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Al-Aqeel S. Nonadherence to antiseizure medications: what have we learned and what can be done next? Expert Rev Pharmacoecon Outcomes Res 2024:1-8. [PMID: 38676921 DOI: 10.1080/14737167.2024.2349191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/25/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Nonadherence to antiseizure medications (ASMs) is associated with increased mortality, morbidity, health care utilization, and costs. AREAS COVERED This article reviewed 18 randomized controlled trials published between Jan 2010 and Feb 2024 on Medication Adherence Enhancing Intervention (MAEI) for people with epilepsy. The adequacy of reporting intervention development process was assessed using the GUIDance for the rEporting of intervention Development (GUIDED). The adequacy of the intervention description was assessed using the Template for Intervention Description and Replication (TIDieR) checklist. The interventions were categorized as educational (n = 7), behavioral (n = 5), or mixed (n = 6). The impact of MAEIs on adherence is mixed with majority of studies either reporting no difference between intervention and control groups (n = 6) or improvement in the intervention group (n = 7). The shortcomings in the reporting of MAEIs development, MAEIs description, and MAEIs impact measurement were discussed. EXPERT OPINION Future research needs to accomplish the following tasks: 1) develop and test valid epilepsy-specific self-report measures for assessing adherence; 2) optimize intervention design; and 3) increase transparency in reporting all stages of research.
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Affiliation(s)
- Sinaa Al-Aqeel
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Chastek B, Carrera A, Landis C, Snyder D, Abedinzadeh L, Bancroft T, Nesheim J, Kennelly M, Staskin D. Real-World Adherence to and Persistence with Vibegron in Patients with Overactive Bladder: A Retrospective Claims Analysis. Adv Ther 2024; 41:2086-2097. [PMID: 38520502 PMCID: PMC11052770 DOI: 10.1007/s12325-024-02824-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/15/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Vibegron is a β3-adrenergic receptor agonist approved for overactive bladder (OAB). This analysis assessed real-world adherence and persistence with vibegron in patients with OAB, along with demographics and clinical characteristics associated with adherence and persistence. METHODS This retrospective study used the Optum Research Database to identify patients treated with vibegron from April 2021 to August 2022 (identification period). Patients had ≥ 60 days of continuous pharmacy coverage in a commercial or Medicare Advantage plan following the index fill (follow-up). Adherence was assessed as proportion of days covered (PDC) from index to end of follow-up and was defined as PDC ≥ 80%. Persistence was measured as days to discontinuation of therapy (30-day gap) or end of follow-up. Data for adherence and persistence are presented descriptively. Characteristics associated with adherence and persistence were analyzed using multivariable models among patients with medical and pharmacy benefits during the 90 days before index (baseline). RESULTS Overall, 9992 patients had a vibegron claim during the identification period; 9712 had ≥ 2 months of follow-up. Mean (SD) age was 74.2 (10.7) years; 68.2% were female. Mean (SD) PDC was 0.64 (0.34). Median (95% confidence interval) persistence was 142 (132-153) days. Of the 5073 patients who were ≥ 18 years old with continuous baseline pharmacy and medical benefits ≥ 90 days before index, 2497 (49.2%) were adherent. Patients were more likely to be adherent and persistent if they received a greater days' supply for the index fill and had baseline medication count ≥ 6. Patients were more likely to discontinue if their index copay was > $45. CONCLUSION Nearly half of the patients initiating vibegron were adherent. Factors associated with adherence and persistence were more likely to be related to prescribing practices than patient characteristics. These results suggest it may be best to follow up with patients approximately 4 to 5 months after initiating treatment with vibegron.
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Affiliation(s)
| | - Adam Carrera
- Sumitomo Pharma America, Inc. (Formerly Urovant Sciences, Inc.), 84 Waterford Dr, Marlborough, MA, 01752, USA.
| | | | - Daniel Snyder
- Sumitomo Pharma America, Inc. (Formerly Urovant Sciences, Inc.), 84 Waterford Dr, Marlborough, MA, 01752, USA
| | - Laleh Abedinzadeh
- Sumitomo Pharma America, Inc. (Formerly Urovant Sciences, Inc.), 84 Waterford Dr, Marlborough, MA, 01752, USA
| | | | - Jeffrey Nesheim
- Sumitomo Pharma America, Inc. (Formerly Urovant Sciences, Inc.), 84 Waterford Dr, Marlborough, MA, 01752, USA
| | | | - David Staskin
- Tufts University School of Medicine, Boston, MA, USA
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Akamine A, Nagasaki Y, Tomizawa A, Otori K. Risk Factors for Non-Adherence to Pharmacist or Non-Pharmacist Explanations on Preoperative Medication Discontinuation: A Retrospective Japanese Study. Patient Prefer Adherence 2024; 18:255-266. [PMID: 38313826 PMCID: PMC10838503 DOI: 10.2147/ppa.s445474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/20/2024] [Indexed: 02/06/2024] Open
Abstract
Purpose The risk factors for non-adherence to pharmacist or non-pharmacist explanations of preoperative medication discontinuation are unknown. The primary outcome of this study was to determine whether the final explainer's occupation was a risk factor for non-adherence. The secondary outcomes were to determine the risk factors for non-adherence after limiting the departments or adjusting for age. Patients and Methods We retrospectively examined the data (including patient age, sex, prescription medications, comorbidities, presence of roommate, and number of days between receiving explanation and surgery) of 1132 patients on medications that could affect surgery at a Japanese university hospital between April 1, 2017, and March 31, 2020. The primary endpoint was whether the occupation of the last person explaining medication discontinuation to the patient was an independent risk factor for non-adherence (age ≥65 years vs <65 years). Secondary endpoints included subgroup analyses in urological, gastrointestinal, and otolaryngological areas, as well as a sensitivity analysis (age as a continuous variable) to confirm the validity of the primary endpoint results. A multivariate binary logistic regression identified independent non-adherence risk factors. Results The main analysis showed that discontinuing two or more medications was a risk factor for non-adherence (adjusted odds ratio (AOR): 1.67; 95% confidence interval (CI): 1.13-2.47; p = 0.01). However, in analyses coordinated by department (urological, gastrointestinal, and otolaryngological), ≥65 (versus <65) years of age was determined as a risk factor for increased nonadherence (AOR: 2.27, 95% CI: 1.11-4.63; p=0.024). Age-adjusted analysis (continuous variables) showed similar results to the primary endpoint (AOR: 1.68, 95% CI: 1.14-2.49, p = 0.009). Conclusion Two or more medications, and not the final explainer's occupation, were associated with pre-surgery medication non-adherence. To prevent non-adherence, pharmacists and non-pharmacists should educate patients about preoperative medication discontinuation. These findings could help identify high-risk non-adherence patients.
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Affiliation(s)
| | - Yuya Nagasaki
- Department of Pharmacy, Kitasato University Hospital, Kanagawa, Japan
| | - Atsushi Tomizawa
- Department of Pharmacy, Kitasato University Hospital, Kanagawa, Japan
| | - Katsuya Otori
- Department of Pharmacy, Kitasato University Hospital, Kanagawa, Japan
- Research and Education Center for Clinical Pharmacy, Division of Clinical Pharmacy, Laboratory of Pharmacy Practice and Science 1, Kitasato University School of Pharmacy, Tokyo, Japan
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Espírito-Santo M, Santos S, Estêvão MD. Digital Solutions Available to Be Used by Informal Caregivers, Contributing to Medication Adherence: A Scoping Review. Pharmacy (Basel) 2024; 12:20. [PMID: 38392927 PMCID: PMC10893508 DOI: 10.3390/pharmacy12010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 02/25/2024] Open
Abstract
Medication adherence is essential for managing chronic diseases and achieving optimal health outcomes. However, this process is often challenging, particularly for patients with complex care needs. Informal caregivers play a pivotal role in supporting medication management, but they may face resource limitations and a lack of necessary support. Digital health tools offer a promising avenue to enhance medication adherence by providing reminders, education, and remote monitoring capabilities. This scoping review aimed to identify and evaluate digital solutions available to informal caregivers for improving medication adherence. A systematic search of PubMed and Web of Science was conducted using relevant keywords. Four studies were included in the review, examining a variety of digital tools including mobile apps, SMS messaging, and wearable devices. These tools demonstrated efficacy in improving medication adherence, managing disease symptoms, and enhancing quality of life for patients and caregivers. Digital health interventions hold the potential to revolutionize medication adherence among chronic disease patients. By empowering informal caregivers, these tools can bridge the gaps in medication management and contribute to better health outcomes. Further research is warranted to optimize the design, implementation, and evaluation of digital interventions for medication adherence.
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Affiliation(s)
- Margarida Espírito-Santo
- School of Health, University of Algarve, 8005-139 Faro, Portugal (M.D.E.)
- Centre for Health Studies and Development (CESUAlg), University of Algarve, 8005-139 Faro, Portugal
- Algarve Biomedical Center Research Institute (ABC-RI), 8005-139 Faro, Portugal
| | - Sancha Santos
- School of Health, University of Algarve, 8005-139 Faro, Portugal (M.D.E.)
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Betts AC, Murphy CC, Shay LA, Balasubramanian BA, Markham C, Roth ME, Allicock M. Polypharmacy and medication fill nonadherence in a population-based sample of adolescent and young adult cancer survivors, 2008-2017. J Cancer Surviv 2023; 17:1688-1697. [PMID: 36346577 PMCID: PMC10164839 DOI: 10.1007/s11764-022-01274-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/11/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE We examined the association between polypharmacy-an established risk factor for nonadherence in the elderly-and medication fill nonadherence in a large national sample of adolescent and young adult cancer survivors (AYAs) in the USA. METHODS We pooled data (2008-2017) from the Medical Expenditure Panel Survey. We defined polypharmacy as ≥ 3 unique medications prescribed, based on self-report and pharmacy data, and medication fill nonadherence as self-reported delay or inability to obtain a necessary medication. We estimated prevalence of medication fill nonadherence among AYAs (age 18-39 years with a cancer history). We used logistic regression to estimate the association between (1) polypharmacy and medication fill nonadherence in AYAs, and (2) total number of medications prescribed and medication fill nonadherence, controlling for sex, number of chronic conditions, disability, and survey year. RESULTS AYAs (n = 598) were predominantly female (76.2%), age 30-39 years (64.9%), and non-Hispanic White (72.1%). Nearly half were poor (19.0%) or near-poor/low income (21.6%). One in ten AYAs reported medication fill nonadherence (9.75%). Of these, more than 70% cited cost-related barriers as the reason. AYAs with polypharmacy had 2.49 times higher odds of medication fill nonadherence (95%CI 1.11-5.59), compared to those without polypharmacy. Odds of medication fill nonadherence increased by 16% with each additional medication prescribed (AOR 1.16, 95% CI 1.07-1.25). CONCLUSIONS Polypharmacy may be an important risk factor for medication fill nonadherence in AYAs in the USA. IMPLICATIONS FOR CANCER SURVIVORS Improving AYAs' medication adherence requires eliminating cost-related barriers, particularly for those with polypharmacy.
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Affiliation(s)
- Andrea C Betts
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA.
| | - Caitlin C Murphy
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Houston, TX, USA
| | - L Aubree Shay
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, San Antonio, TX, USA
| | - Bijal A Balasubramanian
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Dallas, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Dallas, TX, USA
| | - Christine Markham
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Houston, TX, USA
| | - Michael E Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marlyn Allicock
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Dallas, TX, USA
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Purić D, Petrović MB, Živanović M, Lukić P, Zupan Z, Branković M, Ninković M, Lazarević LB, Stanković S, Žeželj I. Development of a novel instrument for assessing intentional non-adherence to official medical recommendations (iNAR-12): a sequential mixed-methods study in Serbia. BMJ Open 2023; 13:e069978. [PMID: 37369402 PMCID: PMC10410978 DOI: 10.1136/bmjopen-2022-069978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES We aimed to (1) develop a novel instrument, suitable for the general population, capturing intentional non-adherence (iNAR), consisting of non-adherence to prescribed therapy, self-medication and avoidance of seeking medical treatment; (2) differentiate it from other forms of non-adherence, for example, smoking; and (3) relate iNAR to patient-related factors, such as sociodemographics, health status and endorsement of irrational beliefs (conspiratorial thinking and superstitions) and to healthcare-related beliefs and experiences ((mis)trust and negative experiences with the healthcare system, normalisation of patient passivity). DESIGN То generate iNAR items, we employed a focus group with medical doctors, supplemented it with a literature search and invited a public health expert to refine it further. We examined the internal structure and predictors of iNAR in an observational study. SETTING Data were collected online using snowball sampling and social networks. PARTICIPANTS After excluding those who failed one or more out of three attention checks, the final sample size was n=583 adult Serbian citizens, 74.4% female, mean age 39.01 years (SD=12.10). PRIMARY AND SECONDARY OUTCOME MEASURES The primary, planned outcome is the iNAR Questionnaire, while smoking was used for comparison purposes. RESULTS Factor analysis yielded a one-factor solution, and the final 12-item iNAR Questionnaire had satisfactory internal reliability (alpha=0.72). Health condition and healthcare-related variables accounted for 14% of the variance of iNAR behaviours, whereas sociodemographics and irrational beliefs did not additionally contribute. CONCLUSIONS We constructed a brief yet comprehensive measure of iNAR behaviours and related them to health and sociodemographic variables and irrational beliefs. The findings suggest that public health interventions should attempt to improve patients' experiences with the system and build trust with their healthcare practitioners rather than aim at specific demographic groups or at correcting patients' unfounded beliefs. STUDY REGISTRATION The design and confirmatory analyses plan were preregistered (https://osf.io/pnugm).
