1
|
McDermott J, Granger B, Thompson S, Baker D, D’Aoust R. Improving Advanced Practice Provider Knowledge and Assessment of Medication Adherence in Patients with Cardiovascular Disease. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
2
|
Does Online Community Participation Contribute to Medication Adherence? An Empirical Study of Patients with Chronic Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105100. [PMID: 34065820 PMCID: PMC8150755 DOI: 10.3390/ijerph18105100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 11/20/2022]
Abstract
Effectively improving the medication adherence of patients is crucial. Past studies focused on treatment-related factors, but little attention has been paid to factors concerning human beliefs such as trust or self-efficacy. The purpose of this study is to explore the following aspects of patients with chronic diseases: (1) The relationship between emotional support, informational support, self-efficacy, and trust; (2) the relationship between self-efficacy, trust, and medication adherence; and, (3) whether chronic patients’ participation in different types of online communities brings about significant statistical differences in the relationships between the abovementioned variables. A questionnaire survey was conducted in this study, with 452 valid questionnaires collected from chronic patients previously participating in online community activities. Partial Least Squares-Structural Equation Modeling analysis showed that emotional support and informational support positively predict self-efficacy and trust, respectively, and consequently, self-efficacy and trust positively predict medication adherence. In addition, three relationships including the influence of emotional support on trust, the influence of trust on medication adherence, and the influence of self-efficacy on medication adherence, the types of online communities result in significant statistical differences. Based on the findings, this research suggests healthcare professionals can enhance patients’ self-efficacy in self-care by providing necessary health information via face-to-face or online communities, and assuring patients of demonstrable support. As such, patients’ levels of trust in healthcare professionals can be established, which in turn improves their medication adherence.
Collapse
|
3
|
Implantable Diuretic Pump for Heart Failure Management. Am J Ther 2021; 27:e320-e322. [PMID: 30985484 DOI: 10.1097/mjt.0000000000000984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
4
|
Scope-of-Practice for Nurse Practitioners and Adherence to Medications for Chronic Illness in Primary Care. J Gen Intern Med 2021; 36:478-486. [PMID: 32583346 PMCID: PMC7878646 DOI: 10.1007/s11606-020-05963-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 06/05/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Nonadherence to medications is costly and improving adherence is difficult, requiring multifactorial solutions, including policy solutions. OBJECTIVE The purpose of this study is to evaluate the effect of one policy strategy on medication adherence. Specifically, we examine the effect on adherence of expanding scope-of-practice regulations for nurse practitioners (NPs) to practice and prescribe without physician supervision. DESIGN We conducted three difference-in-difference multivariable analyses of commercial insurance claims. PARTICIPANTS Patients who filled at least two prescriptions in one of three chronic therapeutic medications: anti-diabetics (n = 514,255), renin angiotensin system antagonists (RASA) (n = 1,679,957), and anti-lipidemics (n = 1,613,692). MAIN MEASURES Medication adherence was measured as the proportion of days covered (PDC). We used one continuous (PDC 0-1) and one binary outcome (PDC of > .8), the latter indicating good adherence. KEY RESULTS Patients taking anti-diabetic medications had a 1.9 percentage point higher medication adherence rate (p < 0.05) and a 2.7 percentage point higher probability of good adherence (p < 0.001) in states that expanded NP scope-of-practice. Medication adherence for patients taking RASA was higher by 2.3 percentage points (p < 0.001) and 3.4 percentage points (p < 0.01) for both measures, respectively. Patients taking anti-lipidemics saw a smaller, but statistically insignificant, improvement in adherence. CONCLUSIONS Results indicate that scope-of-practice regulations that allow NPs to practice and prescribe without physician oversight are associated with improved medication adherence. We postulate that the mechanism for this effect is increased access to health care services, which in turn increases access to prescriptions. Our results suggest that policies allowing NPs to maximally use their skills can be beneficial to patients.
