Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Eva M Vivian
- Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
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Antoniou S, Saxena M, Hamedi N, de Cates C, Moghul S, Lidder S, Kapil V, Lobo MD. Management of Hypertensive Patients With Multiple Drug Intolerances: A Single-Center Experience of a Novel Treatment Algorithm. J Clin Hypertens (Greenwich) 2016; 18:129-38. [PMID: 26306794 PMCID: PMC5049677 DOI: 10.1111/jch.12637] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 06/18/2015] [Accepted: 06/27/2015] [Indexed: 02/05/2023]
Abstract
Multiple drug intolerance to antihypertensive medications (MDI-HTN) is an overlooked cause of nonadherence. In this study, 55 patients with MDI-HTN were managed with a novel treatment algorithm utilizing sequentially initiated monotherapies or combinations of maximally tolerated doses of fractional tablet doses, liquid formulations, transdermal preparations, and off-label tablet medications. A total of 10% of referred patients had MDI-HTN, resulting in insufficient pharmacotherapy and baseline office blood pressure (OBP) of 178±24/94±15 mm Hg. At baseline, patients were intolerant to 7.6±3.6 antihypertensives; they were receiving 1.4±1.1 medications. After 6 months on the novel MDI-HTN treatment algorithm, both OBP and home blood pressure (HBP) were significantly reduced, with patients receiving 2.0±1.2 medications. At 12 months, OBP was reduced from baseline by 17±5/9±3 mm Hg (P<.01, P<.05) and HBP was reduced by 11±5/12±3 mm Hg (P<.01 for both) while patients were receiving 1.9±1.1 medications. Application of a stratified medicine approach allowed patients to tolerate increased numbers of medications and achieved significant long-term lowering of blood pressure.
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Affiliation(s)
- Sotiris Antoniou
- Barts BP Centre of ExcellenceBarts Heart CentreBarts Health NHS TrustLondonUK
- Department of PharmacyBarts Heart CentreSt Bartholomew's HospitalBarts Health NHS TrustLondonUK
| | - Manish Saxena
- Barts BP Centre of ExcellenceBarts Heart CentreBarts Health NHS TrustLondonUK
- William Harvey Research InstituteCentre for Clinical PharmacologyNIHR Cardiovascular Biomedical Research UnitQueen Mary University of LondonLondonUK
| | - Nadya Hamedi
- Department of PharmacyBarts Heart CentreSt Bartholomew's HospitalBarts Health NHS TrustLondonUK
| | - Catherine de Cates
- Barts BP Centre of ExcellenceBarts Heart CentreBarts Health NHS TrustLondonUK
| | - Sakib Moghul
- Barts BP Centre of ExcellenceBarts Heart CentreBarts Health NHS TrustLondonUK
| | - Satnam Lidder
- Barts BP Centre of ExcellenceBarts Heart CentreBarts Health NHS TrustLondonUK
| | - Vikas Kapil
- Barts BP Centre of ExcellenceBarts Heart CentreBarts Health NHS TrustLondonUK
- William Harvey Research InstituteCentre for Clinical PharmacologyNIHR Cardiovascular Biomedical Research UnitQueen Mary University of LondonLondonUK
| | - Melvin D. Lobo
- Barts BP Centre of ExcellenceBarts Heart CentreBarts Health NHS TrustLondonUK
- William Harvey Research InstituteCentre for Clinical PharmacologyNIHR Cardiovascular Biomedical Research UnitQueen Mary University of LondonLondonUK
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Fadare J, Olamoyegun M, Gbadegesin BA. Medication adherence and direct treatment cost among diabetes patients attending a tertiary healthcare facility in Ogbomosho, Nigeria. Malawi Med J 2016; 27:65-70. [PMID: 26405515 DOI: 10.4314/mmj.v27i2.7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is now prevalent in many countries in sub-Saharan Africa, with associated health and socioeconomic consequences. Adherence to antidiabetic medications has been shown to improve glycaemic control, which subsequently improves both the short- and long-term prognosis of the disease. The main objective of this study was to assess the level of adherence to antidiabetic drugs among outpatients in a teaching hospital in southwestern Nigeria. METHODS A cross-sectional study was carried out using the eight-item Morisky Medication Adherence Scale (MMAS-8) among diabetic patients attending the medical outpatients' diabetes clinic of Ladoke Akintola University Teaching Hospital, in Ogbomosho, Oyo State in southwestern Nigeria, during a three-month period (October to December 2013). RESULTS A total of 129 patients participated in the study with a male-to-female ratio of 1:1.5. Seventy-eight (60.5%) patients had systemic hypertension as a comorbid condition while the remaining were being managed for diabetes mellitus alone. Only 6 (4.7%) of the patients had type 1 DM while the remaining 123 (95.3%) were diagnosed with type 2 DM. Metformin was the most prescribed oral hypoglycaemic agent (n = 111, 58.7%) followed by glibenclamide (n = 49, 25.9%). Medication adherence was classified as good, medium, and poor for 52 (40.6%), 42 (32.8%), and 34 (26.6%) patients, respectively. Medication costs accounted for 72.3% of the total direct cost of DM in this study, followed by the cost of laboratory investigations (17.6%). CONCLUSION Adherence of diabetes patients in the study sample to their medications was satisfactory. There is a need for the integration of generic medicines into routine care as a way of further reducing the burden of healthcare expenditure on the patients.
