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Peeters LEJ, Kappers MHW, Boersma E, Massey EK, van Dijk L, van Gelder T, Koch BCP, Versmissen J. The effect of combining therapeutic drug monitoring of antihypertensive drugs with personalised feedback on adherence and resistant hypertension: the (RHYME-RCT) trial protocol of a multi-centre randomised controlled trial. BMC Cardiovasc Disord 2023; 23:87. [PMID: 36788491 PMCID: PMC9926861 DOI: 10.1186/s12872-023-03114-0] [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: 01/04/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Adherence to antihypertensive drugs (AHDs) is important for adequate blood pressure control. Not taking these drugs as prescribed is one of the main underlying causes for resistant hypertension (RH), which in turn leads to an increased risk of cardiovascular events, stroke and kidney damage. Therefore, correct identification of patients that are non-adherent to AHDs is crucial to improve clinical outcome. For this goal, therapeutic drug monitoring is the most reliable method. The primary objective of this trial is to investigate whether monitoring of drug concentrations with a dried blood spot (DBS) sampling method combined with personalised feedback leads to a decrease in prevalence of RH after 12 months due to an increase in adherence. Secondary objectives include the difference over time in the number of required AHDs as well as the defined daily dose (DDD). Lastly, the cost-utility of SoC versus the intervention in RH is determined. METHODS This is a multi-centre single-blinded randomised controlled trial (RHYME-RCT). First, at an eligibility visit, DBS sampling, to monitor drug concentrations in blood, and a 24-h ambulatory blood pressure measurement (24-h ABPM) are performed simultaneously. Patients with a daytime systolic blood pressure (SBP) > 135 and/or diastolic blood pressure (DBP) > 85 mmHg are randomised to SoC or intervention + SoC. The intervention is performed by the treating physician and includes information on drug concentrations and a comprehensive personalised feedback conversation with the use of a communication tool. The follow-up period is one year with visits at 3, 6 and 12 months randomisation and includes 24-h ABPM and DBS sampling. DISCUSSION This will be the first trial that focusses specifically on patients with RH without taking into account suspicion of non-adherence and it combines monitoring of AHD concentrations to identify non-adherence to AHDs with a comprehensive feedback to improve non-adherence. Furthermore, if this trial shows positive outcomes for the intervention it can be directly implemented in clinical practice, which would be a great improvement in the treatment of RH. TRIAL REGISTRATION RHYME-RCT is registered in the Dutch Trial Register on 27/12/2017 (NTR6914) and can be found in the International Clinical Trials Registry Platform.
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Affiliation(s)
- L. E. J. Peeters
- grid.5645.2000000040459992XDepartment of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,grid.5645.2000000040459992XDepartment of Hospital Pharmacy, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - M. H. W. Kappers
- grid.413711.10000 0004 4687 1426Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands
| | - E. Boersma
- grid.5645.2000000040459992XDepartment of Cardiology, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - E. K. Massey
- grid.5645.2000000040459992XDepartment of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - L. van Dijk
- grid.416005.60000 0001 0681 4687Department Pharmaceutical Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands ,grid.4830.f0000 0004 0407 1981Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - T. van Gelder
- grid.5645.2000000040459992XDepartment of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,grid.5645.2000000040459992XDepartment of Hospital Pharmacy, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - B. C. P. Koch
- grid.5645.2000000040459992XDepartment of Hospital Pharmacy, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J. Versmissen
- grid.5645.2000000040459992XDepartment of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,grid.5645.2000000040459992XDepartment of Hospital Pharmacy, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Huddart S, Savic RM, Cattamanchi A. Is Glycemic Control the Secret to Tuberculosis Control? Am J Respir Crit Care Med 2021; 204:254-255. [PMID: 33826869 PMCID: PMC8513585 DOI: 10.1164/rccm.202103-0703ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Sophie Huddart
- Division of Pulmonary and Critical Care Medicine San Francisco General Hospital San Francisco, California
| | - Rada M Savic
