Patient activation and medication adherence in adults

Use and Discontinuation Rates of Long-Acting Injectable Antipsychotics Between Race/Ethnicity in Older Adults Using Medicaid Databases

OBJECTIVE

The primary objective of this study was to assess the prescribing patterns of long acting injectable (LAI) antipsychotics in an older adult population. Secondary objectives were to determine if there were differences in treatment discontinuation rates between different LAI agents and race/ethnicity.

METHODS

Merative MarketScan Multi-State Medicaid Databases (2017-2021) were used to identify patients 65 years or older who were prescribed a LAI antipsychotic. Pharmacy claims for LAI antipsychotics were referenced via National Drug Code (NDC) by brand/generic name and dose. International Classification of Diseases, 10th edition (ICD-10) codes were used to identify older adults diagnosed with schizophrenia, schizotypal or schizoaffective disorders. Those with dementia or related disorders were censored. Conditional associations between race/ethnicity and generation of LAI antipsychotics were investigated using logistic regression controlling for age, sex, and health plan. Cox proportional hazard regression was used to compare the distribution of time until treatment discontinuation among older adults across LAI antipsychotics.

RESULTS

A total of 526 older adults (59% female) with an average age of 70.4 ± 5.5 years met inclusion for analysis. The most commonly used LAI antipsychotics included paliperidone palmitate-1 month formulation (~35%), haloperidol decanoate (~24%), and risperidone microspheres (~15%). Overall, approximately 32% received LAI first-generation antipsychotics and 68% received LAI second generation antipsychotics. Blacks (n = 204) received LAI first-generation antipsychotics more often than Whites (n = 283); (OR: 1.74, 95% [1.18, 2.56], p < 0.01). When controlling for age, sex, and race/ethnicity, LAI first-generation antipsychotics showed earlier discontinuation rates compared to LAI second-generation antipsychotics (HR: 2.12, 95% CI [1.45, 3.10], p < 0.001).

CONCLUSIONS

LAI first-generation antipsychotics showed treatment discontinuation significantly earlier compared to LAI second-generation antipsychotics. Furthermore, Blacks were prescribed LAI first-generation antipsychotics at a higher rate than Whites, which may contribute to poorer health outcomes. Futures studies are needed to establish a causal relationship.

Validation of the Patient Activation Measure in kidney stone disease patients

INTRODUCTION

We aimed to validate the Patient Activation Measure (PAM) within a kidney stone disease (KSD) population, determine the variability of patient activation within this population, and characterize relationships between activation and variables such as health literacy, quality of life, and demographics.

METHODS

This cross-sectional study includes individuals 18 years or older followed for KSD at University of Montreal Hospital Center. Demographic data and responses for the PAM, Wisconsin Stone Quality of Life scale, and Health Literacy Questionnaire (HLQ) were acquired.

RESULTS

Females and those with poor medication adherence were found to have significantly lower activation. The HLQ dimensions "Actively managing my health," "Navigating the healthcare system," and "Understand health information well enough to know what to do" were associated with significantly higher activation. Rasch analysis revealed an item reliability of 0.81, a person reliability of 0.98, and a Cronbach's alpha of 0.88. Regarding item fit, only item 1 (When all is said and done, I am the person who is responsible for taking care of my health) fit poorly with the model. Principle component analysis revealed evidence of a second dimension, accounting for 9.0% of the variation in observed responses.

CONCLUSIONS

Female sex and poor medication adherence were associated with significantly lower activation. Aspects of health literacy concurring with the precise definition of "activation" were associated with significantly higher PAM scores. The PAM was found to have good person and item reliability, and good internal consistency; however, principal component analysis revealed that construct validity is possibly threatened by multidimensionality.

Sociodemographic profile of patients treated by the Hemodynamics and Interventional Cardiology Service from Hospital São Paulo-Brazil

OBJECTIVE

Ischemic heart disease and acute myocardial infarction are the main causes of death and morbidity worldwide. It has been proposed that knowledge of the profile of patients treated allows the development of more effective strategies to improve adherence to treatment and consequently the best clinical results. The aim of this study was to develop a descriptive and observational study to identify and describe the sociodemographic profile of patients treated by the medical complex of Hemodynamics and Interventional Cardiology Service of Hospital São Paulo from Escola Paulista de Medicina/Universidade Federal de São Paulo.

METHODS

This study was performed on 3,593 patients from the Hemodynamics and Interventional Cardiology Service/Hospital São Paulo/Escola Paulista de Medicina/Universidade Federal de São Paulo complex between July 1, 2020, and October 30, 2022. Using data collected on the REDCap platform, variables, such as gender, age group, ethnicity, education level, and origin of the patients, were analyzed.

RESULTS

Of the total patients (3,593), 60.1% were male, 59.18% were older adults, 66.34% belonged to White race, and 33.69% had incomplete primary education. Geographically, most patients were from the capital of São Paulo State (76.46%), with a smaller proportion coming from the greater São Paulo area (16.77%) and other regions.

CONCLUSION

Understanding the sociodemographic profile of patients treated by the medical complex of Hemodynamics and Interventional Cardiology Service/Hospital São Paulo/Escola Paulista de Medicina/Universidade Federal de São Paulo will be fundamental for developing more effective and personalized medical intervention strategies, aiming to increase treatment adherence and improve the quality of care provided. These data may also be useful for other medical centers in Brazil and other parts of the world.

Association between patient activation and adherence to a colorectal enhanced recovery pathway: a prospective cohort study

BACKGROUND

Low adherence to enhanced recovery pathways (ERPs) may negatively affect postoperative outcomes. The objective of this study was to assess the extent to which patient activation (PA, i.e., knowledge, skills, and confidence to participate in care) is associated with adherence to an ERP for colorectal surgery.

METHODS AND PROCEDURES

This cohort study included adult patients (≥ 18 yo) undergoing in-patient elective colorectal surgery at two university-affiliated hospitals in Montreal, Canada. Preoperatively, patients completed the Patient Activation Measure (PAM) questionnaire (score 0-100, categorized into low PA [≤ 55.1] vs. high PA [≥ 55.2]). All patients were managed with an ERP including 15 interventions classified into 2 groups: those requiring active patient participation (5 active ERP interventions, including early oral intake and mobilization) and those directed by the clinical team (10 passive ERP interventions, including early termination of IV fluids and urinary drainage). The adjusted association between PA and ERP adherence was evaluated using linear regression.

RESULTS

A total of 286 patients were included (mean age 59 ± 15 years, 45% female, 62% laparoscopic, 33% rectal, median length of stay 4 days [IQR 2-6]). Most patients had high levels of PA (74%). Mean adherence was 90% (95% CI 88-91%) for passive ERP interventions and 72% (95% CI 70-75%) for active interventions. On regression analysis, high PA was associated with increased adherence to active ERP interventions (+ 6.8% [95% CI + 1.1 to + 12.5%]), but not to passive interventions (+ 2.5% [95% CI - 0.3 to + 5.3%]). Increased active ERP adherence was associated with reduced length of stay, 30-day complications, and hospital readmissions.

CONCLUSION

This study supports that high PA is associated with increased adherence to ERP interventions, particularly those requiring active patient participation. Preoperative identification of patients with low activation may inform interventions to optimize patient involvement with ERPs and improve postoperative outcomes.