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Affiliation(s)
- J Fadare
- Department of Pharmacology, Ekiti State University, Ado-Ekiti, Nigeria
| | - M Olamoyegun
- Department of Medicine, Ladoke Akintola University of Technology (LAUTECH) and LAUTECH Teaching Hospital, Ogbomosho, Nigeria
| | - B A Gbadegesin
- Department of Medicine, Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Ogbomosho, Nigeria
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Elliott RA, O'Callaghan CJ. Impact of Hospitalisation on the Complexity of Older Patients' Medication Regimens and Potential for Regimen Simplification. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2011.tb00060.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Rohan A Elliott
- Austin Health, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash University
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Zamorano J, Erdine S, Lopez AP, Kim JH, Khadra AA, Westergaard M, Sutradhar S, Yunis C. Design and Rationale of a Real-Life Study to Compare Treatment Strategies for Cardiovascular Risk Factors: The CRUCIAL Study. Postgrad Med 2015; 122:7-15. [DOI: 10.3810/pgm.2010.03.2117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kenning C, Protheroe J, Gray N, Ashcroft D, Bower P. The potential for using a Universal Medication Schedule (UMS) to improve adherence in patients taking multiple medications in the UK: a qualitative evaluation. BMC Health Serv Res 2015; 15:94. [PMID: 25888725 PMCID: PMC4359545 DOI: 10.1186/s12913-015-0749-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 02/17/2015] [Indexed: 12/04/2022] Open
Abstract
Background Poor adherence to prescribed medication has major consequences. Managing multiple long-term conditions often involves polypharmacy, potentially increasing complexity and the possibility of poor adherence. As a result of the globally recognised problems in supporting adherence to medication, some researchers have proposed the use of reminder charts. The main aim of the research was to explore the need for and perceptions around the ‘Universal Medication Schedule’ (UMS). Looking at ways in which pharmacists and General Practitioners (GPs) could use the UMS in NHS settings. Methods Semi-structured interviews were carried out with 10 GPs, 10 community pharmacists and 15 patients. Patients were aged 65 years and over, had multiple long-term conditions and were prescribed at least 5 medications. Interviews were recorded and transcribed and thematic analysis was conducted, using a framework approach to manage the data. Results Attitudes towards the UMS were mixed with stakeholders seeing benefits and limitations to the chart. Practitioners proposed a number of existing services where they thought the UMS could easily be integrated but there was evidence of role conflict with GPs feeling it may be best placed with pharmacists and vice versa. The potential for the UMS to be used as a tool to aid communication between the different services involved in a patient’s care was a key theme. Conclusions The UMS chart provides consolidated medicines information that might help to improve patients’ knowledge and health literacy, which may or may not improve adherence but could help patients in making informed decisions about their treatment. One of the key benefits of using the UMS in practice is that it could be introduced across services. In this way it may aid in medicines reconciliation between healthcare settings to ensure continuity of message, improve patient experience and create more joined up working between services. Further research is needed to test implementation in different services and to assess outcomes on patient understanding and adherence. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0749-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cassandra Kenning
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor, Williamson Building, Oxford Road, M13 9PL, Manchester, UK.
| | - Joanne Protheroe
- Institute of Primary Care and Health Sciences, Keele University, Keele, UK.
| | - Nicola Gray
- Independent Pharmacist Researcher and Director- Green Line Consulting Ltd, Manchester, UK.
| | - Darren Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety Research, Manchester Pharmacy School, NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, UK.
| | - Peter Bower
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK.