- Division of Pulmonary and Critical Care Medicine San Francisco General Hospital San Francisco, California.,Department of Bioengineering and Therapeutic Sciences University of California San Francisco San Francisco, California
| | - Adithya Cattamanchi
- Division of Pulmonary and Critical Care Medicine San Francisco General Hospital San Francisco, California.,UCSF Center for Tuberculosis University of California San Francisco San Francisco, California
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3
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A data-driven typology of asthma medication adherence using cluster analysis. Sci Rep 2020; 10:14999. [PMID: 32929109 PMCID: PMC7490405 DOI: 10.1038/s41598-020-72060-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 08/20/2020] [Indexed: 11/17/2022] Open
Abstract
Asthma preventer medication non-adherence is strongly associated with poor asthma control. One-dimensional measures of adherence may ignore clinically important patterns of medication-taking behavior. We sought to construct a data-driven multi-dimensional typology of medication non-adherence in children with asthma. We analyzed data from an intervention study of electronic inhaler monitoring devices, comprising 211 patients yielding 35,161 person-days of data. Five adherence measures were extracted: the percentage of doses taken, the percentage of days on which zero doses were taken, the percentage of days on which both doses were taken, the number of treatment intermissions per 100 study days, and the duration of treatment intermissions per 100 study days. We applied principal component analysis on the measures and subsequently applied k-means to determine cluster membership. Decision trees identified the measure that could predict cluster assignment with the highest accuracy, increasing interpretability and increasing clinical utility. We demonstrate the use of adherence measures towards a three-group categorization of medication non-adherence, which succinctly describes the diversity of patient medication taking patterns in asthma. The percentage of prescribed doses taken during the study contributed to the prediction of cluster assignment most accurately (84% in out-of-sample data).
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Schoenthaler A, de la Calle F, Pitaro M, Lum A, Chaplin W, Mogavero J, Rosal MC. A Systems-Level Approach to Improving Medication Adherence in Hypertensive Latinos: a Randomized Control Trial. J Gen Intern Med 2020; 35:182-189. [PMID: 31625041 PMCID: PMC6957668 DOI: 10.1007/s11606-019-05419-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 07/08/2019] [Accepted: 08/21/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite numerous interventions targeting medication adherence in patients with uncontrolled hypertension, practice-based trials in Latino patients are scant. OBJECTIVE To evaluate the effect of a systems-level adherence intervention, delivered by medical assistants (MAs), versus a comparison condition on medication adherence and blood pressure (BP) in 119 hypertensive Latino patients who were initially non-adherent to their antihypertensive medications. STUDY DESIGN Randomized control trial. PARTICIPANTS Patients (50% women; mean age, 61 years) were recruited from April 2013 to August 2015 in a community-based practice in New York. INTERVENTION Systems-level approach that included an office system component built into the electronic health record and a provider support component consisting of nine MA-delivered health coaching sessions for improving medication adherence. The comparison group received the standard health coaching procedures followed at the clinic. MAIN OUTCOME MEASURES The primary outcome was rate of medication adherence measured by an electronic monitoring device (EMD) across 6 months. The secondary outcomes were self-reported medication adherence measured by the eight-item Morisky Medication Adherence Scale (MMAS-8) and BP reduction from baseline to 6 months. KEY RESULTS Adherence as measure by EMD worsened for both groups (p = 0.04) with no between-group difference (- 9.6% intervention and - 6.6% control, p = 0.66). While systolic BP improved in both groups, the difference between groups was not significant (- 6 mmHg in intervention vs. - 2.7 mmHg in control, p = 0.34). In contrast, the intervention group had a greater improvement in self-reported adherence (mean change 1.98 vs. 1.26, p = 0.03) when measured using the MMAS-8. CONCLUSIONS Among Latinos with poorly controlled BP who were non-adherent to their antihypertensive medications, a systems-level intervention did not improve adherence as measured by EMD nor blood pressure. However, many patients reported challenges to using the EMD. Improvements in self-reported adherence suggest that this measure captures different aspects of adherence behavior than EMD. CLINICAL TRIAL REGISTRATION NCT03560596.
