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Sandahl H, Lindberg LG, Lykke Mortensen E, Carlsson J. Factors affecting adherence to psychotropics in trauma-affected refugees: data from a randomized controlled trial. J Psychiatr Res 2024; 169:272-278. [PMID: 38065051 DOI: 10.1016/j.jpsychires.2023.11.020] [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: 02/05/2023] [Revised: 09/09/2023] [Accepted: 11/15/2023] [Indexed: 01/15/2024]
Abstract
Non-adherence to psychotropic drugs may reduce treatment effectiveness and may cause exacerbation of illness. Among migrant populations, studies have identified low adherence to psychotropic drugs. This study aimed to identify factors that were associated with the three basic components of adherence: non-initiation, non-implementation (blood sample), and discontinuation in a clinical sample of trauma-affected refugees diagnosed with posttraumatic stress disorder. The data for this study is derived from a randomized controlled trial (n = 108). Based on existing literature, individual sociodemographic and clinical candidate predictor variables that may affect the initiation, continuation, and implementation to psychotropics were selected as exposure variables. Logistic regression was used to assess the risk relation between non-initiation, non-implementation, discontinuation, and the individual sociodemographic and clinical factors. Three factors - level of education, turn-up rate for medical doctor sessions, and discomfort in relation to the psychotropics - were associated with non-initiation, non-implementation, or discontinuation. The relatively small sample size poses a limitation. Furthermore, factors not examined in the current study may have affected non-initiation, non-implementation, and discontinuation. The study identified level of education, turn-up rate for medical doctor sessions, and discomfort in relation to medicine as important factors in relation to treatment with psychotropics in trauma-affected refugees. Factors contributing to a low turn-up rate, and factors that are consequences of a low turn-up rate, as well as communication and trust in the patient-provider interaction need further research attention. Furthermore, there is a need for research on interventions addressing adherence for refugees with mental illness.
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Affiliation(s)
- Hinuga Sandahl
- Competence Centre for Transcultural Psychiatry, Mental Health Center, Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark; Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Laura Glahder Lindberg
- Competence Centre for Transcultural Psychiatry, Mental Health Center, Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Center, Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark; Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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2
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Ayre MJ, Lewis PJ, Keers RN. Understanding the medication safety challenges for patients with mental illness in primary care: a scoping review. BMC Psychiatry 2023; 23:417. [PMID: 37308835 DOI: 10.1186/s12888-023-04850-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/06/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Mental illness and medication safety are key priorities for healthcare systems around the world. Despite most patients with mental illness being treated exclusively in primary care, our understanding of medication safety challenges in this setting is fragmented. METHOD Six electronic databases were searched between January 2000-January 2023. Google Scholar and reference lists of relevant/included studies were also screened for studies. Included studies reported data on epidemiology, aetiology, or interventions related to medication safety for patients with mental illness in primary care. Medication safety challenges were defined using the drug-related problems (DRPs) categorisation. RESULTS Seventy-nine studies were included with 77 (97.5%) reporting on epidemiology, 25 (31.6%) on aetiology, and 18 (22.8%) evaluated an intervention. Studies most commonly (33/79, 41.8%) originated from the United States of America (USA) with the most investigated DRP being non-adherence (62/79, 78.5%). General practice was the most common study setting (31/79, 39.2%) and patients with depression were a common focus (48/79, 60.8%). Aetiological data was presented as either causal (15/25, 60.0%) or as risk factors (10/25, 40.0%). Prescriber-related risk factors/causes were reported in 8/25 (32.0%) studies and patient-related risk factors/causes in 23/25 (92.0%) studies. Interventions to improve adherence rates (11/18, 61.1%) were the most evaluated. Specialist pharmacists provided the majority of interventions (10/18, 55.6%) with eight of these studies involving a medication review/monitoring service. All 18 interventions reported positive improvements on some medication safety outcomes but 6/18 reported little difference between groups for certain medication safety measures. CONCLUSION Patients with mental illness are at risk of a variety of DRPs in primary care. However, to date, available research exploring DRPs has focused attention on non-adherence and potential prescribing safety issues in older patients with dementia. Our findings highlight the need for further research on the causes of preventable medication incidents and targeted interventions to improve medication safety for patients with mental illness in primary care.
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Affiliation(s)
- Matthew J Ayre
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - Penny J Lewis
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Richard N Keers
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK
- Suicide, Risk and Safety Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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3
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Schulz M, Laufs U. Not obtaining a medication the first time it is prescribed: primary non-adherence to cardiovascular pharmacotherapy. Clin Res Cardiol 2023:10.1007/s00392-023-02230-3. [PMID: 37209148 DOI: 10.1007/s00392-023-02230-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/08/2023] [Indexed: 05/22/2023]
Abstract
Primary medication non-adherence describes the situation when a first prescription for a new medication is never filled. Primary non-adherence is an important, yet understudied aspect of reduced effectiveness of pharmacotherapy. This review summarizes the frequency, impact, reasons, predictors, and interventions regarding primary non-adherence to cardiovascular/cardiometabolic drugs. The current literature reveals a high prevalence of primary non-adherence. The individual risk of primary non-adherence is determined on multiple factors, e.g., primary non-adherence of lipid-lowering drugs is higher compared to antihypertensive medications. However, the overall rate of primary non-adherence is > 10%. Additionally, this review identifies specific areas for research to better understand why patients forgo evidence-based beneficial pharmacotherapy and to explore targeted interventions. At the same time, measures to reduce primary non-adherence-once proven to be effective-may represent an important new opportunity to reduce cardiovascular diseases.