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Holdford DA, Inocencio TJ. Adherence and persistence associated with an appointment-based medication synchronization program. J Am Pharm Assoc (2003) 2014; 53:576-83. [PMID: 24185429 DOI: 10.1331/japha.2013.13082] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the impact of an appointment-based medication synchronization (ABMS) program on medication adherence and persistence with chronic medications. DESIGN Quasiexperimental study in which study patients were matched with control patients. SETTING Rural pharmacies in the Midwestern United States between June 30, 2011, and October 31, 2012. PATIENTS Individuals receiving at least two refills for one of six categories of medications to treat chronic diseases (i.e., angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta blockers, dihydropyridine calcium channel blockers, thiazide diuretics, metformin, statins). INTERVENTION Patients in the ABMS program were compared with control patients receiving usual care. MAIN OUTCOME MEASURES 1-year adherence rates using proportion of days covered (PDC) and 1-year nonpersistence rates. RESULTS Depending on the drug class, patients enrolled in the medication synchronization program (n = 47-81) had adherences rates of 66.1% to 75.5% during 1 year versus 37.0% to 40.8% among control patients. Program patients had 3.4 to 6.1 times greater odds of adherence compared with control patients. Control patients were 52% to 73% more likely to stop taking their chronic medications over 1 year. CONCLUSION An ABMS program in community pharmacies was associated with improved patient adherence and reduced likelihood of nonpersistence.
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Abstract
Antipsychotic polypharmacy remains prevalent; it has probably increased for the treatment of schizophrenia in real-world clinical settings. The current evidence suggests some clinical benefits of antipsychotic polypharmacy, such as better symptom control with clozapine plus another antipsychotic, and a reversal of metabolic side-effects with a concomitant use of aripiprazole. On the other hand, the interpretation of findings in the literature should be made conservatively in light of the paucity of good studies and potentially serious side-effects. Also, although the available data are still limited, two smaller-scale clinical trials provide preliminary evidence that converting antipsychotic polypharmacy to monotherapy could be a valid and reasonable treatment option. Several studies have explored strategies to change physicians' antipsychotic polypharmacy prescribing behaviours. These have revealed that, while the impact of purely educational interventions may be limited, more aggressive procedures such as directly notifying physicians by letters or phone calls can be more effective in reducing antipsychotic polypharmacy. In conclusion, antipsychotic polypharmacy can work for some clinically difficult conditions; however, it should be the exception rather than the rule and may be avoidable in many patients. More importantly, the paucity of the data clearly emphasizes the need for further investigations on not only advantages and disadvantages of antipsychotic polypharmacy, but also regarding effective interventions in already prescribed polypharmacy regimens.
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Zullig LL, McCant F, Melnyk SD, Danus S, Bosworth HB. A health literacy pilot intervention to improve medication adherence using Meducation® technology. PATIENT EDUCATION AND COUNSELING 2014; 95:288-291. [PMID: 24629834 DOI: 10.1016/j.pec.2014.02.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/23/2014] [Accepted: 02/07/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To determine whether antihypertensive medication adherence could improve using a Meducation® technology health literacy intervention. METHODS We conducted a six-month feasibility study among patients with cardiovascular disease (CVD) risk factors receiving care from hospital-based primary care clinics. All patients received a personalized Meducation® calendar listing CVD-related medications. We evaluated changes in medication adherence and clinical outcomes at six months. RESULTS There was a 42% enrollment rate (n=23). Forty percent had low health literacy, defined as less than 9th grade reading level. At three months, self-reported medication adherence improved. At six months, medication possession ratio improved 3.2%. Also, at six months there were decreases in patients' average systolic blood pressure (0.5 mmHg), diastolic blood pressure (1.5 mmHg), and body weight (3.6 pounds) (p>0.05). CONCLUSIONS A health literacy intervention may be a feasible mechanism to improve cardiovascular-related medication adherence and outcomes. PRACTICE IMPLICATIONS Health literacy interventions may improve adherence while requiring relatively few resources to implement.
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Affiliation(s)
- Leah L Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, USA
| | - Felicia McCant
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, USA
| | - S Dee Melnyk
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, USA; Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Susanne Danus
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, USA
| | - Hayden B Bosworth
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, USA; Department of Medicine, Division of General Internal Medicine, Duke University, Durham, USA; School of Nursing, Duke University, Durham, USA; Department of Psychiatry and Behavioral Sciences, Duke University, Durham, USA.