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Affiliation(s)
- D Purić
- Department of Psychology, University of Belgrade, Belgrade, Serbia
- Laboratory for Research of Individual Differences, University of Belgrade, Belgrade, Serbia
| | - M B Petrović
- Department of Psychology, University of Belgrade, Belgrade, Serbia
- Laboratory for Research of Individual Differences, University of Belgrade, Belgrade, Serbia
| | - M Živanović
- Laboratory for Research of Individual Differences, University of Belgrade, Belgrade, Serbia
- Institute for Psychology, University of Belgrade, Belgrade, Serbia
| | - P Lukić
- Department of Psychology, University of Belgrade, Belgrade, Serbia
- Laboratory for Research of Individual Differences, University of Belgrade, Belgrade, Serbia
| | - Z Zupan
- Laboratory for Research of Individual Differences, University of Belgrade, Belgrade, Serbia
- Institute for Psychology, University of Belgrade, Belgrade, Serbia
| | - M Branković
- Institute for Philosophy and Social Theory, Belgrade, Serbia
- Singidunum University, Belgrade, Serbia
| | - M Ninković
- Department of Psychology, University of Belgrade, Belgrade, Serbia
- Laboratory for Research of Individual Differences, University of Belgrade, Belgrade, Serbia
| | - L B Lazarević
- Laboratory for Research of Individual Differences, University of Belgrade, Belgrade, Serbia
- Institute for Psychology, University of Belgrade, Belgrade, Serbia
| | - S Stanković
- Laboratory for Research of Individual Differences, University of Belgrade, Belgrade, Serbia
- Institute for Psychology, University of Belgrade, Belgrade, Serbia
| | - I Žeželj
- Department of Psychology, University of Belgrade, Belgrade, Serbia
- Laboratory for Research of Individual Differences, University of Belgrade, Belgrade, Serbia
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Mahaisavariya C, Vanitcharoenkul E, Kitcharanant N, Chotiyarnwong P, Unnanuntana A. Exploring the osteoporosis treatment gap after fragility hip fracture at a Tertiary University Medical Center in Thailand. BMC Geriatr 2023; 23:70. [PMID: 36737708 PMCID: PMC9898992 DOI: 10.1186/s12877-023-03778-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND (1) To evaluate the prescription rate of anti-osteoporosis medication, and (2) to identify factors associated with patients not receiving anti-osteoporosis medication or, when prescribed, not persisting with medication 1 year after hip fracture treatment. METHODS We retrospectively reviewed the medical records of all fragility hip fracture patients admitted to the orthopedic unit of the Faculty of Medicine Siriraj Hospital, Mahidol University, between July 1, 2016, and December 31, 2019. We identified patients who did not receive anti-osteoporosis medication both 6 months and 1 year after fracture treatment. Patients who did not receive the medication 1 year after their treatment were enrolled and interviewed using a no-treatment questionnaire. RESULTS In total, 530 patients with fragility hip fractures were eligible (mean age, 79.0 years), and most (74.5%) were women. Only 148 patients (31.6%) received anti-osteoporosis medication 1 year after hip fracture. Logistic regression analysis identified predictors for not receiving the medication: male sex (OR 1.8; 95% CI 1.1-3.0), Charlson comorbidity index score ≥ 5 (OR 1.5; 95% CI 1.0-2.3), and secondary school education or below (OR 2.0; 95% CI 1.2-3.3). The main reason for not receiving the medication was that healthcare providers neither discussed nor initiated pharmacological treatment for osteoporosis (48.2%). When the medication was prescribed, non-persistence primarily stemmed from transportation difficulties that resulted in patients missing follow-ups (50.0%). CONCLUSIONS Improved physician attitudes toward anti-osteoporosis medications might enhance the treatment rate. Developing a follow-up team and facilitating access to medications (eg, courier delivery to patients) would promote therapy compliance. TRIAL REGISTRATIONS The protocol for the first phase and second phase was approved by the Siriraj Institutional Review Board of the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (COA no. Si 180/2021) and for the second phase, patients-informed consent forms used in the cross-sectional component were approved by the Siriraj Institutional Review Board of the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (COA no. Si 180/2021). The research was registered with the Thai Clinical Trials Registry (TCTR number: 20210824002). The study was conducted in accordance with the Declaration of Helsinki. Each patient (or a relative/caregiver) provided informed consent in writing or by telephone to participate in this second study phase.
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Affiliation(s)
- Chantas Mahaisavariya
- grid.10223.320000 0004 1937 0490Golden Jubilee Medical Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ekasame Vanitcharoenkul
- grid.10223.320000 0004 1937 0490Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700 Thailand
| | - Nitchanant Kitcharanant
- grid.7132.70000 0000 9039 7662Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pojchong Chotiyarnwong
- grid.10223.320000 0004 1937 0490Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700 Thailand
| | - Aasis Unnanuntana
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
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Al-Aqeel S, Alsugair J, Alghamdi R. Economic evaluation of interventions to improve medication adherence among patients with chronic diseases: an overview of systematic reviews. Expert Rev Pharmacoecon Outcomes Res 2023; 23:153-179. [PMID: 36562404 DOI: 10.1080/14737167.2023.2161516] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION This overview aimed to find, assess, and synthesize systematic reviews that compared the cost-effectiveness of interventions designed to improve medication adherence among patients with chronic disease. AREAS COVERED PubMed, Web of Science, Cochrane Database of Systematic Reviews, and Center for Review and Dissemination were searched. The quality of the included reviews was assessed using two validated checklists. The review characteristics and findings were summarized narratively. A total of 9 systematic reviews were included. Interventions reported to be cost-effective were simplification of the medication regimen, financial incentives, improved coverage or reduced out-of-pocket spending, and pharmacist care. The most common interventions were patient education and counseling, with mixed results of cost-effectiveness. This evidence comes from economic evaluations with varying degrees of quality. EXPERT OPINION Future evaluations of adherence interventions' cost-effectiveness will be improved in quality as our understanding of the reasons behind intentional and unintentional nonadherence and factors associated with this behavior advances. The development of criteria for the value assessment of medication adherence-enhancing interventions will contribute to improving the quality of adherence intervention cost-effectiveness research.
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Affiliation(s)
- Sinaa Al-Aqeel
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Joud Alsugair
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ruba Alghamdi
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Corral-Partearroyo C, Sánchez-Viñas A, Gil-Girbau M, Peñarrubia-María MT, Aznar-Lou I, Serrano-Blanco A, Carbonell-Duacastella C, Gallardo-González C, Olmos-Palenzuela MDC, Rubio-Valera M. Improving Initial Medication Adherence to cardiovascular disease and diabetes treatments in primary care: Pilot trial of a complex intervention. Front Public Health 2022; 10:1038138. [PMID: 36561857 PMCID: PMC9764337 DOI: 10.3389/fpubh.2022.1038138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction The Initial Medication Adherence (IMA) intervention is a multidisciplinary and shared decision-making intervention to improve initial medication adherence addressed to patients in need of new treatments for cardiovascular diseases and diabetes in primary care (PC). This pilot study aims to evaluate the feasibility and acceptability of the IMA intervention and the feasibility of a cluster-RCT to assess the effectiveness and cost-effectiveness of the intervention. Methods A 3-month pilot trial with an embedded process evaluation was conducted in five PC centers in Catalonia (Spain). Electronic health data were descriptively analyzed to test the availability and quality of records of the trial outcomes (initiation, implementation, clinical parameters and use of services). Recruitment and retention rates of professionals were analyzed. Twenty-nine semi-structured interviews with professionals (general practitioners, nurses, and community pharmacists) and patients were conducted to assess the feasibility and acceptability of the intervention. Three discussion groups with a total of fifteen patients were performed to review and redesign the intervention decision aids. Qualitative data were thematically analyzed. Results A total of 901 new treatments were prescribed to 604 patients. The proportion of missing data in the electronic health records was up to 30% for use of services and around 70% for clinical parameters 5 months before and after a new prescription. Primary and secondary outcomes were within plausible ranges and outliers were barely detected. The IMA intervention and its implementation strategy were considered feasible and acceptable by pilot-study participants. Low recruitment and retention rates, understanding of shared decision-making by professionals, and format and content of decision aids were the main barriers to the feasibility of the IMA intervention. Discussion Involving patients in the decision-making process is crucial to achieving better clinical outcomes. The IMA intervention is feasible and showed good acceptability among professionals and patients. However, we identified barriers and facilitators to implementing the intervention and adapting it to a context affected by the COVID-19 pandemic that should be considered before launching a cluster-RCT. This pilot study identified opportunities for refining the intervention and improving the design of the definitive cluster-RCT to evaluate its effectiveness and cost-effectiveness. Clinical trial registration ClinicalTrials.gov, identifier NCT05094986.
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Affiliation(s)
- Carmen Corral-Partearroyo
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Univ Autonoma de Barcelona, Bellaterra, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública), Madrid, Spain
| | - Alba Sánchez-Viñas
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública), Madrid, Spain,Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Montserrat Gil-Girbau
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Parc Sanitari Sant Joan de Déu,Sant Boi de Llobregat, Spain,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - María Teresa Peñarrubia-María
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública), Madrid, Spain,Primary Care Centre Bartomeu Fabrés Anglada, Direcció D'Atenció Primària Regió Metropolitana Sud, Institut Català de la Salut, Barcelona, Spain,Unitat de Suport a la Recerca Regió Metropolitana Sud, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Ignacio Aznar-Lou
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública), Madrid, Spain
| | - Antoni Serrano-Blanco
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública), Madrid, Spain,Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain,Parc Sanitari Sant Joan de Déu,Sant Boi de Llobregat, Spain
| | - Cristina Carbonell-Duacastella
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública), Madrid, Spain,Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
| | - Carmen Gallardo-González
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain,Primary Care Centre Bartomeu Fabrés Anglada, Direcció D'Atenció Primària Regió Metropolitana Sud, Institut Català de la Salut, Barcelona, Spain,Unitat de Suport a la Recerca Regió Metropolitana Sud, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Maria del Carmen Olmos-Palenzuela
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain,Primary Care Centre Bartomeu Fabrés Anglada, Direcció D'Atenció Primària Regió Metropolitana Sud, Institut Català de la Salut, Barcelona, Spain
| | - Maria Rubio-Valera
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública), Madrid, Spain,Parc Sanitari Sant Joan de Déu,Sant Boi de Llobregat, Spain,*Correspondence: Maria Rubio-Valera
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Sánchez-Viñas A, Corral-Partearroyo C, Gil-Girbau M, Peñarrubia-María MT, Gallardo-González C, Olmos-Palenzuela MDC, Aznar-Lou I, Serrano-Blanco A, Rubio-Valera M. Effectiveness and cost-effectiveness of an intervention to improve Initial Medication Adherence to treatments for cardiovascular diseases and diabetes in primary care: study protocol for a pragmatic cluster randomised controlled trial and economic model (the IMA-cRCT study). BMC Prim Care 2022; 23:170. [PMID: 35790915 PMCID: PMC9255541 DOI: 10.1186/s12875-022-01727-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/04/2022] [Indexed: 02/06/2023]
Abstract
Background Between 2 and 43% of patients who receive a new prescription in PC do not initiate their treatments. Non-initiation is associated with poorer clinical outcomes, more sick leave and higher costs to the healthcare system. Existing evidence suggests that shared decision-making positively impacts medication initiation. The IMA-cRCT assesses the effectiveness of the IMA intervention in improving adherence and clinical parameters compared to usual care in patients with a new treatment for cardiovascular disease and diabetes prescribed in PC, and its cost-effectiveness, through a cRCT and economic modelling. Methods The IMA intervention is a shared decision-making intervention based on the Theoretical Model of Non-initiation. A cRCT will be conducted in 24 PC teams in Catalonia (Spain), randomly assigned to the intervention group (1:1), and community pharmacies in the catchment areas of the intervention PC teams. Healthcare professionals in the intervention group will apply the intervention to all patients who receive a new prescription for cardiovascular disease or diabetes treatment (no other prescription from the same pharmacological group in the previous 6 months). All the study variables will be collected from real-world databases for the 12 months before and after receiving a new prescription. Effectiveness analyses will assess impact on initiation, secondary adherence, cardiovascular risk, clinical parameters and cardiovascular events. Cost-effectiveness analyses will be conducted as part of the cRCT from a healthcare and societal perspective in terms of extra cost per cardiovascular risk reduction and improved adherence; all analyses will be clustered. Economic models will be built to assess the long-term cost-effectiveness of the IMA intervention, in terms of extra cost for gains in QALY and life expectancy, using clinical trial data and data from previous studies. Discussion The IMA-cRCT represents an innovative approach to the design and evaluation of behavioural interventions that use the principles of complex interventions, pragmatic trials and implementation research. This study will provide evidence on the IMA intervention and on a new methodology for developing and evaluating complex interventions. The results of the study will be disseminated among stakeholders to facilitate its transferability to clinical practice. Trial registration ClinicalTrials.gov, NCT05026775. Registered 30th August 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01727-6.
