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Rahman ARA, Magno JDA, Cai J, Han M, Lee HY, Nair T, Narayan O, Panyapat J, Van Minh H, Khurana R. Management of Hypertension in the Asia-Pacific Region: A Structured Review. Am J Cardiovasc Drugs 2024; 24:141-170. [PMID: 38332411 PMCID: PMC10973088 DOI: 10.1007/s40256-023-00625-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/10/2024]
Abstract
This article reviews available evidence regarding hypertension management in the Asia-Pacific region, focussing on five research questions that deal with specific aspects: blood pressure (BP) control, guideline recommendations, role of renin-angiotensin-aldosterone system (RAAS) inhibitors in clinical practice, pharmacological management and real-world adherence to guideline recommendations. A PubMed search identified 2537 articles, of which 94 were considered relevant. Compared with Europeans, Asians have higher systolic/diastolic/mean arterial BP, with a stronger association between BP and stroke. Calcium channel blockers are the most-commonly prescribed monotherapy in Asia, with significant variability between countries in the rates of angiotensin-converting enzyme inhibitors (ACEis)/angiotensin-receptor blockers (ARBs) and single-pill combination (SPC) use. In clinical practice, ARBs are used more commonly than ACEis, despite the absence of recommendation from guidelines and clinical evidence supporting the use of one class of drug over the other. Ideally, antihypertensive treatment should be tailored to the individual patient, but currently there are limited data on the characteristics of hypertension in Asia-Pacific individuals. Large outcome studies assessing RAAS inhibitor efficacy and safety in multi-national Asian populations are lacking. Among treated patients, BP control rates were ~ 35 to 40%; BP control in Asia-Pacific is suboptimal, and disproportionately so compared with Western nations. Strategies to improve the management of hypertension include wider access/availability of affordable treatments, particularly SPCs (which improve adherence), effective public health screening programs targeting patients to drive health-seeking behaviours, an increase in physician/patient awareness and early implementation of lifestyle changes. A unified Asia-Pacific guideline on hypertension management with pragmatic recommendations, particularly in resource-limited settings, is essential.
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Affiliation(s)
- Abdul R A Rahman
- An Nur Specialist Hospital, Jalan Gerbang Wawasan 1, Seksyen 15, 43650, Bandar Baru Bangi, Selangor, Malaysia.
| | - Jose Donato A Magno
- Division of Cardiovascular Medicine, Philippine General Hospital, Cardiovascular Institute, University of the Philippines College of Medicine, Angeles University Foundation Medical Center, Angeles, Philippines
| | - Jun Cai
- Hypertension Center, Fuwai Hospital, Beijing, People's Republic of China
| | - Myint Han
- Grand Hantha International Hospital, Yangon, Myanmar
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro Chongno-gu, Seoul, 03080, South Korea
| | - Tiny Nair
- PRS Hospital, Trivandrum, Kerala, India
| | - Om Narayan
- The Northern Hospital, 185 Cooper St., Epping, VIC, 3122, Australia
| | - Jiampo Panyapat
- Bhumibol Adulyadej Hospital, 171 Paholyothin Road, Saimai, Bangkok, 10220, Thailand
| | - Huynh Van Minh
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue, 530000, Vietnam
| | - Rohit Khurana
- The Harley Street Heart and Vascular Center, Gleneagles Hospital, Singapore, 258500, Singapore
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Sumner J, Bundele A, Lim HW, Phan P, Motani M, Mukhopadhyay A. Developing an Artificial Intelligence-Driven Nudge Intervention to Improve Medication Adherence: A Human-Centred Design Approach. J Med Syst 2023; 48:3. [PMID: 38063940 PMCID: PMC10709244 DOI: 10.1007/s10916-023-02024-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023]
Abstract
To improve medication adherence, we co-developed a digital, artificial intelligence (AI)-driven nudge intervention with stakeholders (patients, providers, and technologists). We used a human-centred design approach to incorporate user needs in creating an AI-driven nudge tool. We report the findings of the first stage of a multi-phase project: understanding user needs and ideating solutions. We interviewed healthcare providers (n = 10) and patients (n = 10). Providers also rated example nudge interventions in a survey. Stakeholders felt the intervention could address existing deficits in medication adherence tracking and were optimistic about the solution. Participants identified flexibility of the intervention, including mode of delivery, intervention intensity, and the ability to stratify to user ability and needs, as critical success factors. Reminder nudges and provision of healthcare worker contact were rated highly by all. Conversely, patients perceived incentive-based nudges poorly. Finally, participants suggested that user burden could be minimised by leveraging existing software (rather than creating a new App) and simplifying or automating the data entry requirements where feasible. Stakeholder interviews generated in-depth data on the perspectives and requirements for the proposed solution. The participatory approach will enable us to incorporate user needs into the design and improve the utility of the intervention. Our findings show that an AI-driven nudge tool is an acceptable and appropriate solution, assuming it is flexible to user requirements.
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Affiliation(s)
- Jennifer Sumner
- Medical Affairs - Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore, Singapore.
| | - Anjali Bundele
- Medical Affairs - Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore, Singapore
| | - Hui Wen Lim
- Medical Affairs - Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore, Singapore
| | - Phillip Phan
- Johns Hopkins Carey Business School and the Department of Medicine, Baltimore, USA
| | - Mehul Motani
- Department of Electrical & Computer Engineering, National University of Singapore, Singapore, Singapore
| | - Amartya Mukhopadhyay
- Medical Affairs - Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Liu S, Yuan D, Zhou Y, Fu G, Wang B. Adherence, adverse drug reactions, and discontinuation associated with adverse drug reactions of HIV post-exposure prophylaxis: a meta-analysis based on cohort studies. Ann Med 2023; 55:2288309. [PMID: 38065681 PMCID: PMC10836249 DOI: 10.1080/07853890.2023.2288309] [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] [Received: 05/03/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
Objective: Evaluate the profiles of post-exposure prophylaxis (PEP) adherence, adverse drug reactions (ADRs), and discontinuation associated with ADRs to provide information for further PEP program improvement and increase adherence to PEP.Methods: The Web of Science, PubMed, Embase, and the Cochrane Library were searched for cohort studies reporting data related to PEP adherence or ADRs (PROSPERO, CRD42022385073). Pooled estimates of adherence, the incidence of ADRs and discontinuation associated with ADRs, and their 95% confidence intervals (CI) were calculated separately for the included literature using random effects models. For substantial heterogeneity, meta-regression and subgroup analyses were conducted to explore sources of heterogeneity.Results: Overall adherence was 58.4% (95% CI: 50.9%-65.8%), with subgroup analysis showing differences in adherence across samples, with the highest adherence among men who had sex with men (MSM) (72.4%, 95% CI: 63.4%-81.3%) and the lowest adherence among survivors of sexual assault (SAs) (41.7%, 95% CI: 28.0%-55.3%). The incidence of ADRs was 60.3% (95% CI: 50.3%-70.3%), and the prevalence of PEP discontinuation associated with ADRs was 32.7% (95% CI: 23.7%-41.7%), with subgroup analyses revealing disparities in the prevalence of discontinuation associated with ADRs among samples with different drug regimens. Time trend analysis showed a slight downward trend in the incidence of ADRs and PEP discontinuation associated with ADRs.Conclusion: Adherence to PEP was less than 60% across samples, however, there was significant heterogeneity depending on the samples. SAs had the lowest adherence and the highest incidence of PEP discontinuation. Ongoing adherence education for participants, timely monitoring, and management of ADRs may improve adherence.