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Affiliation(s)
- Martin Schulz
- Institute of Pharmacy, Freie Universität Berlin, Kelchstraße 31, 12169, Berlin, Germany.
- Drug Commission of German Pharmacists (AMK), Heidestraße 7, 10557, Berlin, Germany.
- German Institute for Drug Use Evaluation (DAPI), Heidestraße 7, 10557, Berlin, Germany.
| | - Ulrich Laufs
- Department of Cardiology, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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4
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Alhassoun RK, AlDossary SA. Utilization of remote e-prescription (Anat) in Saudi Arabia during COVID-19: Factors associated with primary adherence and antibiotic prescription. Digit Health 2023; 9:20552076231194925. [PMID: 37654718 PMCID: PMC10467295 DOI: 10.1177/20552076231194925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/28/2023] [Indexed: 09/02/2023] Open
Abstract
Background The COVID-19 pandemic has affected healthcare systems globally. Various health care technologies have been used to mitigate the risk of disease transmission. Telemedicine is one such technology, and remote consulting and prescribing comprise one of its key aspects. In Saudi Arabia, telephone health services have been widely used through the free Medical Consultation Call Center (937). This platform facilitates medical consultations for all citizens, residents, and visitors. After consultations, healthcare providers are able to issue authenticated e-prescriptions using the Anat platform. Objectives To explore the utilization of the Anat remote prescription system in Saudi Arabia during the COVID-19 pandemic and to identify the factors associated with antibiotic prescription and primary medication adherence. Methods This retrospective analysis included data from the Anat e‑prescription system using a stratified random sample of 25000 prescriptions issued in Saudi Arabia in 2020. Predictive factors related to the patients, practitioners, and prescriptions were identified through bivariate and multivariate logistic regression analyses. Results Out of 25,000 e-prescriptions, 8885 were dispensed, resulting in a 35.5% primary medication adherence rate. The significant predictors of primary adherence were children, respiratory diseases, and antibacterial drugs. In addition, antibiotics made up 32.1% of the e-prescriptions. The prescription of antibiotics was significantly associated with male sex, children, genitourinary system diseases, and being treated by radiologists. Conclusions Almost two thirds 62.2% of e-prescriptions were undispensed, with antibiotic eprescriptions at 32.1%. Findings emphasize the need to enhance primary medication adherence and antibiotic prescription interventions. These findings could aid decision-makers in improving patient-centered e-prescribing practices.
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Affiliation(s)
- Roaa Khaled Alhassoun
- Department of Health Informatics, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sharifah Abdullah AlDossary
- Department of Health Informatics, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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5
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Hempenius M, Rijken S, Groenwold RHH, Hek K, de Boer A, Klungel OH, Gardarsdottir H. Primary nonadherence to drugs prescribed by general practitioners: A Dutch database study. Br J Clin Pharmacol 2023; 89:268-278. [PMID: 35896043 PMCID: PMC10087833 DOI: 10.1111/bcp.15472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/26/2022] [Accepted: 07/19/2022] [Indexed: 11/02/2022] Open
Abstract
AIM Primary nonadherence (PNA) is defined as not filling the first prescription for a drug treatment. PNA can lead not only to poor patient outcomes but also to exposure misclassification in written prescription databases. This study aims to estimate PNA in primary care in the Netherlands and to investigate associated factors. METHODS Patients from the Nivel Primary Care Database (Nivel-PCD) who received a new prescription (>1 year not prescribed) from a general practitioner in 2012 were linked to pharmacy dispensing information of consenting pharmacies based on sex, year of birth, four-digit postal code and at least 50% matching Anatomical Therapeutic Classification codes. PNA was defined as not having a prescription dispensed within 30 days from the prescribing date. PNA was assessed overall and per drug class. The associations between PNA and several patient- and prescription-related characteristics were assessed using mixed-effects logistic regression models. RESULTS After matching 86 361 of 396 251 subjects (21.8%) in the Nivel-PCD records to the pharmacy records, this study included 65 877 subjects who received 181 939 new drug prescriptions. Overall, PNA was 11.5%. PNA was lowest for thyroid hormones (5.5%) and highest for proton pump inhibitors (12.8%). Several factors were associated with PNA, such as having comorbidities (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.37-1.56 for >3 active diagnoses, compared to no active diagnoses) or reimbursement status (OR 2.78, 95% CI 2.65-2.92 for not reimbursed drugs compared to fully reimbursed drugs). CONCLUSIONS A total of 11.5% of newly prescribed drugs were not dispensed. This can lead to overestimation of the actual drug exposure status when using written prescription databases.
