Barriers and Solutions to Improve Therapeutic Adherence from the Perspective of Primary Care and Hospital-Based Physicians

Adherence and persistence among patients with hereditary angioedema receiving long-term prophylaxis in the United States

Introduction: Real-world evidence that compares the treatment patterns of targeted long-term prophylaxis (LTP) for hereditary angioedema (HAE), including berotralstat, lanadelumab, and subcutaneous (SC) plasma-derived C1 inhibitor (pdC1-INH) is limited. Objective: The study aimed to assess adherence and persistence after initiation of berotralstat, lanadelumab, or SC-pdC1-INH. Methods: Electronic health records linked to claims data was used to select patients ages ≥ 12 years, initiating one of three LTPs between June 22, 2017, and September 12, 2023, with mutually exclusive cohorts assigned hierarchically in reverse order of their U.S. Food and Drug Administration approval date. Patients were required to have ≥ 12 months of continuous enrollment before and after the LTP initiation date. Demographics and baseline clinical characteristics were captured. Primary study measures were adherence, defined as the mean proportion of days covered (PDC), and persistence, defined as having no gap in treatment ≥ 45 days after the LTP initiation date. A subgroup analysis was conducted among patients with two or more claims for their index LTP. A sensitivity analysis was performed by reassigning cohorts based on the first claim for qualifying LTP after June 22, 2017. Results: The main analysis included 357 patients (90 on berotralstat, 189 lanadelumab, and 78 SC-pdC1-INH). Overall, 46% to 51% of the patients had LTP experience. Adherence (mean PDC) was similar between treatments at 0.73, 0.78, and 0.74 for berotralstat, lanadelumab, and SC-pdC1-INH, respectively. Proportions of patients persistent on index LTP after 12 months were similar across LTPs: 61%, 58%, and 53% for berotralstat, lanadelumab, and SC-pdC1-INH, respectively. The findings of the subgroup and sensitivity analyses supported the main analysis. Conclusion: Adherence and persistence rates for all three LTP treatments were uniformly high. Berotralstat adherence and persistence were comparable with those observed after lanadelumab or SC-pdC1-INH initiation in the main analysis, among patients with two or more claims for their index LTP, and among cohorts assigned based on the first claim for qualifying LTP.

Non-adherence to immunosuppressive medications in kidney transplant recipients- a systematic scoping review

BACKGROUND

Rejection and graft failure remain common in kidney transplant recipients. Non-adherence to immunosuppressive medications is considered a major contributary factor to reduced long-term graft survival, particularly in younger people. Improvements in clinical practice based on adherence studies has been minimal.

METHODS

Joanna Briggs' Institute Methodology was used. MedlineALL, Embase, Web of Science Core Collection and Scopus databases were searched from January 2000 through to December 2023. Abstract and full text reviews were undertaken independently by two reviewers. Data was collated using a pre-designed extraction tool.

RESULTS

359 articles met the inclusion criteria. Non-adherence was commonly defined using self-reported questionnaires or pharmacy re-fill rates. Prevalence of non-adherence varied widely. There was little correlation between method of measurement and reported rates of non-adherence. Despite younger age being identified as a risk factor for non-adherence, pooled reported prevalence did not differ significantly in studies reporting prevalence in children, adolescents, or young adults vs. older adults (36.0 % vs. 34.0 %). Interventional studies to detect or improve adherence are highly heterogenous, often report small effects and are limited by the lack of gold-standard methods to measure adherence.

DISCUSSION

This scoping review outlines the complexities of non-adherence to immunosuppressive medications among kidney transplant recipients, highlighting significant variability in adherence definitions, measurements, and intervention efficacy. Reported non-adherence rates vary widely (2-89 %), underscoring the need for standardisation of the definition of non-adherence in research. Findings suggest that non-adherence to immunosuppressive medication is driven by a mix of demographic, psychosocial, and transplant-specific factors. Future research should prioritise standardised definitions of adherence, validated tools to measure adherence, and focus on clinically significant outcomes in non-adherent populations to develop meaningful, impactful interventions for long-term patient benefit.

Application of hypertension clinical guidelines among family medicine doctors in primary health care centers in Riyadh City, Saudi Arabia

Background

Effective management of hypertension relies on adherence to evidence-based clinical practice guidelines (CPGs) among healthcare providers. However, adherence to hypertension CPGs and the factors influencing it among primary care physicians in Riyadh, Saudi Arabia, remain poorly understood.

Methodology

This descriptive cross-sectional study aimed to assess the knowledge, application, and determinants of adherence to hypertension CPGs among primary care physicians working in Prince Sultan Military Medical City (PSMMC) and its affiliated primary health care centers in Riyadh, Saudi Arabia. A comprehensive sample of 211 primary care physicians was enrolled, and data were collected using a self-administered questionnaire covering demographic characteristics, adherence to hypertension CPGs, and barriers to guideline application. Descriptive statistics and appropriate statistical tests were used for data analysis.