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Serper M, Patzer RE, Curtis LM, Smith SG, O'Conor R, Baker DW, Wolf MS. Health literacy, cognitive ability, and functional health status among older adults. Health Serv Res 2014; 49:1249-67. [PMID: 24476068 DOI: 10.1111/1475-6773.12154] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To investigate whether previously noted associations between health literacy and functional health status might be explained by cognitive function. DATA SOURCES/STUDY SETTING Health Literacy and Cognition in Older Adults ("LitCog," prospective study funded by National Institute on Aging). Data presented are from interviews conducted among 784 adults, ages 55-74 years receiving care at an academic general medicine clinic or one of four federally qualified health centers in Chicago from 2008 to 2010. STUDY DESIGN Study participants completed structured, in-person interviews administered by trained research assistants. DATA COLLECTION Health literacy was measured using the Test of Functional Health Literacy in Adults, Rapid Estimate of Adult Literacy in Medicine, and Newest Vital Sign. Cognitive function was assessed using measures of long-term and working memory, processing speed, reasoning, and verbal ability. Functional health was assessed with SF-36 physical health summary scale and Patient Reported Outcomes Measurement Information System short form subscales for depression and anxiety. PRINCIPAL FINDINGS All health literacy measures were significantly correlated with all cognitive domains. In multivariable analyses, inadequate health literacy was associated with worse physical health and more depressive symptoms. After adjusting for cognitive abilities, associations between health literacy, physical health, and depressive symptoms were attenuated and no longer significant. CONCLUSIONS Cognitive function explains a significant proportion of the associations between health literacy, physical health, and depression among older adults. Interventions to reduce literacy disparities in health care should minimize the cognitive burden in behaviors patients must adopt to manage personal health.
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Affiliation(s)
- Marina Serper
- Health Literacy and Learning Program, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
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Molfenter TD, Brown RL. Effects of Physician Communication and Family Hardiness on Patient Medication Regimen Beliefs and Adherence. ACTA ACUST UNITED AC 2014; 2. [PMID: 25593977 DOI: 10.4172/2327-5146.1000136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study aims to develop a model that describes how physician communication and family hardiness affect medication regimen beliefs and adherence for patients on regimens to control diabetes and hyperlipidemia (high cholesterol). Study participants (n=1356) completed self-report questionnaires on health beliefs. Pharmacy refill records from a health plan in the United States provided data on their medication adherence. Structural equation modeling was used to model variable relationships. A mediation analysis demonstrated that physician communication behaviors had a significant impact on the patients' behavioral intention to adhere to their regimen and medication adherence when they were mediated by the patient's medication taking health beliefs related to perceived benefit of the regimen, impact of side effects, and cost of regimen. Conversely, family hardiness had no effect on medication-taking behaviors. To improve patient medication-taking behaviors, physician communication behaviors should be targeted. The study suggests the physician's initial regimen discussion is important to both regimen initiation and long-term adherence, and should emphasize the regimen's benefits and how to avoid common side effects. Also, establishing a follow-up physician-patient relationship can enhance regimen adherence and reduce the likelihood that a patient will stop taking the medication due to cost concerns. The research supports the important role the physician plays in health behavior maintenance. Future research should study the effect physicians have on other recurring health behaviors.
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Pizzirusso M, Lin J, Head C, Marcus SM, Ahmed S, Bräu N, Weiss JJ. Impact of hepatitis C treatment initiation on adherence to concomitant medications. J Assoc Nurses AIDS Care 2013; 25:23-31. [PMID: 24070644 DOI: 10.1016/j.jana.2013.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 07/10/2013] [Indexed: 12/26/2022]
Abstract
Our study investigated whether initiating hepatitis C virus (HCV) treatment affected adherence to concomitant medications. Mixed-effects linear regression was used to analyze data from 57 patients (29 co-infected with HIV) in a prospective study of HCV treatment-naïve patients initiating HCV treatment. Adherence was assessed using structured self-report at the time of treatment initiation, and at 12 weeks and 24 weeks into treatment. There was no change in adherence to concomitant medications over the first 24 weeks of HCV treatment. There was a significant interaction effect such that the change in adherence to concomitant medications between baseline and 12 weeks differed between the HIV-infected and HIV-uninfected patients. Adherence to concomitant medications in the HIV-infected patients was found to decrease, whereas adherence in the HIV-uninfected patients was found to increase. HIV-infected patients may be more at risk for adherence problems in the first 12 weeks of HCV treatment as compared to HIV-uninfected patients.