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Affiliation(s)
- Mirjam Hempenius
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Simone Rijken
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Rolf H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Karin Hek
- Department of Integrated Primary Care, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Olaf H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Pharmacy, Division Laboratory and Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands.,Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland
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6
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Sacha M, Sandahl H, Harck L, Carlsson J. Treatment adherence to psychotropic drugs among non-Western migrants: a systematic review. Nord J Psychiatry 2022; 76:250-262. [PMID: 34369289 DOI: 10.1080/08039488.2021.1954689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Low medication adherence is a significant challenge in all medical fields and particularly in mental health treatment, where a lack of insight into one's own disease can repress the ability to adhere. In recent years, the increase in migration combined with a high prevalence of mental illnesses among migrants and the possible consequences of nonadherence, point towards the need for a focus on adherence with psychotropic drugs among migrants. AIM To review current literature, exploring the potential impact of being a migrant from a non-Western country living in a Western country on the level of adherence to psychotropic medication and subsequently to discuss these findings. METHODS A systematic review of studies investigating adherence among non-western migrants was conducted. The literature search was conducted using PubMed and Embase databases in October 2020. RESULTS Seven observational studies were included, all ranging from moderate to high-quality. Six out of seven studies found an association between being a non-Western migrant in a Western country and low adherence to psychotropic drugs. CONCLUSION Studies indicate an association between being a non-Western migrant in a Western country and low adherence to psychotropic drugs. None of the included studies investigated possible causes of the low adherence in migrants. Communication difficulties are, however, considered possible barriers to healthcare access and a contributing factor to nonadherence. There is a need for studies assessing the possible impact of interventions aiming at increasing adherence such as intercultural mediators and training of healthcare providers in cultural competencies.
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Affiliation(s)
- Maria Sacha
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark
| | - Hinuga Sandahl
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark
| | - Line Harck
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark
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7
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Kieseppä V, Markkula N, Taipale H, Holm M, Jokela M, Suvisaari J, Tanskanen A, Gissler M, Lehti V. Antidepressant use among immigrants with depressive disorder living in Finland: A register-based study. J Affect Disord 2022; 299:528-535. [PMID: 34953922 DOI: 10.1016/j.jad.2021.12.071] [Citation(s) in RCA: 3] [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: 07/26/2021] [Revised: 11/08/2021] [Accepted: 12/18/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to examine differences in the initiation and discontinuation of antidepressants between immigrants and the Finnish-born population diagnosed with depression in specialized health care. METHODS The study utilized register-based data, which includes all immigrants living in Finland at the end of 2010 and matched Finnish-born controls. For this study, we selected individuals who had received a diagnosis of depression during 2011-2014 (immigrants n = 2244, Finnish-born n = 2773). Their antidepressant use was studied for a one-year period from initiation. A logistic regression was used to predict initiation and a Cox regression was used to predict discontinuation. RESULTS Immigrants were more likely to initiate the use of antidepressants than the Finnish-born controls (adjusted OR = 1.25, 95% CI = 1.07-1.46), but they also discontinued the medication earlier than the Finnish-born controls (adjusted HR = 1.48, 95% CI = 1.31-1.68). Immigrants from Sub Saharan Africa, the Middle East and Northern Africa were most likely to discontinue antidepressants earlier. More severe depression, a longer length of residence in Finland and more intensive psychiatric treatment were associated with decreased risk of discontinuation. LIMITATIONS The registers do not provide information on the perceived reasons for the discontinuation. CONCLUSIONS Immigrants with depression initiate antidepressants more often than the Finnish-born population, but they also discontinue them earlier. Early discontinuation may be a sign of insufficient treatment suggesting that there could be a need for improvement in mental health care for immigrants in Finland.
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Affiliation(s)
- Valentina Kieseppä
- Finnish Institute for Health and Welfare, Finland, Equality Unit, Helsinki.
| | - Niina Markkula
- University of Helsinki and Helsinki University Hospital, Finland, Department of Psychiatry, Helsinki; Clínica Alemana Universidad del Desarrollo, Chile, Faculty of Medicine, Santiago
| | - Heidi Taipale
- Karolinska Institutet, Sweden, Department of Clinical Neuroscience, Stockholm; Niuvanniemi Hospital, Finland, Kuopio; University of Eastern Finland, Finland, School of Pharmacy, Kuopio
| | - Minna Holm
- Finnish Institute for Health and Welfare, Finland, Equality Unit, Helsinki
| | - Markus Jokela
- University of Helsinki, Finland, Medicum, Department of Psychology and Logopedics, Helsinki
| | - Jaana Suvisaari
- Finnish Institute for Health and Welfare, Finland, Equality Unit, Helsinki
| | - Antti Tanskanen
- Niuvanniemi Hospital, Finland, Kuopio; University of Eastern Finland, Finland, School of Pharmacy, Kuopio
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Finland, Information Services Department, Helsinki; University of Turku, Finland, Research Centre for Child Psychiatry, Turku; Region Stockholm, Sweden, Academic Primary Health Care Centre, Stockholm, and Karolinska Institute, Sweden, Department of Molecular Medicine and Surgery, Stockholm
| | - Venla Lehti
- Finnish Institute for Health and Welfare, Finland, Equality Unit, Helsinki; University of Helsinki and Helsinki University Hospital, Finland, Department of Psychiatry, Helsinki
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Carbonell-Duacastella C, Rubio-Valera M, Marqués-Ercilla S, Peñarrubia-María MT, Gil-Girbau M, Garcia-Cardenas V, Pasarín MI, Parody-Rúa E, Aznar-Lou I. Pediatric Medication Noninitiation in Spain. Pediatrics 2022; 149:184034. [PMID: 34957504 PMCID: PMC9647521 DOI: 10.1542/peds.2020-034371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To estimate medication noninitiation prevalence in the pediatric population and identify the explanatory factors underlying this behavior. METHODS Observational study of patients (<18 years old) receiving at least 1 new prescription (28 pharmaceutical subgroups; July 2017 to June 2018) in Catalonia, Spain. A prescription was considered new when there was no prescription for the same pharmaceutical subgroup in the previous 6 months. Noninitiation occurred when a prescription was not filled within 1 month or 6 months (sensitivity analysis). Prevalence was estimated as the proportion of total prescriptions not initiated. To identify explanatory factors, a multivariable multilevel logistic regression model was used, and adjusted odds ratios were reported. RESULTS Overall, 1 539 003 new prescriptions were issued to 715 895 children. The overall prevalence of 1-month noninitiation was 9.0% (ranging from 2.6% [oral antibiotics] to 21.5% [proton pump inhibitors]), and the prevalence of 6-month noninitiation was 8.5%. Noninitiation was higher in the youngest and oldest population groups, in children from families with a 0% copayment rate (vulnerable populations) and those with conditions from external causes. Out-of-pocket costs of drugs increased the odds of noninitiation. The odds of noninitiation were lower when the prescription was issued by a pediatrician (compared with a primary or secondary care clinician). CONCLUSIONS The prevalence of noninitiation of medical treatments in pediatrics is high and varies according to patients' ages and medical groups. Results suggest that there are inequities in access to pharmacologic treatments in this population that must be taken into account by health care planners and providers.