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Affiliation(s)
- Shanshan Liu
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Defu Yuan
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Ying Zhou
- Department of STD/AIDS Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Gengfeng Fu
- Department of STD/AIDS Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Bei Wang
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China
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Manatpreeprem R, Lerkvaleekul B, Vilaiyuk S. Factors associated with medication adherence among children with rheumatic diseases. Front Pharmacol 2023; 14:1149320. [PMID: 37214435 PMCID: PMC10196057 DOI: 10.3389/fphar.2023.1149320] [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: 01/21/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction: Failure to take medications regularly leads to poorer health outcomes. The Pediatric Rheumatology Adherence Questionnaire (PRAQ) is an effective tool for assessing medication adherence in rheumatic patients. Therefore, we aimed to determine the factors associated with poor medication adherence among children with rheumatic diseases. Methods: This was a cross-sectional study. Patients with rheumatic diseases who had taken at least one medication and had been followed up at our pediatric rheumatology clinic were included in the study, together with their caregivers. Patients with poor medication adherence were characterized as those who had taken less than 80% of their prescribed drugs, as determined using the pill count method. The original PRAQ was translated and validated in Thai language and was completed by caregivers and literate patients over age 13 years. Interviewing for additional problems with taking medications was conducted. We performed descriptive and logistic regression analyses. Results: From 210 patients, 52.86% had juvenile idiopathic arthritis (JIA), and 46.19% had connective tissue diseases. The mean patient age was 14.10 ± 4.74 years, with a median (interquartile range) disease duration of 4.33 (2.08-6.98) years. PRAQ scores in the group with poor adherence were significantly higher than scores in the group with good adherence (11.00 ± 3.47 vs. 9.51 ± 3.16, p = 0.004). Enthesitis-related arthritis (ERA) (odds ratio [OR] 9.09, 95% confidence interval [CI] 1.25-66.18; p = 0.029) and polyarticular JIA (OR 6.43, 95% CI 1.30-31.75; p = 0.022) were associated with poor treatment adherence. Disease duration ≥5 years (OR 3.88, 95% CI 1.17-12.87; p = 0.027), active disease (OR 6.49, 95% CI 1.76-23.99; p = 0.005), PRAQ scores ≥12 (OR 6.48, 95% CI 1.76-23.82; p = 0.005), forgetting to take medications (OR 14.18, 95% CI 4.21-47.73; p < 0.001), and unawareness about the importance of the medicines (OR 44.18, 95% CI 11.30-172.73; p < 0.001) were predictors of poor drug adherence. Conclusion: In the present study, poor medication adherence was found in one-fourth of children with rheumatic illnesses, particularly those with ERA, polyarticular JIA, longer disease duration, active disease, and high PRAQ scores. The most frequent reasons for inadequate medication adherence were forgetfulness and unawareness about the importance of disease control and consistency with treatment.
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Rasalam R, Abdo S, Deed G, O'Brien R, Overland J. Early type 2 diabetes treatment intensification with glucagon-like peptide-1 receptor agonists in primary care: An Australian perspective on guidelines and the global evidence. Diabetes Obes Metab 2023; 25:901-915. [PMID: 36541153 DOI: 10.1111/dom.14953] [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] [Received: 07/10/2022] [Revised: 12/03/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
Early and intensive management of type 2 diabetes has been shown to delay disease progression, reduce the risk of cardiorenal complications and prolong time to treatment failure. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are being increasingly recognized for their potential in early disease management, with recent guideline updates recommending second-line use of this injectable drug class alongside oral glucose-lowering drugs. GLP-1RAs target at least six of the eight core defects implicated in the pathogenesis of type 2 diabetes and offer significant glycaemic and weight-related improvements over other second-line agents in head-to-head trials. In addition, placebo-controlled clinical trials have shown cardiovascular protection with GLP-1RA use. Even so, this therapeutic class is underused in primary care, largely owing to clinical inertia and patient-related barriers to early intensification with GLP-1RAs. Fortunately, clinicians can overcome barriers to treatment acceptance through patient education and training, and management of treatment expectations. In this review we comment on global and Australian guideline updates and evidence in support of early intensification with this therapeutic class, and provide clinicians with practical advice for GLP-1RA use in primary care.
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Affiliation(s)
- Roy Rasalam
- College of Medicine, James Cook University, Townsville, Queensland, Australia
| | - Sarah Abdo
- Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Gary Deed
- Monash University, Melbourne, Victoria, Australia
- HealthcarePlus Medical, Carindale, Queensland, Australia
| | - Richard O'Brien
- Austin Clinical School, University of Melbourne, Heidelberg, Victoria, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| | - Jane Overland
- Total Diabetes Care, Sydney, New South Wales, Australia
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Levin JS, Acosta J, Faherty LJ. New prescription fills of selective serotonin reuptake inhibitors before and during the COVID-19 pandemic in Los Angeles County, California. J Affect Disord 2022; 319:507-510. [PMID: 36055533 PMCID: PMC9428114 DOI: 10.1016/j.jad.2022.08.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/11/2022] [Accepted: 08/26/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study examined whether the COVID-19 pandemic was associated with changes in new selective serotonin reuptake inhibitor (SSRI) prescription fills. METHODS Using IQVIA Xponent data on new SSRI fills in Los Angeles (L.A.) County from March 2019 to June 2021, the authors implemented an interrupted time series analysis comparing the monthly volume and trend of overall fills and fills by age and gender from before to after the pandemic declaration. RESULTS The rate of new SSRI prescription fills briefly decreased after the pandemic declaration but then consistently increased through the rest of the study period. These increases were primarily driven by women, young adults (i.e., 18-39 year-olds), and those under 18 years old. LIMITATIONS Sample is limited to one county and may not be generalizable to other municipalities. CONCLUSIONS The COVID-19 pandemic was associated with significant increases in new SSRI fills among women, young adults, and those under 18. These increases were relatively small compared to increases in depressive symptoms during the same time period.
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Affiliation(s)
- Jonathan S. Levin
- RAND Corporation, Arlington, VA, United States of America,Corresponding author at: 1200 S Hayes St., Arlington, VA 22202, United States of America
| | - Joie Acosta
- RAND Corporation, Arlington, VA, United States of America
| | - Laura J. Faherty
- RAND Corporation, Boston, MA, United States of America,Department of Pediatrics, Maine Medical Center, Portland, ME, United States of America
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Simelane PT, Simelane MS, Amoateng AY. Barriers and facilitators to adherence for antiretroviral therapy: the perspectives of patients from a wellness center in the Mpumalanga Province, South Africa. Afr Health Sci 2022; 22:455-462. [PMID: 36910408 PMCID: PMC9993319 DOI: 10.4314/ahs.v22i3.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Patients' non-adherence to antiretroviral treatment remains a public health concern in many developing countries, especially in South Africa. Objectives The objective of the study was to explore the barriers and facilitators of patients' ART adherence in one health care facility in Mpumalanga Province, South Africa. Methods A qualitative, exploratory, and descriptive design was employed to collect data using a semi-structured interview guide through individual in-depth interviews among twenty (20) purposively selected patients. The thematic analysis approach was used to generate themes from the data. Results A majority of the participants were female (n=12, 60%), married (n=13, 65%), and employed (n=12, 60%). Barriers to ART adherence include insufficient medical staff at the health center and waiting time being too long. Facilitators included service providers' positive attitude, clear instructions for taking medication, benefits of adhering to ART, and dangers of defaulting treatment. Conclusion Barriers and facilitators for adherence included several factors related to the health system, health care workers, and the patients. Achievement of optimal adherence to ART requires the commitment of both patients and providers.
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Affiliation(s)
- Portia T Simelane
- Department of Demography and Population Studies, Northwest University, Mafikeng, Northwest Province, South Africa
| | - Maswati S Simelane
- Department of Statistics and Demography, Faculty of Social Sciences, University of Eswatini, Eswatini
| | - Acheampong Y Amoateng
- School of Research Studies, Northwest University, Mafikeng Campus, Northwest Province, South Africa
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da Silva RC, Gondim MC, Lopes MVDO, da Silva VM, Cavalcante AMRZ. Clinical indicators of the nursing diagnosis ineffective health management: Systematic review and meta-analysis. Worldviews Evid Based Nurs 2022; 19:489-499. [PMID: 36005289 DOI: 10.1111/wvn.12602] [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: 03/09/2022] [Revised: 06/14/2022] [Accepted: 07/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nursing diagnoses should reasonably represent global nursing practice phenomena, organizing indicators in their clinical structure that represent different scenarios and populations. However, few studies have summarized the evidence of these indicators, mainly for behavioral diagnoses. AIM This systematic review aimed to identify the best clinical indicators (CI) to determine the presence or absence of the nursing diagnosis "Ineffective Health Management" (IHM). METHOD A systematic review with meta-analysis was utilized. Six electronic databases were consulted to retrieve studies that identified the nursing diagnosis IHM, with at least one CI. The period of data collection was between September and October 2020. The research group independently conducted the selection, quality assessment, data extraction, and analysis of all included studies. Fixed-effect measures and meta-analyses summarized sensitivity, specificity measures, and diagnostic odds ratios using the statistical software R. The preferred reporting items for systematic reviews and meta-analyses and standards for reporting studies of diagnostic accuracy guidelines were used to guide this review, and quality assessment of diagnostic accuracy studies was used for the critical appraisal of the methodological quality of the included studies. RESULTS The systematic review included 11 studies on people with chronic conditions, the elderly, and pregnant women. The analyzed four CI showed diagnostic odds ratios statistically higher than the unit value, highlighting the "Failure to include the treatment regimen in daily living" (DOR = 45.53; CI = 10.1, 205.6). LINKING EVIDENCE TO ACTION Overall, findings showed that all CI of the IHM nursing diagnosis had good sensitivity, specificity, and diagnostic odds ratio measures to identify their presence correctly. These findings can contribute to better accuracy in nurses' decision-making process, providing indicators to infer the IHM nursing diagnosis early in different population spectra based on the best measures of diagnostic accuracy.