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11
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Fox MG, Cass LM, Sykes KJ, Cummings EL, Fassas SN, Nallani R, Smith JB, Chiu AG, Villwock JA. Factors affecting adherence to intranasal treatment for allergic rhinitis: A qualitative study. Laryngoscope Investig Otolaryngol 2022; 8:40-45. [PMID: 36846400 PMCID: PMC9948570 DOI: 10.1002/lio2.986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/05/2022] [Accepted: 11/11/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To determine the facilitators of and barriers to adherence to use of intranasal pharmacotherapy (daily intranasal corticosteroids and/or antihistamine, and nasal saline irrigation [NSI]), for allergic rhinitis (AR). Methods Patients were recruited from an academic tertiary care rhinology and allergy clinic. Semi-structured interviews were conducted after the initial visit and/or 4-6 weeks following treatment. Transcribed interviews were analyzed using a grounded theory, inductive approach to elucidate themes regarding patient adherence to AR treatment. Results A total of 32 patients (12 male, 20 female; age 22-78) participated (seven at initial visit, seven at follow-up visit, and 18 at both). Memory triggers, such as linking nasal routine to existing daily activities or medications, were identified by patients as the most helpful strategy for adherence at initial and follow-up visits. Logistical obstacles related to NSI (messy, takes time, etc.) was the most common concept discussed at follow-up. Patients modified the regimen based on side effects experienced or perceived efficacy. Conclusions Memory triggers help patients adhere to nasal routines. Logistical obstacles related to NSI can deter from use. Health care providers should address both concepts during patient counseling. Nudge-based interventions that incorporate these concepts may help improve adherence to AR treatment. Level of Evidence 2.
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Affiliation(s)
- Meha G. Fox
- Department of Otolaryngology – Head & Neck SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Lauren M. Cass
- Department of Head and Neck SurgeryKaiser PermanentePortlandOregonUSA
| | - Kevin J. Sykes
- Department of Otolaryngology – Head & Neck SurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Emily L. Cummings
- Department of Internal MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Scott N. Fassas
- Department of Internal MedicineGeorge Washington School of Medicine & Health SciencesWashingtonDistrict of ColumbiaUSA
| | - Rohit Nallani
- Department of Otolaryngology – Head & Neck SurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Josh B. Smith
- Department of Otolaryngology – Head & Neck SurgerySt. Louis University School of MedicineSt. LouisMissouriUSA
| | - Alexander G. Chiu
- Department of Otolaryngology – Head & Neck SurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Jennifer A. Villwock
- Department of Otolaryngology – Head & Neck SurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
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12
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Corral-Partearroyo C, Sánchez-Viñas A, Gil-Girbau M, Peñarrubia-María MT, Aznar-Lou I, Gallardo-González C, Olmos-Palenzuela MDC, Rubio-Valera M. Complex multidisciplinary intervention to improve Initial Medication Adherence to cardiovascular disease and diabetes treatments in primary care (the IMA-cRCT study): mixed-methods process evaluation protocol. BMJ Open 2022; 12:e067468. [PMID: 36316078 PMCID: PMC9628671 DOI: 10.1136/bmjopen-2022-067468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Medication non-initiation, or primary non-adherence, is a persistent public health problem that increases the risk of adverse clinical outcomes. The initial medication adherence (IMA) intervention is a complex multidisciplinary intervention to improve adherence to cardiovascular and diabetes treatments in primary care by empowering the patient and promoting informed prescriptions based on shared decision-making. This paper presents the development and implementation strategy of the IMA intervention and the process evaluation protocol embedded in a cluster randomised controlled trial (the IMA-cRCT) to understand and interpret the outcomes of the trial and comprehend the extent of implementation and fidelity, the active mechanisms of the IMA intervention and in what context the intervention is implemented and works. METHODS AND ANALYSIS We present the protocol for a mixed-methods process evaluation including quantitative and qualitative methods to measure implementation and fidelity and to explore the active mechanisms and the interactions between the intervention, participants and its context. The process evaluation will be conducted in primary care centres and community pharmacies from the IMA-cRCT, and participants include healthcare professionals (general practitioners, nurses and community pharmacists) as well as patients. Quantitative data collection methods include data extraction from the intervention operative records, patient clinical records and participant feedback questionnaires, whereas qualitative data collection involves semistructured interviews, focus groups and field diaries. Quantitative and qualitative data will be analysed separately and triangulated to produce deeper insights and robust results. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Research Ethics Comittee (CEIm) at IDIAP Jordi Gol (codeCEIm 21/051 P). Findings will be disseminated through publications and conferences, as well as presentations to healthcare professionals and stakeholders from healthcare organisations. TRIAL REGISTRATION NUMBER NCT05026775.
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Affiliation(s)
- Carmen Corral-Partearroyo
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu, St Boi de Llobregat, Catalunya, Spain
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universitat Autonoma de Barcelona, Bellaterra, Catalunya, Spain
| | - Alba Sánchez-Viñas
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu, St Boi de Llobregat, Catalunya, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Montserrat Gil-Girbau
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu, St Boi de Llobregat, Catalunya, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Maria Teresa Peñarrubia-María
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu, St Boi de Llobregat, Catalunya, Spain
- Unitat de Suport a la Recerca Regió Metropolitana Sud, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Catalunya, Spain
| | - Ignacio Aznar-Lou
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu, St Boi de Llobregat, Catalunya, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Comunidad de Madrid, Spain
| | - Carmen Gallardo-González
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu, St Boi de Llobregat, Catalunya, Spain
- Unitat de Suport a la Recerca Regió Metropolitana Sud, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Catalunya, Spain
| | - María Del Carmen Olmos-Palenzuela
- Primary Care Centre Bartomeu Fabrés Anglada, Institut Català de la Salut Gerència Territorial Metropolitana Sud, Barcelona, Catalunya, Spain
| | - Maria Rubio-Valera
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu, St Boi de Llobregat, Catalunya, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Comunidad de Madrid, Spain
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Qu J, Zuo W, Took RL, Schafermeyer KW, Lukas S, Wang S, Du L, Liu X, Gao Y, Li J, Pan H, Du X, Mei D, Zhang B. A nationwide survey exploring physicians’ and pharmacists’ knowledge, awareness and perceptions regarding generic medicines in China. BMC Health Serv Res 2022; 22:1069. [PMID: 35987631 PMCID: PMC9392939 DOI: 10.1186/s12913-022-08438-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Generic medicines substitution is an important means to control rapid growth of pharmaceutical expenditures for the healthcare system in China. Acceptance and utilization of generic medicines is highly influenced by healthcare providers’ perceptions. This study aimed to compare the knowledge, awareness and perceptions of generic medicines between physicians and pharmacists in China. Methods We used an online, cross-sectional survey across China. The questionnaire explored four sections: demographic characteristics, assessment of the participants’ knowledge and awareness of generic medicines, perceptions of generic medicines and generic substitution practices. Chi-square or Mann–Whitney-U tests were applied to compare differences between physicians and pharmacists. P-values < 0.05 were considered significant. Results A total of 1644 physicians and 4187 pharmacists participated. Most physicians (82.8%, n = 1362) and pharmacists (89.8%, n = 3760) correctly identified the definition of generic medicines. A similar percentage of physicians and pharmacists agreed that approved generic medicines are as effective (64.1% vs 68.2%) or safe (63.8% vs 69.1%) as brand-name medicines. Most physicians and pharmacists (67.6% vs 71.0%) supported the policy of generic substitution. In practice, 79.4% (n = 1305) of physicians reported that they had prescribed generic medicines. More than 78% of respondents reported an obvious increase in the number of generic medicines prescribed in their medical institutions. The majority of physicians and pharmacists identified lack of trust regarding efficacy and safety of generic medicines and the difficulty of changing patients’ preference as top challenges in generic substitution. Conclusions Both physicians and pharmacists surveyed had adequate knowledge of generic medicines, and hold positive attitude towards generics and generic substitution. Efficacy and safety are key factors related to prescribing or dispensing generic medicines. Various policies and regulations should be taken to encourage successful generic substitution. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08438-9.
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Salmasi S, Safari A, Kapanen A, Adelakun A, Kwan L, MacGillivray J, Andrade JG, Deyell MW, Loewen P. Oral anticoagulant adherence and switching in patients with atrial fibrillation: A prospective observational study. Res Social Adm Pharm 2022; 18:3920-3928. [PMID: 35753963 DOI: 10.1016/j.sapharm.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Adherence to oral anticoagulants (OACs) in patients with atrial fibrillation (AF) is important in preventing stroke. The dominance of retrospective studies using administrative data has led to a lack of data on psychosocial determinants of adherence and prevented comparison of adherence between OAC drug classes. OAC switching is another aspect of adherence that is unexplored. METHODS A prospective design was utilized to measure AF patients' self-reported adherence and OAC switching, and to identify their clinical, demographic, and psychosocial determinants. Participants were recruited from specialized AF clinics in Canada and followed for up to 2 years. Data were collected via telephone every 3-4 months using a structured survey. Adherence was measured using the Morisky Medication Adherence scale (©MMAS-8). RESULTS The included participants (N = 306) were followed for a median follow up time of 14.1 months and had an average of 3.2(SD 1.4) study visits. The mean self-reported adherence on the ©MMAS-8 was 7.28(SD 0.71) for patients receiving care at specialized AF clinics. Older age, experiencing a bleed, and higher satisfaction with the burden of medications were significantly associated with higher adherence. Drug class did not have any significant impact on adherence. 7.8% of the cohort experienced a switch with most of them being from warfarin to DOAC. Taking warfarin as the index medication, experiencing a bleed and older age were significantly associated with higher odds of switching. CONCLUSION Patients with AF reported high adherence to their OAC therapy however being on DOAC may not translate to better adherence compared to VKA. Improving satisfaction with the burden of therapy is important in improving adherence.
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Affiliation(s)
- Shahrzad Salmasi
- Collaboration for Outcomes Research & Evaluation (CORE), University of British Columbia, Vancouver, BC, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Canada
| | - Abdollah Safari
- Faculty of Pharmaceutical Sciences, University of British Columbia, Canada; Data Analytics, Statistics and Informatics, Faculty of Pharmaceutical Sciences, University of British Columbia, Canada
| | - Anita Kapanen
- Collaboration for Outcomes Research & Evaluation (CORE), University of British Columbia, Vancouver, BC, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Canada
| | - Adenike Adelakun
- Collaboration for Outcomes Research & Evaluation (CORE), University of British Columbia, Vancouver, BC, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Canada
| | - Leanne Kwan
- Atrial Fibrillation Clinic, Royal Columbian Hospital, New Westminster, Canada
| | - Jenny MacGillivray
- Atrial Fibrillation Clinic, Vancouver General Hospital, Vancouver, Canada
| | - Jason G Andrade
- Atrial Fibrillation Clinic, Vancouver General Hospital, Vancouver, Canada; Division of Cardiology, Faculty of Medicine, The University of British Columbia, Canada; UBC Centre for Cardiovascular Innovation, Vancouver, Canada
| | - Marc W Deyell
- Division of Cardiology, Faculty of Medicine, The University of British Columbia, Canada; UBC Centre for Cardiovascular Innovation, Vancouver, Canada; Atrial Fibrillation Clinic, St. Paul's Hospital, Vancouver, Canada
| | - Peter Loewen
- Collaboration for Outcomes Research & Evaluation (CORE), University of British Columbia, Vancouver, BC, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Canada; UBC Centre for Cardiovascular Innovation, Vancouver, Canada.
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Chen M, Zhou L, Ye L, Lin G, Pang Y, Lu L, Wang X. Initial adherence by psychiatric outpatients in a general hospital and relevant personal factors. BMC Psychiatry 2022; 22:137. [PMID: 35193529 PMCID: PMC8862299 DOI: 10.1186/s12888-022-03797-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/14/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Initial adherence is a predictor of long-term adherence and thus is a crucial metric to explore and support. This study aimed to investigate initial adherence by psychiatric outpatients and relevant personal factors. METHODS The study surveyed psychiatric outpatients using a 30-day timely return visit rate (TRVR) after the first visit to indicate initial adherence. All participants agreed to engage in the self-designed survey and assessments of the Eysenck Personality Questionnaire (EPQ) and Symptoms Checklist-90 (SCL-90). Clients who missed timely return visits received telephone follow-up to determine the main reasons. RESULTS The overall TRVR was 59.4, and 40.6% of clients missed return visits. Logistic regression analysis revealed risk factors for initial adherence were work, tense family atmosphere, negative attitudes towards medication, higher EPQ psychoticism score, and lower SCL-90 phobic anxiety score. The main reasons given for non-timely return visits were improvement suggesting lack of need for a return visit, various barriers, no improvement, and side effects. CONCLUSION Psychiatric outpatients had poor initial adherence related to multiple dimensional factors, including job, family, personality characteristics, mental status, and thoughts about mental illness and treatments.
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Affiliation(s)
- Minhua Chen
- grid.412558.f0000 0004 1762 1794Department of Psychiatry, Third Affiliated Hospital of Sun Yat-sen University, N0. 600, Tianhe Road, Guangzhou, 510630 China
| | - Lina Zhou
- grid.412558.f0000 0004 1762 1794Department of Psychiatry, Third Affiliated Hospital of Sun Yat-sen University, N0. 600, Tianhe Road, Guangzhou, 510630 China
| | - Li Ye
- grid.412558.f0000 0004 1762 1794Department of Psychiatry, Third Affiliated Hospital of Sun Yat-sen University, N0. 600, Tianhe Road, Guangzhou, 510630 China
| | - Gelin Lin
- grid.412558.f0000 0004 1762 1794Department of Psychiatry, Third Affiliated Hospital of Sun Yat-sen University, N0. 600, Tianhe Road, Guangzhou, 510630 China
| | - Yongli Pang
- grid.412558.f0000 0004 1762 1794Department of Psychiatry, Third Affiliated Hospital of Sun Yat-sen University, N0. 600, Tianhe Road, Guangzhou, 510630 China
| | - Liyun Lu
- grid.412558.f0000 0004 1762 1794Department of Psychiatry, Third Affiliated Hospital of Sun Yat-sen University, N0. 600, Tianhe Road, Guangzhou, 510630 China
| | - Xianglan Wang
- Department of Psychiatry, Fifth Affiliated Hospital of Sun Yat-sen University, N0. 52, East Meihua Road, Zhuhai, 519000, China.