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Affiliation(s)
- Antoinette Schoenthaler
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY, USA.
| | - Franzenith de la Calle
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY, USA
| | | | | | - William Chaplin
- Department of Psychology, St. Johns University, Jamaica, NY, USA
| | - Jazmin Mogavero
- Department of Psychology, St. Johns University, Jamaica, NY, USA
| | - Milagros C Rosal
- Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Aziz H, Hatah E, Makmor-Bakry M, Islahudin F, Ahmad Hamdi N, Mok Pok Wan I. A comparison of medication adherence between subsidized and self-paying patients in Malaysia. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2018; 13:2-9. [PMID: 30302177 PMCID: PMC6173959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Limited efforts have been made to evaluate medication adherence among subsidized and self-paying patients. OBJECTIVE To investigate medication adherence among patients with and without medication subsidies and to identify factors that may influence patients' adherence to medication. Setting: Government healthcare institutions in Kuala Lumpur, Selangor, and Negeri Sembilan and private healthcare institutions in Selangor and Negeri Sembilan, Malaysia. METHODS This cross-sectional study sampled patients with and without medication subsidies (self-paying patients). Only one of the patient's medications was re-packed into Medication Event Monitoring Systems (MEMS) bottles, which were returned after four weeks. Adherence was defined as the dose regimen being executed as prescribed on 80% or more of the days. The factors that may influence patients' adherence were modelled using binary logistic regression. Main outcome measure: Percentage of medication adherence. RESULTS A total of 97 patients, 50 subsidized and 47 self-paying, were included in the study. Medication adherence was observed in 50% of the subsidized patients and 63.8% of the self-paying patients (χ2=1.887, df=1, p=0.219). None of the evaluated variables had a significant influence on patients' medication adherence, with the exception of attending drug counselling. Patients who attended drug counselling were found to be 3.3 times more likely to adhere to medication than those who did not (adjusted odds ratio of 3.29, 95% CI was 1.42 to 7.62, p = 0.006). CONCLUSION There is no significant difference in terms of medication adherence between subsidized and self-paying patients. Future studies may wish to consider evaluating modifiable risk factors in the examination of non-adherence among subsidized and self-paying patients in Malaysia.
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Affiliation(s)
- H Aziz
- PhD, MPharm (Clin), Bpharm (Hons), Faculty of Pharmacy Universiti Kebangsaan Malaysia jalan Raja Muda Abdul Aziz 50300 Kuala Lumpur, Malaysia. Email address:
| | - E Hatah
- Bpharm (Hons), Master of Science (Pharm), Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur Malaysia
| | - M Makmor-Bakry
- PhD, MPharm (Clin), Bpharm (Hons), Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur Malaysia
| | - F Islahudin
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur Malaysia
| | - N Ahmad Hamdi
- Bpharm (Hons), Pharmacy Division, Ministry of Health Jalan Universiti, Petaling Jaya Selangor, Malaysia
| | - I Mok Pok Wan
- MPharm (Clin), Bpharm Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif Bandar Tun Razak, 56000 Cheras Kuala Lumpur, Malaysia
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Schoenthaler A, Knafl GJ, Fiscella K, Ogedegbe G. Addressing the Social Needs of Hypertensive Patients: The Role of Patient-Provider Communication as a Predictor of Medication Adherence. Circ Cardiovasc Qual Outcomes 2018; 10:CIRCOUTCOMES.117.003659. [PMID: 28830861 DOI: 10.1161/circoutcomes.117.003659] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/27/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Poor medication adherence is a pervasive problem in patients with hypertension. Despite research documenting an association between patient-provider communication and medication adherence, there are no empirical data on how the informational and relational aspects of communication affect patient's actual medication-taking behaviors. The aim of this study was to evaluate the impact of patient-provider communication on medication adherence among a sample of primary care providers and their black and white hypertensive patients. METHODS AND RESULTS Cohort study included 92 hypertensive patients and 27 providers in 3 safety-net primary care practices in New York City. Patient-provider encounters were audiotaped at baseline and coded using the Medical Interaction Process System. Medication adherence data were collected continuously during the 3-month study with an electronic monitoring device. The majority of patients were black, 58% women, and most were seeing the same provider for at least 1 year. Approximately half of providers were white (56%), 67% women, and have been in practice for an average of 5.8 years. Fifty-eight percent of patients exhibited poor adherence to prescribed antihypertensive medications. Three categories of patient-provider communication predicted poor medication adherence: lower patient centeredness (odds ratio: 3.08; 95% confidence interval: 1.04-9.12), less discussion about patients' sociodemographic circumstances (living situation, relationship with partner; odds ratio: 6.03; 95% confidence interval: 2.15-17), and about their antihypertensive medications (odds ratio: 6.48; 95% confidence interval: 1.83-23.0). The effect of having less discussion about patients' sociodemographic circumstances on medication adherence was heightened in black patients (odds ratio: 8.01; 95% confidence interval: 2.80-22.9). CONCLUSIONS The odds of poor medication adherence are greater when patient-provider interactions are low in patient centeredness and do not address patients' sociodemographic circumstances or their medication regimen.