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Affiliation(s)
- Cristina Carbonell-Duacastella
- Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain,Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain,Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain,School of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Maria Rubio-Valera
- Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain,Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain,Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain,Address correspondence to Maria Rubio-Valera, Parc Sanitari Sant Joan de Deu, Carrer Pablo Picasso 12, 08830, Sant Boi de Llobregat, Barcelona, Spain. E-mail:
| | - Sílvia Marqués-Ercilla
- Basic Health Area (ABS) Bartomeu Fabrés Anglada, Direcció d'Atenció Primària Costa Ponent, Institut Català de la Salut, Gavà, Spain,Unitat de Suport a la Recerca Costa Ponent, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAP JGol), Barcelona, Spain
| | - Maria Teresa Peñarrubia-María
- Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain,Basic Health Area (ABS) Bartomeu Fabrés Anglada, Direcció d'Atenció Primària Costa Ponent, Institut Català de la Salut, Gavà, Spain,Unitat de Suport a la Recerca Costa Ponent, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAP JGol), Barcelona, Spain
| | - Montserrat Gil-Girbau
- Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain,Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain,Primary Care Prevention and Health Promotion Network (redIAPP), Barcelona, Spain
| | - Victoria Garcia-Cardenas
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Maria Isabel Pasarín
- Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain,Barcelona Public Health Agency (ASPB), Barcelona, Spain,Sant Pau Biomedical Research Institute, Barcelona, Spain,Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Elizabeth Parody-Rúa
- Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain,Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain,Primary Care Prevention and Health Promotion Network (redIAPP), Barcelona, Spain
| | - Ignacio Aznar-Lou
- Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain,Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain,Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
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9
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Donneyong MM, Fischer MA, Langston MA, Joseph JJ, Juarez PD, Zhang P, Kline DM. Examining the Drivers of Racial/Ethnic Disparities in Non-Adherence to Antihypertensive Medications and Mortality Due to Heart Disease and Stroke: A County-Level Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312702. [PMID: 34886429 PMCID: PMC8657217 DOI: 10.3390/ijerph182312702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/30/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022]
Abstract
Background: Prior research has identified disparities in anti-hypertensive medication (AHM) non-adherence between Black/African Americans (BAAs) and non-Hispanic Whites (nHWs) but the role of determinants of health in these gaps is unclear. Non-adherence to AHM may be associated with increased mortality (due to heart disease and stroke) and the extent to which such associations are modified by contextual determinants of health may inform future interventions. Methods: We linked the Centers for Disease Control and Prevention (CDC) Atlas of Heart Disease and Stroke (2014-2016) and the 2016 County Health Ranking (CHR) dataset to investigate the associations between AHM non-adherence, mortality, and determinants of health. A proportion of days covered (PDC) with AHM < 80%, was considered as non-adherence. We computed the prevalence rate ratio (PRR)-the ratio of the prevalence among BAAs to that among nHWs-as an index of BAA-nHW disparity. Hierarchical linear models (HLM) were used to assess the role of four pre-defined determinants of health domains-health behaviors, clinical care, social and economic and physical environment-as contributors to BAA-nHW disparities in AHM non-adherence. A Bayesian paradigm framework was used to quantify the associations between AHM non-adherence and mortality (heart disease and stroke) and to assess whether the determinants of health factors moderated these associations. Results: Overall, BAAs were significantly more likely to be non-adherent: PRR = 1.37, 95% Confidence Interval (CI):1.36, 1.37. The four county-level constructs of determinants of health accounted for 24% of the BAA-nHW variation in AHM non-adherence. The clinical care (β = -0.21, p < 0.001) and social and economic (β = -0.11, p < 0.01) domains were significantly inversely associated with the observed BAA-nHW disparity. AHM non-adherence was associated with both heart disease and stroke mortality among both BAAs and nHWs. We observed that the determinants of health, specifically clinical care and physical environment domains, moderated the effects of AHM non-adherence on heart disease mortality among BAAs but not among nHWs. For the AHM non-adherence-stroke mortality association, the determinants of health did not moderate this association among BAAs; the social and economic domain did moderate this association among nHWs. Conclusions: The socioeconomic, clinical care and physical environmental attributes of the places that patients live are significant contributors to BAA-nHW disparities in AHM non-adherence and mortality due to heart diseases and stroke.