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Wong J, Kurteva S, Motulsky A, Tamblyn R. Association of Antidepressant Prescription Filling With Treatment Indication and Prior Prescription Filling Behaviors and Medication Experiences. Med Care 2022; 60:56-65. [PMID: 34882109 PMCID: PMC8663531 DOI: 10.1097/mlr.0000000000001658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Given the wide range of uses for antidepressants, understanding indication-specific patterns of prescription filling for antidepressants provide valuable insights into how patients use these medications in real-world settings. OBJECTIVE The objective of this study was to determine the association of antidepressant prescription filling with treatment indication, as well as prior prescription filling behaviors and medication experiences. DESIGN This retrospective cohort study took place in Quebec, Canada. PARTICIPANTS Adults with public drug insurance prescribed antidepressants using MOXXI (Medical Office of the XXIst Century)-an electronic prescribing system requiring primary care physicians to document treatment indications and reasons for prescription stops or changes. MEASURES MOXXI provided information on treatment indications, past prescriptions, and prior medication experiences (treatment ineffectiveness and adverse drug reactions). Linked claims data provided information on dispensed medications and other patient-related factors. Multivariable logistic regression models estimated the independent association of not filling an antidepressant prescription (within 90 d) with treatment indication and patients' prior prescription filling behaviors and medication experiences. RESULTS Among 38,751 prescriptions, the prevalence of unfilled prescriptions for new and ongoing antidepressant therapy was 34.2% and 4.1%, respectively. Compared with depression, odds of not filling an antidepressant prescription varied from 0.74 to 1.57 by indication and therapy status. The odds of not filling an antidepressant prescription was higher among adults filling < 50% of their medication prescriptions in the past year and adults with an antidepressant prescription stopped or changed in the past year due to treatment ineffectiveness. CONCLUSION Antidepressant prescription filling behaviors differed by treatment indication and were lower among patients with a history of poor prescription filling or ineffective treatment with antidepressants.
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Affiliation(s)
- Jenna Wong
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Siyana Kurteva
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University
| | - Aude Motulsky
- Research Center, University of Montreal Health Centre (CHUM)
- Department of Management, Evaluation & Health Policy, School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Robyn Tamblyn
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University
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Cooke CE, Xing S, Gale SE, Peters S. Initial non-adherence to antihypertensive medications in the United States: a systematic literature review. J Hum Hypertens 2022; 36:3-13. [PMID: 33990698 DOI: 10.1038/s41371-021-00549-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 04/21/2021] [Accepted: 04/29/2021] [Indexed: 01/31/2023]
Abstract
An important component of hypertension management is the initiation and continuation of antihypertensive medications. Non-adherence during the long-term use of antihypertensive medications is well studied. However, there is a paucity of research about the frequency and clinical consequences of failing to take the first dose of an antihypertensive, a treatment challenge known as initial medication non-adherence (IMN). This systematic literature review summarizes the published evidence from 2010 to 2019 on the prevalence, associated factors, consequences, and solutions for IMN to antihypertensive medications in the United States. Of the fifteen studies identified, nine studies reported the prevalence of IMN, two studies examined patient-reported reasons for IMN, and four studies evaluated interventions aimed to lower IMN. It is estimated that 5-34% of patients do not obtain their new antihypertensive medications. Factors and reasons cited include patient demographics, patient beliefs or perceptions about medications, cost or financial barriers, and clinical characteristics, such as a new hypertension diagnosis or higher co-morbid disease burden. The clinical, economic, and patient-reported outcomes of IMN are not well researched. In addition, interventions to address IMN have yielded inconsistent results. Significant opportunities exist for further research into this dimension of patient behavior to better understand and address IMN to new antihypertensive medications.
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Affiliation(s)
- Catherine E Cooke
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA.
| | - Shan Xing
- Takeda Pharmaceuticals USA, Inc, Lexington, MA, USA
| | - Stormi E Gale
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Sadie Peters
- Center for Population Health Initiatives, Maryland Department of Health, Baltimore, MD, USA
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Brown SL, McRae D, Sheils E, McDonnell BJ, Khan I, James DH. The effect of visual interventions on illness beliefs and medication adherence for chronic conditions: A scoping review of the literature and mapping to behaviour change techniques (BCTs). Res Social Adm Pharm 2021:S1551-7411(21)00378-8. [PMID: 34815181 DOI: 10.1016/j.sapharm.2021.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 11/04/2021] [Accepted: 11/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Maintaining health with chronic conditions often involves taking multiple medications; however, approximately 50% of patients with chronic conditions are non-adherent to medication. Patients' illness beliefs inform health behaviour, including medication-taking. Research has shown that visuals accompanying health information increased patient comprehension and the accuracy of illness perceptions. To date, the influence of visuals on illness beliefs and medication adherence has not been comprehensively reviewed. OBJECTIVES The review aimed to collate available literature on visualisation interventions for illness beliefs and medication adherence in chronic conditions and identify key intervention characteristics. METHODS A scoping review was conducted according to recommended guidelines and the PRISMA-ScR statement. Searches used keywords relating to 'illness', 'visual', 'adherence', 'illness perception', 'intervention', and 'medication'. Six databases were searched from inception to 2019; reference-list searching provided additional articles. Articles were included if the study population had a chronic health condition, the intervention included a visual element, had a measure of illness beliefs or medication adherence. Data regarding intervention characteristics and outcomes were extracted. Behaviour change techniques (BCTs) were identified to provide further insight into intervention characteristics. RESULTS Initially, 18,012 articles were identified. Screening led to 293 full-text articles, ultimately resulting in 45 studies for final analysis. Forty-four were quantitative studies, 1 was qualitative. Studies were grouped into those using visuals to conceptualise a condition, medication reminders and educational interventions. Almost two-thirds of visual interventions were effective post-intervention, 3 sustained post-1-year, although many studies only assessed impact immediately post-intervention. BCTs from 'Natural consequences', 'Socialsupport' and 'Feedback and monitoring' categories were prevalent in effective interventions for both outcomes, particularly the 'Salience of consequences' BCT. CONCLUSIONS This comprehensive scoping review found that visual interventions can positively influence illness beliefs and medication adherence. These findings highlight the need to further evaluate the impact and sustainability of visual interventions.
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Bekker CL, Aslani P, Chen TF. The use of medication adherence guidelines in medication taking behaviour research. Res Social Adm Pharm 2021; 18:2325-2330. [PMID: 34393079 DOI: 10.1016/j.sapharm.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 08/10/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
Medication nonadherence continues to be a serious issue in a range of long-term medical conditions and has been studied extensively over the past few decades. However, despite the plethora of research studies on medication adherence, poor methodological rigour in many studies has contributed to limited generalisability of the positive findings, limited impact on patients' medication adherence, and inability to compare between studies. This paper focuses on current guidelines designed specifically for research on medication adherence. It discusses key elements to consider during study design, selection of adherence measurements, and reporting on medication adherence research, to ensure a higher quality of research in medication adherence. Overall, there appears to be variations in adherence terminology reported in the literature despite improvements in defining medication taking behaviour and the availability of taxonomies. In addition, limited guidance exists on how best to measure adherence. Recommendations are provided on appropriate adherence measures for the adherence behaviour being investigated, including careful consideration of adherence concepts, validity of adherence instruments, appropriate instrument selection, definition of nonadherence threshold, and how to report medication adherence. Improving adherence research requires greater clarity and standardisation of descriptions of nonadherence behaviour, increased methodological rigour in study designs, better selection of adherence measurements, and comprehensive reporting.
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Affiliation(s)
- Charlotte L Bekker
- Radboud University Medical Center, Research Institute for Health Sciences, Department of Pharmacy, Nijmegen, the Netherlands.
| | - Parisa Aslani
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Timothy F Chen
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
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Purba JM, Simamora RH, Karota E. The Relationship of Medication Adherence and Social Functioning of Persons with Schizophrenia in the Long-term Period. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Medication adherence is an essential aspect of the daily lives of persons with schizophrenia, while in-compliance is related to their social functioning performance.
AIM: The study aims to analyze the prolonged relationship between medication adherence and the social functioning of persons with chronic schizophrenia.
METHODS: A descriptive correlation method was carried out on 60 persons with schizophrenia at Pasung in North Sumatra Province, Indonesia, using questionnaires.
RESULTS: The results indicate that 68.3–51.7% of respondents had low adherence to medication and social functioning, respectively. Spearman rank claimed that there is a strong relationship between medication adherence and social functioning among chronic schizophrenia persons. Furthermore, the result reported that medication adherence positively affected social functioning among persons with schizophrenia.
CONCLUSIONS: Medication adherence is a priority for maintaining the behavior of people living with schizophrenia to help them control their psychotic symptoms. Therefore, it can enhance their social functioning performance and daily living activity. Family participation is needed for continuous medication program and relapse rate prevention.
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Menditto E, Cahir C, Malo S, Aguilar-Palacio I, Almada M, Costa E, Giardini A, Gil Peinado M, Massot Mesquida M, Mucherino S, Orlando V, Parra-Calderón CL, Pepiol Salom E, Kardas P, Vrijens B. Persistence as a Robust Indicator of Medication Adherence-Related Quality and Performance. Int J Environ Res Public Health 2021; 18:4872. [PMID: 34063641 DOI: 10.3390/ijerph18094872] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/18/2022]
Abstract
Medication adherence is a priority for health systems worldwide and is widely recognised as a key component of quality of care for disease management. Adherence-related indicators were rarely explicitly included in national health policy agendas. One barrier is the lack of standardised adherence terminology and of routine measures of adherence in clinical practice. This paper discusses the possibility of developing adherence-related performance indicators highlighting the value of measuring persistence as a robust indicator of quality of care. To standardise adherence and persistence-related terminology allowing for benchmarking of adherence strategies, the European Ascertaining Barriers for Compliance (ABC) project proposed a Taxonomy of Adherence in 2012 consisting of three components: initiation, implementation, discontinuation. Persistence, which immediately precedes discontinuation, is a key element of taxonomy, which could capture adherence chronology allowing the examination of patterns of medication-taking behaviour. Advances in eHealth and Information Communication Technology (ICT) could play a major role in providing necessary structures to develop persistence indicators. We propose measuring persistence as an informative and pragmatic measure of medication-taking behaviour. Our view is to develop quality and performance indicators of persistence, which requires investing in ICT solutions enabling healthcare providers to review complete information on patients’ medication-taking patterns, as well as clinical and health outcomes.
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Yeh YC, Cappelleri JC, Marston XL, Shelbaya A. Effects of dose titration on adherence and treatment duration of pregabalin among patients with neuropathic pain: A MarketScan database study. PLoS One 2021; 16:e0242467. [PMID: 33471834 PMCID: PMC7816971 DOI: 10.1371/journal.pone.0242467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 10/25/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To examine pregabalin dose titration and its impact on treatment adherence and duration in patients with neuropathic pain (NeP). METHODS MarketScan database (2009-2014) was used to extract a cohort of incident adult pregabalin users with NeP who had at least 12 months of follow-up data. Any dose augmentation within 45 days following the first pregabalin claim was defined as dose titration. Adherence (measured by medication possession ratio/MPR) and persistence (measured as the duration of continuous treatment) were compared between the cohorts with and without dose titration. Logistic regressions and Cox proportional hazards models were used to identify the factors associated with adherence (MPR ≥ 0.8) and predictors of time to discontinuation. RESULTS Among the 5,186 patients in the analysis, only 18% of patients had dose titration. Patients who had dose titration were approximately 2.6 times as likely to be adherent (MPR ≥ 0.8) (odds ratio = 2.59, P < 0.001) than those who did not have dose titration. Kaplan-Meier analysis shows that the time to discontinuation or switch was significantly longer among patients who had dose titration (4.99 vs. 4.04 months, P = 0.009). CONCLUSIONS Dose titration was associated with improved treatment adherence and persistence among NeP patients receiving pregabalin. The findings will provide valuable evidence to increase physician awareness of dose recommendations in the prescribing information and to educate patients on the importance of titration and adherence.