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Affiliation(s)
- Antoinette Schoenthaler
- From the Division of Health and Behavior, Department of Population Health, Center for Healthful Behavior Change, New York University (A.S., G.O.); School of Nursing, University of North Carolina at Chapel Hill (G.J.K.); and Department of Family Medicine, University of Rochester School of Medicine and Dentistry, NY (K.F.).
| | - George J Knafl
- From the Division of Health and Behavior, Department of Population Health, Center for Healthful Behavior Change, New York University (A.S., G.O.); School of Nursing, University of North Carolina at Chapel Hill (G.J.K.); and Department of Family Medicine, University of Rochester School of Medicine and Dentistry, NY (K.F.)
| | - Kevin Fiscella
- From the Division of Health and Behavior, Department of Population Health, Center for Healthful Behavior Change, New York University (A.S., G.O.); School of Nursing, University of North Carolina at Chapel Hill (G.J.K.); and Department of Family Medicine, University of Rochester School of Medicine and Dentistry, NY (K.F.)
| | - Gbenga Ogedegbe
- From the Division of Health and Behavior, Department of Population Health, Center for Healthful Behavior Change, New York University (A.S., G.O.); School of Nursing, University of North Carolina at Chapel Hill (G.J.K.); and Department of Family Medicine, University of Rochester School of Medicine and Dentistry, NY (K.F.)
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7
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Teshome EM, Oriaro VS, Andango PEA, Prentice AM, Verhoef H. Adherence to home fortification with micronutrient powders in Kenyan pre-school children: self-reporting and sachet counts compared to an electronic monitoring device. BMC Public Health 2018; 18:205. [PMID: 29391008 PMCID: PMC5796300 DOI: 10.1186/s12889-018-5097-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/18/2018] [Indexed: 11/13/2022] Open
Abstract
Background The efficacy of home fortification with iron-containing micronutrient powders varies between trials, perhaps in part due to population differences in adherence. We aimed to assess to what extent adherence measured by sachet count or self-reporting forms is in agreement with adherence measured by electronic device. In addition, we explored how each method of adherence assessment (electronic device, sachet count, self-reporting forms) is associated with haemoglobin concentration measured at the end of intervention; and to what extent baseline factors were associated with adherence as measured by electronic device. Methods Three hundred thirty-eight rural Kenyan children aged 12-36 months were randomly allocated to three treatment arms (home fortification with two different iron formulations or placebo). Home fortificants were administered daily by parents or guardians over a 30 day-intervention period. We assessed adherence using an electronic device that stores and provides information of the time and day of opening of the container that was used to store the fortificants sachets in each child’s residence. In addition, we assessed adherence by self-reporting and sachet counts. We also measured haemoglobin concentration at the end of intervention. Results Adherence, defined as having received at least 24 sachets (≥ 80%), during the 30-day intervention period was attained by only 60.6% of children as assessed by the electronic device. The corresponding values were higher when adherence was assessed by self-report (83.9%; difference: 23.3%, 95% CI: 18.8% to 27.8%) or sachet count (86.3%; difference: 25.7%, 95% CI: 21.0% to 30.4%). Among children who received iron, each 10 openings of the electronic cap of the sachet storage container were associated with an increase in haemoglobin concentration at the end of intervention by 1.2 g/L (95% CI: 0.0 to 1.9 g/L). Adherence was associated with the age of the parent but not with intervention group; with age, sex or anthropometric indices of the child; or with age or sex of the parent or guardian. Conclusions The use of self -reporting and sachet count may lead to overestimates of adherence to home fortification. Trial registration The trial was registered with ClinicalTrials.gov (NCT02073149) on 25 February 2014. Electronic supplementary material The online version of this article (10.1186/s12889-018-5097-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emily M Teshome
