Medication adherence: WHO cares?

Designing a Real-Time Medication Intake and Adherence Dashboard: Features, Functionality, and Data Display to Meet the Needs of Patients, Care Partners and Healthcare Providers

To determine the key features, utilities, and functionalities of an adherence dashboard so that patients, care partners, and healthcare providers can effectively use it to identify and improve medication nonadherence. A qualitative study was conducted in four stages. In Stage 1, semi-structured interviews and focus groups were conducted with patients, care partners, and healthcare providers after showing existing dashboards to gain feedback and determine their needs and preferences for the dashboard. In Stage 2, data gathered from Stage 1 were used to develop paper prototypes. In Stage 3, these prototypes were evaluated by participants to refine the design. Finally, in Stage 4, a framework for the key components of the adherence dashboard was developed based on user feedback. Some of the key features identified include individualized medication adherence, overall adherence summaries, customizable notifications, real-time data visualization, and integration with existing healthcare systems such as electronic health records (EHR). Participants also highlighted the importance of intuitive design, ease of navigation, secure data handling, and the ability to customize the dashboard according to user preferences. This study identifies key features and functionalities and provides a user-centered framework for designing a real-time medication adherence dashboard tailored to the needs of patients, caregivers, and healthcare providers. Future work will focus on developing a fully functional dashboard, integrating it into clinical practice, and evaluating its effectiveness in improving medication adherence.

A Three-Step Data-Driven Methodology to Assess Adherence to Basal Insulin Therapy in Patients With Insulin-Treated Type 2 Diabetes

BACKGROUND

While health care providers (HCPs) are generally aware of the challenges concerning insulin adherence in adults with insulin-treated type 2 diabetes (T2D), data guiding identification of insulin nonadherence and understanding of injection patterns have been limited. Hence, the aim of this study was to examine detailed injection data and provide methods for assessing different aspects of basal insulin adherence.

METHOD

Basal insulin data recorded by a connected insulin pen and prescribed doses were collected from 103 insulin-treated patients (aged ≥18 years) with T2D from an ongoing clinical trial (NCT04981808). We categorized the data and analyzed distributions of correct doses, increased doses, reduced doses, and missed doses to quantify adherence. We developed a three-step model evaluating three aspects of adherence (overall adherence, adherence distribution, and dose deviation) offering HCPs a comprehensive assessment approach.

RESULTS

We used data from a connected insulin pen to exemplify the use of the three-step model to evaluate overall, adherence, adherence distribution, and dose deviation using patient cases.

CONCLUSION

The methodology provides HCPs with detailed access to previously limited clinical data on insulin administration, making it possible to identify specific nonadherence behavior which will guide patient-HCP discussions and potentially provide valuable insights for tailoring the most appropriate forms of support.

The effects of green exercise on the mental and physical health of people with chronic conditions: a systematic review

Green exercise, defined as physical activity in natural settings, shows promise for enhancing exercise participation and improving health. This systematic review aimed to assess the effectiveness of green exercise in people with chronic conditions. Seven electronic databases were searched and of the 7801 screened articles, 14 trials met the inclusion criteria. Green exercise was a safe and well-tolerated intervention, with low drop-out levels. It was found to positively affect participants' quality of life in three studies and mental health in four studies. Compared to non-exercise groups, green exercise significantly improved physical and mental health in patients with breast cancer, COPD, cardiovascular disease risk, chronic low back pain, obesity, and diabetes. However, it had no impact on the physical health of stroke patients or the cognitive performance of those with ADHD. Green exercise appears to be a safe intervention that can improve various chronic health issues.

The Morisky Method for Measuring Medication Adherence in Older Adults With Chronic Diseases: A Cross-Sectional Study

Background and Aims

In the elderly population, the prevalence of chronic diseases and the necessity for supportive and medication treatments are increasing, making medication adherence a crucial factor in enhancing their quality of life.

Methods

This study conducted a comprehensive descriptive-analytical survey on older adults aged over 65 with chronic diseases, who were visiting a specialized diabetes clinic in YAZD in 2023. The clinic provides treatment for elderly diabetic patients as well as those with chronic diseases resulting from or concurrent with diabetes, managed by internal medicine specialists and endocrinologists. The participants had been taking medication for more than 6 months and were suffering from chronic conditions such as asthma, hypertension, diabetes, chronic cardiovascular disease, liver cirrhosis, stroke, and vascular heart disease, with normal cognitive function. Medication adherence was assessed to determine the level of adherence. Data were analyzed using SPSS version 20.0, utilizing logistic regression.

Results

A total of 196 participants took part in the study. The average medication knowledge score was 14.7 ± 3.5, the average depression score was 8.1 ± 2.4, the average health literacy score was 7.5 ± 1.6, and the average self-efficacy score was 29.1 ± 5. Logistic regression analysis revealed that more than half of the participants (58.7%) lacked medication adherence. The analysis also indicated that the presence of a spouse had a significant effect on medication adherence (p-value = 0.038), along with health literacy (p-value = 0.002) and self-efficacy (p-value = 0.000), which had the most significant impact on medication adherence.

Conclusion

The findings suggest that self-efficacy, health literacy, and the presence of a spouse are crucial factors influencing medication adherence in older adults with chronic diseases. These factors can shape the beliefs, attitudes, and behaviors of older adults regarding medication adherence and affect their health outcomes and quality of life. Therefore, interventions aimed at improving medication adherence in this population should consider these factors and attention to the specific needs and preferences of older adults and their spouses or family members.

Effectiveness of inbuilt cell phone reminders in chronic medication compliance

BACKGROUND

 Adherence to chronic medication is crucial for managing chronic diseases and preventing complications. However, maintaining consistent adherence remains challenging, particularly in low- and middle-income countries where forgetfulness is a common barrier. The widespread use of mobile phones, even in resource-limited settings, offers a practical opportunity to leverage inbuilt reminder features to support medication adherence. This study evaluates the effectiveness of inbuilt cell phone reminders in enhancing chronic medication compliance among patients in the eThekwini health district of KwaZulu-Natal, South Africa.

METHODS

 In this prospective, cross-sectional study, 400 patients on chronic medications were systematically selected from five healthcare centres. Participants were divided into two groups: those using mobile phone reminders (Group 1) and those who did not (Group 2). Medication adherence was assessed using a standardised questionnaire, and statistical analyses, including Chi-square tests and logistic regression, were conducted to identify differences in adherence rates.

RESULTS

 Group 1 exhibited significantly higher adherence rates (87%) compared to Group 2 (67%, p  0.001). The use of cell phone reminders was associated with a 2.5-fold increase in the odds of adherence (odds ratio [OR] = 2.5, 95% confidence interval [CI]: 1.7-3.6, p  0.001).

CONCLUSION

 Inbuilt cell phone reminders are a cost-effective intervention that significantly enhances medication adherence, especially in resource-limited settings. Integrating mobile technologies into public health strategies could improve chronic disease management.Contribution: This study highlights the potential of mobile phone reminders as a practical tool for improving medication adherence, with significant implications for public health strategies in low-resource settings.

Evaluation of Reasons for Discontinuation of Atropine 0.01% in Myopia Management: A Single-Center Retrospective Study from Türkiye

Objectives

This study aimed to identify the key factors contributing to non-adherence in patients using 0.01% atropine for progressive myopia control in a specific single-center Turkish population and to propose strategies to enhance adherence.

Materials and Methods

This retrospective study included 30 patients (mean age: 10.67±3.47 years; age range: 5-16 years; 14 males and 16 females) diagnosed with progressive myopia and prescribed 0.01% atropine treatment in our clinic between January and June 2021. All participants had discontinued 0.01% atropine treatment before completion. The reasons for discontinuation were analyzed using patient records and categorized into factors such as light sensitivity, difficulties with near vision, ocular or systemic side effects, the need for monthly eye drop renewal, and the long treatment duration. Data on patients' age, sex, treatment adherence, and reasons for discontinuation were collected. Statistical analyses were performed using IBM SPSS Statistics software.

Results

The treatment discontinuation rate in our patient population was 14.92% (95% confidence interval: 10.23-19.61). The most common reasons for discontinuation were the need for monthly drop renewal (80%), long treatment duration (70%), and light sensitivity (60%). Discontinuation rates did not significantly differ by age group (p>0.05). The need for monthly renewal was more frequently reported as a barrier among female patients. Informed consent procedures had highlighted the long treatment duration and the need for monthly renewal, but these still represented barriers to adherence for some families.

Conclusion

To improve adherence to 0.01% atropine treatment for progressive myopia in our patient population, patient education and enhanced support systems are essential. Implementing strategies to address challenges related to monthly renewal and providing better information about the long-term benefits of treatment could help increase adherence rates.

Barriers to medication adherence for secondary stroke prevention in rural communities in Cameroon: a qualitative study

BACKGROUND

Stroke survivors in rural communities may face unique challenges in accessing and adhering to medications for secondary prevention. This qualitative study aimed to explore the factors associated with medication adherence among stroke survivors in rural settings.

METHODS

We conducted semi-structured interviews with 15 stroke survivors, 5 caregivers, and 5 healthcare providers in rural communities. We conducted thematic analysis of the data using a grounded theory approach.

RESULTS

Six key themes emerged: access (subthemes: inefficient/non-existent healthcare services, limited access to health facilities, shortages of medications), medication-related (subthemes: side effects and polytherapy), patient-level (subthemes: beliefs and knowledge about stroke and medications, attitudes and motivation towards treatment), health system and provider-related (subthemes: quality of patient-provider communication and counselling, shortages of healthcare workers, healthcare workers' knowledge of stroke and medication), economic and environmental barriers (subthemes: poverty, lack of transportation and political conflict), and socio-cultural barriers (subthemes: stigma and social isolation and cultural practices).

CONCLUSION

The barriers to adherence to medications for secondary stroke prevention in the studied rural communities were multifactorial and mostly resulted from preventable health and socioeconomic factors. A multistrategic approach including enhancement of patient education, streamlining medication changes, rural healthcare worker training on secondary stroke prevention, patient counselling and addressing concerns and side effects, community outreach and education to raise awareness about stroke prevention, and the use of single-pill combination therapy can address these barriers and ensure long-term adherence.