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Affiliation(s)
- Yu-Chen Yeh
- Pharmerit International, Newton, MA, United States of America
- * E-mail:
| | - Joseph C. Cappelleri
- Department of Global Biometrics and Data Management, Pfizer Inc, New York, NY, United States of America
| | | | - Ahmed Shelbaya
- Department of Health Economics and Outcomes Research, Pfizer Inc, New York, NY, United States of America
- Mailman School of Public Health, Columbia University, New York, NY, United States of America
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Abstract
BACKGROUND Patients must adhere to their prescribed warfarin regimens and regularly monitor the anticoagulation effect to maintain therapeutic levels. The ability to evaluate regimen adherence accurately is crucial to the success of patient coaching. However, prevention of thromboembolic events is challenging when the association between medication adherence and the actual amount of anticoagulant agent taken cannot be determined. PURPOSE This study used self-reported medication taken and prescription refills to (a) verify warfarin medication adherence and (b) assist clinicians to determine the discrepancy between medication adherence and anticoagulant control efficacy. METHODS This study was conducted at a national-university-affiliated hospital in Yilan County, Taiwan. Structured questionnaires and medical record reviews were adopted. A 100-point visual analog scale was used to measure the reported adherence of participants, whereas medication refill adherence was compared against self-reported adherence. Finally, degree of adherence was evaluated based on time in therapeutic range. RESULTS This study included 192 participants. Half (n = 94, 49%) were women, and the mean age was 69.6 years. Mean scores were 92.2% for the visual analog scale and 87.3% for medication refill adherence. Medication adherence correlated significantly with age, as reflected in the visual analog scale scores (p < .05). The participants who were receiving polypharmacy with five types of medicines or less attained higher visual analog scale scores, whereas participants who were on warfarin for 2-12 months exhibited higher medication refill adherence. Time in therapeutic range correlated negatively with age, although stability improved with therapy duration. CONCLUSIONS/IMPLICATIONS FOR PRACTICE Despite their high self-reported adherence levels, patients of advanced age require careful monitoring of their time in therapeutic range. The participants in this study who were on warfarin for a relatively longer time exhibited higher stability in the therapeutic range, despite their low medication refill adherence. The results of this study suggest that patient age, duration of warfarin therapy, and polypharmacy are factors associated with medication adherence. The findings may facilitate future assessments of warfarin adherence in patients as well as the implementation of more effective clinical nursing procedures and management practices.
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Ruusuvuori J, Aaltonen T, Lonka E, Salmenlinna I, Laakso M. Discussing Hearing Aid Rehabilitation at the Hearing Clinic: Patient Involvement in Deciding upon the Need for a Hearing Aid. Health Commun 2020; 35:1146-1161. [PMID: 31142130 DOI: 10.1080/10410236.2019.1620410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The quality of interaction between hearing health professionals and patients is one prominent, yet under-studied explanation for the low adherence in acquiring and using a hearing aid. This study describes two different ways of introducing hearing aid to the patients at their first visits at the hearing clinic: an inquiry asking patients opinion followed by offer, and an expert evaluation of the necessity of a hearing aid; and shows two different trajectories ensuing from these introductions. The trajectories represent two extreme ends of a continuum of practices of starting a discussion about hearing aid rehabilitation, in terms of how these practices affect patient participation in decision-making. The analysis shows how granting different degrees of deontic and epistemic rights to professionals and patients has different consequences with regard to the activity of reaching shared understanding on the treatment. The data consist of 17 video-recorded encounters at the hearing clinic. The method used is conversation analysis.
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Affiliation(s)
| | - Tarja Aaltonen
- Institute of Behavioral Sciences, University of Helsinki
| | - Eila Lonka
- Institute of Behavioral Sciences, University of Helsinki
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Padilla López A, Alós-Almiñana M, Peris JE. Health Outcomes and Primary Adherence to Secondary Prevention Treatment after St-Elevation Myocardial Infarction: a Spanish Cohort Study. J Cardiovasc Transl Res 2021; 14:308-16. [PMID: 32557320 DOI: 10.1007/s12265-020-10045-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/03/2020] [Indexed: 01/13/2023]
Abstract
This retrospective observational study aimed to establish the first prescription and its dispensation (primary adherence) in the first 30 days of the four pharmacotherapeutic classes recommended after a type 1 STEMI episode, determine the potential risk factors for lack of primary adherence, and evaluate the potential impact of primary adherence on cardiovascular outcomes. Of the 613 patients analyzed, 576 were included (64.7 ± 13.8 years, 73.8% men) between January 2008 and December 2013. Primary adherence exceeded 90% in all groups. Complete primary adherence was higher in high-drug coverage patients and was lower in patients with cardiovascular or neuropsychiatric diseases. According to competing risk analysis, 1-year cardiovascular mortality was significantly lower in patients with complete primary adherence than in those without complete prescription or adherence, 1.8% versus 5.6% (HR = 0.286; p = 0.012). Complete primary adherence did not prevent a 1-year cardiovascular event, 5.6% versus 5.5% (p = 0.904).
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Gil-girbau M, Aznar-lou I, Peñarrubia-maría M, Moreno-peral P, Fernández A, Bellón J, Jové A, Mendive J, Fernández-vergel R, Figueiras A, March-pujol M, Rubio-valera M. Reasons for medication non-initiation: A qualitative exploration of the patients’ perspective. Res Social Adm Pharm 2020; 16:663-72. [DOI: 10.1016/j.sapharm.2019.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 07/25/2019] [Accepted: 08/01/2019] [Indexed: 12/14/2022]
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Kurup R, Martínez JPD, Doucet M, Tyrrell PN. Effectiveness of Electronic Medication Packaging Devices on Medication Adherence: A Scoping Review. J Gerontol Nurs 2020; 46:27-36. [DOI: 10.3928/00989134-20200129-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/11/2019] [Indexed: 11/20/2022]
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Mekonnen GB, Gelayee DA. Low Medication Knowledge and Adherence to Oral Chronic Medications among Patients Attending Community Pharmacies: A Cross-Sectional Study in a Low-Income Country. Biomed Res Int 2020; 2020:4392058. [PMID: 32420342 DOI: 10.1155/2020/4392058] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/07/2019] [Accepted: 12/28/2019] [Indexed: 11/17/2022]
Abstract
Objective To investigate the level of knowledge, medication adherence, and the relationship among patients taking chronic oral medication and attending community pharmacies in Gondar, Northwest Ethiopia. Methods A cross-sectional study was conducted among adult chronic disease patients who were taking oral medications and getting service in 19 community pharmacies in Gondar City, Northwest Ethiopia. Patients' medication knowledge and adherence were assessed using interviewer-administered validated questionnaires. Results Of the 402 study participants (mean ± SD age = 44.7 ± 16.9 years, range = 18–86 years), 53.2% were males, 84.8% were aged <65 years, and 60.7% had high school education and above. About 348 (88.6%) respondents have used oral medications for more than one year. Less than half of respondents have good medication knowledge (n = 54, 38.3%) and were adherent to their medication (n = 158, 39.3%). Chronic disease patients with high school and above education are 5.35 times (95% CI: 3.231–8.857, p < 0.001) more likely to have good knowledge of their medication and having good medication knowledge was linked to higher medication adherence (AOR, 95% CI = 10.300 [6.16517.209]; p < 0.001). A statistically significant correlation was observed between the scores of medication knowledge and adherence (r = −0.471, p < 0.001). Conclusion The majority of patients on oral chronic medications and attending community pharmacies in Gondar town do not have good medication knowledge and were nonadherent. Community pharmacists need to engage in medication counseling to improve medication knowledge and adherence of chronic disease patients.
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Nguyen T, Cao HTK, Quach DN, Le KK, Au SX, Pham ST, Nguyen TH, Pham TT, Taxis K. The Vietnamese Version of the Brief Illness Perception Questionnaire and the Beliefs about Medicines Questionnaire: Translation and Cross-cultural Adaptation. Trop Med Int Health 2019; 24:1465-1474. [PMID: 31599083 DOI: 10.1111/tmi.13312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To translate and cross-culturally adapt the Brief Illness Perception Questionnaire (BIPQ) and the Beliefs about Medicines Questionnaire (BMQ) into Vietnamese. METHODS We followed the guideline by Beaton et al. (2000 & 2007). Stage I: two translators (informed and uninformed) translated the questionnaires. Stage II: the translations were synthesised. Stage III: back translation was performed by two translators fluent in both Vietnamese and English but naïve to the outcome measurement. Stage IV: seven experts reached consensus on the pre-final Vietnamese version (BIPQ-V and BMQ-V). Stage V: field test of the questionnaires on 16 twelve-year-old students and 31 Vietnamese patients. In addition, we determined the internal consistency and test-retest reliability of the questionnaires in 34 Vietnamese patients with acute coronary syndrome. RESULTS All experts agreed that there was semantic, idiomatic, experiential and conceptual equivalence between the original and pre-final Vietnamese versions of the BIPQ and BMQ. Cronbach's alpha coefficients of the internal consistency were acceptable for the BMQ-V Specific-Necessity (0.64), BMQ-V Specific-Concerns (0.62) and BMQ-V General-Harm (0.60), with the exception of BMQ-V General-Overuse (0.27). Intra-class correlation coefficients of the test-retest reliability were acceptable for the subscales of BMQ-V (range: 0.77-0.86), and BIPQ-V items (range: 0.62-0.85) with the exception of BIPQ-V 1 (0.44, 95% CI -014 to 0.72) and BIPQ-V 4 (0.57, 95% CI 0.22-0.81). CONCLUSIONS The Vietnamese version of BIPQ and BMQ are reliable tools to assess illness perceptions and beliefs about medicines of patients with acute coronary syndrome. Psychometric properties of these questionnaires should be tested in different patient populations.
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Affiliation(s)
- Thang Nguyen
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
| | - Hoang T K Cao
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
| | - Dung N Quach
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
| | - Khanh K Le
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
| | - Sam X Au
- Department of Foreign Languages, Faculty of Basic Sciences, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
| | - Suol T Pham
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
| | - Thao H Nguyen
- Department of Clinical Pharmacy, School of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tam T Pham
- Faculty of Public Health, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
| | - Katja Taxis
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
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Booysen V, Burger JR, du Plessis JM, Cockeran M. Assessment of post-operative pain medication adherence after day case orthopaedic surgery: A prospective, cross-sectional study. Int J Orthop Trauma Nurs 2019; 36:100718. [PMID: 31585861 DOI: 10.1016/j.ijotn.2019.100718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIM Patients struggle to adhere to prescribed pain medication after surgery because of, inter alia, side effects, sleep disturbances and pain severity. This study aimed to determine the influence of various factors on, the extent of adherence to prescribed post-operative pain medication (POPM) measured by participant-reported pill count (PRPC) following day case orthopaedic surgery at a private South African hospital. METHODS This prospective, quantitative cross-sectional study involving 120 participants (51 males, 69 females), used a structured questionnaire completed through a telephonic survey, 4 days after orthopaedic surgery. Measurements included PRPC adherence (adherent vs. non-adherent), in relation to post-operative adherence behaviour (POAB), normal medicine adherence behaviour (NMAB), pain severity affecting sleep and mobility, treatment side effects and patient demographic characteristics. RESULTS Based on PRPC measurement 56.7% (n = 68) of participants were adherent. PRPC was significantly associated with severe pain affecting falling sleep (p = .001), pain causing awakening from sleep (p = .035) and POAB (p < .001, Cramér's V = 0.5). PRPC adherence was independent from gender (p = .140), age (p = .822), smoking status (p = 1.000), type and event of side effects (p > .300), NMAB (p = .601) and the treatment regimen (i.e. unimodal vs. bimodal or multimodal) (p = .511). CONCLUSION Non-adherence (overuse or misuse) of prescribed POPM can be a result of severe pain, influencing sleep and movement after orthopaedic surgery, indicating a need for the review of these regimens in order to optimise care.
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Affiliation(s)
- Vanessa Booysen
- Medicine Usage in South Africa (MUSA), School of Pharmacy, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Johanita R Burger
- Medicine Usage in South Africa (MUSA), School of Pharmacy, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
| | - Jesslee M du Plessis
- Medicine Usage in South Africa (MUSA), School of Pharmacy, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Marike Cockeran
- Statistics, School of Computer, Statistical and Mathematical Sciences, North-West University, Potchefstroom, South Africa
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Zullig LL, Jazowski SA, Wang TY, Hellkamp A, Wojdyla D, Thomas L, Egbuonu-Davis L, Beal A, Bosworth HB. Novel application of approaches to predicting medication adherence using medical claims data. Health Serv Res 2019; 54:1255-1262. [PMID: 31429471 DOI: 10.1111/1475-6773.13200] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To compare predictive analytic approaches to characterize medication nonadherence and determine under which circumstances each method may be best applied. DATA SOURCES/STUDY SETTING Medicare Parts A, B, and D claims from 2007 to 2013. STUDY DESIGN We evaluated three statistical techniques to predict statin adherence (proportion of days covered [PDC ≥ 80 percent]) in the year following discharge: standard logistic regression with backward selection of covariates, least absolute shrinkage and selection operator (LASSO), and random forest. We used the C-index to assess model discrimination and decile plots comparing predicted values to observed event rates to evaluate model performance. DATA EXTRACTION We identified 11 969 beneficiaries with an acute myocardial infarction (MI)-related admission from 2007 to 2012, who filled a statin prescription at, or shortly after, discharge. PRINCIPAL FINDINGS In all models, prior statin use was the most important predictor of future adherence (OR = 3.65, 95% CI: 3.34-3.98; OR = 3.55). Although the LASSO regression model selected nearly 90 percent of all candidate predictors, all three analytic approaches had moderate discrimination (C-index ranging from 0.664 to 0.673). CONCLUSIONS Although none of the models emerged as clearly superior, predictive analytics could proactively determine which patients are at risk of nonadherence, thus allowing for timely engagement in adherence-improving interventions.