Collapse
|
5
|
Abstract
BACKGROUND Medication adherence is associated with lower health care utilization and savings in specific patient populations; however, few empirical estimates exist at the population level. OBJECTIVE The main objective of this study was to apply a data-driven approach to obtain population-level estimates of the impact of medication nonadherence among Medicare beneficiaries with chronic conditions. RESEARCH DESIGN Medicare fee-for-service (FFS) claims data were used to calculate the prevalence of medication nonadherence among individuals with diabetes, heart failure, hypertension, and hyperlipidemia. Per person estimates of avoidable health care utilization and spending associated with medication adherence, adjusted for healthy adherer effects, from prior literature were applied to the number of nonadherent Medicare beneficiaries. SUBJECTS A 20% random sample of community-dwelling, continuously enrolled Medicare FFS beneficiaries aged 65 years or older with Part D (N=14,657,735) in 2013. MEASURES Avoidable health care costs and hospital use from medication nonadherence. RESULTS Medication nonadherence for diabetes, heart failure, hyperlipidemia, and hypertension resulted in billions of Medicare FFS expenditures, millions in hospital days, and thousands of emergency department visits that could have been avoided. If the 25% of beneficiaries with hypertension who were nonadherent became adherent, Medicare could save $13.7 billion annually, with over 100,000 emergency department visits and 7 million inpatient hospital days that could be averted. CONCLUSION Medication nonadherence places a large resource burden on the Medicare FFS program. Study results provide actionable information for policymakers considering programs to manage chronic conditions. Caution should be used in summing estimates across disease groups, assuming all nonadherent beneficiaries could become adherent, and applying estimates beyond the Medicare FFS population.
Collapse
|
6
|
Hackerson ML, Luder HR, Beck AF, Wedig JM, Heaton PC, Frede SM. Addressing primary nonadherence: A collaboration between a community pharmacy and a large pediatric clinic. J Am Pharm Assoc (2003) 2018; 58:S101-S108.e1. [PMID: 29730152 DOI: 10.1016/j.japh.2018.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 03/08/2018] [Accepted: 04/05/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To decrease nonadherence rates through the design and implementation of a collaborative prescription management program involving a community pharmacy and a large pediatric primary care center. PRACTICE INNOVATION Kroger and Cincinnati Children's Pediatric Primary Care Center collaborated to identify and address patients' barriers to filling new prescriptions. After filling new medications for clinic patients, pharmacists telephoned patients to inform them that their prescription was ready and to reinforce the importance of initiating the therapy. Pharmacists followed up with families to address barriers when prescriptions remained at the pharmacy after 48 hours. Pharmacists communicated with prescribers if prescriptions were not filled, allowing the clinic staff to follow up. EVALUATION The primary outcome of this prospective pilot study with a comparison group was primary nonadherence (PNA), defined as the proportion of patients who did not pick up prescriptions or a reasonable alternative within 30 days after the pharmacy received the prescription. Secondary outcomes were the impact on secondary nonadherence and identification of adherence barriers. RESULTS Fifty-nine patients were enrolled from November 2016 to April 2017. Characteristics between the intervention group and a standard-care group were similar. The majority of prescribed medications were for acute conditions, the average patient age was 4.9 years, and 86% of patients were covered by Medicaid. Intervention patients had significantly less PNA compared with the standard-care group (14.0% vs. 53.3%, respectively; P < 0.001). Intervention patients had significantly greater secondary adherence rates compared with standard-care patients (38.8% vs. 7%; P < 0.001). Common barriers likely resulting in PNA included lack of time, lack of urgency, transportation challenges, and cost. CONCLUSION Increased communication between the primary care provider and the community pharmacy, coupled with targeted patient-specific interventions before the initial fill of medications, resulted in significant reductions in PNA.
