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Temedda MN, Haesebaert J, Viprey M, Schott AM, Dima AL, Papus M, Schneider MP, Novais T. Motivational interviewing to support medication adherence in older patients: Barriers and facilitators for implementing in hospital setting according to healthcare professionals. PATIENT EDUCATION AND COUNSELING 2024; 124:108253. [PMID: 38507931 DOI: 10.1016/j.pec.2024.108253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/17/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE The aim of this study was to understand through Healthcare professionals' (HCPs) opinions the barriers and facilitators to implement MI in older hospitalized patients. METHODS A qualitative study with semi-structured interviews was performed among 23 HCPs involved in the medication management of older hospitalized patients (geriatricians, nurses, psychologists and pharmacists). A thematic analysis was conducted using a deductive approach through the Theoretical Domain Framework (TDF), and an inductive approach. RESULTS The thematic analysis reported 25 factors influencing MI implementation, mapped into 8 TDF themes, and including 13 facilitators, 8 barriers, and 4 both. The main factors identified were: 'cognitive and sensory disorders' (barrier), 'having dedicated time and HCPs' (facilitator and barrier), and the 'HCP's awareness about MI' (facilitator). Ten factors were identified as specific to the older population. CONCLUSIONS Implementing MI in a hospital setting with older patients presented both barriers and facilitators. PRACTICE IMPLICATIONS To ensure successful MI implementation, it is important to take into account the older patients' context, the hospital environment, and the HCPs-related factors.
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Affiliation(s)
- Mohamed Nour Temedda
- Research on Healthcare Performance (RESHAPE), INSERM U1290, University Lyon1, Lyon, France; Clinical and Research Memory Centre of Lyon (CMRR), Charpennes Hospital, Hospices Civils de Lyon, Lyon, France
| | - Julie Haesebaert
- Research on Healthcare Performance (RESHAPE), INSERM U1290, University Lyon1, Lyon, France; Public Health Department, Hospices Civils de Lyon, Lyon, France
| | - Marie Viprey
- Research on Healthcare Performance (RESHAPE), INSERM U1290, University Lyon1, Lyon, France; Public Health Department, Hospices Civils de Lyon, Lyon, France
| | - Anne Marie Schott
- Research on Healthcare Performance (RESHAPE), INSERM U1290, University Lyon1, Lyon, France; Public Health Department, Hospices Civils de Lyon, Lyon, France
| | - Alexandra L Dima
- Research and Development Unit, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Marlène Papus
- Department of Pharmacy, Charpennes Hospital, Hospices Civils de Lyon, Villeurbanne, France
| | - Marie Paule Schneider
- Chair of Medication Adherence and Interprofesionality, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Switzerland
| | - Teddy Novais
- Research on Healthcare Performance (RESHAPE), INSERM U1290, University Lyon1, Lyon, France; Department of Pharmacy, Charpennes Hospital, Hospices Civils de Lyon, Villeurbanne, France; Lyon Institute for Aging, Hospices Civils de Lyon, France.
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Burnier M. Physician and patient adherence in hypertension trials: a point of view on an important issue to resolve. Expert Rev Pharmacoecon Outcomes Res 2024; 24:749-758. [PMID: 38836304 DOI: 10.1080/14737167.2024.2363401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/30/2024] [Indexed: 06/06/2024]
Abstract
INTRODUCTION Randomized controlled trials (RCTs) are important sources of evidence that strongly influence guidelines for patient management, including for elevated blood pressure in adults. AREAS COVERED Critical questions regarding the interpretation of hypertension trial results have recently increased, especially for concerns over methodology. In particular, investigator adherence to the protocol and patient adherence to investigational drugs are often far from optimal. These issues may be ignored or underreported because physicians' behavior during trials is often not monitored and patients' medication adherence is neither measured adequately nor reported or analyzed in the final report or in the publication. This situation may lead to misinterpretations of study results and misevaluations of the safety and efficacy profile of new drugs. In this short review, the problem of measuring, reporting, and analyzing drug adherence in RCTs is discussed and illustrated with several examples in the field of hypertension. EXPERT OPINION The main conclusion is that drug adherence should always be measured in clinical trials, possibly with more than one method. In addition, prespecified analyses of adherence data should be included in the statistical plan of all trials to improve their overall quality.
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Affiliation(s)
- Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Bandiera C, Cardoso E, Locatelli I, Zaman K, Diciolla A, Digklia A, Stravodimou A, Cristina V, Aedo-Lopez V, Dolcan A, Sarivalasis A, Bouchaab H, Pasquier J, Dotta-Celio J, Peters S, Wagner D, Csajka C, Schneider MP. A pharmacist-led interprofessional medication adherence program improved adherence to oral anticancer therapies: The OpTAT randomized controlled trial. PLoS One 2024; 19:e0304573. [PMID: 38848380 PMCID: PMC11161104 DOI: 10.1371/journal.pone.0304573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 05/13/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Oral anticancer therapies such as protein kinase inhibitors (PKIs) are increasingly prescribed in cancer care. We aimed to evaluate the impact of a pharmacist-led interprofessional medication adherence program (IMAP) on patient implementation (dosing history), persistence (time until premature cessation of the treatment) and adherence to 27 PKIs prescribed for various solid cancers, as well as the impact on patients' beliefs about medicines (BAM) and quality of life (QoL). METHODS Patients (n = 118) were randomized 1:1 into two arms. In the intervention arm, pharmacists supported patient adherence through monthly electronic and motivational feedback, including educational, behavioral and affective components, for 12 months. The control arm received standard care plus EM without intervention. All PKIs were delivered in electronic monitors (EMs). Medication implementation and adherence were compared between groups using generalized estimating equation models, in which relevant covariables were included; persistence was compared with Kaplan‒Meier curves. Information on all treatment interruptions was compiled for the analysis. Questionnaires to evaluate BAM and QoL were completed among patients who refused and those who accepted to participate at inclusion, 6 and 12 months post-inclusion or at study exit. RESULTS Day-by-day PKI implementation was consistently higher and statistically significant in the intervention arm (n = 58) than in the control arm (n = 60), with 98.1% and 95.0% (Δ3.1%, 95% confidence interval (CI) of the difference 2.5%; 3.7%) implementation at 6 months, respectively. The probabilities of persistence and adherence were not different between groups, and no difference was found between groups for BAM and QoL scores. No difference in BAM or QoL was found among patients who refused versus those who participated. The intervention benefited mostly men (at 6 months, Δ4.7%, 95% CI 3.4%; 6.0%), those younger than 60 years (Δ4.0%, 95% CI 3.1%; 4.9%), those who had initiated PKI more than 60 days ago before inclusion (Δ4.5%, 95% CI 3.6%; 5.4%), patients without metastasis (Δ4.5%, 95% CI 3.4%; 5.7%), those who were diagnosed with metastasis more than 2 years ago (Δ5.3%, 95% CI 4.3%; 6.4%) and those who had never used any adherence tool before inclusion (Δ3.8%, 95% CI 3.1%; 4.5%). CONCLUSIONS The IMAP, led by pharmacists in the context of an interprofessional collaborative practice, supported adherence, specifically implementation, to PKIs among patients with solid cancers. To manage adverse drug events, PKI transient interruptions are often mandated as part of a strategy for treatment and adherence optimization according to guidelines. Implementation of longer-term medication adherence interventions in the daily clinic may contribute to the improvement of progression-free survival. TRIAL REGISTRATION ClinicalTrials.gov NCT04484064.