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Klinedinst TC, Opsasnick L, Benavente JY, Wolf M, O'Conor R. The Roles of Busyness and Daily Routine in Medication Management Behaviors Among Older Adults. J Appl Gerontol 2022; 41:2566-2573. [PMID: 35950560 DOI: 10.1177/07334648221120246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Busyness (the density of activities) and daily routine (patterns of organizing time) are two understudied factors that likely impact medication-taking behaviors. We examined the association between busyness and routine with medication adherence (MA) in 405 older adults with adequate cognition using multivariable models. The final model included an interaction term between daily routine and busyness. MA scores (measured by the ASK-12, higher scores mean more barriers to adherence) were higher for individuals reporting low and moderate levels of daily routine versus those with high daily routine. MA scores were higher for individuals reporting moderate and high busyness versus those reporting low busyness. The busyness/routine interaction term was significant for MA; among highly busy individuals, those with high daily routine had lower MA scores than those with low routine. A daily routine may be a modifiable factor for improving MA among older adults, particularly among those with busy lives.
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Affiliation(s)
- Tara C Klinedinst
- Occupational Therapy Department, School of Rehabilitation Sciences, 6186University of Oklahoma Health Sciences Center Schusterman Center, Tulsa, OK, USA.,605473Department of Family Medicine, OU-TU School of Community Medicine, Tulsa, OK, USA
| | - Lauren Opsasnick
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Julia Yoshino Benavente
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Michael Wolf
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Rachel O'Conor
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
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Salisbury KR, Ranpariya VK, Feldman SR. Accountability in reminder-based adherence interventions: A review. PATIENT EDUCATION AND COUNSELING 2022; 105:2645-2652. [PMID: 34953618 DOI: 10.1016/j.pec.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 12/09/2021] [Accepted: 12/12/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Interventions to elicit accountability capitalize on social behaviors to improve adherence but are distinct from reminders. However, little is known about the impact of accountability in reminder-based adherence interventions. Through a literature review, we aim to identify the frequency and effectiveness of accountability in reminder-based intervention studies. METHODS PubMed and PsycArticles were searched for reminder-based adherence studies. Articles were categorized as reminder-only or reminder with accountability studies. Studies were characterized by outcome measures, and differences between control and intervention groups were compared for studies that used electronic monitoring devices. RESULTS 165 studies met the inclusion criteria; 154 used reminders without accountability (93%). 79 of the 154 reminder-only studies (51%) improved adherence in intervention groups compared to controls. Eleven of the 165 studies (6.6%) included an accountability aspect. The intervention group had better adherence than controls in 10 out of the 11 reminder with accountability studies (91%). CONCLUSIONS Although distinct from reminders, accountability can be incorporated in reminder-based interventions. However, it is not commonly included in reminder-based interventions. PRACTICE IMPLICATIONS It is important to consider accountability's effects on encouraging patient medication adherence. The addition of accountability interventions may further boost adherence, but few studies currently incorporate these types of interventions.
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Affiliation(s)
- Katherine R Salisbury
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, USA.
| | - Varun K Ranpariya
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, USA; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, USA; Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, USA; Department of Dermatology, University of Southern Denmark, Odense, Denmark
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Olson DN, Russell T, Ranzini AC. Assessment of adherence to aspirin for preeclampsia prophylaxis and reasons for nonadherence. Am J Obstet Gynecol MFM 2022; 4:100663. [PMID: 35580761 DOI: 10.1016/j.ajogmf.2022.100663] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/08/2022] [Accepted: 05/11/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Preeclampsia is a hypertensive disease unique to pregnancy and has a significant impact on maternal and neonatal morbidity and mortality. Daily aspirin has been demonstrated to reduce the risk of preeclampsia. The American College of Obstetricians and Gynecologists recommends daily low-dose aspirin, ideally before 16 weeks' gestation, in at-risk patients for preeclampsia risk reduction. This study examined whether patients at-risk for preeclampsia by the American College of Obstetricians and Gynecologists criteria recalled aspirin recommendation and factors associated with treatment adherence. OBJECTIVE This study examined whether patients at-risk for preeclampsia by the American College of Obstetricians and Gynecologists criteria recalled aspirin recommendation and factors associated with treatment adherence. STUDY DESIGN This study used an anonymous written survey. Pregnant patients were asked to record self-reported risk factors and to recall recommendation to take aspirin for preeclampsia prophylaxis. Participants were then determined to be high-, moderate-, or low-risk on the basis of the American College of Obstetricians and Gynecologists guidelines. Self-reported adherence to recommendations and factors contributing to the patients' decisions to take or decline aspirin were assessed. Secondary outcomes included demographic characteristics of adherent patients and patients who did not recall aspirin recommendation. RESULTS A total of 544 surveys were distributed and 500 were returned (91.9% response rate). Of the 104 high-risk pregnancies identified, aspirin was recommended in 60 (57.7%; 95% confidence interval, 0.48-0.67). Of the 269 patients with 2 or more moderate-risk factors, aspirin was recommended for 13 (4.8%; 95% confidence interval, 0.03-0.08). Among the participants who recalled aspirin recommendation, adherence was similar between high-risk (81.7%) and moderate-risk (76.9%) groups (P=.69). Patients with chronic hypertension, a history of preeclampsia or gestational hypertension in a previous pregnancy, and pregestational diabetes mellitus were most likely to report receiving aspirin recommendation (78.8%, 76.5%, 63.8%, and 53.3%, respectively). No high-risk factor was associated with a decreased likelihood of adherence. Nonadherent patients rarely discussed their decision with their medical provider (5.9%). In the 42.3% of high-risk participants who did not recall aspirin recommendation, autoimmune disease, multiple gestation, and kidney disease were the most prevalent risk factors (42.9%, 35.7%, and 25.0%, respectively). CONCLUSION In the population studied, many at-risk patients, as defined by the American College of Obstetricians and Gynecologists criteria, did not recall recommendations to take aspirin for preeclampsia prophylaxis. This raises concerns for absent or ineffective counseling. Of the patients who recalled aspirin recommendation, most reported adherence, and a history of hypertensive disorders or preeclampsia, autoimmune disease, and pregestational diabetes mellitus were most often associated with adherence. There was no single factor most strongly associated with intentional nonadherence.
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Affiliation(s)
- Danielle N Olson
- Department of Obstetrics and Gynecology, MetroHealth Medical Center of Case Western Reserve University, Cleveland, OH (Drs Olson and Ranzini).
| | - Theresa Russell
- Northeast Ohio Medical University, Rootstown, OH (XX Russell)
| | - Angela C Ranzini
- Department of Obstetrics and Gynecology, MetroHealth Medical Center of Case Western Reserve University, Cleveland, OH (Drs Olson and Ranzini)
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Oladunjoye AF, Kaleem SZ, Suresh A, Sahni V, Thoonkuzhy MJ, Anugwom G, Oladunjoye O, Otuada D, Ikekwere J, Espiridion ED. Cannabis use and medication nonadherence in bipolar disorder: A nationwide inpatient sample database analysis. J Affect Disord 2022; 299:174-179. [PMID: 34863715 DOI: 10.1016/j.jad.2021.11.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/30/2021] [Accepted: 11/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Medication nonadherence among bipolar disorder (BD) is often linked with comorbid substance use disorders. This study aims to investigate cannabis use disorder (CUD) association with medication noncompliance in hospitalized BD patients. METHODS Using data on 266,303 BD hospitalizations between 2010 and 2014 from the US Nationwide Inpatient Sample database, we obtained medication noncompliance rates stratified by demographics and CUD. Logistic regression was used to evaluate factors associated with medication noncompliance. RESULTS Overall mean age, the prevalence of CUD, and medication nonadherence were 41.58 (± 0.11) years, 15.0% and 16.1%, respectively. There were 56.6% females in the overall population. There was a significant difference in the characteristics of those in the medication nonadherence vs adherence groups, including age, sex, race, comorbid substance use, income, insurance type, hospital region, and hospital teaching status (p < 0.001). After adjusting for other variables using multivariate analysis, there remained a statistically significant association of medication nonadherence in BD hospitalization and CUD (OR 1.42, 95% CI 1.36-1.48). LIMITATION Confounding multiple substance use could not be accounted for, and the retrospective nature of the database which includes only inpatients is prone to possible selection and reporting bias. CONCLUSION CUD statistically predicts increased rates of medication nonadherence among patients with BD. Given the possible association of CUD with medication nonadherence among BD patients, collaborative work between general adult psychiatry and addiction services is imperative in improving the management outcome of patients with BD and comorbid CUD.