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Affiliation(s)
- Macarius M. Donneyong
- College of Pharmacy, The Ohio State University, Columbus, OH 43210, USA
- Correspondence: ; Tel.: +614-292-0075
| | - Michael A. Fischer
- General Internal Medicine at Boston Medical Center, Boston University School of Medicine, Boston, MA 02118, USA;
| | - Michael A. Langston
- Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville, TN 37996, USA;
| | - Joshua J. Joseph
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
| | - Paul D. Juarez
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA;
| | - Ping Zhang
- Division of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH 43210, USA;
| | - David M. Kline
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
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10
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Hempenius M, Groenwold RHH, de Boer A, Klungel OH, Gardarsdottir H. Drug exposure misclassification in pharmacoepidemiology: Sources and relative impact. Pharmacoepidemiol Drug Saf 2021; 30:1703-1715. [PMID: 34396634 PMCID: PMC9292927 DOI: 10.1002/pds.5346] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Drug exposure assessment based on dispensing data can be misclassified when patients do not adhere to their therapy or when information about over-the-counter drugs is not captured in the study database. Previous research has considered hypothetical sensitivity and specificity values, whereas this study aims to assess the impact of literature-based real values of exposure misclassification. METHODS A synthetic cohort study was constructed based on the proportion of exposure theoretically captured in a database (range 0.5-1.0) and the level of adherence (0.5-1.0). Three scenarios were explored: nondifferential misclassification, differential misclassification (misclassifications dependent on an unmeasured risk factor doubling the outcome risk), and nondifferential misclassification in a comparative effectiveness study (RRA and RRB both 2.0 compared to nonuse, RRA-B 1.0). RESULTS For the scenarios with nondifferential misclassification, 25% nonadherence or 25% uncaptured exposure changed the RR from 2.0 to 1.75, and 1.95, respectively. Applying different proportions of nonadherence or uncaptured use (20% vs. 40%) for subgroups with and without the risk factor, an RR of 0.95 was observed in the absence of a true effect (i.e., true RR = 1). In the comparative effectiveness study, no effect on RR was seen for different proportions of uncaptured exposure; however, different levels of nonadherence for the drugs (20% vs. 40%) led to an underestimation of RRA-B (0.89). DISCUSSION All scenarios led to biased estimates, but the magnitude of the bias differed across scenarios. When testing the robustness of findings of pharmacoepidemiologic studies, we recommend using realistic values of nonadherence and uncaptured exposure based on real-world data.
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Affiliation(s)
- Mirjam Hempenius
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Rolf H. H. Groenwold
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Olaf H. Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
- Department of Clinical Pharmacy, Division Laboratory and PharmacyUniversity Medical Center UtrechtUtrechtThe Netherlands
- Faculty of Pharmaceutical SciencesUniversity of IcelandReykjavikIceland
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Sandheimer C, Björkelund C, Hensing G, Mehlig K, Hedenrud T. Implementation of a care manager organisation and its association with antidepressant medication patterns: a register-based study of primary care centres in Sweden. BMJ Open 2021; 11:e044959. [PMID: 33674375 PMCID: PMC7938985 DOI: 10.1136/bmjopen-2020-044959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the implementation of a care manager organisation for common mental disorders and its association with antidepressant medication patterns on primary care centre (PCC) level, compared with PCCs without this organisation. Moreover, to determine whether a care manager organisation is associated with antidepressant medication patterns that is more in accordance with treatment guidelines. DESIGN Register-based study on PCC level. SETTING Primary care in Region Västra Götaland, Sweden. PARTICIPANTS All PCCs in the region. PCCs were analysed in three subgroups: PCCs with a care manager organisation during 2015 and 2016 (n=68), PCCs without the organisation (n=92) and PCCs that shifted to a care manager organisation during 2016 (n=42). OUTCOME MEASURES Proportion of inadequate medication users, defined as number of patients >18 years with a common mental disorder diagnosis receiving care at a PCC in the region during the study period and dispensed 1-179 defined daily doses (DDD) of antidepressants of total patients with at least 1 DDD. The outcome was analysed through generalised linear regression and a linear mixed-effects model. RESULTS Overall, all PCCs had about 30%-34% of inadequate medication users. PCCs with a care manager organisation had significantly lower proportion of inadequate medication users in 2016 compared with PCCs without (-6.4%, p=0.02). These differences were explained by higher proportions in privately run PCCs. PCCs that shifted to a care manager organisation had a significant decrease in inadequate medication users over time (p=0.01). CONCLUSIONS Public PCCs had a more consistent antidepressant medication pattern compared with private PCCs that gained more by introducing a care manager organisation. It was possible to document a significant decrease in inadequate medication users, notwithstanding that PCCs in the region followed the guidelines to a comparatively high extent regardless of present care manager organisation.