A Portal-Based Intervention (PATTERN) Designed to Support Medication Use Among Older Adults: Feasibility and Acceptability Study

Background

Poor medication adherence among older adults with multiple chronic conditions and polypharmacy is a public health concern stemming from distinct challenges. Prior interventions have largely used a one-size-fits-all approach or resource-intensive approaches inappropriate for busy primary care clinics.

Objective

To address this, Phenotyping Adherence Through Technology-Enabled Reports and Navigation (PATTERN) was adapted from prior work. PATTERN is a portal-based intervention for monitoring self-reported medication adherence challenges among older adults in primary care. This study sought to implement and evaluate PATTERN's feasibility and acceptability.

Methods

We conducted a patient randomized study with a posttest design. Primary care physicians at the participating health center were informed of the study, and approval was obtained to contact their patients. Patient eligibility included being aged 60 years or older, having prescription medications for ≥8 chronic conditions, and an upcoming visit with a physician who had provided approval. Potentially eligible patients were identified using an electronic health record query, and a research coordinator phoned them to confirm eligibility, assess interest, obtain consent, and conduct enrollment. Randomization occurred following enrollment. Those randomized to PATTERN received a medication adherence assessment in their patient portal accounts several days ahead of their visit. The assessment identified whether a patient was experiencing a medication adherence challenge, and if so, the type (cognitive, psychological, medical, regimen-related, social, or economic). Identified challenges were sent to the patient's primary care physician. Assessment delivery several days ahead of a visit was thought to offer sufficient time for patients to complete it and clinicians to review any challenges. Approximately 2 weeks after visits, the coordinator recontacted participants to conduct posttest interviews. This ensured clinicians had sufficient time to respond to challenges during or after visits. Posttest interviews measured the self-reported use of the portal, demographic and health characteristics, and for those randomized to PATTERN, intervention satisfaction. Self-reported data were captured in REDCap and analyzed descriptively. Electronic health record data were also analyzed descriptively to objectively identify feasibility, that is, whether intervention arm participants completed the PATTERN assessment.

Results

We enrolled 64 participants (32 received usual care, and 32 received intervention). Most were female (66%, 42/64), not Hispanic or Latino (94%, 60/64), and identified as White (58%, 37/64). The average (SD) age was 75 (6.8) years. Most participants (80%) self-reported using the patient portal ≥12 times per year. However, electronic health record data revealed that less than half of all participants randomized to PATTERN (47%, 15/32) completed the medication adherence assessment. Of those who remembered completing it, 60% (3/5) were very satisfied with the experience and 20% (1/5) were a little satisfied.

Conclusions

PATTERN has the potential for use with older primary care patients experiencing multiple chronic conditions and polypharmacy. Yet, further adaptation is needed to ensure recipients access their patient portal accounts and complete assessments.

Impact of patient counseling on medication adherence in respiratory tract infection patients in a tertiary care teaching hospital

Respiratory tract infections (RTIs) significantly impact public health in India, with high morbidity and mortality rates. Effective management of RTIs relies on medication adherence (MA), which is often challenged by factors like forgetfulness, side effects, and socioeconomic barriers. This study aimed to evaluate the impact of patient counseling on MA among RTI patients and to assess the influence of demographic, socioeconomic, and clinical factors on adherence. A cross-sectional observational study was conducted at Vivekananda General Hospital Hubballi, India, from August 2023 to January 2024, involving 200 RTI patients. MA was measured using the Medication Adherence Report Scale (MARS) before and after patient counseling. Statistical analysis assessed the effect of age, gender, comorbidities, and socioeconomic status on adherence. MA significantly improved following patient counseling, with mean MARS scores increasing from 4.13±1.601 to 6.80±1.592 (p<0.05). Age was positively correlated with adherence, while factors like gender, infection type, and socioeconomic status had varied effects. Overall, patient counseling effectively enhanced adherence across all groups. The study underscores the importance of patient counseling in improving MA among RTI patients. Personalized interventions and addressing socioeconomic barriers are crucial for optimizing treatment outcomes.

Physiotherapist-targeted strategies and tools for recognising patients with limited health literacy and adapting physiotherapeutic communication: A scoping review

OBJECTIVE

To provide an overview of available strategies and tools that support physiotherapists to recognise patients with LHL and to adapt the physiotherapeutic communication during the diagnostic phase.

METHODS

PubMed, Embase, CINAHL and PsycINFO were searched for publications appearing between 2000 and June 2024. Additional grey literature was searched up till October 2022. Studies were included if they described strategies and tools aimed at supporting communication with patients with Limited Health Literacy in physiotherapy. Exclusion criteria focusing on general health literacy prevalence, behavioural interventions, or basic communication training.

RESULTS

Out of the 9960 unique studies identified by our literature searches, 314 full-text studies were assessed and 98 met the inclusion criteria. The data on strategies and tools were extracted into the following six categories: verbal communication (n = 3), written communication (n = 34), digital device (n = 9), questionnaire (n=19), interpreter (n = 22), and other media (n = 2). Within these categories, tools and strategies were further classified based on the communication aims. Some tools and strategies were uncategorisable.

CONCLUSION

While various strategies and tools exist for recognising patients with limited Health Literacy, they are often generic and not tailored to the physiotherapeutic context. This scoping review identifies a gab in physiotherapeutic approaches, particularly on those that go beyond information provision.

PRACTICE IMPLICATIONS

To improve communication in physiotherapy practice, there is a need for the development of tailored strategies and tools that reflect the specific dynamic of the physiotherapeutic process. We recommend engaging in design-based research that involves both patient and physiotherapist to co-create tools and strategies. In the meantime, physiotherapists are advised to use general communication strategies and tools and refer to our resources to select tools that best align with their specific goals.

The Status of Medication Literacy in Young Patients With Hypertension and Its Relationship With Medication Adherence

BACKGROUND

Previous investigators have shown that low levels of ML were associated with poor medication adherence, but few have explored this relationship in young patients with hypertension.

OBJECTIVE

In this study, our objective was to analyze the current state of ML in young Chinese patients with hypertension and determine its relationship with medication adherence.

METHODS

This was a prospective observational study using data from young patients with hypertension in Jiangsu Province, China. Sociodemographic data, ML, and medication adherence of participants were obtained. We used logistic regression and mediation effect analysis to explore the relationship between relevant dimensions of ML and medication adherence.

RESULTS

A total of 171 participants were enrolled, aged 18 to 45 years, who had a median total ML score of 37.0 (score range: 20-51) and median scores of each subdimension of 10.0 for medication knowledge, 9.0 for medication attitude, 6.0 for medication skill, and 13.0 for medication behavior. After a 3-month follow-up, 46.8% of the participants still demonstrated poor medication adherence, with scores below 6 points. Medication attitude (odds ratio [OR], 1.196; 95% confidence interval, 1.041-1.373) and medication behavior (OR, 1.279; 95% confidence interval, 1.069-1.531) were associated with improved medication adherence. Medication behavior partially mediated the relationship between medication attitude and medication adherence with a mediating effect value of 10.9%.

CONCLUSIONS

Young patients with hypertension have poor ML and medication adherence. Medication literacy scores for medication attitude and medication behavior contributed to medication adherence, whereas medication behavior mediated the relationship between medication attitude and medication adherence. More detailed education on medication needs to be implemented to enhance ML.

How do doctors address heart failure patients' disclosures of medication adherence problems during hospital and primary care consultations? An exploratory interaction-based observational cohort study

OBJECTIVES

To investigate how doctors and self-managing older patients with heart failure (HF) discuss the patients' potential or ongoing medication adherence problems, and how such discussions evolve as patients transition from hospital to home, with particular focus on: (1) doctors' communicative actions aimed at addressing patient disclosures of adherence problems and (2) patients' feedback indicating whether their doctor's supportive actions were acceptable to them.

DESIGN

Exploratory interaction-based observational cohort study. Inductive microanalysis of authentic patient-doctor consultations, audio recorded for each patient at: (1) first ward visit in hospital, (2) discharge visit from hospital and (3) follow-up visit with general practitioner (GP).

SETTING

Hospital and primary care, Norway (2022-2023).

PARTICIPANTS

25 patients with HF (+65 years) and their attending doctors (23 hospital doctors, 25 GPs).

RESULTS

Analysis of 74 consultations revealed that 25 HF patients disclosed 23 practical adherence problems indicating risks of unintentional non-adherence (eg, limited resources to manage medications) and 39 perceptual problems indicating risks of intentional non-adherence (eg, worries, negative experience or stance). Doctors addressed 79% of patients' disclosures by: (1) exploring the scope of the problem or (2) providing supportive actions to improve patients' ability or motivation to adhere. We calculated nearly five times higher odds for doctors to address patients' practical problems to their perceptual problems (OR 4.79, 95% CI 1.25 to 25.83). Unresolved problems included: (1) doctors addressed patients' disclosures, but patients signalled the supportive actions were unsuitable (37%) and (2) doctors left disclosures unaddressed (21%).

CONCLUSIONS

In this explorative study, the doctors were more likely to address the patients' adherence problems associated with unintentional non-adherence risks than those associated with intentional non-adherence risks. Even when doctors attempted to address HF patients' medication adherence problems, half of the problems remained unresolved, usually because patients indicated that the doctor's suggestion to improve their situation was against their preference.

Investigating the Time-Varying Nature of Medication Adherence Predictors: An Experimental Approach Using Andersen's Behavioral Model of Health Services Use

Medication adherence is a crucial factor for managing chronic conditions, especially in aging adults. Previous studies have identified predictors of medication adherence. However, current methods fail to capture the time-varying nature of how risk factors can influence adherence behavior. This objective of this study was to implement multitrajectory group-based models to compare a time-varying to a time-fixed approach to identifying non-adherence risk factors. The study population comprised 11,068 Medicare beneficiaries aged 65 and older taking select medications for hypertension, high blood cholesterol, and oral diabetes medications, between 2008 and 2016. Time-fixed predictors (e.g., sex, education) were examined using generalized multinomial logistic regression, while time-varying predictors were explored through multitrajectory group-based modeling. Several predisposing, enabling, and need characteristics were identified as risk factors for following at least one non-adherence trajectory. Time-varying predictors displayed an alternative representation of those risk factors, especially depression symptoms. This study highlights the dynamic nature of medication adherence predictors and the utility of multitrajectory modeling. Findings suggest that targeted interventions can be developed by addressing the key time-varying factors affecting adherence.