Collapse
|
7
|
Hensley C, Heaton PC, Kahn RS, Luder HR, Frede SM, Beck AF. Poverty, Transportation Access, and Medication Nonadherence. Pediatrics 2018; 141:peds.2017-3402. [PMID: 29610400 PMCID: PMC5869333 DOI: 10.1542/peds.2017-3402] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Variability in primary medication nonadherence (PMN), or failure to fill a new prescription, influences disparities and widens equity gaps. This study sought to evaluate PMN across 1 metropolitan area and assess relationships with underlying zip code-level measures. METHODS This was a retrospective observational study using data extracted from 1 regional community pharmacy market-share leader (October 2016-April 2017). Data included patient age, sex, payer, medication type, and home zip code. This zip code was connected to US census measures enumerating poverty and vehicle access, which were treated as continuous variables and within quintiles. The prescription-level outcome was whether prescriptions were not filled within 30 days of reaching the pharmacy. The ecological-level outcome was PMN calculated for each zip code (numerator, unfilled prescriptions; denominator, received prescriptions). RESULTS There were 213 719 prescriptions received by 54 included pharmacies; 12.2% were unfilled. Older children, boys, and those with public insurance were more likely to have prescriptions not filled. Prescriptions originating from the highest poverty quintile were significantly more likely to not be filled than those from the lowest poverty quintile (adjusted odds ratio 1.60; 95% confidence interval 1.52-1.69); a similar pattern was noted for vehicle access (adjusted odds ratio 1.77; 95% confidence interval 1.68-1.87). At the ecological level, there were significant, graded relationships between PMN rates and poverty and vehicle access (both P < .0001); these gradients extended across all medication classes. CONCLUSIONS Poverty and vehicle access are related to significant differences in prescription- and ecological-level PMN across 1 metropolitan area. Pharmacists and pharmacies can be key partners in population health efforts.
Collapse
Affiliation(s)
| | - Pamela C. Heaton
- James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio
| | - Robert S. Kahn
- Department of Pediatrics, College of Medicine and,Division of General & Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; and
| | - Heidi R. Luder
- James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio
| | - Stacey M. Frede
- James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio;,Kroger Pharmacy, Cincinnati, Ohio
| | - Andrew F. Beck
- Department of Pediatrics, College of Medicine and,Division of General & Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; and
| |
Collapse
|
8
|
Amico KR, Mugavero M, Krousel-Wood MA, Bosworth HB, Merlin JS. Advantages to Using Social-Behavioral Models of Medication Adherence in Research and Practice. J Gen Intern Med 2018; 33:207-215. [PMID: 29204968 PMCID: PMC5789100 DOI: 10.1007/s11606-017-4197-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Achieving and sustaining high levels of adherence to medication regimens is essential to improving health outcomes, but continues to be a challenge for a sizable proportion of patients. Decades of research suggests that medication adherence is determined by a complex constellation of factors. Social-behavioral science research has focused on creating frameworks that identify which contextual, personal, social, or drug-related factors appear to most influence adherence. Comprehensive models of adherence propose specific structural relationships between these factors that can be used to plan for, implement, and monitor programs that seek to optimize adherence. The use of social-behavioral models offers multiple advantages in both practice and research environments; however, the breadth and depth of these models can deter many from engaging in this important exercise. To promote the use of social-behavioral frameworks and models of adherence, we provide a brief overview of the advantages in using a social-behavioral lens in adherence work, a sampling of models used in HIV medication adherence research that have high generalizability to other conditions, and practical guidance for grounding adherence promotion strategies in evidence informed by social-behavioral science research.
Collapse
Affiliation(s)
- K Rivet Amico
- University of Michigan, School of Public Health, Ann Arbor, MI, USA.