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Affiliation(s)
- Adeolu Funso Oladunjoye
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX USA; Division of Medical Critical Care, Boston Children's Hospital, Boston, MA USA.
| | | | | | - Vikram Sahni
- Drexel University College of Medicine, Philadelphia, PA USA
| | | | | | - Olubunmi Oladunjoye
- Department of General Internal Medicine, Baylor College of Medicine, Houston, TX, USA; Department of Medicine, Reading Hospital -Tower Health System, West Reading, PA USA
| | - David Otuada
- Department of Psychiatry, Reading Hospital- Tower Health System, West Reading, PA USA
| | - Joseph Ikekwere
- Department of Psychiatry, University of Illinois, Chicago, IL USA
| | - Eduardo D Espiridion
- Department of Psychiatry, Reading Hospital- Tower Health System, West Reading, PA USA; Department of Psychiatry, Drexel University College of Medicine, Philadelphia, PA USA; Department of Psychiatry, Philadelphia College of Osteopathic Medicine, Philadelphia, PA USA; Department of Psychiatry, West Virginia University School of Medicine, Martinsburg, WV USA
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13
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A Pilot Program to Teach Pharmacy Students Practical Skills to Navigate Drug Insurance Benefits. PHARMACY 2022; 10:pharmacy10010023. [PMID: 35202072 PMCID: PMC8878890 DOI: 10.3390/pharmacy10010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 02/05/2023] Open
Abstract
Pharmacists must be able to navigate prescription drug coverages to help providers and patients reduce out-of-pocket costs. Traditionally, curricula on drug insurance benefits rely on lectures and lack a practicum that offers students hands-on experience with determining formulary and cost-sharing information. An activity for pharmacy students to update a free public website that summarizes formularies and copayment requirements across major insurers was piloted. Pharmacy students were trained to locate online formularies and identify a drug’s coverage tier, step therapy, prior authorization, and cost-sharing during a 6-week experiential rotation. Students checked formularies from six insurance plans for 250-plus drugs across 15 health conditions. Graduates were surveyed (74% response rate) about the activities’ impact on their learning and ability to navigate drug benefits. Respondents rated the training as helpful in learning whether a drug was covered (100%), or required step therapy or prior authorization (100%). The majority of graduates reported being able to look up formulary coverage (90%), step therapy or prior authorization (90%), and copayment requirements (65%). Our innovative skills-based pilot activity was effective in teaching pharmacy students to navigate insurance formularies, which is essential for helping patients access medications.
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14
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Pharmacological Adherence Behavior Changes during COVID-19 Outbreak in a Portugal Patient Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031135. [PMID: 35162159 PMCID: PMC8835016 DOI: 10.3390/ijerph19031135] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 02/07/2023]
Abstract
Concerns, behaviours, and beliefs influence how people deal with COVID-19. Understanding the factors influencing adherence behaviour is of utmost importance to develop tailored interventions to increase adherence within this context. Hence, we aimed to understand how COVID-19 affected adherence behaviour in Portugal. A cross-sectional online survey was conducted between 1 March and 3 April 2021. Descriptive statistics were performed, as well as univariable and multivariable regression models. Of the 1202 participants, 476 who were taking at least one medication prescribed by the doctor were selected. Of these, 78.2% were female, and the mean age was 40.3 ± 17.9 years old. About 74.2% were classified as being highly adherent. During the pandemic, 8.2% of participants reported that their adherence improved, while 5.9% had worsened adherence results. Compared with being single, widowers were 3 times more prone to be less adherent (OR:3.390 [1.106–10.390], p = 0.033). Comorbid patients were 1.8 times (OR:1.824 [1.155–2.881], p = 0.010) more prone to be less adherent. Participants who reported that COVID-19 negatively impacted their adherence were 5.6 times more prone to be less adherent, compared with those who reported no changes (OR:5.576 [2.420–12.847], p < 0.001). None of the other variables showed to be significantly associated with pharmacological adherence.
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15
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Onwuchuluba EE, Oyetunde OO, Soremekun RO. Medication Adherence in Type 2 Diabetes Mellitus: A Qualitative Exploration of Barriers and Facilitators From Socioecological Perspectives. J Patient Exp 2021; 8:23743735211034338. [PMID: 34368436 PMCID: PMC8317237 DOI: 10.1177/23743735211034338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Adherence to antidiabetic medications (ADMs) remains a serious challenge among type 2 diabetes mellitus (T2DM) patients. Factors affecting medication adherence are not fully understood in Nigeria. This qualitative study explored patients' views on barriers and facilitators of medication adherence. Data collection was through face-to-face, semistructured, in-depth interviews conducted on 25 purposively sampled patients attending a public tertiary hospital. The interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis based on socioecological framework. NVIVO version 10 identified more codes. Most commonly identified barriers were organizational (clinic structure), personal (perception of T2DM as a dangerous illness), interpersonal (lack of spousal support), and community (concerns about taking ADMs in social gatherings). It was observed that female patients received more spousal support than the males. The facilitators of adherence include perceiving medication-taking a routine, the need to live longer, having savings for ADMs, purchasing medications to last until the next clinic visit. This study identified barriers and facilitators unique to Nigerian T2DM patients. Interventions anchored on these factors would improve medication adherence.
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Affiliation(s)
- EE Onwuchuluba
- Department of Clinical Pharmacy & Biopharmacy, Faculty of Pharmacy, University of Lagos, Idi-araba, Lagos, Nigeria
| | - OO Oyetunde
- Department of Clinical Pharmacy & Biopharmacy, Faculty of Pharmacy, University of Lagos, Idi-araba, Lagos, Nigeria
| | - RO Soremekun
- Department of Clinical Pharmacy & Biopharmacy, Faculty of Pharmacy, University of Lagos, Idi-araba, Lagos, Nigeria
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16
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Michalowski M, Wilk S, Michalowski W, O’Sullivan D, Bonaccio S, Parimbelli E, Carrier M, Le Gal G, Kingwell S, Peleg M. A Health eLearning Ontology and Procedural Reasoning Approach for Developing Personalized Courses to Teach Patients about Their Medical Condition and Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7355. [PMID: 34299806 PMCID: PMC8307382 DOI: 10.3390/ijerph18147355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/01/2021] [Accepted: 07/03/2021] [Indexed: 11/16/2022]
Abstract
We propose a methodological framework to support the development of personalized courses that improve patients' understanding of their condition and prescribed treatment. Inspired by Intelligent Tutoring Systems (ITSs), the framework uses an eLearning ontology to express domain and learner models and to create a course. We combine the ontology with a procedural reasoning approach and precompiled plans to operationalize a design across disease conditions. The resulting courses generated by the framework are personalized across four patient axes-condition and treatment, comprehension level, learning style based on the VARK (Visual, Aural, Read/write, Kinesthetic) presentation model, and the level of understanding of specific course content according to Bloom's taxonomy. Customizing educational materials along these learning axes stimulates and sustains patients' attention when learning about their conditions or treatment options. Our proposed framework creates a personalized course that prepares patients for their meetings with specialists and educates them about their prescribed treatment. We posit that the improvement in patients' understanding of prescribed care will result in better outcomes and we validate that the constructs of our framework are appropriate for representing content and deriving personalized courses for two use cases: anticoagulation treatment of an atrial fibrillation patient and lower back pain management to treat a lumbar degenerative disc condition. We conduct a mostly qualitative study supported by a quantitative questionnaire to investigate the acceptability of the framework among the target patient population and medical practitioners.