Adherence to intravenous chemotherapy and associated factors among patients with cancer at Hawassa University Comprehensive Specialized Hospital Cancer Treatment Center, Sidama Region, Southern Ethiopia

BACKGROUND

Medication adherence refers to how closely a patient follows the prescribed timing and dosage of their treatment. Adherence to chemotherapy is particularly complex and multifaceted, and it can have a significant impact on the effectiveness of the therapy. In Ethiopia, non-adherence to chemotherapy is on the rise, but there has been limited research specifically on adherence to intravenous (IV) chemotherapy.

OBJECTIVE

This study assesses IV chemotherapy adherence and associated factors among cancer patients in the Sidama Region, southern Ethiopia.

METHODS

A hospital-based cross-sectional study included a purposive sample of 413 cancer patients undergoing IV chemotherapy. The Morisky Medication Adherence Scale was used to measure adherence levels. Data analysis was performed using SPSS version 26, employing descriptive statistics such as frequency distribution, mean, median, and standard deviation to describe the characteristics and magnitude of IV chemotherapy adherence. Bivariable and multivariable logistical regression analysis was conducted to identify factors associated with IV chemotherapy adherence.

RESULT

The current study revealed that the overall magnitude of good adherence toward chemotherapy treatment among cancer patients was 176/413(42.6%), with a 95% CI of 38-47.9. The multivariable analysis identified several independent factors associated with IV chemotherapy adherence. These factors included being married (AOR = 3.2, 95% CI:1.3,8), employment as a government employee (AOR = 2.4,95% CI:1.3,4.5), availability of transportation (AOR = 5.5, 95% CI:2.1,14), Good social support (AOR = 2.1,95% CI:1.9,11.3) and having a curative goal of treatment (AOR = 1.7,95% CI:1.1,2.7).

CONCLUSION

In the current study, the magnitude of intravenous chemotherapy adherence among patients with cancer was low compared to published national and international findings. Possible contributing factors include marital status, employment, Transportation availability, and social support. Targeted measures are needed to improve adherence and, as a result, maximize therapeutic benefits.

Barriers and Facilitators to Taking Medication in Newly Diagnosed Patients With Type 2 Diabetes: A Qualitative Study Based on the Transtheoretical Model

PurposeThe purpose of this study was to explore the barriers and facilitators to taking medication in newly diagnosed patients with type 2 diabetes (T2DM) at each stage of change from the perspective of the Transtheoretical model.MethodsThis qualitative descriptive study used purposive sampling to select 32 newly diagnosed patients with T2DM, with 8 representing each of the 4 stages of change (precontemplation, contemplation, preparation, and action). Participants were recruited at a community health service center in Sichuan Province, China. Semistructured interviews were conducted, and data were transcribed and analyzed using qualitative content analysis.ResultsThis study identified barriers and facilitators related to the patient, medication, health care service, and sociocultural dimensions. At the precontemplation and contemplation stages, various barriers across different domains predominated (e.g., incomplete comprehension of the disease; gaps in medication knowledge regarding importance, benefits, and indications; limited access to care; preferred traditional and alternative medication approaches). At the preparation and action stages, although patient, medication, health care service, and sociocultural facilitators were more reported (e.g., awareness of medication benefits, health system financial support, peer medication experiences), medication-related barriers persisted (e.g., medication knowledge gaps regarding side effects, adverse reactions, administration procedures, and missed dose management).ConclusionsThe primary barriers to taking medication in newly diagnosed patients with T2DM are medication-related factors, with barriers and facilitators dynamically evolving across the stages of change. Future research should focus on developing and evaluating stage-matched interventions to promote medication-taking behavior and patient well-being.

Criticality of Benzoyl Peroxide and Antibiotic Fixed Combinations in Combating Rising Resistance in Cutibacterium acnes

Background

Antibiotic resistance is growing globally, with multiple countries reporting resistance in >50% of Cutibacterium acnes (C. acnes) strains. Combination formulations of an antibiotic and the antimicrobial benzoyl peroxide (BPO) may reduce this resistance risk, especially with prolonged use. This 4-part study tested susceptibility of 31 C. acnes clinical strains and development of resistance to antibiotics alone or combined with BPO.

Methods

C. acnes susceptibility to single-drug antibiotics was assessed via minimum inhibitory concentration (MIC) values obtained from epsilometer tests, with lower MIC indicating higher susceptibility. Susceptibility to fixed-dose antibiotic/BPO combination products was determined by measuring the zone of inhibition using the agar diffusion method, with larger diameter indicating increased bacterial inhibition. The effect (synergistic, additive, antagonistic, or indifferent [no interaction]) of combining clindamycin with BPO on C. acnes inhibition was evaluated using a checkerboard assay, wherein 2 test compounds are combined in varying concentrations. Resistance development was assessed using serial passage of bacterial cultures in increasing concentrations of clindamycin alone or in combination with BPO.

Results

All tested antibiotics (clindamycin, doxycycline, erythromycin, and minocycline) exhibited similar activity. C. acnes susceptibility was variable, with some strains having elevated MIC values-an indication of resistance-against different antibiotics. For 6 strains resistant to clindamycin alone (inhibitory zone=0 cm), formulations with BPO enhanced activity against the same isolates (range: 0.8-2.2 cm). Of 7 acne-associated strains, combining clindamycin and BPO had an additive effect against 4, and no interaction against 3. Bacterial cultures repeatedly exposed to the combination of clindamycin and BPO did not develop antibiotic resistance, which occurred with exposure to clindamycin alone.

Conclusion

Overall, antibiotic susceptibility was highly dependent on the C. acnes strain, and antibiotic formulations with BPO exhibited enhanced activity against less susceptible strains. Fixed combinations of BPO with an antibiotic may improve antimicrobial activity and protect against resistance development.

How and Why Do Multimorbid Patients Decide to Follow Their Multiple Medication Prescriptions? Looking Beyond the Risk-Benefit Scale

Current public health guidelines emphasize the necessity to optimize medication prescriptions for multimorbid patients with multiple medications to ensure patient adherence while minimizing harm and waste. Nevertheless, there is limited understanding of how these patients choose to follow their medication regimen. This study aimed to describe the variations in the way patients account for their adherence (and non-adherence) to multiple medications and to draw links between these variations and patients' socioeconomic status. Twenty semi-structured interviews were conducted with patients aged 47-82 years with cardiovascular disease and multiple medically treated chronic conditions. They were transcribed and analyzed using reflexive thematic analysis. We first describe shared concerns about multiple medication taking and situations of medical uncertainty which arose when patients encounter conflicting medical instructions. We then highlight two overarching approaches through which patients conceptualized following their medical prescriptions. Some patients predominantly deferred the choice of medication to their physicians, while others steered the decision-making process and closely monitored what they were prescribed. These styles reflected different ways of engaging with doctors, dealing with side effects, and evaluating prescriptions and were linked to patients' socioeconomic status. We discuss our results by borrowing from Hirschman's theory of voice, exit, and loyalty. Findings argue in favor of better coordinated care to reduce prescription ambiguities and highlight the importance of patients with multimorbidity being given sufficient time and space to voice their concerns.

Factors influencing self-report adherence to treatment in a sample of patients with hypertension in the west Pomeranian Voivodeship of Poland

Background/objectives

One of the major challenges in managing hypertension is non-adherence to treatment recommendations. This issue poses a significant barrier to effectively controlling blood pressure and preventing related cardiovascular complications. The main objective of this study was to demonstrate the level of adherence to therapeutic recommendations by hypertensive patients, and to determine how socio-demographic and medical variables affect adherence.

Methods

The study was conducted among 205 patients with diagnosed hypertension hospitalized in the West Pomeranian Voivodeship. The study used a diagnostic survey method, a survey technique, and a self-administered questionnaire and the Adherence to Refills and Medication Scale.

Results

The overall score for the ARMS questionnaire was 24.32, which is 2.03 points per question and indicates that adherence to therapeutic recommendations among the hypertensive patients surveyed was at a good level. Based on the collected data, it was shown that the older the age, the worse the adherence was. In addition, urban residents adhered to therapeutic recommendations less frequently than other respondents.

Conclusion

Patients with diabetes were more likely to be non-compliant than patients without diabetes. And respondents with diagnosed CHF were more likely to adhere to recommendations than other respondents. Age, occupational activity and place of residence influenced adherence to treatment recommendations among hypertensive patients surveyed.

Evaluation of Attitudes to Learning Doctor-Patient Communication Skills in 427 Postgraduate Doctors Using the Communication Skills Attitude Scale (CSAS) Questionnaire

BACKGROUND Effective communication between doctors and patients is crucial for improving healthcare quality and ensuring patient safety. This study aimed to evaluate attitudes to learning doctor-patient communication skills in 427 postgraduate doctors, using the self-reported 26-item communication skills attitude scale (CSAS) questionnaire. MATERIAL AND METHODS The study was conducted online between October 2023 and May 2024 via the LimeSurvey platform, with 427 physicians (response rate: 21.35%) participating in specialist courses at the Centre of Postgraduate Medical Education in Warsaw. The survey used the Communication Skills Attitude Scale (CSAS), including 26 items divided into positive and negative affect scales. Responses were scored on a 5-point Likert scale, with negative attitude scale items reverse-scored, for a maximum score of 130 points. Descriptive statistics and sociodemographic analysis explored factors influencing attitudes. RESULTS Most participants (55.5%) were under 30 years of age, and 70% were women. Women demonstrated significantly more positive attitudes (M=52.53, SD=8.65) than men (M=50.65, SD=9.74; P=0.048). Physicians aged 41 to 50 years showed the most positive attitudes (M=55.78, SD=6.48), although age differences were not statistically significant (P=0.129). Divorced or separated participants had the highest scores (M=58.00, SD=6.08; P=0.010), while those with longer professional experience had more negative attitudes (P=0.004). CONCLUSIONS Sociodemographic factors, including sex, marital status, and professional experience, influenced attitudes toward learning communication skills. Training programs should consider these factors, to better meet the needs of diverse healthcare professionals.