- MRCG Keneba at MRC Unit The Gambia, and MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK. .,Faculty of Epidemiology and Population Heath, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Veronica S Oriaro
- Maseno University, School of Public Health and Community Development, Maseno, Kenya
| | - Pauline E A Andango
- Maseno University, School of Public Health and Community Development, Maseno, Kenya
| | - Andrew M Prentice
- MRCG Keneba at MRC Unit The Gambia, and MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK.,Faculty of Epidemiology and Population Heath, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Hans Verhoef
- MRCG Keneba at MRC Unit The Gambia, and MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK.,Cell Biology and Immunology Group and Division of Human Nutrition, Wageningen University, Maseno, The Netherlands
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Gellad WF, Thorpe CT, Steiner JF, Voils CI. The myths of medication adherence. Pharmacoepidemiol Drug Saf 2017; 26:1437-1441. [PMID: 28994158 DOI: 10.1002/pds.4334] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/24/2017] [Accepted: 09/11/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Walid F Gellad
- Division of General Medicine and Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh, Pittsburgh, PA, USA.,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Carolyn T Thorpe
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - John F Steiner
- Institute for Health Research, Kaiser Permanente, Denver, CO, USA
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.,Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Teshome EM, Otieno W, Terwel SR, Osoti V, Demir AY, Andango PEA, Prentice AM, Verhoef H. Comparison of home fortification with two iron formulations among Kenyan children: Rationale and design of a placebo-controlled non-inferiority trial. Contemp Clin Trials Commun 2017; 7:1-10. [PMID: 29696163 PMCID: PMC5898495 DOI: 10.1016/j.conctc.2017.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/11/2017] [Accepted: 04/08/2017] [Indexed: 10/24/2022] Open
Abstract
Introduction Home fortification powders containing iron and other micronutrients have been recommended by World Health Organisation to prevent iron deficiency anaemia in areas of high prevalence. There is evidence, however, that home fortification at this iron dose may cause gastrointestinal adverse events including diarrhoea. Providing a low dose of highly absorbable iron (3 mg iron as NaFeEDTA) may be safer because the decreased amount of iron in the gut lumen can possibly reduce the burden of these adverse effects whilst resulting in similar or higher amounts of absorbed iron. Objective To show non-inferiority of home fortification with 3 mg iron as NaFeEDTA compared with 12.5 mg iron as encapsulated ferrous fumarate, with haemoglobin response as the primary outcome. Design 338 Kenyan children aged 12-36 months will be randomly allocated to daily home fortification with either: a) 3 mg iron as NaFeEDTA (experimental treatment), b) 12.5 mg iron as encapsulated ferrous fumarate (reference), or c) placebo. At baseline, after 30 days of intervention and within 100 days post-intervention, blood samples will be assessed for primary outcome (haemoglobin concentration), iron status markers, Plasmodium parasitaemia and inflammation markers. Urine and stool samples will be assessed for hepcidin concentrations and inflammation, respectively. Adherence will be assessed by self-reporting, sachet counts and by an electronic monitoring device. Conclusion If daily home fortification with a low dose of iron (3 mg NaFeEDTA) has similar or superior efficacy to a high dose (12.5 mg ferrous fumarate) then it would be the preferred choice for treatment of iron deficiency anaemia in children.
