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Jelinek L, Vaclavik J, Lazarova M. Interventions for increasing medication adherence in heart failure patients: A narrative review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024; 168:200-205. [PMID: 39023062 DOI: 10.5507/bp.2024.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
Heart failure is one of the critical and most costly medical challenges of the 21st century. It is a chronic debilitating condition and adherence to medication, a precondition for successful treatment is often poor. There are various interventions for improving the adherence. Depending on the goal of the intervention, these are roughly patient centric, healthcare provider centric and system centric. We provide an overview of these interventions with a focus on effectiveness and appropriateness in different clinical situations. Their use can lead to improved patient outcomes and reduced economic burden of the disease.
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Affiliation(s)
- Libor Jelinek
- Department of Exercise Medicine and Cardiovascular Rehabilitation, University Hospital Olomouc and Faculty of Medicine, Palacky University Olomouc, Olomouc, Czech Republic
| | - Jan Vaclavik
- Department of Internal Medicine and Cardiology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Marie Lazarova
- Department of Internal Medicine and Cardiology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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Chung H, Cantu C, Pankratova C, Kemner J, Alvir J, Prasad S, Chen Y. Adherence and persistence to tafamidis treatment among Medicare beneficiaries in the presence of a patient assistance program. Sci Rep 2024; 14:16261. [PMID: 39009615 PMCID: PMC11251142 DOI: 10.1038/s41598-024-62660-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/20/2024] [Indexed: 07/17/2024] Open
Abstract
Tafamidis is the only disease-modifying therapy approved to treat patients in the United States with transthyretin amyloid cardiomyopathy (ATTR-CM), which most commonly affects patients aged ≥ 65 years. The manufacturer operates a patient assistance program (PAP) to support access to tafamidis. This study conducted Privacy Preserving Record Linking (PPRL) using Datavant tokens to match patients across Medicare prescription drug plan (PDP) and PAP databases to evaluate the impact of PAPs on treatment exposure classification, adherence, and persistence determined using Medicare PDP data alone. We found 35% of Medicare PDP patients received tafamidis through the PAP only; 14% through both Medicare PDP and the PAP, and 51% through Medicare PDP only. Adherence and persistence were comparable between these cohorts but underestimated among patients who received ≥ 2 prescriptions through Medicare PDP and ≥ 1 through the PAP when solely using Medicare data versus pooled Medicare and PAP data (modified Medication Possession Ratio: 84% [69% ≥ 80% adherent] vs. 96% [93%]; Proportion of Days Covered: 77% [66% ≥ 80% adherent] vs. 88% [88%]; mean days to discontinuation: 186 vs. 252; total discontinuation: 13% vs. 11%). Cross-database PPRL is a valuable method to build more complete treatment journeys and reduce the risk of exposure misclassification in real-world analyses.
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Affiliation(s)
| | - Cera Cantu
- Clarify Health Solutions, New York, NY, USA
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FarzanehRad A, Allahbakhshian A, Gholizadeh L, Khalili AF, Hasankhani H. Randomized comparison of the effects of tailored text messaging versus pillbox organizers on medication adherence of heart failure patients. BMC Cardiovasc Disord 2024; 24:244. [PMID: 38724943 PMCID: PMC11080170 DOI: 10.1186/s12872-024-03884-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/09/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Heart failure (HF) is a major public health issue worldwide, affecting approximately 64.3 million people in 2017. Non-adherence to medication is a common and serious issue in the management of HF. However, new reminder systems utilizing mobile technology, such as text messaging, have shown promise in improving medication adherence. The purpose of this study was to compare the impact of tailored text messaging (TTM) and pillbox organizers on medication adherence in individuals with HF. METHODS A randomized controlled trial was conducted, involving 189 eligible patients with HF who were randomly assigned to either the TTM, pillbox organizer, or control group. Medication adherence was evaluated using pill counting and the Medication Adherence Rating Scale (MARS) over a period of three months and compared across the groups. The data were analyzed using Kruskal-Wallis, Analysis of Variance (ANOVA), and Repeated Measures ANOVA tests. RESULTS The results indicate that both the TTM and pillbox organizers groups had significantly higher medication adherence compared to the control group, as measured by pill counting (MD = 0.05, 95%CI = 0.03-0.06; p < 0.001 for TTM group, MD = 0.04, 95%CI = 0.03-0.06; p < 0.001 for pillbox organizers group) and the MARS (MD = 1.32, 95%CI = 0.93 to 1.72; p < 0.001 for TTM group, MD = 1.33, 95%CI = 0.95 to 1.72; p < 0.001 for pillbox organizers group). However, there was no statistically significant difference in medication adherence between the two intervention groups using either measurement method. The TTM group exhibited a lower hospitalization rate than the other groups in the first follow up (p = 0.016). CONCLUSIONS Both the TTM and pillbox organizers were shown to be effective in enhancing medication adherence among patients with HF. Therefore, healthcare providers should take into account the patient's condition and preferences when selecting one of these methods to promote medication adherence. Future research should aim to address the limitations of this study, such as controlling for confounding variables, considering long-term effects, and comparing the effectiveness of different interventions.