Medical Mistrust: A Concept Analysis

Background: The term "medical mistrust" has increased in literary usage within the last ten years, but the term has not yet been fully conceptualized. This article analyzes the usage of the term "medical mistrust" in the extant literature in order to articulate its antecedents, attributes, and consequences. The aim of this article is to provide a preliminary conceptual definition and conceptual figure for medical mistrust. Methods: Walker and Avant's method of conceptual analysis was used to extract concept attributes, antecedents, and consequences and define empirical referents. The databases PubMed, CINAHL, Scopus, and PSYCinfo and the Google search engine were used. Results: Medical mistrust is a social determinant of health fueled by a fear of harm and exploitation and is experienced at both the interpersonal, intergenerational, and institutional levels, reinforced by structural racism and systemic inequalities. Medical mistrust is antedated by historical trauma, socioeconomic disparities, medical gaslighting, traumatic medical experiences, maladaptive health beliefs and behaviors, and individual minority identities and is transmitted intergenerationally and culturally. The consequences of medical mistrust include the underutilization of health services, delays in diagnosis and care, poor treatment adherence, poor health outcomes, negative psychological effects, and an increase in the uptake of medical misinformation and maladaptive health behaviors. Conclusions: The findings of this concept analysis have important implications for healthcare providers, healthcare systems, and researchers, as well as healthcare policy makers.

Cost-Related Barriers to Medication Adherence in Uveitis Patients Enrolled in NIH's All of Us Program

BACKGROUND AND OBJECTIVE

To investigate cost-related barriers to medication adherence in patients with uveitis.

METHODS

Non-interventional, retrospective study. The study examined the responses to cost-related medication adherence questions of 879 patients with uveitis who were enrolled in the National Institutes of Health All of Us Research Program database. To be eligible for inclusion, patients were required to have successfully completed at least one self-reported survey. Logistic regression analysis was employed to assess the relationship between race/ethnicity and medication adherence, controlling for relevant covariates.

RESULTS

Patients with an annual income of less than $75 000 were significantly more likely than those with an income above $150 000 to report difficulty affording medication, delaying filling prescriptions, skipping doses, taking less medication, and exploring alternative therapies to save money. Patients aged 60 years and above were more likely to report difficulty affording medication, as were those without health insurance.

CONCLUSION

This study revealed that income and age are barriers to medication adherence. These findings have important implications for health care providers and policymakers, who should consider strategies to address these cost-related barriers to medication adherence.

Linking Electronic Health Record Prescribing Data and Pharmacy Dispensing Records to Identify Patient-Level Factors Associated With Psychotropic Medication Receipt: Retrospective Study

Background

Pharmacoepidemiology studies using electronic health record (EHR) data typically rely on medication prescriptions to determine which patients have received a medication. However, such data do not affirmatively indicate whether these prescriptions have been filled. External dispensing databases can bridge this information gap; however, few established methods exist for linking EHR data and pharmacy dispensing records.

Objective

We described a process for linking EHR prescribing data with pharmacy dispensing records from Surescripts. As a use case, we considered the prescriptions and resulting fills for psychotropic medications among pediatric patients. We evaluated how dispensing information affects identifying patients receiving prescribed medications and assessing the association between filling prescriptions and subsequent health behaviors.

Methods

This retrospective study identified all new psychotropic prescriptions to patients younger than 18 years of age at Duke University Health System in 2021. We linked dispensing to prescribing data using proximate dates and matching codes between RxNorm concept unique identifiers and National Drug Codes. We described demographic, clinical, and service use characteristics to assess differences between patients who did versus did not fill prescriptions. We fit a least absolute shrinkage and selection operator (LASSO) regression model to evaluate the predictability of a fill. We then fit time-to-event models to assess the association between whether a patient filled a prescription and a future provider visit.

Results

We identified 1254 pediatric patients with a new psychotropic prescription. In total, 976 (77.8%) patients filled their prescriptions within 30 days of their prescribing encounters. Thus, we set 30 days as a cut point for defining a valid prescription fill. Patients who filled prescriptions differed from those who did not in several key factors. Those who did not fill had slightly higher BMIs, lived in more disadvantaged neighborhoods, were more likely to have public insurance or self-pay, and included a higher proportion of male patients. Patients with prior well-child visits or prescriptions from primary care providers were more likely to fill. Additionally, patients with anxiety diagnoses and those prescribed selective serotonin reuptake inhibitors were more likely to fill prescriptions. The LASSO model achieved an area under the receiver operator characteristic curve of 0.816. The time to the follow-up visit with the same provider was censored at 90 days after the initial encounter. Patients who filled prescriptions showed higher levels of follow-up visits. The marginal hazard ratio of a follow-up visit with the same provider was 1.673 (95% CI 1.463-1.913) for patients who filled their prescriptions. Using the LASSO model as a propensity-based weight, we calculated the weighted hazard ratio as 1.447 (95% CI 1.257-1.665).

Conclusions

Systematic differences existed between patients who did versus did not fill prescriptions. Incorporating external dispensing databases into EHR-based studies informs medication receipt and associated health outcomes.

The link between adherence to antihypertensive medications and mortality rates in patients with hypertension: a systematic review and meta-analysis of cohort studies

BACKGROUND

Hypertension (HTN) significantly contributes to cardiovascular disease (CVD) and mortality. This systematic review and meta-analysis specifically investigates how different levels of adherence to antihypertensive therapy (AHT) affect mortality rates in HTN patients. By synthesizing cohort studies, it aims to enhance understanding and inform clinical practices to improve outcomes in hypertensive populations.

METHODS

Our meta-analysis employed a comprehensive search strategy using keywords related to hypertension, medical adherence, and mortality across PubMed, Scopus, and Web of Science, up to July 2024. The eligibility criteria focused on cohort studies linking AHT adherence to mortality. The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias (ROB). Quantitative analyses involved hazard ratios (HR) and confidence intervals (CI), with an 80% adherence threshold. Subgroup and meta-regression analyses were also conducted using STATA-17 to explore various outcome factors.

RESULTS

From initial 1,999 studies 12 cohort studies included in our analysis. All included studies had low ROB score. A meta-analysis of 12 studies involving 2,198,311 patient with HTN revealed that poor adherence to treatment significantly increased all-cause mortality (HR: 1.32 [1.14, 1.51], p < 0.001) with high heterogeneity (I²: 98.73%). Additionally, an analysis of four studies with 1,695,872 patients indicated that low adherence was linked to elevated cardiovascular mortality (HR: 1.61 [1.43, 1.78], p < 0.001), showing moderate heterogeneity (I²: 49.51%).

CONCLUSIONS

The study found that poor adherence to AHT significantly increases overall and cardiovascular mortality risk, underscoring the need for improved compliance strategies. Limitations like inconsistent definitions, observational biases, and varying follow-up durations necessitate further research to validate these findings.

CLINICAL TRIAL NUMBER

Not applicable.

Determinants of compliance with iron-folic acid supplementation among pregnant mothers in Bule Hora district, Southern Ethiopia: unmatched case-control study

BACKGROUND

The World Health Organization has recommended daily supplementation with iron folic acid, to prevent anemias during pregnancy. However, due to many factors, compliance of pregnant women with this recommendation of iron and folic acid supplementation remains low, both in Africa and Ethiopia. Studies conducted in issue shows setting specific difference regarding determinants of iron and folic acid compliance.

OBJECTIVE

This study aimed to assess the determinants of iron and folic acid supplementation compliance among antenatal care attendee pregnant women in the Bule Hora district, South Ethiopia, in 2024.

METHODS

A health facility -based, unmatched case-control study was conducted in Bule Hora district from April 2024 to June 2024, via a pretested interviewer-administered questionnaire. The sample size for the study was calculated using Epi Info version 7.2.6 software. A total of 115 cases and 230 controls were included in the study. The sample size was proportionally allocated to each health facility on basis of the number of pregnant women supplemented with iron-folic acid at least one month before the data collection period; after that, systematic sampling techniques were used to select every 2nd participant from each health facility. Binary and multivariable logistic regression was conducted to identify determinants of iron folic acid compliance; AOR at a P-value < 0.05 with 95% CI was used to declare a statistically significant association after checking for the absence of multicollinearity (VIF < 1.65, tolerance > 0.6) and the Hosmer and Leme-show test of model fitness (p- value = 0.08).

RESULTS

A total of 345 pregnant women were included in the study with, a 100% response rate. Prim gravidity [AOR: 4.67, 95% CI (1.60, 13.57)], antenatal care contact 4 or more times [AOR: 7.84, 95% CI (3.34-18.41)], having a husband/family support to take iron folic acid [AOR: 4.48, 95% CI (2.19-9.13)] and good knowledge on anemia [AOR: 3.79, 95%CI (1.85-7.75)] were significantly associated with iron-folic acid compliance.

CONCLUSION

This study revealed that prim-gravidity, antenatal care contact 4 or more times, having husband support, and good knowledge of anemias were determinants of good compliance. Promotion of husbands' support and frequency of antenatal care contact and provision of information about anemias are needed to increase compliance with iron folic acid.

The Impact of Education Sources on Patient Compliance with the Recommended Oral Nutritional Supplement (ONS) Intake: A Qualitative Survey

BACKGROUND

Nutritional support through oral nutritional supplements (ONSs) is important for patients. It leads to improved nutritional intake and better clinical and economic outcomes.

OBJECTIVES

The problem that often accompanies the use of ONSs is their consumption below the optimal prescribed doses. One of the reasons for this is patient education on the importance of ONS intake. This study investigated hospitalized patients and focused on the impact that educational sources have on ONS intake. It also investigated patient compliance with the intake of the prescribed dose, and the time of initiation and discontinuation of ONS consumption.

METHODS

A qualitative survey using an anonymous questionnaire was conducted on 120 hospital patients across three locations in the Republic of Croatia: Varaždin General Hospital, the Special Hospital for Chronic Diseases in Novi Marof, and the hospital for lung diseases and tuberculosis in Klenovnik. Data were collected by independent nurses and analyzed using appropriate statistical tests, including Shapiro-Wilk, Levene, Mann-Whitney, and χ2 tests.