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Affiliation(s)
- Christine Sandheimer
- Social medicine, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Cecilia Björkelund
- Social medicine, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgenska Academy, University of Gothenburg, Goteborg, Sweden
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research and Development, Primary Health Care, Region Västra Götaland, Sweden
| | - Gunnel Hensing
- Social medicine, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Kirsten Mehlig
- Social medicine, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgenska Academy, University of Gothenburg, Goteborg, Sweden
- Lifecourse Epidemiology, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tove Hedenrud
- Social medicine, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgenska Academy, University of Gothenburg, Goteborg, Sweden
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12
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Jang S, Cho H, Kang C, Jang S. Antidepressant adherence and its predictors in immigrants with depression: A population-based study. Medicine (Baltimore) 2020; 99:e23308. [PMID: 33371064 PMCID: PMC7748329 DOI: 10.1097/md.0000000000023308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 10/21/2020] [Indexed: 11/26/2022] Open
Abstract
Immigrants in Korea are relatively vulnerable in terms of medication self-management and have low levels of medication adherence. We aimed to evaluate antidepressant adherence and its patterns in immigrants and to identify predictors of nonadherence.In this matched cohort study using the National Health Insurance claims database, immigrants who were newly prescribed antidepressants were identified (n = 2,398). The immigrants were matched with native-born Koreans in a 1:1 ratio. Antidepressant adherence was measured by the medication possession ratio at monthly intervals. Logistic regression was performed to compare antidepressant nonadherence between immigrants and native-born Koreans, and to identify factors affecting immigrants' nonadherence.The average medication possession ratio of immigrants was 27.1%, which was lower than that of native-born Koreans (30.9%) (P = .038). Immigrants had a lower likelihood of adherence than native-born Koreans (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.3-0.92). Older age, visiting a psychiatrist for the first diagnosis of depression (OR 2.24, 95% CI 1.60-3.13), achieving appropriateness of care (OR 3.54, 95% CI 2.51-4.98), and having a usual source of care (OR 1.69, 95% CI 1.25-2.27) were associated with a higher likelihood of adherence in immigrants.This study showed that antidepressant adherence of immigrants was lower than that of native-born Koreans. However, it appears that visiting a psychiatrist, achieving appropriateness of care, and having a usual source of care might increase antidepressant adherence among immigrants. Further research that focuses on cultural and/or linguistic factors affecting immigrants' adherence and healthcare utilization is suggested as a way to increase adherence.
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Affiliation(s)
- Suhyun Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon
| | - Hyemin Cho
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon
| | - Cinoo Kang
- Department of Biostatics and Epidemiology Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon
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13
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Treatment of Anxiety Disorders - The Role of Pharmacists. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2019. [DOI: 10.2478/sjecr-2019-0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Abstract
Anxiety disorders represent the group of the most prevalent mental diseases which may have serious negative consequences for mental and social health. Anxiety is generally treated with a combination of the psychotherapeutic treatment and pharmacotherapy. Pharmacotherapy of anxiety implies the use of antidepressants, which are used as basic drugs, and an additional therapy with anxiolytics. This therapeutic approach in the treatment of anxiety disorders is accompanied by significant limitations. Adherence of anxiety patients is often insufficient due to the late onset of the effects of antidepressants, the appearance of adverse effects, the stigmatization of psychiatric patients in society and other reasons. Certain exogenous factors, such as an excessive use of coffee, smoking of marijuana, sleep disorders and personal problems, such as family problems or financial problems, can exacerbate anxiety and make it more difficult to treat it. Prolonged use of benzodiazepines, as an adjunct therapy in the treatment of anxiety, may be accompanied by the development of psycho-physical dependence. Finally, the drugs used to treat anxiety have a serious potential for the drug-drug interactions. All of these limitations may be completely or partially overcome through the active participation of Pharmacists as equal members of collaborative medical teams for the treatment of anxiety disorders.
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14
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Cheen MHH, Tan YZ, Oh LF, Wee HL, Thumboo J. Prevalence of and factors associated with primary medication non-adherence in chronic disease: A systematic review and meta-analysis. Int J Clin Pract 2019; 73:e13350. [PMID: 30941854 DOI: 10.1111/ijcp.13350] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 03/20/2019] [Accepted: 03/30/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Primary medication non-adherence (PMN), defined as failure to obtain newly prescribed medications, results in adverse clinical and economic outcomes. We aimed to (a) assess the prevalence of PMN in six common chronic diseases: asthma and/ or chronic obstructive pulmonary disease, depression, diabetes mellitus, hyperlipidaemia, hypertension and osteoporosis; (b) identify and categorise factors associated with PMN; (c) explore characteristics that contributed to heterogeneity between studies. METHODS We performed a systematic search in MEDLINE, Embase, Cochrane Library, CINAHL and PsycINFO. Studies published in English between January 2008 and August 2018 assessing PMN in subjects aged ≥18 years were included. We used the Cochrane risk of bias tool, Newcastle-Ottawa Scale and National Heart, Lung and Blood Institute Quality Assessment Tool to assess the quality of randomised controlled trials, cohort and cross-sectional studies, respectively. Findings were reported using the PRISMA checklist. PMN rates were pooled using a random effects model. We summarised factors associated with PMN descriptively. Subgroup analysis was performed to explore sources of heterogeneity. RESULTS We screened 3083 articles and included 33 (5 randomised controlled trials, 26 cohort and 2 cross-sectional studies, n = 539 156), of which 31 (n = 519 971) were used in meta-analysis. The pooled PMN rate was 17% (95% CI: 15%-20%). Pooled PMN rates were highest in osteoporosis (25%, 95% CI: 7%-44%) and hyperlipidaemia (25%, 95% CI: 18%-32%) and lowest in diabetes mellitus (10%, 95% CI: 7%-12%). Factors commonly associated with PMN include younger age, number of concurrent medications, practitioner specialty and higher co-payment. Type of chronic disease, age, study setting and PMN definition contributed to heterogeneity between studies (all P < 0.001). CONCLUSION Primary medication non-adherence is common among patients with chronic diseases and more needs to be done to address this issue in order to improve patient outcomes. Future PMN studies could benefit from greater standardisation to enhance comparability.