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Affiliation(s)
- Ameneh FarzanehRad
- Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences Tabriz, Tabriz, East Azerbaijan, Iran
| | - Atefeh Allahbakhshian
- Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences Tabriz, Tabriz, East Azerbaijan, Iran.
- School of Nursing & Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Leila Gholizadeh
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Azizeh Farshbaf Khalili
- Physical Medicine and Rehabilitation Research Centre, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Hadi Hasankhani
- Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences Tabriz, Tabriz, East Azerbaijan, Iran
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Pacheco M, Sá P, Santos G, Boa-Sorte N, Domingues K, Assis L, Silva M, Oliveira A, Santos D, Ferreira J, Fernandes R, Fortes F, Rocha R, Santana G. Impact of an intervention program on drug adherence in patients with ulcerative colitis: Randomized clinical trial. PLoS One 2023; 18:e0295832. [PMID: 38150452 PMCID: PMC10752503 DOI: 10.1371/journal.pone.0295832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/20/2023] [Indexed: 12/29/2023] Open
Abstract
AIMS Evaluate the impact of an intervention program in non-adherent patients with ulcerative colitis. METHODS Parallel controlled randomized clinical trial (1:1), approved by the ethics committee (No. 3.068.511/2018) and registered at The Brazilian Clinical Trials Registry (No. RBR-79dn4k). Non-adherent ulcerative colitis patients according to the Morisky-Green-Levine-test were included. Recruitment began in August 2019 until August 2020, with 6-month follow-up. All participants received standard usual care, and additionally the intervention group received educational (video, educational leaflet, verbal guidance) and behavioral interventions (therapeutic scheme, motivational and reminder type short message services). Researchers were blinded for allocation prior to data collection at Visits 1 and 2 (0 and 6 months). Primary outcome: 180-day adherence rate, with relative risk 95%CI. Secondary outcome: 180-day quality of life according to SF-36 domains, using Student's t test. Variables with p<0.20 were selected for regression. Analysis included data from August/2019 to May/2021. RESULTS Forty-six and 49 participants were allocated in control and intervention groups, respectively. Two were excluded due to intervention refusal, and 4 and 6 were lost to follow-up in control and intervention groups. There was no post-intervention adherence rate difference, even after adjustment for type of non-adherence (unintentional/both/intentional) as confounder, or if considered as adherent the intervention group participants lost in follow-up. Interventions promoted better quality of life scores even after multivariate analysis for "Pain", when adjusted for ulcerative colitis severity, sex, and marital status (β = 18.352, p = 0.004), "Vitality", when adjusted for ulcerative colitis severity (β = 10.568, p = 0.015) and "Emotional Aspects", when adjusted for disease severity, income, and education (β = 24.907, p = 0.041). CONCLUSIONS The intervention program was not able to produce a significant medication adherence rate difference between comparative groups, however, there was a significant improvement in quality of life. Study limitations may include: sample size calculated to identify differences of 30%, leading to a possible insufficient power; non blinded participants, exposing the results to the risk of performance bias; outcomes based on self-reported data.
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Affiliation(s)
- Mila Pacheco
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
| | - Pedro Sá
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
| | - Gláucia Santos
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
| | - Ney Boa-Sorte
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
| | - Kilma Domingues
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
| | - Larissa Assis
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
| | - Marina Silva
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
| | - Ana Oliveira
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
| | - Daniel Santos
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
| | - Jamile Ferreira
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
| | - Rosemeire Fernandes
- Centro de Infusões e Medicamentos Especializados da Bahia (CIMEB), Salvador, Bahia, Brazil
| | - Flora Fortes
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
| | - Raquel Rocha
- Universidade Federal da Bahia (UFBA), Canela, Salvador, BA–Brazil
| | - Genoile Santana
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
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Cotter G, Davison BA, Lam CSP, Metra M, Ponikowski P, Teerlink JR, Mebazaa A. Acute Heart Failure Is a Malignant Process: But We Can Induce Remission. J Am Heart Assoc 2023; 12:e031745. [PMID: 37889197 PMCID: PMC10727371 DOI: 10.1161/jaha.123.031745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Acute heart failure is a common and increasingly prevalent condition, affecting >10 million people annually. For those patients who survive to discharge, early readmissions and death rates are >30% everywhere on the planet, making it a malignant condition. Beyond these adverse outcomes, it represents one of the largest drivers of health care costs globally. Studies in the past 2 years have demonstrated that we can induce remissions in this malignant process if therapy is instituted rapidly, at the first acute heart failure episode, using full doses of all available effective medications. Multiple studies have demonstrated that this goal can be achieved safely and effectively. Now the urgent call is for all stakeholders, patients, physicians, payers, politicians, and the public at large to come together to address the gaps in implementation and enable health care providers to induce durable remissions in patients with acute heart failure.