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Affiliation(s)
- Carole Bandiera
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Evelina Cardoso
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Isabella Locatelli
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Khalil Zaman
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Antonella Diciolla
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Antonia Digklia
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Athina Stravodimou
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Valérie Cristina
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Veronica Aedo-Lopez
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ana Dolcan
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Apostolos Sarivalasis
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Hasna Bouchaab
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jérôme Pasquier
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Jennifer Dotta-Celio
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Solange Peters
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Dorothea Wagner
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Chantal Csajka
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marie Paule Schneider
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
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Clark ED, Lawley SD. How drug onset rate and duration of action affect drug forgiveness. J Pharmacokinet Pharmacodyn 2024; 51:213-226. [PMID: 38198076 DOI: 10.1007/s10928-023-09897-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/07/2023] [Indexed: 01/11/2024]
Abstract
Medication nonadherence is one of the largest problems in healthcare today, particularly for patients undergoing long-term pharmacotherapy. To combat nonadherence, it is often recommended to prescribe so-called "forgiving" drugs, which maintain their effect despite lapses in patient adherence. Nevertheless, drug forgiveness is difficult to quantify and compare between different drugs. In this paper, we construct and analyze a stochastic pharmacokinetic/pharmacodynamic (PK/PD) model to quantify and understand drug forgiveness. The model parameterizes a medication merely by an effective rate of onset of effect when the medication is taken (on-rate) and an effective rate of loss of effect when a dose is missed (off-rate). Patient dosing is modeled by a stochastic process that allows for correlations in missed doses. We analyze this "on/off" model and derive explicit formulas that show how treatment efficacy depends on drug parameters and patient adherence. As a case study, we compare the effects of nonadherence on the efficacy of various antihypertensive medications. Our analysis shows how different drugs can have identical efficacies under perfect adherence, but vastly different efficacies for adherence patterns typical of actual patients. We further demonstrate that complex PK/PD models can indeed be parameterized in terms of effective on-rates and off-rates. Finally, we have created an online app to allow pharmacometricians to explore the implications of our model and analysis.
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Affiliation(s)
- Elias D Clark
- Metrum Research Group, 2 Tunxis Road, Suite 112, Tariffville, CT, 06081, USA
- Department of Mathematics, University of Utah, Salt Lake City, UT, 84112, USA
| | - Sean D Lawley
- Department of Mathematics, University of Utah, Salt Lake City, UT, 84112, USA.
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Al-Aqeel S. Nonadherence to antiseizure medications: what have we learned and what can be done next? Expert Rev Pharmacoecon Outcomes Res 2024:1-8. [PMID: 38676921 DOI: 10.1080/14737167.2024.2349191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/25/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Nonadherence to antiseizure medications (ASMs) is associated with increased mortality, morbidity, health care utilization, and costs. AREAS COVERED This article reviewed 18 randomized controlled trials published between Jan 2010 and Feb 2024 on Medication Adherence Enhancing Intervention (MAEI) for people with epilepsy. The adequacy of reporting intervention development process was assessed using the GUIDance for the rEporting of intervention Development (GUIDED). The adequacy of the intervention description was assessed using the Template for Intervention Description and Replication (TIDieR) checklist. The interventions were categorized as educational (n = 7), behavioral (n = 5), or mixed (n = 6). The impact of MAEIs on adherence is mixed with majority of studies either reporting no difference between intervention and control groups (n = 6) or improvement in the intervention group (n = 7). The shortcomings in the reporting of MAEIs development, MAEIs description, and MAEIs impact measurement were discussed. EXPERT OPINION Future research needs to accomplish the following tasks: 1) develop and test valid epilepsy-specific self-report measures for assessing adherence; 2) optimize intervention design; and 3) increase transparency in reporting all stages of research.
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Affiliation(s)
- Sinaa Al-Aqeel
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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van Boven JFM, Lavorini F, Agh T, Sadatsafavi M, Patino O, Muresan B. Cost-Effectiveness and Impact on Health Care Utilization of Interventions to Improve Medication Adherence and Outcomes in Asthma and Chronic Obstructive Pulmonary Disease: A Systematic Literature Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1228-1243. [PMID: 38182099 DOI: 10.1016/j.jaip.2023.12.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/08/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Poor adherence to asthma and chronic obstructive pulmonary disease maintenance therapies impairs health outcomes. Proven and cost-effective programs to promote adherence and persistence are not yet in regular widespread use. Implementation costs are a potential barrier to uptake of such programs. OBJECTIVE We undertook a systematic literature review and narrative synthesis of studies investigating the cost-effectiveness of treatment adherence-promoting programs or that determined their impact on health care budget directly or via health care resource use (HCRU). METHODS We identified relevant publications using Medline and PreMEDLINE (PubMed), Embase (Embase.com, Elsevier), and EconLit for publications between January 2000 and July 2021. We also searched clinical trial databases and selected conference proceedings. RESULTS Of 1,910 potentially relevant articles, 26 met prespecified inclusion criteria and underwent data extraction. Eleven reported a direct assessment of adherence, 15 included economic evaluations, and 17 described HCRU. None included an analysis of biologic medication use. When they were studied, interventions were often found to be highly cost-effective, with dominant incremental cost-effectiveness ratios in some cases. Reductions in direct costs and HCRU (health care visits, hospital admissions, and/or the use of medications, including add-on/reliever treatment and antibiotics) were frequently reported. Reported use of maintenance treatments improved in some studies. Counseling and/or digitally informed programs were used in all cases in which favorable outcomes were observed. CONCLUSIONS Adherence-promoting interventions are mostly cost-effective and often result in reduced HCRU and associated costs. Multidisciplinary care involving one-to-one advice and digitally enhanced communications appear to offer the greatest benefit.
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Affiliation(s)
- Job F M van Boven
- Department of Clinical Pharmacy and Pharmacology, Groningen Research Institute for Asthma and COPD, University Medical Centre Groningen, Groningen, University of Groningen, Groningen, The Netherlands.
| | - Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Tamas Agh
- Syreon Research Institute, Budapest, Hungary; Center for Health Technology Assessment and Pharmacoeconomic Research, University of Pecs, Pecs, Hungary
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Oliver Patino
- Teva Pharmaceuticals Europe BV, Amsterdam, The Netherlands
| | - Bogdan Muresan
- Teva Pharmaceuticals Europe BV, Amsterdam, The Netherlands
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McGrady ME, Ignjatovic V, Jones S, Bruce A, Goldenberg NA, Rizzi M, Thornburg CD, Todd KE, Luchtman-Jones L. Evaluation, analysis, and reporting of medication adherence for clinical trials of anticoagulants in children: guidance from the ISTH SSC Subcommittee on Pediatric and Neonatal Thrombosis and Hemostasis. J Thromb Haemost 2024:S1538-7836(24)00217-4. [PMID: 38642706 DOI: 10.1016/j.jtha.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/22/2024]
Abstract
In response to growing recognition that nonadherence prevents children, adolescents, and young adults from achieving the therapeutic benefits of anticoagulant medication, the International Society on Thrombosis and Haemostasis Scientific and Standardization Committee Subcommittee on Pediatric and Neonatal Thrombosis and Hemostasis convened a working party on medication adherence. The primary aim of this article was to synthesize recommendations from the larger adherence science literature to provide guidance regarding the classification, collection, and interpretation of anticoagulation adherence data. The secondary aim of this article was to evaluate the degree to which trials published from 2013 to 2023 adhered to these guidance recommendations. As less than half of all trials reported on adherence and none included all recommended elements, the proposed International Society on Thrombosis and Haemostasis Scientific and Standardization Committee guidance has the potential to enhance the rigor and reproducibility of pediatric anticoagulant research.