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Affiliation(s)
- McVin Hua Heng Cheen
- Department of Pharmacy, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Yan Zhi Tan
- Department of Pharmacy, Singapore General Hospital, Singapore
| | - Ling Fen Oh
- Department of Pharmacy, National University of Singapore, Singapore
| | - Hwee Lin Wee
- Saw Swee Hock School of Public Health, Department of Pharmacy, National University of Singapore, Singapore
| | - Julian Thumboo
- Duke-NUS Medical School, Singapore
- Rheumatology and Immunology, Singapore General Hospital, Singapore
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15
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Jeong S, Kang C, Cho H, Kang HJ, Jang S. Socioeconomic determinants affecting the access and utilization of depression care services in immigrants: A population-based study. PLoS One 2019; 14:e0213020. [PMID: 30865684 PMCID: PMC6415893 DOI: 10.1371/journal.pone.0213020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 02/13/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND It is imperative to address the health problems faced by immigrants in their destination countries in light of the current magnitude of migration processes worldwide. We aimed to evaluate the socioeconomic determinants of healthcare utilization in immigrants with depression. METHOD A population-based cohort comprising all immigrants who were eligible for National Health Insurance coverage (permanent residents, marriage immigrants, and naturalized citizens) using the National Health Insurance Claims Database in 2011-2013 was established. Cases were defined as immigrants with new-onset depression. Controls were new-onset Korean patients with depression matched by age, sex, and Charlson comorbidity index in a 1:2 ratio. Appropriateness of care (AOC) was defined as visiting a clinic for depression management at least 3 times in the first 12 weeks and 4 times thereafter until 12 months post-cohort entry. RESULTS A total of 2,378 immigrants and 4,756 matched Korean patients were identified. Of the immigrants, 30.0% achieved AOC, in contrast to 38.7% of Koreans (p < .0001). Adjusting for possible covariates, AOC was less likely for immigrants (adjusted OR (aOR), 0.760; 95% CI: 0.670-0.863). Medical Aid (aOR, 2.309; 95% CI, 1.479-3.610), rural residence (aOR, 1.536; 95% CI, 1.054-2.237), the presence of a psychiatric comorbidity (aOR, 1.912; 95% CI, 1.484-2.463), and visiting a psychiatrist (aOR, 2.387; 95% CI, 1.821-3.125) were associated with an increased likelihood of AOC in immigrants. CONCLUSION Socioeconomic determinants included insurance type (Medical Aid and National Health Insurance), place of residence, psychiatric comorbid status, doctor specialty, easy access to medical services (clinic-based), and a SSRI-based treatment regimen. Those predictors should be taken into account when developing healthcare strategies for immigrants.
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Affiliation(s)
- Sohyun Jeong
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Korea
| | - Cinoo Kang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Korea
| | - Hyemin Cho
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Korea
| | - Hee-Jin Kang
- Big Data Steering Department of National Health Insurance Service, Wonju, Korea
| | - Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Korea
- * E-mail:
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16
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Svenningsson I, Udo C, Westman J, Nejati S, Hange D, Björkelund C, Petersson EL. Creating a safety net for patients with depression in primary care; a qualitative study of care managers' experiences. Scand J Prim Health Care 2018; 36:355-362. [PMID: 30314415 PMCID: PMC6381518 DOI: 10.1080/02813432.2018.1529018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore nurses' experiences and perceptions of working as care managers at primary care centers. DESIGN Qualitative, focus group study. Systematic text condensation was used to analyze the data. SETTING Primary health care in the region of Västra Götaland and region of Dalarna in Sweden. SUBJECTS Eight nurses were trained during three days including treatment of depression and how to work as care managers. The training was followed by continuous support. MAIN OUTCOME MEASURES The nurses' experiences and perceptions of working as care managers at primary care centers. RESULTS The care managers described their role as providing additional support to the already existing care at the primary care center, working in teams with a person-centered focus, where they were given the opportunity to follow, support, and constitute a safety net for patients with depression. Further, they perceived that the care manager increased continuity and accessibility to primary care for patients with depression. CONCLUSION The nurses perceived that working as care managers enabled them to follow and support patients with depression and to maintain close contact during the illness. The care manager function helped to provide continuity in care which is a main task of primary health care. Key Points The care managers described their role as an additional support to the already existing care at the primary care center. • They emphasized that as care managers, they had a person-centered focus and constituted a safety net for patients with depression. • Their role as care managers enabled them to follow and support patients with depression over time, which made their work more meaningful. • Care managers helped to achieve continuity and accessibility to primary health care for patients with depression.