Results

The demographic profile of participants revealed a comprehensive representation of age, marital status, nationality, job title, qualification, and years of practice. The majority of participants demonstrated acceptable levels of knowledge (76.3%) and application (89.1%) of hypertension CPGs. However, barriers related to patient nonadherence to lifestyle modifications and medications were reported, highlighting challenges in implementing guideline recommendations in clinical practice. Significant associations were found between nationality, job title, qualification, and adherence to CPGs, with non-Saudi nationality and junior physicians exhibiting higher rates of unacceptable knowledge and application. Moreover, differences in adherence were observed among physicians following different hypertension CPGs.

Conclusion

While primary care physicians in Riyadh demonstrate a strong foundation in evidence-based hypertension management, addressing barriers and disparities in adherence to CPGs requires targeted interventions and collaborative efforts. Promoting a culture of evidence-based practice, enhancing patient education and engagement strategies, and fostering collaboration among stakeholders are essential steps toward improving hypertension control and prevention in the region.

[Cardiovascular preventive recommendations. PAPPS 2024 thematic updates]

The recommendations of the semFYC's Program for Preventive Activities and Health Promotion (PAPPS) for the prevention of vascular diseases (VD) are presented. New in this edition are new sections such as obesity, chronic kidney disease and metabolic hepatic steatosis, as well as a 'Don't Do' section in the different pathologies treated. The sections have been updated: epidemiological review, where the current morbidity and mortality of CVD in Spain and its evolution as well as the main risk factors are described; vascular risk (VR) and recommendations for the calculation of CV risk; main risk factors such as arterial hypertension, dyslipidemia and diabetes mellitus, describing the method for their diagnosis, therapeutic objectives and recommendations for lifestyle measures and pharmacological treatment; indications for antiplatelet therapy, and recommendations for screening of atrial fibrillation, and recommendations for management of chronic conditions. The quality of testing and the strength of the recommendation are included in the main recommendations.

Opinions and perceptions of patients with cardiovascular disease on adherence: a qualitative study of focus groups

BACKGROUND

Cardiovascular diseases are becoming more frequent throughout the world. Adherence to both pharmacological and non-pharmacological treatment, as well as lifestyles, is important for good management and control of the disease. This study aims to explore the opinions and perceptions of patients with ischemic heart disease on the difficulties associated with therapeutic adherence.

METHODS

An interpretive phenomenological study was carried out using focus groups and one semi-structured interview. The MAXQDA qualitative data analysis program was used for inductive interpretation of the group discourses and interview. Data were coded, and these were grouped by categories and then consolidated under the main themes identified.

RESULTS

Two in-person focus groups and one remote semi-structured interview were performed. Twelve participants (6 men and 6 women) from the Hospital de San Juan de Alicante participated, two of them being family companions . The main themes identified were aspects related to the individual, heart disease, drug treatment, and the perception of the health care system.

CONCLUSIONS

Adhering to recommendations on healthy behaviors and taking prescribed medications for cardiovascular disease was important for most participants. However, they sometimes found polypharmacy difficult to manage, especially when they did not perceive the symptoms of their disease. Participants related the concept of fear to therapeutic adherence, believing that the latter increased with the former. The relationship with health professionals was described as optimal, but, nevertheless, the coordination of the health care system was seen as limited.

Adherence to Oral Antidiabetic Drugs in Patients with Type 2 Diabetes: Systematic Review and Meta-Analysis

Poor adherence to oral antidiabetic drugs (OADs) in patients with type 2 diabetes (T2D) can lead to therapy failure and risk of complications. The aim of this study was to produce an adherence proportion to OADs and estimate the association between good adherence and good glycemic control in patients with T2D. We searched in MEDLINE, Scopus, and CENTRAL databases to find observational studies on therapeutic adherence in OAD users. We calculated the proportion of adherent patients to the total number of participants for each study and pooled study-specific adherence proportions using random effect models with Freeman-Tukey transformation. We also calculated the odds ratio (OR) of having good glycemic control and good adherence and pooled study-specific OR with the generic inverse variance method. A total of 156 studies (10,041,928 patients) were included in the systematic review and meta-analysis. The pooled proportion of adherent patients was 54% (95% confidence interval, CI: 51-58%). We observed a significant association between good glycemic control and good adherence (OR: 1.33; 95% CI: 1.17-1.51). This study demonstrated that adherence to OADs in patients with T2D is sub-optimal. Improving therapeutic adherence through health-promoting programs and prescription of personalized therapies could be an effective strategy to reduce the risk of complications.

[Cardiovascular preventive recommendations. PAPPS 2022 thematic updates. Working groups of the PAPPS]

The recommendations of the semFYC's Program for Preventive Activities and Health Promotion (PAPPS) for the prevention of cardiovascular diseases (CVD) are presented. The following sections are included: epidemiological review, where the current morbidity and mortality of CVD in Spain and its evolution as well as the main risk factors are described; cardiovascular (CV) risk and recommendations for the calculation of CV risk; main risk factors such as arterial hypertension, dyslipidemia and diabetes mellitus, describing the method for their diagnosis, therapeutic objectives and recommendations for lifestyle measures and pharmacological treatment; indications for antiplatelet therapy, and recommendations for screening of atrial fibrillation, and recommendations for management of chronic conditions. The quality of testing and the strength of the recommendation are included in the main recommendations.