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Affiliation(s)
- Meghan E McGrady
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
| | - Vera Ignjatovic
- Haematology, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Sophie Jones
- Haematology, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Clinical Haematology, The Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Nursing, The University of Melbourne, Parkville, Victoria, Australia
| | - Aisha Bruce
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Neil A Goldenberg
- Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, Florida, USA; Departments of Pediatrics and Medicine, Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mattia Rizzi
- Hematology/Oncology Unit, Division of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - Courtney D Thornburg
- Division of Pediatric Hematology/Oncology, Rady Children's Hospital San Diego, San Diego, California, USA; Department of Pediatrics, UC San Diego School of Medicine, La Jolla, California, USA
| | - Kevin E Todd
- Department of Pediatric Hematology/Oncology, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA
| | - Lori Luchtman-Jones
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Larsen RE, Hole K, Selle ML, Johannessen Landmark C, Krogstad T, Holm LB. Access to a tailored mobile application enhances medication adherence among young users of antidepressants. Front Pharmacol 2024; 15:1379700. [PMID: 38659579 PMCID: PMC11039783 DOI: 10.3389/fphar.2024.1379700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/20/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Patients' adherence to antidepressants is generally reported to be poor. This study examined whether users of selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) enhance medication adherence following access to a mobile application (app) tailored for this patient group. The study addresses the implementation phase of medication adherence. Methods The study was a single group pre-post intervention design. Data were collected using the validated OsloMet Adherence-to-medication Survey tool (OMAS-37) before and after app access. Pre-app access survey (Survey 1) was conducted via social media and online newspapers, encompassing 445 SSRI/SNRI users aged 18 years and above. Post-app access survey (Survey 2) was sent to 103 SSRI/SNRI users from Survey 1. Wilcoxon Signed Rank Test compared pre- and post-intervention adherence measurements. Pearson's chi-square tests and Fisher's exact tests compared study population categories. Results Forty-two SSRI/SNRI users, median age 26 (IQR 17), 93% identifying as female, used the app while using the same antidepressant during the 2-month period between gaining access to the app and Survey 2. There was a statistically significant reduction in non-adherence score post-app access (z = 3.57, n = 42, p < 0.001) with medium effect size (r = 0.39), indicating enhanced adherence. Total non-adherence score decreased by 39% from pre-to post-access, and there was a 12% decrease in users scoring equivalent with poor adherence (score <2) post-access. Twenty-nine of 37 non-adherence causes improved, with three showing statistical significance. Of 42 responders, 50% (n = 21) indicated using the app one to two times, while 50% (n = 21) more than three times. Approximately 69% (n = 28) found it useful, and 43% (n = 18) felt safer in their use of antidepressants after access to the app. No significant preference was observed for the app over alternative sources of information. Discussion Enhanced medication adherence was observed among antidepressant users following access to the tailored app. Further studies are warranted to evaluate the app applicability to a broader range of antidepressants users or other patient groups, encompassing those in the initiation phase of medication adherence. The app is intended as an easily accessible supplement to the information and advice provided by prescribing physicians and dispensing pharmacists.
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Affiliation(s)
| | - Kristine Hole
- Department of Pharmacy, Oslo Metropolitan University, Oslo, Norway
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
| | - Maria Lie Selle
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Cecilie Johannessen Landmark
- Department of Pharmacy, Oslo Metropolitan University, Oslo, Norway
- The National Centre for Epilepsy, Member of the ERN Network EpiCare, Oslo University Hospital, Oslo, Norway
- Section for Clinical Pharmacology, Department of Pharmacology, Oslo University Hospital, Oslo, Norway
| | - Tonje Krogstad
- Department of Pharmacy, Oslo Metropolitan University, Oslo, Norway
| | - Lene Berge Holm
- Department of Pharmacy, Oslo Metropolitan University, Oslo, Norway
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Michael TJF, Wright DFB, Chan JS, Coleshill MJ, Aslani P, Hughes DA, Day RO, Stocker SL. Patient-Led Urate Self-Monitoring to Improve Clinical Outcomes in People With Gout: A Feasibility Study. ACR Open Rheumatol 2024. [PMID: 38591107 DOI: 10.1002/acr2.11666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/30/2024] [Accepted: 02/24/2024] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVE Self-monitored point-of-care urate-measuring devices are an underexplored strategy to improve adherence to urate-lowering therapy and clinical outcomes in gout. This study observed patient-led urate self-monitoring practice and assessed its influence on allopurinol adherence, urate control, and health-related quality of life. METHODS People with gout (n = 31) and prescribed allopurinol self-monitored their urate concentrations (HumaSens2.0plus) at baseline and thereafter monthly for 12 months (3 months per quarter). Adherence to allopurinol was measured using medication event monitoring technology (Medication Event Monitoring System cap). Time spent below the target urate concentration (<0.36 mmol/L) was determined. Health-related quality of life was measured using a survey (EuroQoL EQ-5D-5L). Gout flares were recorded. Two-tailed Spearman correlation and the Wilcoxon matched-pairs signed-rank test (P < 0.05) were used for statistical comparisons. RESULTS Most participants were male (94%) and had urate concentrations below the target (74%) at baseline. Overall, seven participants demonstrated repeated periods of "missed doses" (two or fewer allopurinol doses missed consecutively) and "drug holidays" (three or more missed doses). Most participants (94%) persisted with allopurinol. Time spent within the target urate concentration increased 1.3-fold (from 79% to 100%; P = 0.346), and the incidence of gout flares decreased 1.6-fold (from 8 to 5; P = 0.25) in the final quarter compared to that in the first quarter of the study. Health-related quality of life was reduced for participants reporting at least one gout flare (median utility values 0.9309 vs 0.9563, P = 0.04). CONCLUSION Patient-led urate self-monitoring may support the maintenance of allopurinol adherence and improve urate control, thus reducing the incidence of gout flares. Further research on patient-led urate self-monitoring in a randomized controlled study is warranted.