RESULTS

There is a statistically significant difference between compliance with the intake at home and the source of information on how to consume ONSs (p = 0.003). There is also a statistically significant difference between compliance with intake at home and the initiation of ONS consumption (p = 0.000) with a key time of six months (half a year) when most of them give up.

CONCLUSIONS

Only 47.95% complied with the recommended dose of ONS intake at home who received the information from a nurse, if we look at the information source. There is a clear need to change patient education by developing a standardized form and tools accessible to patients. After six months, most patients discontinue ONS consumption. Further research is necessary to determine whether a medical specialist is the reason for discontinuation, or whether discontinuation happened due to insufficient education on the importance of ONS intake.

A systematic review for improper application of nasal spray in allergic rhinitis: A proposed role of community pharmacist for patient education and counseling in practical setting

The application of nasal spray is encountered with technique errors, which can lead to decreased therapeutic response and treatment failure. Community pharmacists can play a pivotal role in providing appropriate knowledge and counseling services for the proper and effective use of these topical drugs. The aim of this systematic review was to assess the most important aspects of application technique errors and the impact of community pharmacist-led interventions on the provision of patient education and counseling regarding the application of these topical preparations in clinical practice. Preferred reporting items for systematic review and meta-analysis (PRISMA) criteria were used to set up a systematic search through different databases, including Scopus, Web of Science, and PubMed. A total of 10 articles were included in this study. Nearly three-quarters of the publications discussed improper technique, poor knowledge about installation technique, and poor adherence. Only 2 studies discussed pharmacist intervention, which comprised individualized brief education and training on the correct use of the nasal spray. The study highlights that there are many different aspects of application errors encountered by patients while using nasal spray. The study also highlights that there is a dearth of involvement of community pharmacists and pharmacist-led interventions for proper technique and application of these topical preparations.

Development and validation of a nomogram predicting multidrug-resistant tuberculosis risk in East China

Objective

Multidrug-resistant tuberculosis (MDR-TB) is a global health threat. Our study aimed to develop and externally validate a nomogram to estimate the probability of MDR-TB in patients with TB.

Methods

A total of 453 patients with TB in Anhui Chest Hospital between January 2019 and December 2020 were included in the training cohort. In addition, 116 patients with TB from Anhui Provincial Hospital Infection District between January 2015 and November 2023 were included in the validation cohort. Multivariable logistic regression analysis was applied to build a predictive model by combining the feature selected in the least absolute shrinkage and selection operator regression model. The C-index, calibration plot, and decision curve analysis were implemented to evaluate the predictive model's discrimination, calibration, and clinical practicality. Then, logistic regression and least absolute shrinkage and selection operator (LASSO) models were constructed using R software, and the accuracy, goodness of fit, and stability of the models were verified using the validation cohort.

Results

Eight variables of patients with TB were selected using the best penalization parameter of the LASSO regression method, and the nomogram was established. The model displayed good discrimination with a C-index of 0.752 and good calibration. A high C-index value of 0.825 could still be reached in the validation cohort. The decision curve analysis demonstrated the clinical value of the model.

Conclusion

In this study, we constructed the LASSO regression model based on eight clinical traits and outcomes of laboratory tests, providing a novel insight for evaluating MDR-TB.

Association of medication adherence with treatment preferences: incentivizing truthful self-reporting

OBJECTIVE

Self-reported medication adherence may be influenced by socially desirable answers and untruthful reporting. Misreporting of adherence behavior can bias estimations of treatment (cost)effectiveness. This study investigated how to induce truthful self-reported medication adherence and evaluated how self-reported (truth-induced vs. regularly reported) medication adherence and treatment preferences were associated.

METHODS

Medication adherence was measured after a discrete choice experiment eliciting stated preferences for Multiple Sclerosis (MS)-treatments. Data was collected among MS-patients in three Western countries. Half of the sample was randomized to 'choice-matching', a novel mechanism which induces truthfulness. It financially compensates respondents based on their self-reported adherence and guesses about other respondents' adherence. To investigate the impact of truth-incentivized adherence reporting on preference heterogeneity, interaction effects between medication adherence and treatment preferences were tested separately within the choice-matching and the 'standard' group.

RESULTS

The sample comprised 380 MS-patients (mean age 41y, 69% female). Respondents in the choice-matching group reported a lower medication adherence compared to the standard group (always adherent: 39.3% vs. 46.6%). Mixed logit models showed significant interaction effects: in the choice-matching group, higher medication adherence resulted in lower utility for pills twice/day compared to injections three times/week (p = 0.019), while in the standard group, respondents with higher medication adherence preferred pills once/day compared to injections three times/week (p = 0.005).

CONCLUSION

Choice-matching likely encouraged respondents to report their true medication adherence. Linking truthful behavior to patients' preferences allows for a better understanding of preference heterogeneity and helping to make decisions that fit patients' true preferences.

Treatment Adherence in a Large Cohort of Turkish Multiple Sclerosis Population

OBJECTIVES

This study aimed to evaluate adherence to disease-modifying therapies (DMTs) among patients with multiple sclerosis (MS) and to identify factors influencing compliance, based on perceptions and preferences of both patients and neurologists.

METHODS

Questionnaires were designed by a team of experts, including MS specialists, psychologists, and statisticians, to capture data on treatment adherence and related factors. A total of 1021 MS patients and their neurologists participated. Patients' adherence to oral, injectable, and infusion DMTs was assessed alongside demographic and disease-related characteristics.

RESULTS

The study included 1021 MS patients with a mean age of 35.69 ± 9.07 years. Infusion therapies demonstrated the highest adherence rates (96.6%). Among all patients, 78.9% maintained treatment without interruption, while 56.7% of those who interrupted therapy informed their physicians. Patients with a disease duration of less than one year or more than 10 years exhibited lower rates of treatment interruption compared to those with a disease duration of 1-10 years (p = 0.032). In the injectable DMT group, significant differences in adherence were noted (p < 0.001). The lowest interruption rate (13.5%) was seen in patients with a disease duration of less than one year, whereas interruption rates were markedly higher (83%) in those with a duration exceeding 16 years.

CONCLUSION

Improving adherence requires a patient-centered, collaborative approach emphasizing shared decision-making between physicians and patients. Addressing factors that contribute to non-compliance is essential for optimizing treatment outcomes and enhancing long-term disease management in MS.

Sustained in situ protein production and release in the mammalian gut by an engineered bacteriophage

Oral administration of biologic drugs is challenging because of the degradative activity of the upper gastrointestinal tract. Strategies that use engineered microbes to produce biologics in the lower gastrointestinal tract are limited by competition with resident commensal bacteria. Here we demonstrate the engineering of bacteriophage (phage) that infect resident commensals to express heterologous proteins released during cell lysis. Working with the virulent T4 phage, which targets resident, nonpathogenic Escherichia coli, we first identify T4-specific promoters with maximal protein expression and minimal impact on T4 phage titers. We engineer T4 phage to express a serine protease inhibitor of a pro-inflammatory enzyme with increased activity in ulcerative colitis and observe reduced enzyme activity in a mouse model of colitis. We also apply the approach to reduce weight gain and inflammation in mouse models of diet-induced obesity. This work highlights an application of virulent phages in the mammalian gut as engineerable vectors to release therapeutics from resident gut bacteria.

Adherence to pharmacological therapy for hypertension in Portugal: a health professionals focus groups study

INTRODUCTION

The perspectives of local healthcare professionals for developing effective strategies to enhance medication adherence in arterial Hypertension as well as its barriers have not yet been explored through qualitative research in Portugal.

OBJECTIVES

This study aimed to assess the views of healthcare professionals including general practitioners/family physicians, nurses, and community pharmacists, from Portugal on effective strategies to improve medication adherence in Hypertension, and to identify factors hindering pharmacological adherence.

METHODS AND ANALYSES

This was a qualitative study with synchronous online focus groups, in which, the participants were general practitioners/family physicians, family nurses, or community pharmacists in Portugal with experience managing patients with Hypertension. They were selected based on age, sex, and geographical region with the number of focus groups determined by theoretical saturation. Recruitment was facilitated through specific mailing lists. Purposive and snowball sampling techniques were employed. Focus group discussions were recorded and transcribed. Two researchers conducted content analyses via MAXQDA®2023, applying comparative analysis and reaching consensus. The results are described narratively.

RESULTS

Three focus group discussions revealed a multifaceted approach to improving medication adherence for Hypertension. Key strategies to enhance coordination and communication among healthcare professionals, patients, and caregivers were identified. These included shared informatics software among healthcare professionals; using mobile applications and wearables; health literacy initiatives and patient empowerment; preprepared medication in pillboxes; involving family and the concept of a "family pharmacist". Participants highlighted barriers to medication adherence such as the lack of communication with patients concerning issues like medication adherence.

CONCLUSIONS

This qualitative study outlines strategies to improve medication adherence among patients with Hypertension in Portugal. These involve improving healthcare coordination and communication, patient empowerment, and involving family and "family pharmacists" in supporting adherence. These strategies are based on the insights of healthcare professionals and could be implemented following robust intervention studies.

CLINICAL TRIAL NUMBER

Not applicable.

A systematic review of improper eye drop application and role of pharmacists for patient education

The application of eye drop is encountered with many technique errors, which can lead to decreased therapeutic response and treatment failure. Community pharmacists can play a pivotal role in providing appropriate knowledge and counselling services for the proper and effective use of eye drop. The aim of this systematic review was to assess the most important aspects of technique errors regarding eye drop application, along with the important role and impact of community pharmacist-led interventions towards the provision of patient education and counselling regarding the proper application of this topical preparation in clinical practice. PRISMA criteria were used to conduct a systematic search on the administration of eye drop through different databases, including Scopus, Web of Science, and PubMed between the years 1990 and 2023. A total of 22 articles were included in this study. Nearly three-quarters of the studies discussed the improper technique and non-adherence for eye drop instillation (77.3%). Five studies discussed the interventions by health care professionals for proper eye drop instillation technique (22.7%). Two studies discussed the intervention by community pharmacist in patient education and improved training on the correct instillation of eye drop. There are different aspects of application errors encountered by patients while using eye drop, particularly in glaucoma elderly patients, and polypharmacy. These application errors could lead to a diverse range of complications, such as poor medication, ocular infections, increased health care expenses, reduced treatment effectiveness, and lower health outcomes. There is a potential role of pharmacist-led interventions in minimising procedures associated with improper technique and application of eye drops to avoid decreased therapeutic response and treatment failure.