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Affiliation(s)
- Martin Michalowski
- Nursing Informatics, School of Nursing, University of Minnesota, Minneapolis, MN 55455, USA
| | - Szymon Wilk
- Institute of Computing Science, Poznan University of Technology, 60-965 Poznań, Poland;
| | - Wojtek Michalowski
- Telfer School of Management, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (W.M.); (S.B.)
| | - Dympna O’Sullivan
- School of Computer Science, Technological University Dublin, D02 HW71 Dublin, Ireland;
| | - Silvia Bonaccio
- Telfer School of Management, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (W.M.); (S.B.)
| | - Enea Parimbelli
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, 27100 Pavia, Italy;
| | - Marc Carrier
- Division of Hematology, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada;
| | - Grégoire Le Gal
- Department of Medicine, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada;
| | - Stephen Kingwell
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada;
| | - Mor Peleg
- Department of Information Systems, University of Haifa, Haifa 3498838, Israel;
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17
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Taliaferro T, Layson-Wolf C, Seung H, Banjo O, Tran D. Impact of pharmacist-led program on knowledge of college students about pre-exposure prophylaxis. J Am Pharm Assoc (2003) 2021; 61:S30-S38. [PMID: 34215394 DOI: 10.1016/j.japh.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/29/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study's primary objective was to evaluate the impact of a pharmacist-led educational program on undergraduate college students' knowledge about PrEP. METHODS This was a cross-sectional, pre- and postprogram survey study. The study included undergraduate students at least 18 years old at a university in Washington, DC. Graduate students, pharmacy students, and those not enrolled at the university were excluded. Before the educational program, the participants completed an anonymous preprogram survey to assess their perception and knowledge of HIV prevention and PrEP as well as their willingness to obtain a prescription for PrEP. A pharmacist delivered a 30-minute educational program to students regarding HIV prevention and PrEP in small groups. After the program, the participants completed a postprogram survey to evaluate the changes from the baseline responses. Paired t tests and chi-square tests detected the associations between the pre- and postprogram surveys. RESULTS One-hundred sixteen students participated in the program, and 102 surveys were included in the data analysis. Students' perception of their knowledge of HIV (4.2 vs. 4.6; P < 0.001), perception of their knowledge of PrEP (3.1 vs. 4.5; P < 0.001), and their willingness to obtain a prescription for PrEP (3.8 vs. 4.5; P < 0.001) was statistically significant after the education. There was a statistically significant increase in the participants' actual knowledge of HIV risk factors (62.4% correct vs. 90.2% correct; P < 0.001) and knowledge of PrEP effectiveness (26.3% vs. 75.0%; P < 0.001). CONCLUSION These findings demonstrated that a pharmacist-led educational program may have an impact on undergraduate students' perception and knowledge of HIV and PrEP. This study may help to further guide pharmacists' PrEP initiatives in this targeted population.
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18
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Woodbury MJ, Cohen JM, Merola JF, Perez-Chada LM. Leveraging behavioral economics to promote treatment adherence: A primer for the practicing dermatologist. J Am Acad Dermatol 2021; 87:1075-1080. [PMID: 34098000 DOI: 10.1016/j.jaad.2021.05.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 01/23/2023]
Abstract
The problem of suboptimal treatment adherence among patients with dermatologic or other diseases has not been adequately addressed in health care. Despite a wide range of efficacious therapies, nonadherence remains a primary driver of suboptimal clinical outcomes. Novel solutions to address this unmet need can be found in behavioral economics. By leveraging our understanding of human decision-making, we may better promote treatment adherence, thereby improving quality of life and decreasing economic burdens. Behavioral economics has been studied extensively in relation to topics such as health policy and health behaviors; however, there is a dearth of research applying this approach to chronic diseases and only a handful within dermatology. We conducted a scoping review in PubMed to identify articles that discuss behavioral economics and its application to treatment adherence in dermatologic patients, with a particular focus on psoriasis, followed by a summary of key ethical considerations. We found that such principles can be employed in cost-effective, scalable interventions that improve patient adherence to a range of medical therapies and lifestyle modifications.
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Affiliation(s)
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Joseph F Merola
- Division of Rheumatology, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Lourdes M Perez-Chada
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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19
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Müller S, Junker S, Wilke T, Lommatzsch A, Schuster AK, Kaymak H, Ehlken C, Ziemssen F. Questionnaire for the assessment of adherence barriers of intravitreal therapy: the ABQ-IVT. Int J Retina Vitreous 2021; 7:43. [PMID: 34078475 PMCID: PMC8170736 DOI: 10.1186/s40942-021-00311-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/09/2021] [Indexed: 01/26/2023] Open
Abstract
Objective To develop and validate a questionnaire for the investigation of non-adherence (NA) barriers in patients receiving intravitreal injection (IVT). Design Questionnaire development and cross-sectional patient survey combined with a retrospective medical chart review. Participants German patients with neovascular age-related macular degeneration (nAMD) or diabetic macular edema (DME) receiving anti-vascular endothelial growth factor (anti-VEGF) treatment via IVT. Methods The previously validated (indications: atrial fibrillation, human immunodeficiency virus, chronic inflammatory lung disease) Adherence Barriers Questionnaire (ABQ) was revised according to specifications of IVT, within the framework of an expert panel. The ABQ-IVT, which initially consisted of 24 items formulated as statements (4-point-Likert-scale ranging from “strongly agree” to “strongly disagree”), was applied in a cross-sectional survey. Evaluation of the questionnaire included an assessment of internal consistency and factor analysis. The occurrence of potential barriers in the patient sample was evaluated using descriptive statistics. To identify patient subpopulations, hierarchical cluster analysis was performed using ABQ-IVT answers as predictors. Due to difficulties in capturing NA as an external criterion, the evaluation of the questionnaire was limited to its internal validity and reliability. Main outcome measures Patients’ answers to the ABQ-IVT questionnaire and interviews. Results Of 253 patients, 234 (92%) were able to complete the ABQ-IVT questionnaire. Within the reliability analysis, the ABQ-IVT was reduced to 17 items. The condensed questionnaire demonstrated good internal consistency (Cronbach’s alpha = 0.78), and factor analysis showed no evidence for subscales of the questionnaire. Nearly half of the patients (49%) reported being affected by at least three different barriers. On average, a patient was affected by 3.1 barriers. The most frequently reported barriers were “Challenge due to time commitment of physician visits” (45% of the patients), “Depression” (29%) and “Travel and opportunity costs” (27%). Cluster analysis identified six patient subpopulations, each affected by different sets of barriers and differed regarding their patient characteristics. Conclusions The ABQ-IVT is a practical and reliable instrument for identifying patient-specific barriers to IVT treatment adherence. In practice, the questionnaire may be useful in assessing whether individual patients are at higher risk of NA due to specific adherence barriers. Aside from better awareness, this allows earlier interventions, though these still need to be validated. Patient subpopulations face different barriers and may, therefore, need distinct preventative care. Supplementary Information The online version contains supplementary material available at 10.1186/s40942-021-00311-x.
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Affiliation(s)
- Sabrina Müller
- IPAM e.v, University of Wismar, University of Applied Sciences, Alter Holzhafen 19, 23966, Wismar, Germany.
| | - Sophia Junker
- Ingress-Health HWM GmbH, Alter Holzhafen 19, 23966, Wismar, Germany
| | - Thomas Wilke
- IPAM e.v, University of Wismar, University of Applied Sciences, Alter Holzhafen 19, 23966, Wismar, Germany
| | - Albrecht Lommatzsch
- Augenzentrum Am St. Franziskus-Hospital Münster, Hohenzollerning 74, 48145, Münster, Germany
| | - Alexander K Schuster
- MORE Reading Center, Augenklinik Und Poliklinik Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Hakan Kaymak
- Augenchirugie Clinic, Theo-Champion-Str. 1, 40549, Düsseldorf, Germany
| | - Christoph Ehlken
- Universitaetsklinikum Schleswig-Holstein Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Focke Ziemssen
- Universitäts-Augenklinik Tübingen, Elfriede-Aulhorn-Straße 7, 72076, Tübingen, Germany
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20
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Prajapati AR, Dima A, Mosa G, Scott S, Song F, Wilson J, Bhattacharya D. Mapping modifiable determinants of medication adherence in bipolar disorder (BD) to the theoretical domains framework (TDF): a systematic review. Psychol Med 2021; 51:1082-1098. [PMID: 34006337 PMCID: PMC8188530 DOI: 10.1017/s0033291721001446] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Around 40% of people with bipolar disorder (BD) are non-adherent to medication leading to relapse, hospitalisation and increased suicide risk. Limited progress in addressing non-adherence may be partly attributable to insufficient understanding of the modifiable determinants of adherence that require targeting in interventions. We synthesised the modifiable determinants of adherence in BD and map them to the theoretical domains framework (TDF). METHOD We searched CINAHL, Cochrane Library, Embase, LILACS, Medline, PsychINFO and PubMed until February 2020. We included studies reporting modifiable determinants of adherence in BD. Two reviewers independently screened studies, assessed quality, extracted modifiable determinants and mapped them to TDF. RESULTS We included 57 studies involving 32 894 participants. Determinants reported by patients spanned 11 of the 14 TDF domains compared to six domains represented by clinician/researcher. The TDF domains most commonly represented (% and example) in studies were: 'Environmental context and resources' (63%, e.g. experiencing side effects), 'Beliefs about consequences' (63%, e.g. beliefs about medication effects), 'Knowledge' (40%, e.g. knowledge about disorder), 'Social influences' (33%, e.g. support from family/clinicians), 'Memory, attention and decision processes' (33%, e.g. forgetfulness), 'Emotion' (21%, e.g. fear of addiction) and 'Intentions' (21%, e.g. wanting alternative treatment). 'Intentions', 'Memory, attention and decision processes' and 'Emotion' domains were only reported by patients but not clinicians. CONCLUSIONS Clinicians may be underappreciating the full range of modifiable determinants of adherence and thus not providing adherence support reflective of patients' needs. Reporting of modifiable determinants in behavioural terms facilitates developing theory-based interventions to address non-adherence in BD.