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Affiliation(s)
- Emily M Teshome
- MRCG Keneba, MRC Unit The Gambia, Banjul, Gambia.,MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Walter Otieno
- Maseno University, School of Medicine, Maseno, Kenya
| | - Sofie R Terwel
- Wageningen University, Cell Biology and Immunology Group, Division of Human Nutrition, Wageningen, The Netherlands
| | - Victor Osoti
- International Centre of Insect Physiology and Ecology, Nairobi, Kenya
| | - Ayşe Y Demir
- Meander Medical Centre, Laboratory for Clinical Chemistry, Amersfoort, The Netherlands
| | - Pauline E A Andango
- Maseno University, School of Public Health and Community Development, Maseno, Kenya
| | - Andrew M Prentice
- MRCG Keneba, MRC Unit The Gambia, Banjul, Gambia.,MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Hans Verhoef
- MRCG Keneba, MRC Unit The Gambia, Banjul, Gambia.,MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK.,Wageningen University, Cell Biology and Immunology Group, Division of Human Nutrition, Wageningen, The Netherlands
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Dickson VV, Knafl GJ, Riegel B. Predictors of medication nonadherence differ among black and white patients with heart failure. Res Nurs Health 2015; 38:289-300. [PMID: 25962474 DOI: 10.1002/nur.21663] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2015] [Indexed: 12/13/2022]
Abstract
Heart failure (HF) is a global public health problem, and outcomes remain poor, especially among ethnic minority populations. Medication adherence can improve heart failure outcomes but is notoriously low. The purpose of this secondary analysis of data from a prospective cohort comparison study of adults with heart failure was to explore differences in predictors of medication nonadherence by racial group (Black vs. White) in 212 adults with heart failure. Adaptive modeling analytic methods were used to model HF patient medication nonadherence separately for Black (31.7%) and White (68.3%) participants in order to investigate differences between these two racial groups. Of the 63 Black participants, 33.3% had low medication adherence, compared to 27.5% of the 149 White participants. Among Blacks, 16 risk factors were related to adherence in bivariate analyses; four of these (more comorbidities, lower serum sodium, higher systolic blood pressure, and use of fewer activities compensating for forgetfulness) jointly predicted nonadherence. In the multiple risk factor model, the number of risk factors in Black patients ranged from 0 to 4, and 76.2% had at least one risk factor. The estimated odds ratio for medication nonadherence was increased 9.34 times with each additional risk factor. Among White participants, five risk factors were related to adherence in bivariate analyses; one of these (older age) explained the individual effects of the other four. Because Blacks with HF have different and more risk factors than Whites for low medication adherence, interventions are needed that address unique risk factors among Black patients with HF.
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Affiliation(s)
- Victoria Vaughan Dickson
- Assistant Professor College of Nursing, New York University, 433 First Avenue, #742, New York, NY, 10010
| | - George J Knafl
- Professor School of Nursing, University of North Carolina, Chapel Hill, NC
| | - Barbara Riegel
- Professor and Edith Clemmer Steinbright Chair of Gerontology School of Nursing, University of Pennsylvania, Philadelphia, PA
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11
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Solomon A, Schoenthaler A, Seixas A, Ogedegbe G, Jean-Louis G, Lai D. Medication Routines and Adherence Among Hypertensive African Americans. J Clin Hypertens (Greenwich) 2015; 17:668-72. [PMID: 25952495 DOI: 10.1111/jch.12566] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/17/2015] [Accepted: 02/19/2015] [Indexed: 01/09/2023]
Abstract
Poor adherence to prescribed medication regimens remains an important challenge preventing successful treatment of cardiovascular diseases such as hypertension. While studies have documented differences in the time of day or weekday vs weekend on medication adherence, no study has examined whether having a medication-taking routine contributes to increased medication adherence. The purpose of this study was to: (1) identify patients' sociodemographic factors associated with consistent medication-taking routine; (2) examine associations between medication-taking consistency, medication adherence, and blood pressure (BP) control. The study included black patients with hypertension (n = 190; 22 men and 168 women; age, mean±standard deviation 54 ± 12.08 years) who completed a practice-based randomized controlled trial. Findings showed that medication-taking consistency was significantly associated with better medication adherence (F = 9.54, P = .002). Associations with the consistency index were not statistically significant for diastolic BP control (odds ratio, 1.319; 95% confidence interval, 0.410-4.246; P = .642) and systolic BP control (odds ratio, 0.621; 95% confidence interval, 0.195-1.974; P = .419).