The Feasibility and Acceptability of a Clinical Pharmacist-delivered Intervention to Reduce Bothersome Health Symptoms from Polypharmacy and Alcohol Use and Communicate Risk among People with HIV: Pilot Study Protocol

Among persons with HIV (PWH), unhealthy alcohol use and polypharmacy contribute to bothersome symptoms (e.g., fatigue, dizziness, memory loss). However, effective risk communication targeting these associations is challenging. The HIV and Alcohol Research center focused on Polypharmacy (HARP) is conducting a pilot study that will generate feasibility and acceptability data on a clinical pharmacist-delivered counseling intervention targeting the modification of unhealthy alcohol use and polypharmacy in PWH. Counseling is guided by the Information-Motivation-Behavioral Skills-Motivational Interviewing (IMB-MI) model. Herein, we describe the study protocol. This pilot uses a one-group pre-test/post-test design. We will recruit 50 participants from those who participated in the consented cohort of the Veterans Aging Cohort Study. Participants must be prescribed ≥ 5 long-term medications, have a self-reported Alcohol Use Disorders Identification Test score > 0, and be living with HIV. We will exclude those with moderate-severe alcohol use disorder as identified by an Alcohol Symptom Checklist score ≥ 4. Data are collected using three self-administered surveys (baseline, immediately after booster intervention, and 30-days post-intervention), two PEth blood tests (baseline, 30 days post-intervention), and medication data from the electronic health record (baseline). The intervention includes a 60-minute IMB-MI-based counseling session followed by a booster session 2 weeks later. Some participants will also be asked to participate in a qualitative interview to provide feedback on the intervention. The pilot investigates the impact of an intervention on alcohol consumption and the use of multiple medications among PWH, exploring how best to reduce bothersome symptoms, communicate risk, and support behavior change in this population.

Glucagon-like Peptide-1 Receptor Agonist Use in Hospital: A Multicentre Observational Study

BACKGROUND

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are effective medications for type 2 diabetes mellitus (T2DM) and obesity, yet their uptake among individuals most likely to benefit has been slow.

METHODS

We conducted a cross-sectional analysis of medication exposure in adults hospitalized at 16 hospitals in Ontario, Canada, between 2015 and 2022. We estimated the proportions of those with T2DM, obesity, and cardiovascular disease. We identified the frequency of GLP-1RA use and conducted multivariable logistic regression to identify factors associated with their use.

RESULTS

Across 1,278,863 hospitalizations, 396,084 (31%) patients had T2DM and approximately 327,844 (26%) had obesity. GLP-1RA use (n=1,274) was low among those with a diagnosis of T2DM (0.3%) or obesity (0.7%), despite a high prevalence of cardiovascular disease (36%). In contrast, the use of diabetes medications lacking cardiovascular benefit was high during inpatient hospitalizations related to diabetes: 60% (n=236,612) received insulin and 14% (n=54,885) received a sulfonylurea. Apart from T2DM (odds ratio [OR]=29.6, 95% confidence interval [CI] 23.5 to 37.2), characteristics associated with greater odds of receiving a GLP-1RA were seen in those 50 to 70 years of age (OR=1.71, 95% CI 1.38 to 2.11) compared with those <50 years of age, glycated hemoglobin >9% (OR=1.83, 95% CI 1.36 to 2.47) compared with <6.5%, and highest income quintile (OR=1.73, 95% CI 1.45 to 2.07) compared with lowest income quintile.

CONCLUSION

Knowledge translation interventions are needed to address the low adoption of GLP-1RAs among hospitalized patients with T2DM and obesity, who are the most likely to benefit from this treatment.

Psychosocial Determinants of Non-adherence to Antihypertensive Therapy: A Cross-Sectional Study in Pakistani Tertiary Care Hospitals

Background Hypertension is a major public health concern and leading cause of cardiovascular morbidity and mortality worldwide. Non-adherence to antihypertensive therapy is a global challenge, with adherence rates ranging from 50% to 70% in high-income countries and significantly lower in low- and middle-income countries (LMICs). Poor adherence contributes to inadequate blood pressure control and increases the risk of stroke, myocardial infarction, and other cardiovascular complications. Even though effective antihypertensive drugs are available, adherence is still not very good, especially in LMICs because of problems with money, healthcare access, and psychosocial factors. Pakistan, like many LMICs, faces a high burden of hypertension; however, adherence rates remain underreported due to inconsistent methodologies and a lack of large-scale studies. Psychosocial factors, including perceived stress, social support, and health literacy, play a crucial role in influencing medication adherence; however, limited research has explored these determinants within the Pakistani population. Objective This study aimed to investigate the psychosocial determinants of non-adherence to antihypertensive therapy among patients receiving treatment at tertiary care hospitals in Pakistan. By identifying the key psychosocial factors affecting adherence, this study sought to provide evidence-based recommendations for improving hypertension management strategies. Methods A cross-sectional study was conducted at three tertiary care hospitals in Pakistan: Punjab Rangers Teaching Hospital, Lahore; Sharif Medical and Dental College, Lahore; and Lady Reading Hospital, Peshawar. In total, 360 patients with hypertension were recruited for this study. Medication adherence was assessed using a Medication Adherence Questionnaire (MAQ). Psychosocial determinants were evaluated using validated scales, including the Depression, Anxiety, and Stress Scale-21 (DASS-21) for perceived stress; the Multidimensional Scale of Perceived Social Support (MSPSS) for social support; and the Living with Medicines Questionnaire (LMQ) for health literacy. Chi-square tests and multivariate logistic regression were used for statistical analysis to find independent predictors of non-adherence. Results Among the 360 participants, 145 (40.3%) were classified as nonadherent. Significant associations were observed between non-adherence and lower educational levels (87, 60.0%; p < 0.001), low social support (62, 42.8%; p < 0.001), high perceived stress (127, 87.6%; p < 0.001), and lower monthly income (79, 54.5%; p = 0.002). The most commonly reported reasons for non-adherence were forgetfulness (67, 46.2%), medication costs (52, 35.9%), and perceived lack of necessity (32, 22.1%). Hospital-wise adherence rates varied significantly, with the highest adherence at Punjab Rangers Teaching Hospital (119, 66.1%) and the lowest at Lady Reading Hospital (38, 52.3%) (p = 0.028). Conclusion Non-adherence to antihypertensive therapy remains a significant public health concern, particularly in LMICs, such as Pakistan, where financial constraints, low education levels, and psychosocial stressors impact adherence. Taking these factors into account through patient education, financial aid programs, and psychosocial support systems may increase the number of people who stick to their treatment plans and lead to better management of hypertension.

Identifying predictors of sodium-glucose cotransporter 2 inhibitor and glucagon-like peptide 1 receptor agonist use in hospital among adults with diabetes

AIMS

To identify factors associated with use of novel diabetes medications among patients hospitalized under general internal medicine.

METHODS

We conducted a cohort study of patients with type 2 diabetes mellitus (T2DM) hospitalized in Ontario, Canada between 2015 and 2020. We evaluated the patient- and physician-level factors associated with sodium-glucose cotransporter 2 inhibitor (SGLT2) and glucagon-like peptide 1 receptor agonist (GLP1R) use using a multivariable logistic regression model.

RESULTS

There were 253,152 hospitalizations and 68,126 involved patients who had T2DM. Prior to discharge, 3.7 % (N = 2490) of patients with T2DM received an SGLT2 and 0.2 % (N = 121) received a GLP1R. The strongest predictors for receiving a novel diabetes medication were hemoglobin A1C > 9.0 % (Odds Ratio (OR) = 1.81, 95 % Confidence Interval (CI) 1.28, 2.60) and patients aged 40-60 compared with patients <40 years old (OR = 1.81, 95 % CI 1.33, 2.68). The strongest predictors for not receiving a novel diabetes medication were dementia (OR = 0.47, 95 % CI 0.39, 0.56) and creatinine ≥200 μmol/L (OR = 0.11, 95 % CI 0.08, 0.15). Overall, 46.8 % of patients hospitalized with T2DM not receiving a novel diabetes medication would potentially benefit from an SGLT2 inhibitor.

CONCLUSIONS

Novel diabetes medications were rarely continued or initiated during hospitalization despite a high prevalence of cardiovascular disease, raising the concern for systematic under-utilization after discharge.

Impact of the family doctor system on medication adherence among type 2 diabetes patients in China: a difference-in-differences analysis

BACKGROUND

Nonadherence to medication is a prevalent issue among patients with type 2 diabetes mellitus (T2DM). The family doctor system promotes continuous, integrated, and personalized primary care, which may improve medication adherence. However, more evidence is needed regarding causal association between family doctor system and medication adherence. This study is to assess the impact of the family doctor system on medication adherence among T2DM patients.

METHODS

This cohort study utilized data between 2014 and 2019 from three separate administrative databases of an eastern city in China. Adult patients with T2DM who continuously registered with family doctors from 2015 to 2019 (n = 18,841) were assigned to the intervention group, while those who never registered during this period (n = 1,429) were classified as the control group. A difference-in-differences design was employed to compare medication adherence between registered and unregistered T2DM patients after the first stage of family doctor system in 2015 and the second stage in 2018. Propensity score matching was applied to ensure the robustness. The mean proportion of days covered (PDC), and proportion of patients with good adherence (PDC ≥ 80%) were the outcomes of interest. All recommended T2DM medications were included to calculate PDC.

RESULTS

Compared to the unregistered group, PDC across all institutions for registered patients increased by 5.0% (p < 0.001) after the first stage of family doctor system, and by 5.9% (p < 0.001) after the second stage. The proportion of patients with good adherence increased by 9.5% (p < 0.001) and by 11.8% (p < 0.001) after two stages, respectively. The adherence improvement was more pronounced in community health centers. However, the overall good adherence rate among registered patients in 2019 remained relatively low, reaching only 59.77%.