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Affiliation(s)
- Leah L Zullig
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina.,Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Shelley A Jazowski
- Department of Population Health Sciences, Duke University, Durham, North Carolina.,Department of Health Policy and Management, University of North Carolina, Chapel Hill, North Carolina
| | - Tracy Y Wang
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Anne Hellkamp
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Daniel Wojdyla
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Laine Thomas
- Duke Clinical Research Institute, Duke University, Durham, North Carolina.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Lisa Egbuonu-Davis
- Global Patient Centered Outcomes and Solutions, Sanofi, New York, New York
| | - Anne Beal
- Global Patient Centered Outcomes and Solutions, Sanofi, New York, New York
| | - Hayden B Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina.,Department of Population Health Sciences, Duke University, Durham, North Carolina.,School of Nursing, Duke University, Durham, North Carolina.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina.,Department of Medicine, Duke University, Durham, North Carolina
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Félix IB, Guerreiro MP, Cavaco A, Cláudio AP, Mendes A, Balsa J, Carmo MB, Pimenta N, Henriques A. Development of a Complex Intervention to Improve Adherence to Antidiabetic Medication in Older People Using an Anthropomorphic Virtual Assistant Software. Front Pharmacol 2019; 10:680. [PMID: 31281256 PMCID: PMC6597679 DOI: 10.3389/fphar.2019.00680] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/24/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction: Improving adherence to antidiabetic medication is crucial, resulting in improved health outcomes, cost reduction, and minimization of waste. A lack of underlying theory in existing interventions may explain the limited success in sustaining behavior change. This paper describes the development of a theory and evidence-based complex intervention to improve adherence to oral antidiabetics in older people via a software prototype with an anthropomorphic virtual assistant. Methods: The Behavior Change Wheel (BCW) was used to develop a theoretical understanding of the change process, corresponding to the first phase of the Medical Research Council Framework for developing and evaluating complex interventions. At the BCW core is a model of human behavior (COM-B), which posits that human behavior (B) results from the interaction between capabilities (C), opportunities (O), and motivation (M). Literature-derived medication adherence determinants were mapped onto COM-B components. Then, intervention functions (IFs) were selected employing the APEASE criteria. Finally, standardized behavior change techniques (BCTs) were chosen based on their suitability and their effectiveness on medication adherence trials. The prototype was developed for android devices; its core was implemented in Unity3D, using a female 3D virtual assistant, named Vitória. Results: Two COM-B components were identified as main targets for behavior change—psychological capability and reflective motivation; these were linked with four IFs—education, persuasion, enablement, and environmental restructuring. Eleven BCTs were, in turn, linked with the IFs. An example of a BCT is “problem solving”; it requires users to pinpoint factors influencing non-adherence and subsequently offers strategies to achieve the desired behavior. BCTs were operationalized into the dialogues with Vitória and into supplementary software features. Vitória communicates with users verbally and non-verbally, expressing emotions. Input options consist of buttons or recording values, such as medication taken. Conclusion: The present approach enabled us to derive the most appropriate BCTs for our intervention. The use of an explicit bundle of BCTs, often overlooked in interventions promoting medication adherence, is expected to maximize effectiveness and facilitates replication. The first prototype is being refined with users and health professionals’ contributions. Future work includes subjecting the prototype to usability tests and a feasibility trial.
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Affiliation(s)
- Isa Brito Félix
- Unidade de Investigação e Desenvolvimento em Enfermagem (UI&DE), Lisbon Nursing School, Lisbon, Portugal
| | - Mara Pereira Guerreiro
- Unidade de Investigação e Desenvolvimento em Enfermagem (UI&DE), Lisbon Nursing School, Lisbon, Portugal.,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, Monte de Caparica, Portugal
| | - Afonso Cavaco
- iMed.ULisboa, Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Ana Paula Cláudio
- Biosystems & Integrative Sciences Institute (BioISI), Faculty of Sciences, University of Lisbon, Lisbon, Portugal
| | - Anabela Mendes
- Unidade de Investigação e Desenvolvimento em Enfermagem (UI&DE), Lisbon Nursing School, Lisbon, Portugal
| | - João Balsa
- Biosystems & Integrative Sciences Institute (BioISI), Faculty of Sciences, University of Lisbon, Lisbon, Portugal
| | - Maria Beatriz Carmo
- Biosystems & Integrative Sciences Institute (BioISI), Faculty of Sciences, University of Lisbon, Lisbon, Portugal
| | - Nuno Pimenta
- Sport Sciences School of Rio Maior, Polytechnic Institute of Santarém, Santarém, Portugal
| | - Adriana Henriques
- Unidade de Investigação e Desenvolvimento em Enfermagem (UI&DE), Lisbon Nursing School, Lisbon, Portugal
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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: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Roseleur J, Harvey G, Stocks N, Karnon J. Behavioral economic insights to improve medication adherence in adults with chronic conditions: a scoping review protocol. ACTA ACUST UNITED AC 2019; 17:1915-1923. [PMID: 31145189 DOI: 10.11124/jbisrir-2017-003971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objective of this review is to map the evidence on the use of behavioral economic insights to improve medication adherence in adults with chronic conditions. INTRODUCTION Medication non-adherence is a barrier to effectively managing chronic conditions, leading to poorer patient outcomes and placing an additional financial burden on healthcare systems. As the population ages and the prevalence of chronic disease increases, new ways to influence patient behavior are needed. Approaches that use insights from behavioral economics may help improve medication adherence, thus reducing morbidity, mortality and financial costs of unmanaged chronic diseases. INCLUSION CRITERIA Eligible studies will include adults taking medication for a chronic condition. All interventions relevant to high-income settings using insights from behavioral economics to improve medication adherence in adults will be considered. Contexts may include, but are not limited to, primary health care, corporate wellness programs and health insurance schemes. Any study design published in English will be considered. Studies in facilities where medication is administered to patients will be excluded. METHODS PubMed, Embase, Scopus, PsycINFO, EconLit and CINAHL will be searched from database inception to present. Gray literature will be searched using Google Scholar, OpenGrey and the Grey Literature Report. One reviewer will review titles, and then two reviewers will independently review abstracts to identify eligible studies. One reviewer will extract data on study characteristics, study design and study outcomes. A second reviewer will validate 25% of the extracted information. The results of the data extraction will be presented in a table, and a narrative summary will be presented.
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Affiliation(s)
- Jacqueline Roseleur
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Gillian Harvey
- Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, The University of Adelaide, Adelaide, Australia
| | - Jonathan Karnon
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
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Bryan CE, Cade JC, Mackin AJ, Sullivant AM. Evaluation of a structured individualised protocol as a potential cost-effective diagnostic and therapeutic approach to chronic diarrhoea in the dog. Vet Med Sci 2019; 5:210-221. [PMID: 30746901 PMCID: PMC6498526 DOI: 10.1002/vms3.154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Diagnostic investigation and management of chronic diarrhoea in dogs can be cost‐prohibitive to many owners. The objectives of this study were to evaluate evidence‐based, individualised diagnostic and therapeutic protocols for management of dogs with chronic diarrhoea, where financial constraints dictate a budget‐limited approach and where more expensive approaches are deferred until simple affordable protocols are unsuccessful. Twenty‐two client‐owned dogs with chronic (minimum 2 weeks duration) untreated small, large or mixed small/large bowel diarrhoea were enrolled in a budget‐limited step‐wise management protocol (maximum expenditure $300 over 6 weeks), with diagnostic testing and therapeutic trials managed in an individualised and evidence‐based fashion. Success was defined as complete resolution of diarrhoea for a minimum of 1 month. Dogs that failed to respond to a budget‐limited protocol were then enrolled for complete, referral‐level management. Four dogs exited the project early (one death due to caval syndrome, three lost to follow‐up). Thirteen out of the remaining 18 dogs had complete resolution of diarrhoea utilising a budget‐limited approach (success rate 72.2%, confidence intervals 46.5–90.3%) and five dogs were moved on to a referral‐level investigation, with complete resolution of diarrhoea in four out of five. Seventeen out of the 18 dogs therefore responded to a protocol based on a budget‐limited approach followed by extensive investigation only if needed, for an overall success rate of 94.4% (CI 72.7–99.9%). Comprehensive investigation of chronic diarrhoea can be deferred while simple affordable diagnostics and therapeutic trials are conducted in stable canine patients and, often, an extensive management approach will be unnecessary.
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Affiliation(s)
- Christine E Bryan
- Department of Clinical Sciences, Mississippi State University College of Veterinary Medicine, Mississippi State, Mississippi, USA
| | - Jeb C Cade
- Department of Clinical Sciences, Mississippi State University College of Veterinary Medicine, Mississippi State, Mississippi, USA
| | - Andrew J Mackin
- Department of Clinical Sciences, Mississippi State University College of Veterinary Medicine, Mississippi State, Mississippi, USA
| | - Alyssa M Sullivant
- Department of Clinical Sciences, Mississippi State University College of Veterinary Medicine, Mississippi State, Mississippi, USA
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Garrido MM, Frakt AB. Improving adherence to high-value medications through prescription cost-sharing policies. BMJ Qual Saf 2018; 27:868-870. [PMID: 29674484 PMCID: PMC8218013 DOI: 10.1136/bmjqs-2018-007916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Melissa M Garrido
- Partnered Evidence-based Policy Resource Center, Boston VA Healthcare System, Boston, Massachusetts, USA
- Geriatrics Research, Education, and Clinical Center, James J Peters VA Medical Center, Bronx, New York, USA
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Austin B Frakt
- Partnered Evidence-based Policy Resource Center, Boston VA Healthcare System, Boston, Massachusetts, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
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Swart KMA, van Vilsteren M, van Hout W, Draak E, van der Zwaard BC, van der Horst HE, Hugtenburg JG, Elders PJM. Factors related to intentional non-initiation of bisphosphonate treatment in patients with a high fracture risk in primary care: a qualitative study. BMC Fam Pract 2018; 19:141. [PMID: 30139341 PMCID: PMC6108118 DOI: 10.1186/s12875-018-0828-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 08/14/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Adherence to osteoporosis treatment is crucial for good treatment effects. However, adherence has been shown to be poor and a substantial part of the patients don't even initiate treatment. This study aimed to gain insight into the considerations of both osteoporosis patients and general practitioners (GP) concerning intentional non-initiation of bisphosphonate treatment. METHODS Osteoporosis patients and GPs were recruited from the SALT Osteoporosis Study and a transmural fracture liaison service, both carried out in the Netherlands. Using questionnaires, we identified non-starters and starters of bisphosphonate treatment. Semi-structured interviews were conducted to gain a detailed overview of all considerations until saturation of the data was reached. Starters were asked to reflect on the considerations that were brought forward by the non-starters. Interviews were open coded and the codes were classified into main themes and subthemes using an inductive approach. RESULTS 16 non-starters, 10 starters, and 13 GPs were interviewed. We identified three main themes: insufficient medical advice, attitudes towards medication use including concerns about side effects, and disease awareness. From patients' as well as GPs' perspective, insufficient or ambiguous information from the GP influenced the decision of the non-starters to not start bisphosphonates. In contrast, starters were either properly informed, or they collected information themselves. Patients' aversion towards medication, fear of side effects, and a low risk perception also contributed to not starting the medication, whereas starters were aware of their fracture risk and were confident of the outcome of the treatment. Concerns about osteoporosis treatment and its side effects were also expressed by several GPs. Some GPs appeared to have a limited understanding of the current osteoporosis guidelines and the indications for treatment. CONCLUSIONS Many reasons we found for not starting bisphosphonate treatment were related to the patients or the GPs themselves being insufficiently informed. Attitudes of the GPs were shown to play a role in the decision of patients not to start treatment. Interventions need to be developed that are aimed at GPs, and at education of patients.
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Affiliation(s)
- Karin M A Swart
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands. .,Stichting Artsen Laboratorium en Trombosedienst, Molenwerf 11, 1541 WR, Koog aan de Zaan, Netherlands.
| | - Myrthe van Vilsteren
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands.,Stichting Artsen Laboratorium en Trombosedienst, Molenwerf 11, 1541 WR, Koog aan de Zaan, Netherlands
| | - Wesley van Hout
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Esther Draak
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Babette C van der Zwaard
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Henriette E van der Horst
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Petra J M Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
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Edmondson D, Falzon L, Sundquist KJ, Julian J, Meli L, Sumner JA, Kronish IM. A systematic review of the inclusion of mechanisms of action in NIH-funded intervention trials to improve medication adherence. Behav Res Ther 2018; 101:12-19. [PMID: 29033097 PMCID: PMC5800992 DOI: 10.1016/j.brat.2017.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 09/12/2017] [Accepted: 10/01/2017] [Indexed: 10/18/2022]
Abstract
Medication nonadherence contributes to morbidity/mortality, but adherence interventions yield small and inconsistent effects. Understanding the mechanisms underlying initiation and maintenance of adherence could improve interventions. The National Institutes of Health (NIH) support adherence research, but it is unclear whether existing NIH-funded research incorporates mechanisms. We conducted a systematic review to determine the proportion of NIH-funded adherence trials that have tested hypothesized mechanisms of intervention effects. We included randomized and quasi-randomized NIH-funded trials with medication adherence in adults as the primary outcome. Studies were identified by searching electronic databases from inception to 6/2016, references, and clinicaltrials.gov. Two of 18 (11%) NIH-funded trials tested a hypothesized mechanism of an intervention's effect on medication adherence. Another 44 studies with medication adherence as a secondary outcome were described in protocol form, and are either ongoing or never published results, but none mentioned mechanism tests. Overall, 3% of NIH-funded trials with adherence as an outcome conducted, or plan to conduct, tests of behavior change mechanisms. These results mirror previous findings that very few studies of behavior change interventions actually test the mechanism by which the intervention is hypothesized to improve health behaviors. We must understand mechanisms if we are to improve the effectiveness of interventions.