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Affiliation(s)
- Asta Ratna Prajapati
- Norfolk and Suffolk NHS Foundation NHS Trust, NorwichNR6 5BE, UK
- University of East Anglia, Norwich Research Park, NorwichNR4 7TJ, UK
| | | | | | - Sion Scott
- University of East Anglia, Norwich Research Park, NorwichNR4 7TJ, UK
| | - Fujian Song
- University of East Anglia, Norwich Research Park, NorwichNR4 7TJ, UK
| | - Jonathan Wilson
- Norfolk and Suffolk NHS Foundation NHS Trust, NorwichNR6 5BE, UK
- University of East Anglia, Norwich Research Park, NorwichNR4 7TJ, UK
| | - Debi Bhattacharya
- University of East Anglia, Norwich Research Park, NorwichNR4 7TJ, UK
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21
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Taliaferro T, Layson-Wolf C, Seung H, Banjo O, Tran D. Impact of pharmacist-led program on knowledge of college students about pre-exposure prophylaxis. J Am Pharm Assoc (2003) 2020; 61:206-212.e2. [PMID: 33388259 DOI: 10.1016/j.japh.2020.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/24/2020] [Accepted: 11/29/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study's primary objective was to evaluate the impact of a pharmacist-led educational program on undergraduate college students' knowledge about PrEP. METHODS This was a cross-sectional, pre- and postprogram survey study. The study included undergraduate students at least 18 years old at a university in Washington, DC. Graduate students, pharmacy students, and those not enrolled at the university were excluded. Before the educational program, the participants completed an anonymous preprogram survey to assess their perception and knowledge of HIV prevention and PrEP as well as their willingness to obtain a prescription for PrEP. A pharmacist delivered a 30-minute educational program to students regarding HIV prevention and PrEP in small groups. After the program, the participants completed a postprogram survey to evaluate the changes from the baseline responses. Paired t tests and chi-square tests detected the associations between the pre- and postprogram surveys. RESULTS One-hundred sixteen students participated in the program, and 102 surveys were included in the data analysis. Students' perception of their knowledge of HIV (4.2 vs. 4.6; P < 0.001), perception of their knowledge of PrEP (3.1 vs. 4.5; P < 0.001), and their willingness to obtain a prescription for PrEP (3.8 vs. 4.5; P < 0.001) was statistically significant after the education. There was a statistically significant increase in the participants' actual knowledge of HIV risk factors (62.4% correct vs. 90.2% correct; P < 0.001) and knowledge of PrEP effectiveness (26.3% vs. 75.0%; P < 0.001). CONCLUSION These findings demonstrated that a pharmacist-led educational program may have an impact on undergraduate students' perception and knowledge of HIV and PrEP. This study may help to further guide pharmacists' PrEP initiatives in this targeted population.
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22
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Xu HY, Yu YJ, Zhang QH, Hu HY, Li M. Tailored Interventions to Improve Medication Adherence for Cardiovascular Diseases. Front Pharmacol 2020; 11:510339. [PMID: 33364935 PMCID: PMC7751638 DOI: 10.3389/fphar.2020.510339] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 09/21/2020] [Indexed: 12/12/2022] Open
Abstract
Over the past half-century, medical research on cardiovascular disease (CVD) has achieved a great deal; however, medication adherence is unsatisfactory. Nearly 50% of patients do not follow prescriptions when taking medications, which limits the ability to maximize their therapeutic effects and results in adverse clinical outcomes and high healthcare costs. Furthermore, the effects of medication adherence interventions are disappointing, and tailored interventions have been proposed as an appropriate way to improve medication adherence. To rethink and reconstruct methods of improving medication adherence for CVD, the literature on tailored interventions for medication adherence focusing on CVD within the last 5 years is retrieved and reviewed. Focusing on identifying nonadherent patients, detecting barriers to medication adherence, delivering clinical interventions, and constructing theories, this article reviews the present state of tailored interventions for medication adherence in CVD and also rethinks the present difficulties and suggests avenues for future development.
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Affiliation(s)
- Hai-Yan Xu
- Department of Military Psychology, School of Psychology, Army Medical University, Chongqing, China
| | - Yong-Ju Yu
- Department of Social Work, School of Sociology and Law, Sichuan International Studies University, Chongqing, China
| | - Qian-Hui Zhang
- Department of Foreign Languages, School of Basic Medicine, Army Medical University, Chongqing, China
| | - Hou-Yuan Hu
- Department of Cardiology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Min Li
- Department of Military Psychology, School of Psychology, Army Medical University, Chongqing, China
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Ritschl V, Stamm TA, Aletaha D, Bijlsma JWJ, Böhm P, Dragoi R, Dures E, Estévez-López F, Gossec L, Iagnocco A, Negrón JB, Nudel M, Marques A, Moholt E, Skrubbeltrang C, Van den Bemt B, Viktil K, Voshaar M, Carmona L, de Thurah A. Prevention, screening, assessing and managing of non-adherent behaviour in people with rheumatic and musculoskeletal diseases: systematic reviews informing the 2020 EULAR points to consider. RMD Open 2020; 6:e001432. [PMID: 33161377 PMCID: PMC7856118 DOI: 10.1136/rmdopen-2020-001432] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/08/2020] [Accepted: 10/17/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To analyse how non-adherence to prescribed treatments might be prevented, screened, assessed and managed in people with rheumatic and musculoskeletal diseases (RMDs). METHODS An overview of systematic reviews (SR) was performed in four bibliographic databases. Research questions focused on: (1) effective interventions or strategies, (2) associated factors, (3) impact of shared decision making and effective communication, (4) practical things to prevent non-adherence, (5) effect of non-adherence on outcome, (6) screening and assessment tools and (7) responsible healthcare providers. The methodological quality of the reviews was assessed using AMSTAR-2. The qualitative synthesis focused on results and on the level of evidence attained from the studies included in the reviews. RESULTS After reviewing 9908 titles, the overview included 38 SR on medication, 29 on non-pharmacological interventions and 28 on assessment. Content and quality of the included SR was very heterogeneous. The number of factors that may influence adherence exceed 700. Among 53 intervention studies, 54.7% showed a small statistically significant effect on adherence, and all three multicomponent interventions, including different modes of patient education and delivered by a variety of healthcare providers, showed a positive result in adherence to medication. No single assessment provided a comprehensive measure of adherence to either medication or exercise. CONCLUSIONS The results underscore the complexity of non-adherence, its changing pattern and dependence on multi-level factors, the need to involve all stakeholders in all steps, the absence of a gold standard for screening and the requirement of multi-component interventions to manage it.