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Affiliation(s)
| | - Antoinette Schoenthaler
- Prairie View A&M University, Houston, TX.,Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, NY
| | - Azizi Seixas
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, NY
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, NY
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, NY
| | - Dejian Lai
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, NY
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Hanumunthadu D, Dehabadi MH, Cordeiro MF. Neuroprotection in glaucoma: current and emerging approaches. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.2014.892415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Ahmed R, Aslani P. Attention-deficit/hyperactivity disorder: an update on medication adherence and persistence in children, adolescents and adults. Expert Rev Pharmacoecon Outcomes Res 2014; 13:791-815. [DOI: 10.1586/14737167.2013.841544] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
BACKGROUND Medication nonadherence is a major cause of hospitalization in patients with heart failure (HF), which contributes enormously to health care costs. We previously found, using the World Health Organization adherence dimensions, that condition and patient level factors predicted nonadherence in HF. In this study, we assessed a wider variety of condition and patient factors and interactions to improve our ability to identify those at risk for hospitalization. MATERIALS AND METHODS Medication adherence was measured electronically over the course of 6 months, using the Medication Event Monitoring System (MEMS). A total of 242 HF patients completed the study, and usable MEMS data were available for 218 (90.1%). Participants were primarily white (68.3%), male (64.2%), and retired (44.5%). Education ranged from 8-29 years (mean, 14.0 years; standard deviation, 2.9 years). Ages ranged from 30-89 years (mean, 62.8 years; standard deviation, 11.6 years). Analyses used adaptive methods based on heuristic searches controlled by cross-validation scores. First, individual patient adherence patterns over time were used to categorize patients in poor versus better adherence types. Then, risk factors for poor adherence were identified. Finally, an effective model for predicting poor adherence was identified based on identified risk factors and possible pairwise interactions between them. RESULTS A total of 63 (28.9%) patients had poor adherence. Three interaction risk factors for poor adherence were identified: a higher number of comorbid conditions with a higher total number of daily medicines, older age with poorer global sleep quality, and fewer months since diagnosis of HF with poorer global sleep quality. Patients had between zero and three risk factors. The odds for poor adherence increased by 2.6 times with a unit increase in the number of risk factors (odds ratio, 2.62; 95% confidence interval, 1.78-3.86; P<0.001). CONCLUSION Newly diagnosed, older HF patients with comorbid conditions, polypharmacy, and poor sleep are at risk for poor medication adherence. Interventions addressing these specific barriers are needed.
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Affiliation(s)
- George J Knafl
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, USA
- Correspondence: Barbara Riegel, School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104-4217, USA, Tel +1 215 898 9927, Fax +1 240 282 7707, Email
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Hu D, Juarez DT, Yeboah M, Castillo TP. Interventions to increase medication adherence in African-American and Latino populations: a literature review. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2014; 73:11-18. [PMID: 24470982 PMCID: PMC3901167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The objective of this systematic review was to investigate the effectiveness of interventions to improve medication adherence in ethnic minority populations. A literature search from January 2000 to August 2012 was conducted through PubMed/Medline, Web of Science, The Cochrane Library, and Google Scholar. Search terms used included: medication (MeSH), adherence, medication adherence (MeSH), compliance (MeSH), persistence, race, ethnicity, ethnic groups (MeSH), minority, African-American, Hispanic, Latino, Asian, Pacific Islander, and intervention. Studies which did not have ≥75% of the sample population comprised of individuals of any one ethnic background were excluded, unless the authors performed sub-group analyses by race/ethnicity. Of the 36 studies identified, 20 studies showed significant post-intervention differences. Sample population sizes ranged from 10 to 520, with a median of 126.5. The studies in this review were conducted with patients of mainly African-American and Latino descent. No studies were identified which focused on Asians, Pacific Islanders, or Native Americans. Interventions demonstrating mixed results included motivational interviewing, reminder devices, community health worker (CHW) delivered interventions, and pharmacist-delivered interventions. Directly observed therapy (DOT) was a successful intervention in two studies. Interventions which did not involve human contact with patients were ineffective. In this literature review, studies varied significantly in their methods and design as well as the populations studied. There was a lack of congruence among studies in the way adherence was measured and reported. No single intervention has been seen to be universally successful, particularly for patients from ethnic minority backgrounds.