CONCLUSIONS

The family doctor system significantly improved medication adherence among T2DM patients by providing patient-centered, continuous, and integrated primary services, especially in community health centers. Nevertheless, further efforts should be made to enhance medication adherence.

M. O, Menon V, Abdi Beshir S, Fatehi Abdalla S, Mohammed A, Baraka M, T. Alsulami F, Saeed Alqarni Y, Al Mazrouei N, Awad Al-Kubaisi K, Yousif El Khidir I, Ganana K, Al Amoodi A. A cross-sectional study on the assessment of adherence to cardiovascular medications in Sudan heart center

BACKGROUND

Non-adherence to cardiovascular medications is a global problem with clinical, economic, and humanistic consequences. Investigation of this problem may open the road for proper management of cardiovascular diseases.

OBJECTIVE

Our objectives were to assess the level of adherence to, and to examine factors influencing adherence to, cardiovascular medications in subjects visiting a heart center in Sudan.

METHODS

We have conducted a cross-sectional study that assessed adherence to cardiovascular medications among subjects visiting outpatient cardiac clinics in a heart center-Khartoum State, Sudan. The validated Adherence to Refills and Medication Scale (ARMS) tool was used to assess the level of medication adherence. A score of >16 was used as a cut-off point to categorize surveyed patients into non-adherent (e.g., 17-48) and adherent (e.g., 12-16) in ARMS. Descriptive statistics (frequencies and percentages) and inferential tests such as One-Way ANOVA and Binary regression were used for data analysis.

RESULTS

A total of 255 subjects were enrolled in this study. Slightly more than half the respondents were males (54.5%) and their ages ranged between (51-60 years), and have no insurance coverage (58%). Most of the subjects were married (60.4%), were from Khartoum-State (67.8%), and were unemployed (77.6%). About 39.6% had primary education while 34.5% had secondary (34.5%) education. Diabetes (56.1%) and hypertension (45.5%) were common among the study population. The results showed a high non-adherence prevalence rate (97.6%). The cited reasons for non-adherence include forgetfulness and the costs of refilling medications. Education and age were associated with the level of adherence. Those with high non-adherence behaviors were the more educated, younger and old patients, those not employed, and those having comorbid diseases.

CONCLUSION

The results generally showed a high level of non-adherence to cardiovascular medications, necessitating interventions to support patients' adherence.

Formulation of minitablets with personalised dissolution profile by fluid-bed granulation ofdrug nanosuspensions

Transforming poorly soluble active pharmaceutical ingredients (APIs) into a nanoparticulate form is a proven way of improving their dissolution characteristics. The preparation of API nanosuspensions is commonly achieved by wet-stirred media milling. The challenge lies in converting the nanosuspension into a solid dosage form without compromising its re-dispersibility. In the present work, an API nanosuspension was combined with additional excipients and used as abinder in fluid-bed granulation to obtain granules with systematically varying dissolution properties. Specifically, polymeric excipients (hydroxypropyl methylcellulose grade E5 and polyvinylpyrrolidone grade K30) were used in the nanosuspension binder to granulate microcrystalline cellulose or Pearlitol CR-H substrate. The resulting granules were used as feed material to prepare minitablets whose combination enabled the formation of multi-unit dosage form (MUDF) capsules with tuneable drug release profiles, paving the way to rational design and manufacturing of precision medicines.

Recent advances in the management of knee osteoarthritis: a narrative review

Knee osteoarthritis (OA) is a common condition that causes pain and reduces the quality of life for many people. It also leads to high health and financial costs. Managing knee OA pain requires using different methods together for the best results. This review overviews current therapeutic options for knee OA pain, focusing on their efficacy, safety, and potential roles in clinical practice. Topical treatments, such as NSAIDs and capsaicin, offer significant pain relief with minimal systemic side effects and are suitable for initial therapy, together with nonpharmacologic interventions like exercise and, when relevant, weight loss. Oral analgesics, including acetaminophen and opioids, have limited efficacy and serious side effects, making them appropriate only for short-term or rescue therapy. Intra-articular injections, such as corticosteroids, hyaluronic acid, and platelet rich plasma, demonstrate varying levels of efficacy and safety. Nutritional supplements, including curcumin, Boswellia serrata, and glucosaminechondroitin combinations, offer modest benefits and are best used as adjuncts to standart treatment. Nonpharmacological treatments, such as transcutaneous electrical nerve stimulation (TENS), acupuncture, and local heat therapy, provide variable pain relief and should be customized based on individual patient responses. Targeted biologic agents, such as antibodies to TNF-α, IL-1, and NGF, hold promise for more precise pain relief; however, further research is required to establish their routine use. Treating knee OA pain should be personalized, combining several methods. Research must continue to improve treatments and make them safer.

Enhancing Therapy Adherence: Impact on Clinical Outcomes, Healthcare Costs, and Patient Quality of Life

Adherence to therapy, defined as the extent to which a patient follows prescribed therapeutic recommendations, is a pivotal factor in the effective management of chronic diseases such as diabetes, hypertension, and cardiovascular conditions. This review highlights the profound influence of adherence on clinical outcomes, healthcare costs, and patient quality of life. Despite its critical importance, non-adherence remains a pervasive challenge globally, contributing to suboptimal treatment results, higher rates of complications, increased hospitalizations, and substantial healthcare expenditures. This narrative review examines the multifaceted impact of adherence, focusing on its role in achieving clinical efficacy, mitigating economic burdens, and enhancing patient well-being. The findings reveal that poor adherence exacerbates the risk of disease progression, complications, and higher healthcare costs. Conversely, improved adherence promotes better disease control, fewer complications, and enhanced patient quality of life. Interventions such as patient education, streamlined treatment regimens, and the integration of digital health tools have shown promise in addressing adherence barriers. Furthermore, the role of healthcare professionals is underscored as fundamental, with their continuous support, effective communication, and efforts to build patient trust being essential to fostering better adherence. In conclusion, adherence significantly affects clinical outcomes, healthcare costs, and patient quality of life. Addressing barriers to adherence requires a comprehensive and personalized approach, considering individual patient needs and circumstances. Future research should prioritize the long-term evaluation of emerging technologies and the development of tailored strategies to improve adherence across diverse patient populations. Strengthening adherence is not only crucial for individual patient outcomes, but also for enhancing the sustainability and efficiency of healthcare systems.

A Systematic Review Uncovering Modifiable Influences on Statin Adherence

Statins are effective in reducing cardiovascular disease (CVD) risk, but adherence rates remain low globally. Understanding and addressing modifiable influences on adherence is key to improving outcomes. Existing reviews have methodological limitations, often failing to integrate qualitative and quantitative data or consider specific barriers to statin adherence. This systematic review aimed to identify modifiable barriers and facilitators to statin adherence using the Theoretical Domains Framework (TDF). A comprehensive search of Embase, MEDLINE, PsycINFO, and CINAHL was conducted, covering studies from January 1998 to November 2023. Data were coded to TDF domains and synthesized to identify specific influences on adherence. The nature of the evidence (qualitative or quantitative) was recorded for each influence, and variations among patient groups were noted. Seventy studies from 20 countries were included, with only one focused on ethnic minorities. The most commonly identified domains affecting adherence were "Beliefs about Consequences", "Knowledge", 'Environmental Context and Resources', and "Social Influences". Key factors included knowledge of disease, perceived disease threat, perceived benefits of statins, and patient-provider communication and trust. While side effects had inconsistent associations with adherence, forgetfulness was mainly addressed in quantitative studies, and social influences were highlighted in qualitative research. This review identified modifiable factors that could improve statin adherence. Future research should focus on addressing barriers faced by underrepresented groups to create more inclusive and effective interventions that enhance patient support and communication for better health outcomes.

AI-based medication adherence prediction in patients with schizophrenia and attenuated psychotic disorders

OBJECTIVE

The capacity of machine-learning algorithms to predict medication adherence was assessed using data from AiCure, a computer vision-assisted smartphone application, which records the medication ingestion event.

METHODS

Patients treated with BI 409306 were recruited from two Phase II randomized, placebo-controlled trials in schizophrenia (NCT03351244) and attenuated psychotic disorders (NCT03230097). A machine-learning model was optimized to predict overall trial adherence using AiCure data collected over three monitoring periods (7/10/14 days), adherence cut-offs (0.6/0.7/0.8) and timepoints (Start/Mid/End). Area under the curve (AUC), false negative rate, and false omission rate averaged across 10 model cross-validations were analyzed. In NCT03351244, post hoc analyses compared time to first relapse in patients observed as adherent versus those predicted adherent by the model.

RESULTS

Of 235 patients, 60.4 % demonstrated ≥80 % adherence. At an adherence cut-off of 0.8, the 14-day model performed best (AUC: 0.81 versus 0.79 [10-day], 0.77 [7-day]). Within the 14-day model, 0.6 cut-off was optimal (AUC: 0.87 versus 0.85 [0.7 cut-off], 0.81 [0.8 cut-off]). The Trial-End timepoint yielded the most accurate prediction (AUC: 0.92 versus 0.87 [Start], 0.85 [Mid]). Despite NCT03351244 not meeting the primary endpoint, a reduction in risk of first relapse with BI 409306 versus placebo was observed when analyzed with adherent completers (≥80 % across trial; HR = 0.485) and patients with predicted adherence ≥60 % (HR = 0.510).

CONCLUSIONS

Adherence data with longer monitoring durations (14 days), lower adherence cut-offs (0.6), and later timepoints (Trial-End) produced most accurate adherence predictions. Accurate adherence prediction provides insights about medication adherence patterns that may help clinicians improve individual adherence.

Impact of a clinical pharmacist-led, artificial intelligence-supported medication adherence program on medication adherence performance, chronic disease control measures, and cost savings

BACKGROUND

Chronic diseases are the leading cause of disability and death in the United States. Clinical pharmacists have been shown to optimize health outcomes and reduce health care expenditures in patients with chronic diseases through improving medication adherence.

OBJECTIVE

The primary objective of this study was to evaluate a pharmacist-led, artificial intelligence (AI)-supported medication adherence program on medication adherence, select disease control measures, and health care expenditures.