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Affiliation(s)
- Toni J F Michael
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | | | - Jian S Chan
- St. Vincent's Clinical Campus, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Matthew J Coleshill
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Randwick, Australia
| | - Parisa Aslani
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Dyfrig A Hughes
- School of Medical and Health Sciences, Bangor University, Bangor, United Kingdom
| | - Richard O Day
- St. Vincent's Clinical Campus, Faculty of Medicine, University of New South Wales, Sydney, Australia, and Department of Clinical Pharmacology and Toxicology, St. Vincent's Hospital, Darlinghurst, Australia
| | - Sophie L Stocker
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia, and Department of Clinical Pharmacology and Toxicology, St. Vincent's Hospital, Darlinghurst, Australia
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Sahota O, Narayanasamy M, Bastounis A, Paskins Z, Bishop S, Langley T, Gittoes N, Davis S, Baily A, Holmes M, Leonardi-Bee J. Bisphosphonate alternative regimens for the prevention of osteoporotic fragility fractures: BLAST-OFF, a mixed-methods study. Health Technol Assess 2024; 28:1-169. [PMID: 38634483 PMCID: PMC11056815 DOI: 10.3310/wypf0472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Background Bisphosphonates are a class of medication commonly used to treat osteoporosis. Alendronate is recommended as the first-line treatment; however, long-term adherence (both treatment compliance and persistence) is poor. Alternative bisphosphonates are available, which can be given intravenously and have been shown to improve long-term adherence. However, the most clinically effective and cost-effective alternative bisphosphonate regimen remains unclear. What is the most cost-effective bisphosphonate in clinical trials may not be the most cost-effective or acceptable to patients in everyday clinical practice. Objectives 1. Explore patient, clinician and stakeholder views, experiences and preferences of alendronate compared to alternative bisphosphonates. 2. Update and refine the 2016 systematic review and cost-effectiveness analysis of bisphosphonates, and estimate the value of further research into their benefits. 3. Undertake stakeholder/consensus engagement to identify important research questions and further rank research priorities. Methods The study was conducted in two stages, stages 1A and 1B in parallel, followed by stage 2: • Stage 1A - we elicited patient and healthcare experiences to understand their preferences of bisphosphonates for the treatment of osteoporosis. This was undertaken by performing a systematic review and framework synthesis of qualitative studies, followed by semistructured qualitative interviews with participants. • Stage 1B - we updated and expanded the existing Health Technology Assessment systematic review and clinical and cost-effectiveness model, incorporating a more comprehensive review of treatment efficacy, safety, side effects, compliance and long-term persistence. • Stage 2 - we identified and ranked further research questions that need to be answered about the effectiveness and acceptability of bisphosphonates. Results Patients and healthcare professionals identified a number of challenges in adhering to bisphosphonate medication, balancing the potential for long-term risk reduction against the work involved in adhering to oral alendronate. Intravenous zoledronate treatment was generally more acceptable, with such regimens perceived to be more straightforward to engage in, although a portion of patients taking alendronate were satisfied with their current treatment. Intravenous zoledronate was found to be the most effective, with higher adherence rates compared to the other bisphosphonates, for reducing the risk of fragility fracture. However, oral bisphosphonates are more cost-effective than intravenous zoledronate due to the high cost of zoledronate administration in hospital. The importance of including patients and healthcare professionals when setting research priorities is recognised. Important areas for research were related to patient factors influencing treatment selection and effectiveness, how to optimise long-term care and the cost-effectiveness of delivering zoledronate in an alternative, non-hospital setting. Conclusions Intravenous zoledronate treatment was generally more acceptable to patients and found to be the most effective bisphosphonate and with greater adherence; however, the cost-effectiveness relative to oral alendronate is limited by its higher zoledronate hospital administration costs. Future work Further research is needed to support people to make decisions influencing treatment selection, effectiveness and optimal long-term care, together with the clinical and cost-effectiveness of intravenous zoledronate administered in a non-hospital (community) setting. Limitations Lack of clarity and limitations in the many studies included in the systematic review may have under-interpreted some of the findings relating to effects of bisphosphonates. Trial registration This trial is registered as ISRCTN10491361. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR127550) and is published in full in Health Technology Assessment; Vol. 28, No. 21. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Opinder Sahota
- Department of Health Care for Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | - Zoe Paskins
- School of Medicine, Keele University and Haywood Academic Rheumatology Centre, Stoke-on-Trent, UK
| | - Simon Bishop
- Business School, University of Nottingham, Nottingham, UK
| | - Tessa Langley
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Neil Gittoes
- Centre for Endocrinology Diabetes and Metabolism, University of Birmingham, Birmingham, UK
| | - Sarah Davis
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ann Baily
- Lay Member, Nottingham Osteoporosis Society Patient Support group, Nottingham, UK
| | - Moira Holmes
- Lay Member, Nottingham Osteoporosis Society Patient Support group, Nottingham, UK
| | - Jo Leonardi-Bee
- School of Medicine, University of Nottingham, Nottingham, UK
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11
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Al-Saleh S, Conley S, Pace T, Insel KC. A Cross-Sectional Study of Cognitive Function, Illness Perceptions, and Immunosuppression Medication Adherence After Heart Transplantation. West J Nurs Res 2024; 46:164-171. [PMID: 38146266 DOI: 10.1177/01939459231220283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
BACKGROUND There are few studies that examine relationships between cognitive function, illness perceptions, and medication adherence after heart transplantation, limiting the development of effective adherence-promoting interventions. OBJECTIVE The purpose of this study was to describe relationships between cognitive function, illness perceptions, and medication adherence among heart transplant recipients. METHODS A cross-sectional, observational design was used. Measures included the telephone-Montreal Cognitive Assessment (t-MoCA©), Patient Health Questionnaire-9, Brief Test of Adult Cognition by Telephone, Basel Assessment of Adherence to Immunosuppressive Medications Scale, and the Brief Illness Perceptions Questionnaire. Descriptive statistics, point-biserial correlations, Pearson's correlations, and logistic regression were used to describe relationships. RESULTS Of the 35 participants (mean age: 61 years [SD: 10.3], 71.4% male, 71.4% white), 31.4% (n = 11) were classified as nonadherent to their immunosuppression medications. Higher immediate word recall, indicating better episodic memory (memory for autobiographical and recent events), and higher illness coherence scores were associated with not missing doses of medication. Higher t-MoCA© total scores, indicating normal cognitive function, and lower depression scores were associated with taking medications on time. More than 22% (n = 8) of participants scored less than 19 on the t-MoCA©, an indication of mild cognitive impairment. CONCLUSION Cognitive impairment may be more common among heart transplant recipients than what is currently recognized, and specific domains of cognitive function were related to medication adherence after transplantation in this study. Future studies should include longitudinal evaluations of cognitive function, depression, and medication adherence. Consideration of these relationships is needed when designing adherence-promoting interventions for this population.
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Affiliation(s)
| | | | - Thaddeus Pace
- College of Nursing, The University of Arizona, Tucson, AZ, USA
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12
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Kengne AP, Brière JB, Gudiña IA, Jiang X, Kodjamanova P, Bennetts L, Khan ZM. The impact of non-pharmacological interventions on adherence to medication and persistence in dyslipidaemia and hypertension: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2024:1-10. [PMID: 38366854 DOI: 10.1080/14737167.2024.2319598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 02/13/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Suboptimal medication adherence is common among patients with cardiovascular diseases. We sought evidence on non-pharmacological interventions used to support adherence for patients with hypertension and/or dyslipidemia. METHODS We searched MEDLINE, EMBASE, MEDLINE In-Process, ClinicalTrials.gov, EUCTR, and conference proceedings from July 2011 to July 2021 to identify trials evaluating effects of health education, phone reminders, or digital interventions on medication adherence or persistence of adult patients with hypertension and/or dyslipidemia. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool v2. RESULTS Of 64 studies, 62 used health education approaches (e.g. educational interviews, motivational meetings, advice from physicians, and mobile health content), 16 phone reminders (e.g. text reminders, electronic pill-box linked reminders, bi-directional text messaging), and 10 digital applications as interventions (e.g., various self-management applications). All studies assessed medication adherence; only two persistence. Overall, 30 studies (83%) assessing health education approaches alone and 25 (78%) combined with other strategies, 12 (75%) phone reminders and eight studies (80%) digital applications combined with other strategies reported improved medication adherence. Two studies assessing health education approaches reported improved persistence. CONCLUSIONS Our findings indicate non-pharmacological interventions may positively impact adherence. Therefore, 'beyond the pill' approaches could play a role in preventing cardiovascular diseases.