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Affiliation(s)
- Gad Cotter
- Heart InitiativeDurhamNC
- Momentum Research, IncDurhamNC
- Université Paris Cité, INSERM UMR‐S 942 (MASCOT)ParisFrance
| | - Beth A. Davison
- Heart InitiativeDurhamNC
- Momentum Research, IncDurhamNC
- Université Paris Cité, INSERM UMR‐S 942 (MASCOT)ParisFrance
| | - Carolyn S. P. Lam
- National Heart Centre SingaporeSingapore
- Duke–National University of SingaporeSingapore
| | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical UniversityWrocławPoland
| | - John R. Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of MedicineUniversity of California San FranciscoSan FranciscoCA
| | - Alexandre Mebazaa
- Université Paris Cité, INSERM UMR‐S 942 (MASCOT)ParisFrance
- Department of Anesthesiology and Critical Care and Burn UnitSaint‐Louis and Lariboisière Hospitals, FHU PROMICE, DMU Parabol, APHP NordParisFrance
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Ukoha-Kalu BO, Isah A, Biambo AA, Samaila A, Abubakar MM, Kalu UA, Soyiri IN. Effectiveness of educational interventions on hypertensive patients' self-management behaviours: an umbrella review protocol. BMJ Open 2023; 13:e073682. [PMID: 37550030 PMCID: PMC10407355 DOI: 10.1136/bmjopen-2023-073682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/27/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Although different educational interventions have been widely used to manage and treat hypertension, alone or in combination with other interventions, there is a significant variation in their claimed effectiveness. REVIEW QUESTION/OBJECTIVE The objective of this umbrella review is to determine the effectiveness of educational interventions, alone or in combination with other interventions, for improving blood pressure control and self-management practices among hypertensive patients. The review question is: Do educational interventions, alone or in combination with other interventions, improve self-management practices among patients with hypertension? METHODS We will conduct a review of systematic reviews involving studies that implemented educational interventions, alone or in combination with other interventions, designed to change self-care practices among hypertensive patients who are 18 years and above, regardless of their sex and ethnicity. Following the guidelines set forth in the Preferred Reporting Items for Systematic Review and Meta-Analysis statement, a comprehensive literature search will be conducted from September to December 2023 on six electronic databases: MEDLINE, Embase, PsycINFO, CINAHL, Web of Science Core Collection and Google Scholar. Search terms will be developed using database-specific indexed terms and text words derived from the review aim. We will present the effects of the educational interventions, alone or in combination with other interventions, on hypertension self-management practices. We will report the outcome data with 95% CIs for each study. Relative risk, mean differences or ORs will be used, depending on the measuring indices in each study. ETHICS AND DISSEMINATION Ethical approval is not required as this study will use aggregated data from previously published systematic reviews. However, we have registered the protocol in PROSPERO. We confirm that all methods will be performed following the guidelines of the Declaration of Helsinki. The findings from this study will be disseminated through presentations at academic conferences and publication in peer-reviewed international journals. PROSPERO REGISTRATION NUMBER CRD42022375581.
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Affiliation(s)
- Blessing Onyinye Ukoha-Kalu
- Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nsukka, Enugu state, Nigeria
- School of Medicine, University of Nottingham, Nottingham, England, UK
| | - Abdulmuminu Isah
- Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nsukka, Enugu state, Nigeria
| | - Aminu A Biambo
- Clinical Pharmacy and Pharmacy Practice, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Aliyu Samaila
- Clinical Pharmacy and Pharmacy Practice, Usmanu Danfodiyo University, Sokoto, Nigeria
| | | | - Ukoha Agwu Kalu
- Department of Pediatric Surgery, Hull University Teaching Hospitals NHS Trust, Hull, UK
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