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Matthews KA, Brenner MJ, Brenner AC. Evaluation of the efficacy and safety of a hydrochlorothiazide to chlorthalidone medication change in veterans with hypertension. Clin Ther 2013; 35:1423-30. [PMID: 23993697 DOI: 10.1016/j.clinthera.2013.07.430] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 06/20/2013] [Accepted: 07/30/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are few data available examining the clinical impact of switching patients from hydrochlorothiazide (HCTZ) to chlorthalidone for blood pressure management. OBJECTIVES The goal of this study was to compare within-patient clinic blood pressure readings, serum electrolyte levels, and renal function markers before and after a medication change from HCTZ to chlorthalidone in a veteran population. METHODS This was a retrospective, pre- and postmeasure, self-controlled study. Veterans Affairs Ann Arbor Healthcare System patients switched from HCTZ to chlorthalidone between January 1, 2001, and January 31, 2012, who had at least 1 follow-up clinic blood pressure reading recorded between 2 and 8 weeks from the date of the medication change were included in the study. Mean pre- and postmeasure values for systolic and diastolic clinic blood pressures, serum potassium, serum sodium, serum calcium, serum creatinine, and blood urea nitrogen were compared by using a 2-tailed, paired t test with a significance level (α) of 0.05. RESULTS Of the 40 patients included in the study 95% were male, 65% were white, and the mean age was 64.9 (10.8) years. Both mean systolic (-15.8 mm Hg [95% CI, 8.9 to 22.6], P < 0.0001) and mean diastolic (-4.2 mm Hg [95% CI, 1.5 to 6.9], P = 0.0035) blood pressures showed statistically and clinically significant reductions after the medication change. A statistically significant decrease in mean sodium (-1.1 mmol/L [95% CI, 0.4 to 1.9], P = 0.003) and an increase in mean serum creatinine (0.06 mg/dL [95% CI, -0.09 to -0.02], P = 0.002) was observed; however, these changes may not be viewed as clinically significant by many practitioners. No statistically significant changes were observed in any of the other outcomes examined. Most patients (38 of 40) were taking at least 1 additional antihypertensive agent; 73% of patients were using ≥ 3 antihypertensive agents at the time of the medication change. CONCLUSIONS In patients with hypertension already taking HCTZ, switching to chlorthalidone seems to further reduce systolic and diastolic blood pressures without any clinically significant changes in renal function or electrolyte levels.
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Kiss Z, Nagy L, Reiber I, Paragh G, Molnar MP, Rokszin G, Abonyi-Toth Z, Mark L. Persistence with statin therapy in Hungary. Arch Med Sci 2013; 9:409-17. [PMID: 23847660 PMCID: PMC3701976 DOI: 10.5114/aoms.2013.35327] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 03/23/2013] [Accepted: 04/13/2013] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Persistence with lipid-lowering drug therapy by cardiovascular patients in Hungary has not been studied previously. This study was designed to determine the rate with which Hungarian patients with hyperlipidemia persist in taking lipid-lowering agents, and to compare this with rates reported from other countries. MATERIAL AND METHODS This was a retrospective study that utilized data from the Institutional Database of the National Health Insurance Fund to analyze persistence rates with statins and ezetimibe. The study included data for patients who started lipid-lowering therapy between January 1, 2007, and March 31, 2009. Variables included type of lipid-lowering therapy, year of therapy start, and patient age. Main outcome measures were medians of persistence in months, percentages of patients persisting in therapy for 6 and 12 months, and Kaplan-Meier persistence plots. RESULTS The percentage of patients who persisted with overall statin therapy was 46% after 1 month, 40.3% after 2 months, 27% after 6 months, and 20.1% after 12 months. Persistence was slightly greater for statin therapy started during 2008 than during 2007. Older patients were more persistent with therapy than younger patients. Persistence with the combination of ezetimibe-statin therapy was greater than with statin or ezetimibe monotherapy. CONCLUSIONS Persistence with statin therapy by patients in Hungary was low compared with other countries. Low persistence may have negated potential clinical benefits of long-term statin therapy.