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Affiliation(s)
| | | | | | - Xiaobin Jiang
- Health Economics and Market Access, Amaris Consulting, Shanghai, China
| | - Petya Kodjamanova
- Health Economics and Market Access, Amaris Consulting, Sofia, Bulgaria
| | - Liga Bennetts
- Health Economics and Market Access, Amaris Consulting, Montréal, Canada
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13
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Oh EH, Kim CJ, Schlenk EA. A predictive model for medication adherence in older adults with heart failure. Eur J Cardiovasc Nurs 2024:zvae021. [PMID: 38408016 DOI: 10.1093/eurjcn/zvae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/28/2024]
Abstract
AIMS Although many studies have examined the predictors of medication adherence (MA), further empirical research is required to clarify the best model for predicting MA for older adults with heart failure (HF). Thus, we hypothesized a model in which information (knowledge), motivation (social support and depressive symptoms), and behavioural skills (barriers to self-efficacy) would be associated with MA in patients with HF. METHODS AND RESULTS Using a cross-sectional survey, 153 adults aged ≥ 65 years taking medication for HF were recruited from a university hospital in Korea. Data were collected based on the information-motivation-behavioural skills (IMB) model constructs and MA. In the hypothesized path model, self-efficacy was directly related to MA (β = -0.335, P = 0.006), whereas social support was indirectly related to MA through self-efficacy (β = -0.078, P = 0.027). Depressive symptoms were directly related to MA (β = 0.359, P = 0.004) and indirectly related to MA through self-efficacy (β = 0.141, P = 0.004). The hypothesized MA model showed a good fit for the data. Knowledge, social support, and depressive symptoms accounted for 44.3% of the variance in self-efficacy (P = 0.004). Left ventricular ejection fraction, knowledge, social support, depressive symptoms, and self-efficacy explained 64.4% of the variance in MA (P = 0.004). CONCLUSION These results confirmed the IMB model's suitability for predicting MA in older adults with HF. These findings may guide and inform intervention programmes designed to alleviate depressive symptoms in older adults with HF and enhance their HF knowledge, social support, and self-efficacy, with the ultimate goal of improving their MA.
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Affiliation(s)
- Eun Ha Oh
- Department of Cariology, St. Vincent's Hospital, Catholic University, Suwon, Korea
| | - Chun-Ja Kim
- College of Nursing and Research Institute of Nursing Science, Ajou University, Suwon, Korea
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14
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Romagnoli A, Santoleri F, Costantini A, Di Risio A. Adherence, persistence and switching rates of apixaban, dabigatran and rivaroxaban in non-valvular atrial fibrillation: a multicentre real-life analysis at 3 years. Eur J Hosp Pharm 2024; 31:156-161. [PMID: 35961767 PMCID: PMC10895192 DOI: 10.1136/ejhpharm-2022-003338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/02/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Adherence to and persistence with long-term treatment with oral anticoagulants play a significant role in preventing adverse events and mortality in patients with cardiac conditions. The aim of this study was to evaluate the adherence, persistence and switching rate at 3 years in real-life patients with non-valvular atrial fibrillation receiving treatment with first-line new oral anticoagulants. METHODS The study assessed all patients treated with drugs with the ATC codes B01AA, B01AE, B01AF and dispensed in pharmacies in the Lanciano-Vasto-Chieti and Pescara Local Health Units from 1 January 2011 to 30 September 2021. Adherence was calculated as the proportion of days covered; persistence was calculated as the difference in days between the start and end of treatment; and the switching rate was calculated as the difference in days between the start of treatment and the switch. RESULTS A total of 4270 patients were analysed. The absolute adherence figure at 3 years was 0.85. The lowest adherence levels were found in patients treated with dabigatran with an absolute value of 0.72, while the highest levels were found in patients treated with rivaroxaban with an absolute value at 3 years of 0.88. The persistence curves at 3 years of treatment with dabigatran showed a statistically significant difference (p<0.0001) compared with those of rivaroxaban and apixaban. CONCLUSIONS The data collected over a 3-year period showed that adherence and persistence levels and switch data were optimal and comparable in patients with non-valvular atrial fibrillation receiving treatment with either rivaroxaban or apixaban. In contrast, patients treated with dabigatran had worrying adherence and persistence levels.
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Affiliation(s)
- Alessia Romagnoli
- Territorial Pharmaceutical Service, Local Health Unit Lanciano Vasto Chieti, Chieti, Italy
| | | | | | - Angelora Di Risio
- Territorial Pharmaceutical Service, Local Health Unit Lanciano Vasto Chieti, Chieti, Italy
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15
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Aguilar-Palacio I, Rabanaque M, Castel S, Maldonado L, González-García J, Compés L, Malo S. Cohort Profile: The CArdiovascular Risk factors for hEalth Services research (CARhES) cohort study. Int J Epidemiol 2024; 53:dyae015. [PMID: 38380446 PMCID: PMC10879753 DOI: 10.1093/ije/dyae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/24/2024] [Indexed: 02/22/2024] Open
Affiliation(s)
- Isabel Aguilar-Palacio
- Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
| | - MªJosé Rabanaque
- Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
| | - Sara Castel
- Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Lina Maldonado
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Department of Applied Economics, University of Zaragoza, Zaragoza, Spain
| | - Juan González-García
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Biocomputing Unit, Aragón Health Sciences Institute (IACS), Zaragoza, Spain
- Data Science for Health Services and Policy Research Group, Aragón Health Sciences Institute (IACS), Zaragoza, Spain
| | - Luisa Compés
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Departamento de Sanidad de Aragón, Dirección General de Asistencia Sanitaria, Zaragoza, Spain
| | - Sara Malo
- Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
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16
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Emad Y, Dalbeth N, Weinman J, Chalder T, Petrie KJ. Can Smartphone Notifications Help With Gout Management? A Feasibility Study. J Rheumatol 2024; 51:189-196. [PMID: 37967906 DOI: 10.3899/jrheum.2023-0711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE This feasibility study aimed to assess the acceptability of using smartphone notifications to modify the medication beliefs of people with gout. We evaluated the feasibility and acceptability of a smartphone application using the Technology Acceptance Model. We explored adherence rate differences and outcomes between the intervention and control groups. METHODS Fifty-two patients with gout who were prescribed allopurinol were randomly assigned to either active control (n = 24) or intervention group (n = 28). Over 3 months, both groups used the study app on their smartphones. The active control group received notifications about general health advice, whereas the intervention group received adherence-targeted notifications. The feasibility and acceptability of the smartphone app was measured through semistructured interviews. Adherence rate was assessed through serum urate levels and missed doses at 3 timepoints: baseline, 3 months (post intervention), and 6 months (follow-up). RESULTS The smartphone app demonstrated high feasibility, with strong participant retention and compliance. The participants expressed high levels of satisfaction with the app's user-friendliness and content, highlighting its acceptability. Both groups showed a significant reduction in missed doses over time (P < 0.05), but no significant differences in serum urate levels were found between the groups. Patients who received adherence-targeted notifications reported finding it more convenient to take allopurinol and expressed higher overall treatment satisfaction throughout the study. CONCLUSION Adherence-targeted notifications have the potential to be an effective and scalable approach to supporting medication adherence in patients with gout. Further research is needed with larger samples to refine the components of the intervention and explore its optimal implementation.