| | - M Mugavero
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marie A Krousel-Wood
- Tulane University Schools of Medicine and Public Health and Tropical Medicine and Ochsner Health System, New Orleans, LA, USA
| | - Hayden B Bosworth
- Center for Health Services Research in Primary Care, Durham VAMC, Duke University Medical Center, Durham, NC, USA
| | - Jessica S Merlin
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
9
|
|
10
|
The availability of pharmacies in the United States: 2007-2015. PLoS One 2017; 12:e0183172. [PMID: 28813473 PMCID: PMC5559230 DOI: 10.1371/journal.pone.0183172] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 07/31/2017] [Indexed: 11/19/2022] Open
Abstract
Importance Despite their increasingly important role in health care delivery, little is known about the availability, and characteristics, of community pharmacies in the United States. Objectives (1) To examine trends in the availability of community pharmacies and pharmacy characteristics (24-hour, drive-up, home delivery, e-prescribing, and multilingual staffing) associated with access to prescription medications in the U.S. between 2007 and 2015; and (2) to determine whether and how these patterns varied by pharmacy type (retail chains, independents, mass retailers, food stores, government and clinic-based) and across counties. Methods Retrospective analysis using annual data from the National Council for Prescription Drug Programs. Pharmacy locations were mapped and linked to the several publically-available data to derive information on county-level population demographics, including annual estimates of total population, percent of population that is non-English speaking, percent with an ambulatory disability and percent aged ≥65 years. The key outcomes were availability of pharmacies (total number and per-capita) and pharmacy characteristics overall, by pharmacy type, and across counties. Results The number of community pharmacies increased by 6.3% from 63,752 (2007) to 67,753 (2015). Retail chain and independent pharmacies persistently accounted for 40% and 35% of all pharmacies, respectively, while the remainder were comprised of mass retailer (12%), food store, (10%), clinic-based (3%) or government (<1%) pharmacies. With the exception of e-prescribing, there was no substantial change in pharmacy characteristics over time. While the number of pharmacies per 10,000 people (2.11) did not change between 2007 and 2015 at the national-level, it varied substantially across counties ranging from 0 to 13.6 per-capita in 2015. We also found that the majority of pharmacies do not offer accommodations that facilitate access to prescription medications, including home-delivery, with considerable variation by pharmacy type and across counties. For example, the provision of home-delivery services ranged from less than <1% of mass retailers to 67% of independent stores and was not associated with county demographics, including ambulatory disability population and percent of the population aged ≥65 years. Conclusions Despite modest growth of pharmacies in the U.S., the availability of pharmacies, and pharmacy characteristics associated with access to prescription medications, vary substantially across local areas. Policy efforts aimed at improving access to prescription medications should ensure the availability of pharmacies and their accommodations align with local population needs.
Collapse
|
11
|
Whalley Buono E, Vrijens B, Bosworth HB, Liu LZ, Zullig LL, Granger BB. Coming full circle in the measurement of medication adherence: opportunities and implications for health care. Patient Prefer Adherence 2017; 11:1009-1017. [PMID: 28652710 PMCID: PMC5472434 DOI: 10.2147/ppa.s127131] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
There is little debate that medication nonadherence is a major public health issue and that measuring nonadherence is a crucial step toward improving it. Moreover, while measuring adherence is becoming both more feasible and more common in the era of electronic information, the reliability and usefulness of various measurements of adherence have not been well established. This paper outlines the most commonly used measures of adherence and discusses the advantages and disadvantages of each that depend on the purpose for which the measure will be used. International consensus statements on definitions and guidelines for selection and use of medication adherence measures were reviewed. The quality of recommended measures was evaluated in selected publications from 2009 to 2014. The most robust medication adherence measures are often ill suited for large-scale use. Less robust measures were found to be commonly misapplied and subsequently misinterpreted in population-level analyses. Adherence assessment and measurement were rarely integrated into standard patient care practice patterns. Successful scalable and impactful strategies to improve medication adherence will depend on understanding how to efficiently and effectively measure adherence.
Collapse
Affiliation(s)
| | | | - Hayden B Bosworth
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Larry Z Liu
- Center for Observational and Real World Evidence, Merck, Rahway, NJ and Weill Medical College of Cornell University, New York, NY
| | - Leah L Zullig
- Division of General Internal Medicine, Duke University School of Medicine
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System
| | - Bradi B Granger
- Duke University School of Nursing
- Heart Center Nursing Research Program, Duke University Health System, Durham, NC, USA
- Correspondence: Bradi B Granger, Heart Center Nursing Research Program, Duke University Health System, 307 Trent Drive, DUMC 3322 Durham, NC 27710, USA, Tel +1 919 684 1622, Email
| |
Collapse
|