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Affiliation(s)
| | | | - Istvan Reiber
- St. George Fejer County Hospital, 4 Department of Medicine, Szekesfehervar, Hungary
| | - György Paragh
- Medical and Health Science Centre, University of Debrecen, 1 Department of Medicine, Debrecen, Hungary
| | | | | | | | - Laszlo Mark
- Pandy Kalman Bekes County Hospital, 2 Department of Medicine – Cardiology, Gyula, Hungary
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Sav A, King MA, Whitty JA, Kendall E, McMillan SS, Kelly F, Hunter B, Wheeler AJ. Burden of treatment for chronic illness: a concept analysis and review of the literature. Health Expect 2013; 18:312-24. [PMID: 23363080 DOI: 10.1111/hex.12046] [Citation(s) in RCA: 186] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2012] [Indexed: 01/08/2023] Open
Abstract
CONTEXT Treatment burden, the burden associated with the treatment and management of chronic illness, has not yet been well articulated. OBJECTIVE Using Rodgers' (1989, Journal of Advanced Nursing, 14, 330-335) method of concept analysis, this review describes the ways in which treatment burden has been conceptualized to define the concept and to develop a framework for understanding its attributes, antecedents and consequences. METHODS Leading databases were searched electronically between the years 2002 and 2011. To ensure the review focused on actual observations of the concept of interest, articles that did not measure treatment burden (either qualitatively or quantitatively) were excluded. An inductive approach was used to identify themes related to the concept of treatment burden. MAIN RESULTS Thirty articles, identified from 1557 abstracts, were included in the review. The attributes of treatment burden include burden as a dynamic process, as a multidimensional concept, and comprising of both subjective and objective elements. Prominent predisposing factors (antecedents) include the person's age and gender, their family circumstances, possible comorbidity, high use of medications, characteristics of treatment and their relationship with their health-care provider. The most dominant consequences are poor health and well-being, non-adherence to treatment, ineffective resource use and burden on significant others. Furthermore, many of these consequences can also become antecedents, reflecting the cyclic and dynamic nature of treatment burden. CONCLUSION The findings underscore the need for researchers and health-care professionals to engage in collaborative discussions and make cooperative efforts to help alleviate treatment burden and tailor treatment regimens to the realities of people's daily lives.
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Affiliation(s)
- Adem Sav
- Griffith Health Institute, Griffith University, Meadowbrook, Qld, Australia
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Tani H, Uchida H, Suzuki T, Fujii Y, Mimura M. Interventions to reduce antipsychotic polypharmacy: a systematic review. Schizophr Res 2013; 143:215-20. [PMID: 23158205 DOI: 10.1016/j.schres.2012.10.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 09/23/2012] [Accepted: 10/21/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND It still remains unclear as to how to counteract antipsychotic polypharmacy that remains controversial but common. The objective of this study was to synthesize the clinical evidence to reduce antipsychotic polypharmacy (i.e. use of multiple antipsychotics) in schizophrenia. METHODS A literature search was performed to identify clinical trials that attempted to reduce antipsychotic polypharmacy in patients with schizophrenia by any form of systematic intervention using PubMed as well as MEDLINE, EMBASE, and PsycINFO (last search: June 2012). The search terms included "antipsychotics" and "polypharmacy". Cross-referencing was also performed. RESULTS The literature search identified 17 studies. Only 3 studies (1 randomized controlled trial and 2 open-label trials) were found that systematically switched antipsychotic polypharmacy to monotherapy. In two of them, more than two thirds of the subjects successfully completed the switch (40/58, 69.0%; 34/44, and 77.3%, respectively) while less than half the subjects tolerated it in the other study (6/14 and 42.9%) although the sample size was very small. On the other hand, 14 studies that examined impacts of interventions have physicians refrain from antipsychotic polypharmacy. While a modest intervention with educational approach alone was effective in three of the five articles, a more assertive intervention that directly cautioned physicians on the use of polypharmacy was effective in 10 of 12 articles. CONCLUSION The literature search revealed the paucity of the data. Careful switching from polypharmacy to monotherapy seems feasible in a majority of patients with schizophrenia. Assertive interventions, rather than passive educational approaches alone, appear more effective in reducing antipsychotic polypharmacy.
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Affiliation(s)
- Hideaki Tani
- Department of Psychiatry, Yamanashi Prefectural Kita Hospital, Yamanashi, Japan
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