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Affiliation(s)
- Yasaman Emad
- Y. Emad, MA, K.J. Petrie, PhD, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand;
| | - Nicola Dalbeth
- N. Dalbeth, MD, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - John Weinman
- J. Weinman, PhD, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Trudie Chalder
- T. Chalder, PhD, School of Psychology, King's College London, London, UK
| | - Keith J Petrie
- Y. Emad, MA, K.J. Petrie, PhD, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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17
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Ágh T, Hiligsmann M, Borah B, Beaudart C, Turcu-Stiolica A, Manias E, Jakab I, Pednekar P, Zeber J, Peterson AM. Systematic Review of Outcomes for Assessment of Medication Adherence Enhancing Interventions: An ISPOR Special Interest Group Report. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:133-142. [PMID: 37952839 DOI: 10.1016/j.jval.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/17/2023] [Accepted: 10/27/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES The lack of universal guidance on outcome measures for evaluating medication adherence enhancing interventions (MAEIs) poses a challenge for assessing their effectiveness. This literature review aimed to provide a systematic overview of outcome measures currently used for the value assessment of MAEIs. METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched MEDLINE, PsycINFO, Scopus, CINAHL, and Academic Search Complete for randomized and nonrandomized clinical trials, prospective cohort studies, model-based economic evaluations, and value frameworks published in English between January 2010 and September 2020. Two independent reviewers screened all titles and abstracts, followed by a full-text review. Due to the large number of relevant studies, data extraction was limited to articles published between January 2018 and September 2020. We collected data on the general characteristics of the study, the type of intervention, and the outcomes measured. RESULTS We screened 14 685 records and identified 308 articles for data extraction. Behavioral interventions were the most common (n = 143), followed by educational interventions (n = 110) and mixed-method interventions (n = 73). Outcomes were clustered into 7 categories with medication adherence (n = 286) being the most frequently measured, followed by clinical outcomes (n = 155), health-related quality of life (n = 57), resource use (n = 43), patient satisfaction (n = 31), economic outcomes (n = 18), and other outcomes (n = 76). CONCLUSIONS Various outcomes measures have been used to evaluate MAEIs, with only a small number of studies exploring economic and patient-reported outcomes. Future research is warranted to develop a consensus-based set of criteria for assessing MAEIs to facilitate the comparison of interventions and enable informed decision making.
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Affiliation(s)
- Tamás Ágh
- Syreon Research Institute, Budapest, Hungary; Center for Health Technology Assessment and Pharmacoeconomic Research, University of Pécs, Pécs, Hungary.
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care & Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Bijan Borah
- Division of Health Care Delivery Research, Mayo Clinic College of Medicine and Science and the Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Charlotte Beaudart
- Research Institute for Life Sciences (NARILIS), Department of Biomedical Sciences, Faculty of Medicine, University of Namur, Namur, Belgium
| | - Adina Turcu-Stiolica
- Faculty of Pharmacy, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Elizabeth Manias
- School of Nursing and Midwifery, Monash University, Clayton, Australia; Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia
| | | | | | - John Zeber
- Department of Health Promotion & Policy, University of Massachusetts, Amherst, MA, USA
| | - Andrew M Peterson
- Philadelphia College of Pharmacy, Saint Joseph's University, Philadelphia, PA, USA
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18
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Bandiera C, Dotta-Celio J, Locatelli I, Nobre D, Wuerzner G, Pruijm M, Lamine F, Burnier M, Zanchi A, Schneider MP. The differential impact of a 6- versus 12-month pharmacist-led interprofessional medication adherence program on medication adherence in patients with diabetic kidney disease: the randomized PANDIA-IRIS study. Front Pharmacol 2024; 15:1294436. [PMID: 38327981 PMCID: PMC10847300 DOI: 10.3389/fphar.2024.1294436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/04/2024] [Indexed: 02/09/2024] Open
Abstract
Background: For every 100 patients with diabetes, 40 will develop diabetic kidney disease (DKD) over time. This diabetes complication may be partly due to poor adherence to their prescribed medications. In this study, we aimed to evaluate the differential impact of a 6- versus 12-month pharmacist-led interprofessional medication adherence program (IMAP) on the components of adherence (i.e., implementation and discontinuation) in patients with DKD, during and after the intervention. Methods: All included patients benefited from the IMAP, which consists in face-to-face regular motivational interviews between the patient and the pharmacist based on the adherence feedback from electronic monitors (EMs), in which the prescribed treatments were delivered. Adherence reports were available to prescribers during the intervention period. Patients were randomized 1:1 into two parallel arms: a 12-month IMAP intervention in group A versus a 6-month intervention in group B. Adherence was monitored continuously for 24 months post-inclusion during the consecutive intervention and follow-up phases. In the follow-up phase post-intervention, EM data were blinded. Blood pressure was measured by the pharmacist at each visit. The repeated measures of daily patient medication intake outcomes (1/0) to antidiabetics, antihypertensive drugs, and statins were modeled longitudinally using the generalized estimated equation in both groups and in both the intervention and the follow-up phases. Results: EM data of 72 patients were analyzed (34 in group A and 38 in group B). Patient implementation to antidiabetics and antihypertensive drugs increased during the IMAP intervention phase and decreased progressively during the follow-up period. At 12 months, implementation to antidiabetics was statistically higher in group A versus group B (93.8% versus 86.8%; Δ 7.0%, 95% CI: 5.7%; 8.3%); implementation to antihypertensive drugs was also higher in group A versus B (97.9% versus 92.1%; Δ 5.8%, 95% CI: 4.8%; 6.7%). At 24 months, implementation to antidiabetics and antihypertensive drugs remained higher in group A versus B (for antidiabetics: 88.6% versus 85.6%; Δ 3.0%, 95% CI: 1.7%; 4.4% and for antihypertensive drugs: 94.4% versus 85.9%; Δ 8.5%, 95% CI: 6.6%; 10.7%). No difference in pharmacy-based blood pressure was observed between groups. Implementation to statins was comparable at each time point between groups. Three patients discontinued at least one treatment; they were all in group B. In total, 46% (16/35) of patients in the 12-month intervention versus 37% (14/38) of patients in the 6-month intervention left the study during the intervention phase, mainly due to personal reasons. Conclusion: The IMAP improves adherence to chronic medications in patients with DKD. The longer the patients benefit from the intervention, the more the implementation increases over time, and the more the effect lasts after the end of the intervention. These data suggest that a 12-month rather than a 6-month program should be provided as a standard of care to support medication adherence in this population. The impact on clinical outcomes needs to be demonstrated. Clinical Trial Registration: Clinicaltrials.gov, identifier NCT04190251_PANDIA IRIS.
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Affiliation(s)
- Carole Bandiera
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Jennifer Dotta-Celio
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Isabella Locatelli
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Dina Nobre
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Grégoire Wuerzner
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Menno Pruijm
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Faiza Lamine
- Service of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Michel Burnier
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anne Zanchi
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Service of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Marie Paule Schneider
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
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19
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Peeters LE, Kappers M, Hesselink D, van der Net J, Hartong S, van de Laar R, Ezzahti M, van de Ven P, van der Meer I, de Bruijne E, Kroon A, Indhirajanti-Tomasoa S, van der Linde N, Bahmany S, Boersma E, Massey EK, van Dijk L, van Gelder T, Koch BC, Versmissen J. Antihypertensive drug concentration measurement combined with personalized feedback in resistant hypertension: a randomized controlled trial. J Hypertens 2024; 42:169-178. [PMID: 37796233 PMCID: PMC10713002 DOI: 10.1097/hjh.0000000000003585] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Adherence to antihypertensive drugs (AHDs) is crucial for controlling blood pressure (BP). We aimed to determine the effectiveness of measuring AHD concentrations using a dried blood spot (DBS) sampling method to identify nonadherence, combined with personalized feedback, in reducing resistant hypertension. METHODS We conducted a multicenter, randomized, controlled trial (RHYME-RCT, ICTRP NTR6914) in patients with established resistant hypertension. Patients were randomized to receive either an intervention with standard of care (SoC) or SoC alone. SoC consisted of BP measurement and DBS sampling at baseline, 3 months (t3), 6 months (t6), and 12 months (t12); AHD concentrations were measured but not reported in this arm. In the intervention arm, results on AHD concentrations were discussed during a personalized feedback conversation at baseline and t3. Study endpoints included the proportion of patients with RH and AHD adherence at t12. RESULTS Forty-nine patients were randomized to receive the intervention+SoC, and 51 were randomized to receive SoC alone. The proportion of adherent patients improved from 70.0 to 92.5% in the intervention+SoC arm ( P = 0.008, n = 40) and remained the same in the SoC arm (71.4%, n = 42). The difference in adherence between the arms was statistically significant ( P = 0.014). The prevalence of resistant hypertension decreased to 75.0% in the intervention+SoC arm ( P < 0.001, n = 40) and 59.5% in the SoC arm ( P < 0.001, n = 42) at t12; the difference between the arms was statistically nonsignificant ( P = 0.14). CONCLUSION Personalized feedback conversations based on DBS-derived AHD concentrations improved AHD adherence but did not reduce the prevalence of RH.