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Affiliation(s)
- Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th Street, New York, NY, United States.
| | - Louise Falzon
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th Street, New York, NY, United States
| | - Kevin J Sundquist
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th Street, New York, NY, United States
| | - Jacob Julian
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th Street, New York, NY, United States
| | - Laura Meli
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th Street, New York, NY, United States; Teachers College, Department of Counseling and Clinical Psychology, Columbia University, 428 Horace Mann, New York, NY, United States
| | - Jennifer A Sumner
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th Street, New York, NY, United States
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th Street, New York, NY, United States
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Laforest L, Belhassen M, Devouassoux G, Didier A, Ginoux M, Van Ganse E. Long-Term Inhaled Corticosteroid Adherence in Asthma Patients with Short-Term Adherence. J Allergy Clin Immunol Pract 2017; 4:890-899.e2. [PMID: 27587320 DOI: 10.1016/j.jaip.2016.07.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/19/2016] [Accepted: 07/20/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although the use of inhaled corticosteroids (ICS) in asthma is known to be overall erratic, the long-term use of ICS by patients selected during an episode of regular use is poorly documented. OBJECTIVE In a cohort of patients with asthma regularly acquiring ICS therapy over several months, we verified whether these patients remained treated in the following 12 months. The correlates of regular ICS use over this period were investigated. METHODS A historical cohort of patients with asthma was identified from the Echantillon généraliste de bénéficiaires national French health care reimbursement data (2007-2012). Patients (6-40 years) were selected during a regular ICS use episode, with 3 or more ICS refills within 120 days. Continuous multiple-interval measures of medication availability (CMA) were computed for the 12 months after the third dispensation, and the factors associated with a CMA value of 80% or more (adherent patients) were identified. RESULTS Among 5096 patients (42.1% children/teenagers, 48.8% females), only 24.0% had a CMA value of 80% or more (mean CMA = 54.4%) over the 12 months following the ICS selection period. Achieving a CMA value of 80% or more was primarily associated with being a child/teenager (P = .002), having more severe or less controlled asthma (P = .007), more previous dispensing of short-acting beta agonists (P < .0001), and receiving devices with 200 unit doses (P < .0001). Adherent patients had more frequent general practitioner visits (P < .0001), more distinct prescribers of respiratory therapy (P = .0002), and more frequent switches of ICS (P < .0001). CONCLUSIONS Most patients with asthma selected during an episode of regular ICS use did not maintain therapy over the following months. Adherence should be repeatedly monitored, and the reasons for discontinuation should be investigated, at prescriber and patient levels.
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Affiliation(s)
- Laurent Laforest
- PELyon, Lyon, France; HESPER, EA 7425, Health Services and Performance Research, Université Claude Bernard, Lyon, France
| | - Manon Belhassen
- PELyon, Lyon, France; HESPER, EA 7425, Health Services and Performance Research, Université Claude Bernard, Lyon, France
| | | | - Alain Didier
- Respiratory Medicine, Larrey University Hospital, Toulouse, France
| | - Marine Ginoux
- HESPER, EA 7425, Health Services and Performance Research, Université Claude Bernard, Lyon, France
| | - Eric Van Ganse
- PELyon, Lyon, France; HESPER, EA 7425, Health Services and Performance Research, Université Claude Bernard, Lyon, France; Respiratory Medicine, Croix Rousse University Hospital, Lyon, France.
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Edmondson D, Falzon L, Sundquist KJ, Julian J, Meli L, Sumner JA, Kronish IM. A systematic review of the inclusion of mechanisms of action in NIH-funded intervention trials to improve medication adherence. Behav Res Ther 2017. [PMID: 29033097 DOI: 10.1016/j.brat.2017.10.001.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
Medication nonadherence contributes to morbidity/mortality, but adherence interventions yield small and inconsistent effects. Understanding the mechanisms underlying initiation and maintenance of adherence could improve interventions. The National Institutes of Health (NIH) support adherence research, but it is unclear whether existing NIH-funded research incorporates mechanisms. We conducted a systematic review to determine the proportion of NIH-funded adherence trials that have tested hypothesized mechanisms of intervention effects. We included randomized and quasi-randomized NIH-funded trials with medication adherence in adults as the primary outcome. Studies were identified by searching electronic databases from inception to 6/2016, references, and clinicaltrials.gov. Two of 18 (11%) NIH-funded trials tested a hypothesized mechanism of an intervention's effect on medication adherence. Another 44 studies with medication adherence as a secondary outcome were described in protocol form, and are either ongoing or never published results, but none mentioned mechanism tests. Overall, 3% of NIH-funded trials with adherence as an outcome conducted, or plan to conduct, tests of behavior change mechanisms. These results mirror previous findings that very few studies of behavior change interventions actually test the mechanism by which the intervention is hypothesized to improve health behaviors. We must understand mechanisms if we are to improve the effectiveness of interventions.
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Affiliation(s)
- Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th Street, New York, NY, United States.
| | - Louise Falzon
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th Street, New York, NY, United States
| | - Kevin J Sundquist
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th Street, New York, NY, United States
| | - Jacob Julian
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th Street, New York, NY, United States
| | - Laura Meli
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th Street, New York, NY, United States; Teachers College, Department of Counseling and Clinical Psychology, Columbia University, 428 Horace Mann, New York, NY, United States
| | - Jennifer A Sumner
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th Street, New York, NY, United States
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th Street, New York, NY, United States
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Allemann SS, Nieuwlaat R, Navarro T, Haynes B, Hersberger KE, Arnet I. Congruence between patient characteristics and interventions may partly explain medication adherence intervention effectiveness: an analysis of 190 randomized controlled trials from a Cochrane systematic review. J Clin Epidemiol 2017; 91:70-79. [PMID: 28802672 DOI: 10.1016/j.jclinepi.2017.07.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/25/2017] [Accepted: 07/24/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Due to the negative outcomes of medication nonadherence, interventions to improve adherence have been the focus of countless studies. The congruence between adherence-related patient characteristics and interventions may partly explain the variability of effectiveness in medication adherence studies. In their latest update of a Cochrane review reporting inconsistent effects of adherence interventions, the authors offered access to their database for subanalysis. We aimed to use this database to assess congruence between adherence-related patient characteristics and interventions and its association with intervention effects. STUDY DESIGN AND SETTING We developed a congruence score consisting of six features related to inclusion criteria, patient characteristics at baseline, and intervention design. Two independent raters extracted and scored items from the 190 studies available in the Cochrane database. We correlated overall congruence score and individual features with intervention effects regarding adherence and clinical outcomes using Kruskal-Wallis rank sum test and Fisher's exact test. RESULTS Interrater reliability for newly extracted data was almost perfect with a Cohen's Kappa of 0.92 [95% confidence interval (CI) = 0.89-0.94; P < 0.001]. Although present in only six studies, the inclusion of nonadherent patients was the single feature significantly associated with effective adherence interventions (P = 0.003). Moreover, effective adherence interventions were significantly associated with improved clinical outcomes (odds ratio = 6.0; 95% CI = 3.1-12.0; P < 0.0001). However, neither the overall congruence score nor any other individual feature (i.e., "determinants of nonadherence as inclusion criteria," "tailoring of interventions to the inclusion criteria," "reasons for nonadherence assessed at baseline," "adjustment of intervention to individual patient needs," and "theory-based interventions") was significantly associated with intervention effects. CONCLUSION The presence of only six studies that included nonadherent patients and the interdependency of this feature with the remaining five might preclude a conclusive assessment of congruence between patient characteristics and adherence interventions. In order to obtain clinical benefits from effective adherence interventions, we encourage researchers to focus on the inclusion of nonadherent patients.
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Affiliation(s)
- Samuel S Allemann
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel, Klingelbergstrasse 50, 4056 Basel, Switzerland.
| | - Robby Nieuwlaat
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton General Hospital Campus, 237 Barton Street, East Hamilton, ON L8L 2X2, Canada
| | - Tamara Navarro
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton General Hospital Campus, 237 Barton Street, East Hamilton, ON L8L 2X2, Canada
| | - Brian Haynes
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton General Hospital Campus, 237 Barton Street, East Hamilton, ON L8L 2X2, Canada
| | - Kurt E Hersberger
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel, Klingelbergstrasse 50, 4056 Basel, Switzerland
| | - Isabelle Arnet
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel, Klingelbergstrasse 50, 4056 Basel, Switzerland
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Aznar-Lou I, Fernández A, Gil-Girbau M, Sabés-Figuera R, Fajó-Pascual M, Peñarrubia-María MT, Serrano-Blanco A, Moreno-Peral P, Sánchez-Niubó A, March-Pujol M, Rubio-Valera M. Impact of initial medication non-adherence on use of healthcare services and sick leave: a longitudinal study in a large primary care cohort in Spain. Br J Gen Pract 2017; 67:e614-22. [PMID: 28760740 DOI: 10.3399/bjgp17X692129] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/05/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Initial medication non-adherence is highly prevalent in primary care but no previous studies have evaluated its impact on the use of healthcare services and/or days on sick leave. AIM To estimate the impact of initial medication non-adherence on the use of healthcare services, days of sick leave, and costs overall and in specific medication groups. DESIGN AND SETTING A 3-year longitudinal register-based study of all primary care patients (a cohort of 1.7 million) who were prescribed a new medication in Catalonia (Spain) in 2012. METHOD Thirteen of the most prescribed and/or costly medication subgroups were considered. All medication and medication subgroups (chronic, analgesics, and penicillin) were analysed. The number of healthcare services used and days on sick leave were considered. Multilevel multivariate linear regression was used. Three levels were included: patient, GP, and primary care centre. RESULTS Initially adherent patients made more use of medicines and some healthcare services than non-adherent and partially adherent patients. They had lower productivity losses, producing a net economic return, especially when drugs for acute diseases (such as penicillins) were considered. Initial medication non-adherence resulted in a higher economic burden to the system in the short term. CONCLUSION Initial medication non-adherence seems to have a short-term impact on productivity losses and costs. The clinical consequences and long-term economic consequences of initial medication non-adherence need to be assessed. Interventions to promote initial medication adherence in primary care may reduce costs and improve health outcomes.
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Peper FE, Esteban S, Terrasa SA. [Evaluation of primary adherence to medications in patients with chronic conditions: A retrospective cohort study]. Aten Primaria 2017; 50:96-105. [PMID: 28521859 PMCID: PMC6837084 DOI: 10.1016/j.aprim.2017.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To assess the proportion of members of a private health insurance at the Hospital Italiano de Buenos Aires with primary adherence to, 1) bisphosphonates for secondary prevention of osteoporotic fractures, 2) insulin and metformin in type 2 diabetes, and 3) tamoxifen in the context of treatment of breast cancer. DESIGN Retrospective cohort study to determine the proportion of primary treatment adherence during 2012 and 2013. SITE: Hospital Italiano de Buenos Aires, Argentina. PARTICIPANTS Members of the Hospital Italiano de Buenos Aires private health insurance, who had received a new electronic prescription (alendronate or ibandronate for secondary prevention of fractures following an osteoporotic fracture; insulin and/or metformin for type 2 diabetes; or tamoxifen as a treatment for breast cancer) during the years 2012 and 2013. An analysis was performed on 1,403 new electronic prescriptions, of which 673 were excluded for not meeting the inclusion criteria. MAIN MEASUREMENTS Primary adherence has been defined as the execution of a first-time treatment after it was agreed with the health care provider. The primary analysis assessed the proportion of primary adherence for the three medications. A bivariate analysis was performed to compare the characteristics and potential predictors of primary adherence. RESULTS Primary adherence for each drug group was, 93% Bisphosphonates, 88% Metformin, 96% Insulin, and 92% Tamoxifen. CONCLUSIONS To the best of our knowledge, this is the first study that has evaluated primary adherence in Argentina, and the first for Tamoxifen world wide. The primary adherence documented in our study was somewhat higher than that reported in the literature.
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Affiliation(s)
| | - Santiago Esteban
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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Dossa AR, Moisan J, Guénette L, Lauzier S, Grégoire JP. Association between interpersonal continuity of care and medication adherence in type 2 diabetes: an observational cohort study. CMAJ Open 2017; 5:E359-E364. [PMID: 28483785 PMCID: PMC5498180 DOI: 10.9778/cmajo.20160063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Prior studies have shown that, compared to patients with a low level of interpersonal continuity of care, patients with a high level of continuity of care have a lower likelihood of hospital admission and emergency department visits, and a higher likelihood of patient satisfaction. We sought to determine whether higher levels of continuity of care are associated with medication persistence and compliance among new users of oral antidiabetic treatment. METHODS We conducted a medicoadministrative cohort study of new users of oral antidiabetics aged 18 years or more among people covered by the Quebec public drug plan. We excluded people with fewer than 730 days of treatment and those who had been in hospital for 275 days or more in the first or second year after initiation of antidiabetic treatment. We categorized continuity of care observed in the first year after treatment initiation as low, intermediate or high. The association between continuity of care and medication persistence and compliance was assessed using generalized linear models. RESULTS In this cohort of 60 924 new users of oral antidiabetic treatment, compared to patients with a high level of continuity of care, those with an intermediate and a low level of continuity of care were less likely to be persistent (adjusted prevalence ratio 0.97 [95% confidence interval (CI) 0.96-0.98] and 0.96 [95% CI 0.95-0.97], respectively) and compliant (adjusted prevalence ratio 0.98 [95% CI 0.97-0.99] and 0.95 [0.94-0.97], respectively) with their antidiabetic treatment. INTERPRETATION A higher level of interpersonal continuity of care was associated with a higher likelihood of drug persistence and compliance. Since the strength of this association was weak, further research is required to determine whether continuity of care plays a role in medication adherence.