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Affiliation(s)
- Valentin Ritschl
- Section for Outcomes Research, Medical University of Vienna, Wien, Austria
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Wien, Austria
| | - Daniel Aletaha
- Division of Rheumatology, Medical University of Vienna, Wien, Austria
| | | | - Peter Böhm
- Deutsche Rheuma-Liga Bundesverband e.V., Bonn, Germany
| | - Razvan Dragoi
- University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, Romania
| | - Emma Dures
- University of the West of England Bristol, Bristol, UK
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
| | | | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | - José B Negrón
- Instituto de Investigación Social y Sanitaria, Puerto Rico
| | | | - Andréa Marques
- Centro Hospitalar e Universitário de Coimbra, Health Sciences Research Unit: Nursing, UICISA-E, Coimbra, Portugal
| | - Ellen Moholt
- Diakonhjemmet Hospital, Division of Rheumatology and Research, Oslo, Norway
| | | | - Bart Van den Bemt
- Pharmacy, Sint Maartenskliniek, Nijmegen, Netherlands
- Radboud University Medical Centre, Nijmegen, Netherlands
| | - Kirsten Viktil
- University of Oslo, Oslo, Norway
- Diakonhjemmet Hospital Pharmacy, Oslo, Norway
| | | | - Loreto Carmona
- Instituto de Salud Musculoesquelética (Inmusc), Madrid, Spain
| | - Annette de Thurah
- Rheumatology, Aarhus University Hospital, Århus N, Denmark
- Clinical Medicine, Aarhus University, Aarhus, Denmark
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Khan S, Khan SU. Adverse drug event of hypokalaemia-induced cardiotoxicity secondary to the use of laxatives: A systematic review of case reports. J Clin Pharm Ther 2020; 45:927-936. [PMID: 32672366 DOI: 10.1111/jcpt.13204] [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] [Received: 04/13/2020] [Revised: 05/03/2020] [Accepted: 05/21/2020] [Indexed: 12/24/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The imbalance in serum potassium caused by laxatives can negatively affect the cardiovascular system, leading to life-threatening consequences. Our objective was to evaluate the reported evidence of adverse events related to the cardiac system due to laxative-induced hypokalaemia from case reports. METHODS A systematic electronic literature search of PubMed, Embase, the Cochrane Library and Science Direct was conducted for the period 1995-2019. In these databases, search terms describing hypokalaemia and cardiotoxicity were combined with the term laxative use. RESULTS AND DISCUSSION Over the 23 years, 27 incidents were identified in 12 countries. There were 19 female and eight male patients, with ages ranging from 1 month to 93 years. The frequency of reported cases according to severity was the following: severe hypokalaemia 48%, moderate hypokalaemia 44.4% and mild hypokalaemia 7.4%. In 70% of patients, the effect of laxative on the heart was typical hypokalaemic electrographic changes, 7.4% showed abnormal changes in cardiac rhythm, whereas in 18.5%, the cardiotoxicity observed was a very serious kind. Two patients died due to severe cardiac effects. WHAT IS NEW AND CONCLUSION The laxatives-along with the involvement of some other contributing factors-caused mild-to-severe hypokalaemic cardiotoxicity. These factors were non-adherence of the patient to the recommended dosage, laxative abuse, drug-drug and drug-disease interactions, non-potassium electrolyte imbalances and the use of herbal laxatives. We recommend that laxatives and aggravating factors should be taken into account in the assessment of patients with suspected hypokalaemic cardiotoxicity.
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Affiliation(s)
- Safeer Khan
- Pharmacist at Al-Taaluf National Group of Polyclinics, Alqunfudhah, Saudi Arabia
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25
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Hamrick J, Augustine JM, Pinkerton D, Klein CM, Elliott J. Simulated medication adherence: First and second-year pharmacy students' perceptions of adhering to a multi-drug medication regimen. CURRENTS IN PHARMACY TEACHING & LEARNING 2020; 12:858-863. [PMID: 32540048 DOI: 10.1016/j.cptl.2020.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/24/2020] [Accepted: 02/26/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND PURPOSE Through a realistic medication adherence activity, the objective was to improve students' ability to identify non-adherent patients, build empathy toward patients, and prepare them to provide patient-centered care. EDUCATIONAL ACTIVITY AND SETTING First- and second-year student pharmacists completed a two-month activity, which required adherence to a pre-specified medication regimen. Prior to starting, a survey was administered to assess students' perceived difficulty and success of the medication adherence activity. Upon completion, students were asked their perceived success and difficulty with the activity, challenges to maintaining adherence, and lessons learned from the project. Changes in perceived difficulty and success were analyzed using Wilcoxon signed rank tests. Challenges and lessons learned were coded for similar themes and frequencies. FINDINGS 298 student pharmacists completed the pre- and post-survey (response rate 99%). Students' perceived difficulty of adherence was higher on the post-survey (median on post = 7.0 (out of 10) versus median on pre = 6.0, p = 0.023). Students' perceived success was higher on the presurvey (median on pre = 8.0 versus median on post = 6.0, p < 0.001). The most frequent challenges were remembering to take the medications (n = 133) and medication regimen timing (n = 98). The most frequent lesson learned was that "adherence is a difficult concept" (n = 143). SUMMARY Students participated in a "hands-on" medication adherence activity. Students found that medication adherence is more difficult than perceived. Future research should examine the long-term impact of students maintaining empathy toward patients and provision of medication adherence services.
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Affiliation(s)
- Johnathan Hamrick
- Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA 30341, United States
| | - Jill M Augustine
- Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA 30341, United States
| | - David Pinkerton
- Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA 30341, United States
| | - Christine M Klein
- Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA 30341, United States
| | - Jennifer Elliott
- Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA 30341, United States.
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26
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Oliveira GL, Lula-Barros DS, Silva DLM, Leite SN. Fatores relacionados à adesão ao tratamento sob a perspectiva da pessoa idosa. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2020. [DOI: 10.1590/1981-22562020023.200160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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27
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Haidari W, Glines KR, Cline A, Feldman SR. Adherence in Acne. TREATMENT ADHERENCE IN DERMATOLOGY 2020. [DOI: 10.1007/978-3-030-27809-0_9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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28
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Cohen SR, Haidari W, Feldman SR. Why aren't they using their medicine? Pediatr Dermatol 2020; 37:62-63. [PMID: 31997454 DOI: 10.1111/pde.14098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Stephanie R Cohen
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Wasim Haidari
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Steven R Feldman
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
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29
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Müller S, Ziemssen T, Diehm C, Duncker T, Hoffmanns P, Thate-Waschke IM, Schürks M, Wilke T. How to Implement Adherence-Promoting Programs in Clinical Practice? A Discrete Choice Experiment on Physicians' Preferences. Patient Prefer Adherence 2020; 14:267-276. [PMID: 32103911 PMCID: PMC7028386 DOI: 10.2147/ppa.s222725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 12/05/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The aim of this study was to examine physicians' preferences regarding adherence-promoting programs (APPs), and to investigate which APP characteristics influence the willingness of physicians to implement these in daily practice. MATERIALS AND METHODS A discrete choice experiment was conducted among general practitioners, cardiologists, neurologists and ophthalmologists in Germany. The design considered five attributes with two or three attribute levels each: validation status of the APP; possibility for physicians to receive a certificate; type of intervention; time commitment per patient and quarter of the year to carry out the APP; reimbursement for APP participation, per included patient and quarter of the year.A multinomial logit model was run to estimate physicians' utility for each attribute and to evaluate the influence of different levels on the probability of choosing a specific APP. The relative importance of the attributes was compared between different pre-defined subgroups. RESULTS In total, 222 physicians were included in the analysis. The most important characteristics of APPs were time commitment to carry out the program (34.8% importance), reimbursement (33.3%), and validation status of the program (23.7%). The remaining attributes (type of intervention: 3.6%; possibility to receive a certificate: 4.7%) were proven to be less important for a physician's decision to participate in an APP. Physicians on average preferred APP alternatives characterized by little time commitment (β=1.456, p<0.001), high reimbursement for work (β=1.392, p<0.001), "positive validation status" (β=0.990, p<0.001), the "possibility to get a certificate" (β=0.197, p<0.001), and the provision of "tools for both physicians and patients" (β=0.150, p<0.001). CONCLUSION For the majority of the physicians participating in this survey, the willingness to implement an APP is determined by the associated time commitment and reimbursement. Considering physicians' preferences regarding different APP features in the promoting process of these programs may enhance physicians' participation and engagement.
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Affiliation(s)
- Sabrina Müller
- Ingress-Health, Wismar23966, Germany
- Correspondence: Sabrina Müller Ingress-Health, Alter Holzhafen 19, Wismar23966, Germany Email
| | - Tjalf Ziemssen
- Zentrum für klinische Neurowissenschaften, Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden01307, Germany
| | - Curt Diehm
- Private Practice, Ettlingen76275, Germany
| | | | | | | | | | - Thomas Wilke
- Institut für Pharmakoökonomie und Arzneimittelogistik, Wismar23966, Germany
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30
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Abstract
The word ‘compliance' comes from the Latin word complire, meaning to fill up and hence to complete an action, transaction, or process and to fulfil a promise. In the Oxford English Dictionary, the relevant definition is ‘The acting in accordance with, or the yielding to a desire, request, condition, direction, etc.; a consenting to act in conformity with; an acceding to; practical assent”. Compliance with therapy is simply patients understanding of medication, motivation toward having this medication is a prescribed manner with the belief that the prescriber and prescribed medicine will be beneficial for his well-being. Although this is often the case, in a number of situations, the physician and pharmacist have not provided the patient with adequate instructions or have not presented the instructions in such a manner that the patient understands them. Nothing should be taken for granted regarding the patient's understanding of how to use medication, and appropriate steps must be taken to provide patients with the information and counseling necessary to use their medications as effectively and as safely as possible. 20% to 30% of new prescriptions are never filled at the pharmacy. Medication is not taken as prescribed 50% of the time. For patients prescribed medications for chronic diseases, after six months, the majority take less medication than prescribed or stop the medication altogether. There are both federal and state laws that make using or sharing prescription drugs illegal. If someone take a pill that was prescribed to someone else or give that pill to another person, not only is it against the law, it's extremely dangerous.