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Affiliation(s)
- Laura E.J. Peeters
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy
- Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Rotterdam
| | | | - D.A. Hesselink
- Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Rotterdam
| | - J.B. van der Net
- Albert Schweitzer Hospital, Department of Internal Medicine, Dordrecht
| | - S.C.C. Hartong
- Albert Schweitzer Hospital, Department of Internal Medicine, Dordrecht
| | - R. van de Laar
- Ikazia Hospital, Department of Internal Medicine, Rotterdam
| | - M. Ezzahti
- Bravis Hospital, Department of Internal Medicine, Bergen op Zoom
| | | | | | - E.L.E. de Bruijne
- IJsselland Hospital, Department of Internal Medicine, Capelle aan den Ijssel
| | - A.A. Kroon
- Maastricht University Medical Center, Department of Internal Medicine, Maastricht
| | | | | | - S. Bahmany
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy
| | - E. Boersma
- Erasmus MC, University Medical Center Rotterdam, Department of Cardiology, Rotterdam
| | - E. K. Massey
- Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Rotterdam
| | - L. van Dijk
- Nivel, Netherlands Institute for Health Services Research, Department Pharmaceutical Care, Utrecht
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - T. van Gelder
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy
- Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Rotterdam
| | - Birgit C.P. Koch
- Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Rotterdam
| | - Jorie Versmissen
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy
- Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Rotterdam
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20
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Kardas P. From non-adherence to adherence: Can innovative solutions resolve a longstanding problem? Eur J Intern Med 2024; 119:6-12. [PMID: 37848351 DOI: 10.1016/j.ejim.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 10/19/2023]
Abstract
Non-adherence to medication is a longstanding problem, profoundly affecting patient outcomes and sustainability of healthcare systems. Historically, non-adherence has been observed since the time of Hippocrates, however, when potent drugs became available in the midst of the 20th century, it became a pivotal concern. Despite numerous studies and interventions designed, medication adherence rates remain suboptimal, currently reaching about 50 % still, as described in WHO report two decades ago. What is worse, many healthcare professionals feel neither responsible nor able to change it. Enhancing adherence requires in-depth understanding of the concept, as many intuitive approaches fail to work. For example, contrary to expectations, patient education alone proves insufficient when addressing this issue. Both behavioural models and recent experience reflecting low acceptance of COVID-19 vaccinations strongly suggest that patients' decisions are driven by emotions, which often results in intentional non-adherence. Several technical innovations, such as smart inhalers and electronic pill dispensers, offer potential solutions. However, their effectiveness varies, and standardized certification procedures are lacking. Altogether, technical solutions do not eliminate the problem entirely. To move forward, social and health system innovation is equally needed. Multiple stakeholders could benefit from improved adherence, therefore their greater involvement is advisable to create an adherence-supporting environment. In conclusion, despite available evidence-based interventions, non-adherence remains a complex challenge. Technical and social innovations, combined with a shift in policy priorities, could lead to improved medication adherence and better patient outcomes. The global tide of non-communicable chronic conditions, and aging of societies urges us to take this problem seriously.
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Affiliation(s)
- Przemyslaw Kardas
- Medication Adherence Research Center, Department of Family Medicine, Medical University of Lodz, Lodz, Poland
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21
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Zamanillo-Campos R, Zaforteza Dezcallar M, Boronat Moreiro MA, Leiva Rus A, Ripoll Amengual J, Konieczna J, Fiol-deRoque MA, Ricci-Cabello I. Non-adherence to non-insulin glucose-lowering drugs: Prevalence, predictors and impact on glycemic control and insulin initiation. A longitudinal cohort study in a large primary care database in Spain. Eur J Gen Pract 2023; 29:2268838. [PMID: 37874585 PMCID: PMC10990259 DOI: 10.1080/13814788.2023.2268838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 10/03/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND A better understanding of patient non-adherence to type 2 diabetes medication is needed to design effective interventions to address this issue. OBJECTIVES (1) To estimate the prevalence of non-adherence to diabetes medication; (2) to examine its impact on glycemic control and insulin initiation; (3) to develop and validate a prediction model of non-adherence. METHODS We conducted a longitudinal cohort study based on data from electronic health records. We included adult patients registered within the Health Service of the Balearic Islands (Spain) starting a new prescription of a non-insulin glucose-lowering drug between January 2016 and December 2018. We calculated non-adherence at 12 months follow-up, defined as medication possession ratio (MPR) ≤ 80%. We fitted multivariable regression models to examine the association between non-adherence and glycemic control and insulin initiation and identified predictors of non-adherence. RESULTS Of 18,119 patients identified, after 12 months follow-up, 5,740 (31.68%) were non-adherent. Compared with non-adherent, adherent patients presented lower HbA1c levels (mean difference = -0.32%; 95%CI = -0.38%; -0.27%) and were less likely to initiate insulin (aOR = 0.77; 95%CI = 0.63; 0.94). A predictive model explained 22.3% of the variation and presented a satisfactory performance (AUC = 0.721; Brier score = 0.177). The most important predictors of non-adherence were: non-Spanish nationality, currently working, low adherence to previous drugs, taking biguanides, smoker and absence of hypertension. CONCLUSION Around one-third of the patients do not adhere to their non-insulin glucose-lowering drugs. More research is needed to optimise the performance of the predicting model before considering its implementation in routine clinical practice.