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Affiliation(s)
- Daniel Hu
- University of Hawai'i at Hilo; Hilo, HI (DH, DTJ)
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Burg MM, Edmondson D, Shimbo D, Shaffer J, Kronish IM, Whang W, Alcántara C, Schwartz JE, Muntner P, Davidson KW. The 'perfect storm' and acute coronary syndrome onset: do psychosocial factors play a role? Prog Cardiovasc Dis 2013; 55:601-10. [PMID: 23621970 DOI: 10.1016/j.pcad.2013.03.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The revolution in cardiac care over the past two decades, characterized by emergent revascularization, drug eluting stents, anti-platelet medications, and advanced imaging has had little impact on overall ACS recurrence, or ACS prevention. The "Perfect Storm" refers to a confluence of events and processes, including atherosclerotic plaque, coronary flow dynamics, hemostatic and fibrinolytic function, metabolic and inflammatory conditions, neurohormonal dysregulation, and environmental events that give rise to, and result in an ACS event. In this article we illustrate the limits of the traditional main effect research model, giving a brief description of the current state of knowledge regarding the development of atherosclerotic plaque and the rupturing of these plaques that defines an ACS event. We then apply the Perfect Storm conceptualization to describe a program of research concerning a psychosocial vulnerability factor that contributes to increased risk of recurrent ACS and early mortality, and that has defied our efforts to identify underlying pathophysiology and successfully mount efforts to fully mitigate this risk.
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Affiliation(s)
- Matthew M Burg
- Department of Medicine, Center for Cardiovascular Behavioral Health, Columbia University, New York, NY 10032, USA
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Abstract
Approximately 50% of patients with cardiovascular disease and/or its major risk factors have poor adherence to their prescribed medications. Finding novel methods to help patients improve their adherence to existing evidence-based cardiovascular drug therapies has enormous potential to improve health outcomes while potentially reducing health care costs. The goal of this report is to provide a review of the current understanding of adherence to cardiovascular medications from the point of view of prescribing clinicians and cardiovascular researchers. Key topics addressed include: (1) definitions of medication adherence; (2) prevalence and impact of non-adherence; (3) methods for assessing medication adherence; 4) reasons for poor adherence; and 5) approaches to improving adherence to cardiovascular medications. For each of these topics, the report seeks to identify important gaps in knowledge and opportunities for advancing the field of cardiovascular adherence research.
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Riegel B, Knafl GJ. Electronically monitored medication adherence predicts hospitalization in heart failure patients. Patient Prefer Adherence 2013; 8:1-13. [PMID: 24353407 PMCID: PMC3862652 DOI: 10.2147/ppa.s54520] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Hospitalization contributes enormously to health care costs associated with heart failure. Many investigators have attempted to predict hospitalization in these patients. None of these models has been highly effective in prediction, suggesting that important risk factors remain unidentified. PURPOSE To assess prospectively collected medication adherence, objectively measured by the Medication Event Monitoring System, as a predictor of hospitalization in heart failure patients. MATERIALS AND METHODS We used recently developed adaptive modeling methods to describe patterns of medication adherence in a sample of heart failure patients, and tested the hypothesis that poor medication adherence as determined by adaptive methods was a significant predictor of hospitalization within 6 months. RESULTS Medication adherence was the best predictor of hospitalization. Besides two dimensions of poor adherence (adherence pattern type and low percentage of prescribed doses taken), four other single factors predicted hospitalization: low hemoglobin, depressed ejection fraction, New York Heart Association class IV, and 12 or more medications taken daily. Seven interactions increased the predictive capability of the model: 1) pattern of poor adherence type and lower score on the Letter-Number Sequencing test, a measure of short-term memory; 2) higher number of comorbid conditions and higher number of daily medications; 3) higher blood urea nitrogen and lower percentage of prescribed doses taken; 4) lower hemoglobin and much worse perceived health compared to last year; 5) older age and lower score on the Telephone Interview of Cognitive Status; 6) higher body mass index and lower hemoglobin; and 7) lower ejection fraction and higher fatigue. Patients with none of these seven interactions had a hospitalization rate of 9.7%. For those with five of these interaction risk factors, 100% were hospitalized. The C-index (the area under the receiver-operating characteristics [ROC] curve) for the model based on the seven interactions was 0.83, indicating excellent discrimination. CONCLUSION Medication adherence adds important new information to the list of variables previously shown to predict hospitalization in adults with heart failure.
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Affiliation(s)
- Barbara Riegel
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- University of Pennsylvania Leonard Davis Institute, Philadelphia, PA, USA
- Correspondence: Barbara Riegel, University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19104-4217, USA, Tel +1 215 898 9927, Fax +1 240 282 7707, Email
| | - George J Knafl
- University of North Carolina School of Nursing, Chapel Hill, NC, USA
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