METHODS

This was a multicenter, retrospective, quasi-experimental evaluation from January 2019 to December 2019 (preimplementation) and January 2021 to December 2021 (postimplementation). This pharmacy-driven service focuses on improving medication adherence and patient outcomes through AI-supported analytics, individual patient case review, and pharmacist-led individual patient outreach. The primary end point was to determine whether implementation improved medication adherence in 3 medication-related measures: medication adherence for hypertension (MAH), medication adherence for cholesterol (MAC), and medication adherence for diabetes (MAD). Secondary outcomes were to evaluate reductions in select chronic diseases control measures and cost savings of this service after implementation of this service.

RESULTS

This medication adherence service was deployed across 10,477 patients: 60.6% of patients were in at least 1 medication-related measure, generating 2762 actionable medication adherence gaps. After the implementation of this pharmacist-led program, medication adherence improved in all 3 disease state measures (MAH 5.9% improvement, MAC 7.9% improvement, MAD, 6.4% improvement), and Medicare Star ratings also improved. The percentage of patients with diabetes who reached their A1c goal also increased (75.5%-81.7%). Furthermore, reductions in overall health care expenditures were seen per member per month in patients who were adherent in comparison with those who were nonadherent (hypertension 31% cost savings, hyperlipidemia 25% cost savings, diabetes 32% cost savings).

CONCLUSION

This clinical pharmacist-driven service leveraged technology and patient connection to increase medication adherence in patients with chronic disease states and led to improvement in select disease control measures and substantial health care cost savings.

Phosphate binder in dialysis: a cross-sectional study of patients' adherence and pill burden

INTRODUCTION

Phosphate (P) binders are among the most common medications prescribed to control P levels in patients with chronic kidney disease on dialysis. There is still a paucity of data on adherence to P binders with no comparison between dialysis modalities.

METHODS

We accessed factors associated with P binder adherence among patients on dialysis in an academic hospital. Adherence was calculated as the ratio between the number of pills taken per day as reported and the prescribed number of pills. Patients were considered non-adherent if adherence was at least 20% less or 30% more than prescribed.

RESULTS

Patients (N = 137) were young, mostly women, and on dialysis for a median time of 53 months. Sevelamer and calcium carbonate were prescribed as P binders to 70.8% and 10.2% of patients, respectively, with no difference across dialysis modalities (p = 0.839). P correlated with the number of pills prescribed (r = 0.368, p = 0.001) and the number of pills taken per day (r = 0.275, p = 0.001). Hyperphosphatemia was found in 52 patients (36.4%). Adherence to Ca carbonate and sevelamer was 100% and 68.4%, respectively. Non-adherent patients were women, younger, with higher serum albumin and urea, and lower serum calcium. Logistic regression showed that female sex (HR 3.30, 95% CI: 1.39-7.84, p = 0.007) and hemodialysis vs. peritoneal dialysis (HR 4.55, 95%, CI: 1.26-16.39, p = 0.021) remained independently associated with a non-adherence behavior.

CONCLUSIONS

The current study suggests that strategies to increase adherence should be implemented. Whether phosphate binder adherence is associated with better outcomes deserves further investigation.

Identifying the Relative Importance of Factors Influencing Medication Compliance in General Patients Using Regularized Logistic Regression and LightGBM: Web-Based Survey Analysis

BACKGROUND

Medication compliance, which refers to the extent to which patients correctly adhere to prescribed regimens, is influenced by various psychological, behavioral, and demographic factors. When analyzing these factors, challenges such as multicollinearity and variable selection often arise, complicating the interpretation of results. To address the issue of multicollinearity and better analyze the importance of each factor, machine learning methods are considered to be useful.

OBJECTIVE

This study aimed to identify key factors influencing medication compliance by applying regularized logistic regression and LightGBM.

METHODS

A questionnaire survey was conducted among 638 adult patients in Japan who had been continuously taking medications for at least 3 months. The survey collected data on demographics, medication habits, psychological adherence factors, and compliance. Logistic regression with regularization was used to handle multicollinearity, while LightGBM was used to calculate feature importance.

RESULTS

The regularized logistic regression model identified significant predictors, including "using the drug at approximately the same time each day" (coefficient 0.479; P=.02), "taking meals at approximately the same time each day" (coefficient 0.407; P=.02), and "I would like to have my medication reduced" (coefficient -0.410; P=.01). The top 5 variables with the highest feature importance scores in the LightGBM results were "Age" (feature importance 179.1), "Using the drug at approximately the same time each day" (feature importance 148.4), "Taking meals at approximately the same time each day" (feature importance 109.0), "I would like to have my medication reduced" (feature importance 77.48), and "I think I want to take my medicine" (feature importance 70.85). Additionally, the feature importance scores for the groups of medication adherence-related factors were 77.92 for lifestyle-related items, 52.04 for awareness of medication, 20.30 for relationships with health care professionals, and 5.05 for others.

CONCLUSIONS

The most significant factors for medication compliance were the consistency of medication and meal timing (mean of feature importance), followed by the number of medications and patient attitudes toward their treatment. This study is the first to use a machine learning model to calculate and compare the relative importance of factors affecting medication adherence. Our findings demonstrate that, in terms of relative importance, lifestyle habits are the most significant contributors to medication compliance among the general patient population. The findings suggest that regularization and machine learning methods, such as LightGBM, are useful for better understanding the numerous adherence factors affected by multicollinearity.

Development and Validation of a New Adherence Scale for Antiseizure Medications [ASASM]

Objective: The objective was to develop and validate a multidimensional scale that measures adherence levels to antiseizure medications and detects patients' reasons for non-adherence. Methods: A new scale was developed, namely the "Adherence Scale for Anti-Seizure Medication(s)-10 items [ASASM-10]". It consists of ten statements that cover different causes of non-adherence to antiseizure medications. The domain selection was based on a comprehensive literature review. Guidelines for constructing an effective scale were followed to write the statements. Three independent expert judges assessed the content validity of the scale. The reliability of ASASM-10 was tested using three methods: internal consistency measurement (Cronbach's alpha), Intraclass Correlation Coefficient [ICC] with a 95% Confidence Interval [95% CI], and test-retest reliability. Validity was tested using Principal Component Analysis [PCA] and a correlation coefficient. PCA was applied after measuring sampling adequacy via Kaiser-Meyer-Olkin [KMO] and Bartlett's sphericity. The Medication Adherence Rating Scale [MARS] was selected as a pre-existing self-report method for validation of this new scale. Results: A total of 162 patients completed the study scales (mean ages ± SD: 34.07 ± 10.406 years). The scale demonstrated a good internal consistency with Cronbach's alpha coefficient of 0.80 and exceeded the required value (i.e., 0.70) for the reliability of new scales. ASASM-10 showed a satisfactory ICC (95% CI) of 0.799 (0.718-0.857), p-value < 0.001. The test-retest reliability demonstrated a good correlation of ρ = 0.648, p-value < 0.001. The construct validity assessed by PCA retained four components as their eigenvalues exceeded one. The correlation coefficient demonstrated a positive moderate correlation between ASASM-10 and MARS (ρ = 0.283), p-value < 0.001. Conclusions: The present analyses provided evidence that ASASM-10 is a reliable and valid scale for evaluating patients' adherence to antiseizure medications. It is the first available scale for assessing medication adherence in patients with epilepsy that can be utilized in clinical practice and research settings.

Strategies for Effective Communication in Hypertension Management: Validation of Messages from a Mobile Application to Assist Hypertensive Older Adults in Adherence to Treatment, Nutrition and Physical Activity

BACKGROUND

Poor adherence to antihypertensive treatment is a common problem among elderly hypertensive patients and one of the leading causes of inadequate blood pressure control. In this sense, it is essential to improve strategies for effective communication in managing hypertension treatment for this group.

OBJECTIVE

This study aimed to validate the text messages of a mobile application to aid adherence to antihypertensive treatment, nutrition, and physical activity among older adults with hypertension treated in Brazilian public primary health care.

METHODS

This descriptive, methodological development study with a quantitative approach was carried out between March and August 2024.

RESULTS

A total of 27 messages were constructed and validated by 13 experts, and this stage was divided into two rounds. The Content Validity index and percentage of agreement were used in the validation process. The messages were developed using theory, national guidelines, validation, and expert review.

CONCLUSIONS

Text messages for adherence to antihypertensive treatment involving medication, nutrition, and physical activity have enormous potential with the target audience studied.

Characterizing ADRs of Enfortumab vedotin and Erdafitinib in bladder cancer treatment: a descriptive analysis from WHO-VigiAccess

Introduction

Enfortumab vedotin (EV) and Erdafitinib are effective therapeutic drugs for bladder cancer patients following post-chemotherapy and immunotherapy. This study assessed adverse drug reactions (ADRs) from both drugs, comparing their safety profiles to guide clinical use.

Methods

A retrospective descriptive analysis was conducted on ADR reports for EV and Erdafitinib from the World Health Organization (WHO)-VigiAccess database. Data on patient demographics, system organ classes (SOCs), global patient regions, symptoms, and ADRs frequencies were analyzed and compared.

Results

As of 2024, 3,438 ADR reports were identified (2,257 for EV and 1,181 for Erdafitinib). The number of adverse reaction reports for EV is significantly higher than that for Erdafitinib. Among them, the SOC with the most adverse signals is gastrointestinal disorders, with the top five reports being nausea, gastrointestinal disorders, dry mouth, abdominal pain, and diarrhea. The top five reported adverse events (AEs) for EV are as follows: skin and subcutaneous tissue disorders (20.70%), general disorders and administration site conditions (14.23%), nervous system disorders (11.12%), gastrointestinal disorders (7.78%), and metabolism and nutrition disorders (6.47%). In contrast, the top five AEs for Erdafitinib are: general disorders and administration site conditions (25.36%), skin and subcutaneous tissue disorders (10.94%), gastrointestinal disorders (10.19%), eye disorders (9.21%), and injury poisoning and procedural complications (7.31%).

Conclusion

Our study identified and compared potential and novel ADRs between EV and Erdafitinib, providing key insights into their safety profiles and highlighting the need for personalized treatment strategies based on individual patient risk factors.