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Affiliation(s)
- Anara Richi Dossa
- Affiliations: Chair on Adherence to Treatments (Dossa, Moisan, Guénette, Lauzier, Grégoire), Faculty of Pharmacy, Université Laval; Population Health and Optimal Practices in Health Research Unit (Dossa, Moisan, Guénette, Lauzier, Grégoire), Centre hospitalier universitaire de Québec-Université Laval Research Centre, Québec, Que
| | - Jocelyne Moisan
- Affiliations: Chair on Adherence to Treatments (Dossa, Moisan, Guénette, Lauzier, Grégoire), Faculty of Pharmacy, Université Laval; Population Health and Optimal Practices in Health Research Unit (Dossa, Moisan, Guénette, Lauzier, Grégoire), Centre hospitalier universitaire de Québec-Université Laval Research Centre, Québec, Que
| | - Line Guénette
- Affiliations: Chair on Adherence to Treatments (Dossa, Moisan, Guénette, Lauzier, Grégoire), Faculty of Pharmacy, Université Laval; Population Health and Optimal Practices in Health Research Unit (Dossa, Moisan, Guénette, Lauzier, Grégoire), Centre hospitalier universitaire de Québec-Université Laval Research Centre, Québec, Que
| | - Sophie Lauzier
- Affiliations: Chair on Adherence to Treatments (Dossa, Moisan, Guénette, Lauzier, Grégoire), Faculty of Pharmacy, Université Laval; Population Health and Optimal Practices in Health Research Unit (Dossa, Moisan, Guénette, Lauzier, Grégoire), Centre hospitalier universitaire de Québec-Université Laval Research Centre, Québec, Que
| | - Jean-Pierre Grégoire
- Affiliations: Chair on Adherence to Treatments (Dossa, Moisan, Guénette, Lauzier, Grégoire), Faculty of Pharmacy, Université Laval; Population Health and Optimal Practices in Health Research Unit (Dossa, Moisan, Guénette, Lauzier, Grégoire), Centre hospitalier universitaire de Québec-Université Laval Research Centre, Québec, Que
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Peaslee A, Wickizer M, Olson J, Topp R. Impact of a Combined Value-Based Insurance Design and Medication Therapy Management Program on Diabetes Medication Adherence. J Manag Care Spec Pharm 2017; 22:1303-1309. [PMID: 27783550 PMCID: PMC10397600 DOI: 10.18553/jmcp.2016.22.11.1303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Value-based insurance design (VBID) waives or reduces prescription copayments in order to decrease member cost barriers to refilling medications. Medication therapy management (MTM) is a member clinical intervention designed to reinforce members' knowledge of their medications, which addresses barriers to medication adherence. Both methods have been shown to increase adherence in members, particularly when used in combination. To date, studies of such combined programs have often been completed within integrated health systems but have rarely included control populations. OBJECTIVE To determine the effect of a combined VBID and MTM program on key medication adherence metrics among diabetic members of a large employer group in the Midwest. METHODS A retrospective pre/post longitudinal analysis of pharmacy claims data was performed for 77 participants in a combined VBID/MTM program and 77 eligible nonparticipants, matched by the baseline adherence metrics of proportion of days covered (PDC) and number of days without therapy, also known as gaps in therapy (GIT). Oral antidiabetic medication adherence and cost-related outcomes for all pharmacy claims were evaluated within and between groups over a 6-month period. Post hoc analyses were performed to investigate the effect of the intervention by gender and among a less adherent subpopulation of participants with a PDC of < 100% at baseline. RESULTS Introduction of the intervention resulted in a nonsignificant increase in PDC from 92.9% to 95.4%, in contrast to a nonsignificant decrease from 92.8% to 91.7% in the comparison group. GIT underwent a nonsignificant decrease of 2.83 days during intervention, while nonsignificantly increasing 2.82 days in the comparators. Pharmacy claims costs paid by the plan per member per 6-month period significantly increased in the intervention group from $1,991.23 to $3,092.74, compared with a nonsignificant increase from $1,402.21 to $1,645.68 in the comparison group. Among the less-adherent subpopulation, PDC increased significantly after intervention from 84.7% to 93.1% compared with a nonsignificant increase from 84.6% to 89.0% among nonparticipants. A significant 10.69-day decrease in GIT was also observed among nonadherent participants compared with a nonsignificant 3.59-day decrease among nonparticipants. Female participants experienced a significant PDC increase from 91.5% to 96.8% and a GIT decrease of 7.32 days, while male participants did not change significantly. CONCLUSIONS While statistically significant improvements to adherence were not observed among this population of members who were highly adherent at baseline, improvement trends and subgroup analyses demonstrated that the combined VBD/MTM program may have the potential to influence member behavior in employer groups. Larger, longer-term studies are needed to confirm this potential. Additional benefit may be realized by targeting members with lower adherence metrics at baseline and examining potential cost savings associated with medical outcomes. DISCLOSURES Funding for this project was provided by Navitus Health Solutions. Peaslee, Wickizer, and Olson are employed by Navitus Health Solutions. Peaslee is a clinical staff pharmacist working in Formulary Services and a former PGY-1 Managed Care Clinical Pharmacy Resident at this location. Wickizer is the Associate Manager of Clinical Programs and Residency Programs. Olson is the Director of Clinical Programs and Product Development. Topp is the Patricia A. Chin Nursing Research Endowed Professor at the Hahn School of Nursing and Health Science at the University of San Diego specializing in statistics. Topp received consulting fees from Navitus Health Solutions for work on this project. Study concept and design were contributed by Peaslee, Wickizer, and Olson, with assistance from Topp. Peaslee took the lead in data collection, with assistance from Wickizer, and data interpretation was performed by Peaslee, Topp, Wickizer, and Olson. The manuscript was written primarily by Peaslee, with assistance from the other authors, and revised by Topp, Wickizer, and Olson, assisted by Peaslee.
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Affiliation(s)
| | | | - Julie Olson
- 1 Navitus Health Solutions, Madison, Wisconsin
| | - Robert Topp
- 2 University of San Diego Hahn School of Nursing and Health Science, San Diego, California
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Campbell CI, Parthasarathy S, Young-Wolff KC, Satre DD. Buprenorphine Treatment and Patient Use of Health Services after the Affordable Care Act in an Integrated Health Care System. J Psychoactive Drugs 2017; 49:160-168. [PMID: 28426332 DOI: 10.1080/02791072.2017.1305519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Affordable Care Act (ACA) was expected to benefit patients with substance use disorders, including opioid use disorders (OUDs). This study examined buprenorphine use and health services utilization by patients with OUDs pre- and post-ACA in a large health care system. Using electronic health record data, we examined demographic and clinical characteristics (substance use, psychiatric and medical conditions) of two patient cohorts using buprenorphine: those newly enrolled in 2012 ("pre-ACA," N = 204) and in 2014 ("post-ACA," N = 258). Logistic and negative binomial regressions were used to model persistent buprenorphine use, and to examine whether persistent use was related to health services utilization. Buprenorphine patients were largely similar pre- and post-ACA, although more post-ACA patients had a marijuana use disorder (p < .01). Post-ACA patients were more likely to have high-deductible benefit plans (p < .01). Use of psychiatry services was lower post-ACA (IRR: 0.56, p < .01), and high-deductible plans were also related to lower use of psychiatry services (IRR: 0.30, p < .01). The relationship between marijuana use disorder and prescription opioid use is complex, and deserves further study, particularly with increasingly widespread marijuana legalization. Access to psychiatry services may be more challenging for buprenorphine patients post-ACA, especially for patients with deductible plans.
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Affiliation(s)
- Cynthia I Campbell
- a Research Scientist, Division of Research , Kaiser Permanente Northern California Region , Oakland , CA , USA
| | - Sujaya Parthasarathy
- b Economist, Division of Research , Kaiser Permanente Northern California Region , Oakland , CA , USA
| | - Kelly C Young-Wolff
- a Research Scientist, Division of Research , Kaiser Permanente Northern California Region , Oakland , CA , USA
| | - Derek D Satre
- c Associate Professor, Department of Psychiatry , UCSF Weill Institute for Neurosciences, University of California, San Francisco , San Francisco , CA , USA
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Kaae S, Aarup KHF, Sporrong SK. Patient responses to inhaler advice given by community pharmacies: The importance of meaningfulness. Res Social Adm Pharm 2017; 13:364-368. [DOI: 10.1016/j.sapharm.2016.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 11/25/2022]
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Müller S, Wilke T, Fuchs A, Maywald U, Flacke JP, Heinisch H, Krüger K. Non-persistence and non-adherence to MTX therapy in patients with rheumatoid arthritis: a retrospective cohort study based on German RA patients. Patient Prefer Adherence 2017; 11:1253-1264. [PMID: 28790807 PMCID: PMC5530851 DOI: 10.2147/ppa.s134924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE This study aimed to assess the level of nonpersistence (NP) and nonadherence (NA) to methotrexate (MTX) therapy in German patients with rheumatoid arthritis (RA). MATERIALS AND METHODS Based on German claims data, RA patients who received a MTX therapy (subgroup: treatment-naive patients) were analyzed. NP was defined as treatment gap >12 weeks. Regarding NA, it is the overall medication possession ratio (MPR) during an observational period of 12 or 24 months after therapy, and the MPR is calculated only for the periods of therapy continuation; NA was defined as MPR <80%. RESULTS A total of 7,146 RA patients who received at least one MTX prescription (subgroup: 1,211 treatment-naive patients) could be observed (mean age: 64.4 years, 73.6% female). Percentage of NP patients among MTX-naive patients after 6, 12 and 18 months was 16.7%, 34.0% and 36.7%, respectively. After MTX therapy discontinuation, 39.9% had restarted their MTX therapy, 13.8% had received another non-MTX synthetic disease-modifying antirheumatic drug (sDMARD), 8.1% had biological DMARD (bDMARD) and 49.2% had not received any DMARD prescription at all. Overall, 12- and 24-month MPRs for MTX therapy were 83.0% and 76.5% with a percentage of NA patients of 25.8% and 33.8%, respectively. During periods of general treatment continuation, the percentage of patients with an MPR <80% was 6.5%. CONCLUSION NP to MTX treatment seems to be common in one-fourth of German patients with RA. An additional number of patients, at least 6.5%, are also affected by NA. A considerable percentage of RA patients who discontinued MTX therapy do not receive any follow-up DMARD therapy.
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Affiliation(s)
- Sabrina Müller
- Institute for Pharmacoeconomics and Medication Logistics, University of Wismar, Wismar
- Correspondence: Sabrina Müller, Institute for Pharmacoeconomics and Medication Logistics, University of Wismar, Alter Holzhafen 19, 23966 Wismar, Germany, Tel +49 3841 758 1014, Fax +49 3841 758 1011, Email
| | - Thomas Wilke
- Institute for Pharmacoeconomics and Medication Logistics, University of Wismar, Wismar
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Allemann SS, Nieuwlaat R, van den Bemt BJF, Hersberger KE, Arnet I. Matching Adherence Interventions to Patient Determinants Using the Theoretical Domains Framework. Front Pharmacol 2016; 7:429. [PMID: 27895583 PMCID: PMC5107738 DOI: 10.3389/fphar.2016.00429] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 10/27/2016] [Indexed: 12/31/2022] Open
Abstract
Introduction: Despite much research, interventions to improve medication adherence report disappointing and inconsistent results. Tailored approaches that match interventions and patient determinants of non-adherence were seldom used in clinical trials. The presence of a multitude of theoretical frameworks and models to categorize interventions and patient determinants complicated the development of common categories shared by interventions and determinants. We retrieved potential interventions and patient determinants from published literature on medication adherence, matched them like locks and keys, and categorized them according to the Theoretical Domains Framework (TDF). Methods: We identified the most relevant literature reviews on interventions and determinants in a pragmatic literature search, extracted all interventions and determinants, grouped similar concepts to umbrella terms and assigned them to TDF categories. All steps were finalized in consensus discussion between the authors. Results: Sixteen articles (5 with determinants, 11 with interventions) were included for analysis. We extracted 103 interventions and 42 determinants that we divided in 26 modifiable and 16 unmodifiable determinants. All interventions and modifiable determinants were matched within 11 categories (Knowledge; Skills; Social/professional role and identity; Beliefs about capabilities; Beliefs about consequences; Intentions; Memory, Attention and decision processes; Environmental context and resources; Social influences; Emotion; and Behavioral regulation). Conclusion: In published trials on medication adherence, the congruence between interventions and determinants can be assessed with matching interventions to determinants. To be successful, interventions in medication adherence should target current modifiable determinants and be tailored to the unmodifiable determinants. Modifiable and unmodifiable determinants need to be assessed at inclusion of intervention studies to identify the patients most in need of an adherence intervention. Our matched categories may be useful to develop interventions in trials that investigate the effectiveness of adherence interventions.
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Affiliation(s)
- Samuel S Allemann
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel Basel, Switzerland
| | - Robby Nieuwlaat
- Department of Clinical Epidemiology and Biostatistics, McMaster University Hamilton, ON, Canada
| | - Bart J F van den Bemt
- Department of Pharmacy, Radboud University Medical CenterNijmegen, Netherlands; Department of Pharmacy, Sint MaartenskliniekNijmegen, Netherlands
| | - Kurt E Hersberger
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel Basel, Switzerland
| | - Isabelle Arnet
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel Basel, Switzerland
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