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Affiliation(s)
- Irene Svenningsson
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
- Primary Health Care, Närhälsan Research and Development, Region Västra Götaland, Sweden;
- CONTACT Irene Svenningsson Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenPrimary Health Care, Närhälsan Research and Development, Region Västra Götaland, Sweden
| | - Camilla Udo
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden;
- Centre for Clinical Research, Dalarna, Sweden;
| | - Jeanette Westman
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Shabnam Nejati
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
| | - Dominique Hange
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
| | - Cecilia Björkelund
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
| | - Eva-Lisa Petersson
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
- Primary Health Care, Närhälsan Research and Development, Region Västra Götaland, Sweden;
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17
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Lemstra M, Nwankwo C, Bird Y, Moraros J. Primary nonadherence to chronic disease medications: a meta-analysis. Patient Prefer Adherence 2018; 12:721-731. [PMID: 29765208 PMCID: PMC5944464 DOI: 10.2147/ppa.s161151] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Medication nonadherence is a global problem that requires urgent attention. Primary nonadherence occurs when a patient consults with a medical doctor, receives a referral for medical therapy but never fills the first dispensation for the prescription medication. Nonadherence to chronic disease medications costs the USA ~$290 billion (USD) every year in avoidable health care costs. In Canada, it is estimated that 5.4% of all hospitalizations are due to medication nonadherence. OBJECTIVES The objective of this study was to quantify the extent of primary nonadherence for four of the most common chronic disease medications. The second objective was to identify factors associated with primary nonadherence to chronic disease medications. MATERIALS AND METHODS We conducted an extensive systematic literature review of eight databases with a wide range of keywords. We identified relevant articles for primary nonadherence to antihypertensives, lipid-lowering agents, hypoglycemics, and antidepressants. After further screening and assessment of methodologic quality, relevant data were extracted and analyzed using a random-effects model. RESULTS Twenty-four articles were included for our meta-analysis after full review and assessment for risk of bias. The pooled primary nonadherence rate for the four chronic disease medications was 14.6% (95% CI: 13.1%-16.2%). Primary medication nonadherence was higher for lipid-lowering medications among the four chronic disease medications assessed (20.8%; 95% CI: 16.0%-25.6%). The rates in North America (17.0%; 95% CI: 14.4%-19.5%) were twice those from Europe (8.5%; 95% CI: 7.1%-9.9%). The absence of social support (20%; 95% CI: 14.4%-26.6%) was the most common sociodemographic variable associated with chronic disease medication primary nonadherence. CONCLUSION Evidence suggests that a considerable percentage of patients do not initially fill their medications for treatable chronic diseases or conditions. This represents a major health care problem that can be successfully addressed. Efforts should be directed toward proper medication counseling, patient social support, and clinical follow-up, especially when the indications for the prescribed medication aim to provide primary prevention.
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Affiliation(s)
- Mark Lemstra
- Alliance Health Medical Clinics, Moose Jaw, Regina and Saskatoon, Saskatchewan, Canada
- Correspondence: Mark Lemstra, Alliance Health Medical Clinics, B70 500 – 1st Avenue NW, Moose Jaw, SK S6H 3M5, Canada, Email
| | - Chijioke Nwankwo
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Yelena Bird
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John Moraros
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Valachis A, Garmo H, Weinman J, Fredriksson I, Ahlgren J, Sund M, Holmberg L. Effect of selective serotonin reuptake inhibitors use on endocrine therapy adherence and breast cancer mortality: a population-based study. Breast Cancer Res Treat 2016; 159:293-303. [PMID: 27492739 PMCID: PMC5012147 DOI: 10.1007/s10549-016-3928-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/20/2016] [Indexed: 01/13/2023]
Abstract
The purpose of the study was to investigate whether the concomitant use of selective serotonin reuptake inhibitors (SSRI) with tamoxifen influences the risk of death due to breast cancer, and we also investigated the association between SSRI use and adherence to oral endocrine therapy (ET). We analyzed data from BCBaSe Sweden, which is a database created by the data linkage of Registries from three different regions of Sweden. To investigate the association between ET adherence and SSRI use, we included all women who were diagnosed with non-distant metastatic ER-positive invasive breast cancer from July 2007 to July 2011 and had at least one dispensed prescription of oral tamoxifen or aromatase inhibitor. To investigate the role of concurrent administration of SSRI and tamoxifen on breast cancer prognosis, we performed a nested case–control study. In the adherence cohort, 9104 women were included in the analyses. Women who received SSRI, either before or after breast cancer diagnosis, were at higher risk for low adherence to ET. However, when the overlapping period between SSRI use and ET was >50 %, no excess risk for low adherence was observed. Non-adherence (<80 %) to ET was significantly associated with worse breast cancer survival (OR 4.07; 95 % CI 3.27–5.06). In the case–control study, 445 cases and 11125 controls were included. The concomitant administration of SSRI and tamoxifen did not influence breast cancer survival, neither in short-term (OR 1.41; 95 % CI 0.74–2.68) nor in long-term SSRI users (OR 0.85; 95 % CI 0.35–2.08). Concomitant SSRI and tamoxifen use does not seem to increase risk for death due to breast cancer. Given the positive association between continuing antidepressive pharmacotherapy for a longer period of time and adherence to ET, it is essential to capture and treat depression in breast cancer patients to secure adherence to ET.
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Affiliation(s)
- Antonis Valachis
- Centre for Clinical Research Sörmland, Uppsala University, 63188, Eskilstuna, Sweden.
| | - Hans Garmo
- Division of Cancer Studies, Cancer Epidemiology Unit, School of Medicine, King's College London, London, UK
| | - John Weinman
- Institute of Pharmaceutical Science, King's College London, London, SE1 9NH, UK
| | - Irma Fredriksson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Ahlgren
- Department of Oncology, Faculty of Medicine and Health, University of Örebro, Örebro, Sweden
| | - Malin Sund
- Department of Surgical and Perioperative Sciences, Umeå University, 901 85, Umeå, Sweden
| | - Lars Holmberg
- Division of Cancer Studies, Cancer Epidemiology Unit, School of Medicine, King's College London, London, UK
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