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Affiliation(s)
- A K Mohiuddin
- Department of Pharmacy, World University of Bangladesh
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31
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Cohen SR, Pona A, Cline AE, Feldman SR. The complexity of adverse event assessment and counseling for patients on biologic treatment. Expert Rev Clin Immunol 2019; 15:809-811. [PMID: 31290340 DOI: 10.1080/1744666x.2019.1642749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Stephanie R Cohen
- a Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Adrian Pona
- a Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Abigail E Cline
- a Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Steven R Feldman
- a Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine , Winston-Salem , NC , USA.,b Department of Pathology, Wake Forest School of Medicine , Winston-Salem , NC , USA.,c Department of Social Sciences & Health Policy, Wake Forest School of Medicine , Winston-Salem , NC , USA
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32
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Svendsen MT, Feldmann S, Tiedemann SN, Sørensen ASS, Rivas CMR, Andersen KE. Improving psoriasis patients' adherence to topical drugs: a systematic review. J DERMATOL TREAT 2019; 31:776-785. [PMID: 31122090 DOI: 10.1080/09546634.2019.1623371] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Poor adherence to topical antipsoriatic drugs limits treatment effectiveness.Objective: The aim of this study was to investigate how health care providers may improve psoriasis patients' adherence to topical treatment.Materials and methods: A systematic literature search was performed for English-language articles in Embase, Medline, PsycINFO, Cinahl, Scopus, and the Cochrane Library.Results: Ten studies of varying quality were identified. Two randomized controlled trials (RCTs) testing the adherence-improving potential of interventions by health care providers to support patients showed improvement in adherence to topical treatment. In a prospective study with a pre/postdesign, an individualized, face-to-face consultation reported an improvement in patient-reported adherence to topical treatment over a 9-week period. Based on seven qualitative studies obtaining insights from either patients or health care providers, health care providers may need to address socio-economic factors, health care system factors, and treatment-, patient-, and disease-related factors in interventions that aim to improve the adherence of psoriasis patients to topical antipsoriatic drugs.Conclusion: There is a need to develop better adherence-improving interventions. A good patient-health care provider relationship is considered crucial to adherence and may be an important intervention target. Before interventions to improve adherence to topicals can be recommended for the clinic, the intervention should be tested in high-quality RCTs.
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Affiliation(s)
- Mathias Tiedemann Svendsen
- Research Unit of Dermatovenerology and Allergy Centre, University of Southern Denmark, Sønderborg, Denmark
| | - Steven Feldmann
- Research Unit of Dermatovenerology and Allergy Centre, University of Southern Denmark, Sønderborg, Denmark.,Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | | | - Klaus Ejner Andersen
- Research Unit of Dermatovenerology and Allergy Centre, University of Southern Denmark, Sønderborg, Denmark
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33
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Roseleur J, Harvey G, Stocks N, Karnon J. Behavioral economic insights to improve medication adherence in adults with chronic conditions: a scoping review protocol. ACTA ACUST UNITED AC 2019; 17:1915-1923. [PMID: 31145189 DOI: 10.11124/jbisrir-2017-003971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objective of this review is to map the evidence on the use of behavioral economic insights to improve medication adherence in adults with chronic conditions. INTRODUCTION Medication non-adherence is a barrier to effectively managing chronic conditions, leading to poorer patient outcomes and placing an additional financial burden on healthcare systems. As the population ages and the prevalence of chronic disease increases, new ways to influence patient behavior are needed. Approaches that use insights from behavioral economics may help improve medication adherence, thus reducing morbidity, mortality and financial costs of unmanaged chronic diseases. INCLUSION CRITERIA Eligible studies will include adults taking medication for a chronic condition. All interventions relevant to high-income settings using insights from behavioral economics to improve medication adherence in adults will be considered. Contexts may include, but are not limited to, primary health care, corporate wellness programs and health insurance schemes. Any study design published in English will be considered. Studies in facilities where medication is administered to patients will be excluded. METHODS PubMed, Embase, Scopus, PsycINFO, EconLit and CINAHL will be searched from database inception to present. Gray literature will be searched using Google Scholar, OpenGrey and the Grey Literature Report. One reviewer will review titles, and then two reviewers will independently review abstracts to identify eligible studies. One reviewer will extract data on study characteristics, study design and study outcomes. A second reviewer will validate 25% of the extracted information. The results of the data extraction will be presented in a table, and a narrative summary will be presented.
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Affiliation(s)
- Jacqueline Roseleur
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Gillian Harvey
- Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, The University of Adelaide, Adelaide, Australia
| | - Jonathan Karnon
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
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Prajapati AR, Dima AL, Clark AB, Gant C, Gibbons C, Gorrod R, Mosa G, Scott S, Song F, Teague B, Twigg MJ, Wilson J, Bhattacharya D. Mapping of modifiable barriers and facilitators of medication adherence in bipolar disorder to the Theoretical Domains Framework: a systematic review protocol. BMJ Open 2019; 9:e026980. [PMID: 30760516 PMCID: PMC6377513 DOI: 10.1136/bmjopen-2018-026980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION People with bipolar disorder require long-term treatment but it is estimated that 40% of these people do not adhere to prescribed medication regimens. Non-adherence increases the risk of relapse, hospitalisation and suicide. Some evidence syntheses report barriers to mental health treatment adherence but rarely delineate between modifiable and non-modifiable barriers. They also fail to distinguish between the patients' perspective and that of other stakeholders such as clinicians despite of their different understanding and priorities about adherence. Facilitators of adherence, which are also important for informing adherence intervention design, are also lacking from syntheses and few syntheses focus on medications for bipolar disorder.This systematic review aims to identify modifiable barriers and facilitators (determinants) of medication adherence in bipolar disorder. We also plan to report determinants of medication adherence from perspectives of patients, carers, healthcare professionals and other third parties. A unique feature of this systematic review in the context of mental health is the use of the Theoretical Domains Framework (TDF) to organise the literature identified determinants of medication adherence. METHODS AND ANALYSIS The protocol adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols and ENhancing Transparency in REporting the synthesis of Qualitative research (ENTREQ) guidelines. This review will include both qualitative and quantitative primary studies exploring determinants of medication adherence in bipolar disorder. We will search the following databases using a preplanned strategy: CINAHL, Cochrane Library (CENTRAL), Embase, LiLACS, Medline, PsychINFO, PubMed without date restrictions. We will report the quality of included studies. We will use framework synthesis using the TDF as an a priori 'framework'. We will map the literature identified modifiable determinants to the domains of TDF. ETHICS AND DISSEMINATION Ethical approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publication. PROSPERO REGISTRATION NUMBER CRD42018096306.
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Affiliation(s)
- Asta Ratna Prajapati
- Pharmacy, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
- School of Pharmacy, University of East Anglia, Norwich, UK
| | | | | | - Claire Gant
- Patient and Carer Representatives, Norwich, UK
| | - Chris Gibbons
- Faculty of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - George Mosa
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Sion Scott
- School of Pharmacy, University of East Anglia, Norwich, UK
| | | | - Bonnie Teague
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | | | - Jon Wilson
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
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35
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Svendsen MT, Möller S, Feldman SR, Andersen KE. Sociodemographic factors do not have a large influence on adherence to topical treatment in patients with psoriasis. Br J Dermatol 2019; 181:381-382. [PMID: 30703257 DOI: 10.1111/bjd.17707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M T Svendsen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.,Centre for Innovative Medical Technology (CIMT), University of Southern Denmark, Odense, Denmark.,Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - S Möller
- Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - S R Feldman
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.,Department of Dermatology (Center for Dermatology Research), Wake Forest School of Medicine, Winston-Salem, CA, U.S.A
| | - K E Andersen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.,Dermatological Investigations Scandinavia, University of Southern Denmark, Odense, Denmark.,Clinical Institute, University of Southern Denmark, Odense, Denmark
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