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Affiliation(s)
- Rocío Zamanillo-Campos
- Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Palma, Spain
| | | | | | - Alfonso Leiva Rus
- Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Palma, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS, RD21/0016/0005), Barcelona, Spain
| | - Joana Ripoll Amengual
- Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Palma, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS, RD21/0016/0005), Barcelona, Spain
| | - Jadwiga Konieczna
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Madrid, Spain
- Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology (NUTRECOR), Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases (HUSE), Palma de Mallorca, Spain
| | - Maria Antonia Fiol-deRoque
- Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Palma, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS, RD21/0016/0005), Barcelona, Spain
| | - Ignacio Ricci-Cabello
- Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Palma, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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22
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Russell CL, Chesnut SR, Bartlett Ellis RJ, Freiburghaus M, Madison M, Ruggeri SY, Stephens MB, Yerram P, Wakefield MR. A Descriptive, Correlational Study of Perceptions of Adult Kidney Transplant Recipients and Those Waiting for a Kidney Transplant About Managing Their Medications During a Pandemic. Prog Transplant 2023; 33:318-327. [PMID: 37964572 DOI: 10.1177/15269248231212906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Introduction: Little is known about COVID-19 impact on patient medication management. Research Question: The aim was to describe medication management, healthcare team interactions, and adherence during the COVID-19 pandemic in kidney transplant patients and those on the kidney transplant wait list. Design: Using a descriptive, correlational design 340 adults from a midwestern US transplant program were recruited. The Managing Medications in the Midst of a Pandemic Survey measured healthcare team encounters and medication management. The Basel assessment of adherence to medications scale measured medication adherence. Results: The response rate was 35% (119/340). During the pandemic, 88% had practiced/were currently practicing socially distancing, 85% had worn/were currently wearing a face mask in public, 18% had been/were currently diagnosed with COVID-19 and 82% received the vaccine. Medication management: 76% planned and organized their own medications. Healthcare team interactions: 89% met in the office, 20% via phone, 12% telehealth, and 13% delayed seeing a healthcare provider because of COVID-19 concerns. Pharmacy interactions: 11% changed their method of obtaining medications from pharmacy due to social distancing. Medication adherence implementation was problematic with 19% missing a dose; results from the binary logistic regression suggested that those with higher levels of education were more likely to report missing a dose. Conclusions: Patients acted to prevent COVID-19 but some still contracted the virus. The pandemic changed healthcare team medication management interactions. Adherence implementation problems were nearly 20%. Findings are relevant to the transplant healthcare team to understand the impact of a pandemic on patient/team interactions and medication adherence.
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Affiliation(s)
- Cynthia L Russell
- University of Missouri-Kansas City, School of Nursing and Health Studies, Kansas City, MO, USA
| | - Steven R Chesnut
- University of Missouri-Kansas City, School of Nursing and Health Studies, Kansas City, MO, USA
| | | | - Mary Freiburghaus
- University of Missouri-Kansas City, School of Nursing and Health Studies, Kansas City, MO, USA
| | - Mercedes Madison
- University of Missouri-Kansas City, School of Nursing and Health Studies, Kansas City, MO, USA
| | - Sunny Yoo Ruggeri
- Dr. Lillian R. Goodman Department of Nursing, Worcester State University, Worcester, MA, USA
| | - Mary B Stephens
- University of Missouri Healthcare Renal Transplant Program, University of Missouri Health Care, Columbia, MO, USA
| | - Preethi Yerram
- Division of Nephrology, Department of Medicine, University of Missouri-Columbia, Staff Physician-Harry S Truman VA Hospital, Columbia, MO, USA
| | - Mark R Wakefield
- Renal Transplant Program Director, University of Missouri Health Care, Columbia, MO, USA
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23
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Mucherino S, Rafaniello C, Serino M, Zinzi A, Trama U, Capuano A, Menditto E, Orlando V. Drug Utilization and Measurement of Medication Adherence: A Real World Study of Psoriasis in Italy. Pharmaceutics 2023; 15:2647. [PMID: 38139989 PMCID: PMC10747905 DOI: 10.3390/pharmaceutics15122647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/17/2023] [Accepted: 11/19/2023] [Indexed: 12/24/2023] Open
Abstract
Exceptional advances have been made with systemic treatment for psoriasis (PSO). However, that disease still represents a heavy burden in terms of impact on healthcare systems worldwide. This study comprehensively assesses medication adherence in a real world setting in Italy across all phases-initiation, implementation, and persistence-of PSO therapies. By distinguishing between switches and swaps, it provides unique insights into the patient's own approach to prescribed therapy as well as clinical decision-making processes, enhancing our understanding of medication adherence and discontinuation in a real world daily setting. The study's refined methodology for assessing persistence, considering variations in refill gaps and complex dosing regimens, shows that anti-interleukin (IL) therapies are associated with longer periods of adherence compared with other available therapeutic strategies. Among the selected drugs, ixekizumab and secukinumab were the ones with higher rate of treatment adherence at the expense of anti-TNF-α and anti-PDE4 agents. Notably, patients who opt for swaps are approximately 2.8 times more likely to discontinue their PSO therapy within one year. These findings carry practical implications for optimizing medication adherence, including tailored patient counseling, monitoring, and therapeutic adjustments, highlighting the need for a comprehensive and patient-centered approach to managing these conditions.
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Affiliation(s)
- Sara Mucherino
- Center of Pharmacoeconomics and Drug Utilization Research (CIRFF), Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy; (S.M.); (M.S.); (E.M.)
| | - Concetta Rafaniello
- Department of Experimental Medicine—Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Via Costantinopoli 16, 80138 Naples, Italy; (C.R.); (A.Z.); (A.C.)
| | - Marianna Serino
- Center of Pharmacoeconomics and Drug Utilization Research (CIRFF), Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy; (S.M.); (M.S.); (E.M.)
| | - Alessia Zinzi
- Department of Experimental Medicine—Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Via Costantinopoli 16, 80138 Naples, Italy; (C.R.); (A.Z.); (A.C.)
| | - Ugo Trama
- Regional Pharmaceutical Unit, Campania Region, 80143 Naples, Italy;
| | - Annalisa Capuano
- Department of Experimental Medicine—Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Via Costantinopoli 16, 80138 Naples, Italy; (C.R.); (A.Z.); (A.C.)
| | - Enrica Menditto
- Center of Pharmacoeconomics and Drug Utilization Research (CIRFF), Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy; (S.M.); (M.S.); (E.M.)
| | - Valentina Orlando
- Center of Pharmacoeconomics and Drug Utilization Research (CIRFF), Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy; (S.M.); (M.S.); (E.M.)
- HealthCare Datalab, Campania Region, 80143 Naples, Italy
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24
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Grayek E, Krishnamurti T, Hu L, Babich O, Warren K, Fischhoff B. Collection and Analysis of Adherence Information for Software as a Medical Device Clinical Trials: Systematic Review. JMIR Mhealth Uhealth 2023; 11:e46237. [PMID: 37966871 PMCID: PMC10687688 DOI: 10.2196/46237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/31/2023] [Accepted: 08/25/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The rapid growth of digital health apps has necessitated new regulatory approaches to ensure compliance with safety and effectiveness standards. Nonadherence and heterogeneous user engagement with digital health apps can lead to trial estimates that overestimate or underestimate an app's effectiveness. However, there are no current standards for how researchers should measure adherence or address the risk of bias imposed by nonadherence through efficacy analyses. OBJECTIVE This systematic review aims to address 2 critical questions regarding clinical trials of software as a medical device (SaMD) apps: How well do researchers report adherence and engagement metrics for studies of effectiveness and efficacy? and What efficacy analyses do researchers use to account for nonadherence and how appropriate are their methods? METHODS We searched the Food and Drug Administration's registration database for registrations of repeated-use, patient-facing SaMD therapeutics. For each such registration, we searched ClinicalTrials.gov, company websites, and MEDLINE for the corresponding clinical trial and study articles through March 2022. Adherence and engagement data were summarized for each of the 24 identified articles, corresponding to 10 SaMD therapeutics. Each article was analyzed with a framework developed using the Cochrane risk-of-bias questions to estimate the potential effects of imperfect adherence on SaMD effectiveness. This review, funded by the Richard King Mellon Foundation, is registered on the Open Science Framework. RESULTS We found that although most articles (23/24, 96%) reported collecting information about SaMD therapeutic engagement, of the 20 articles for apps with prescribed use, only 9 (45%) reported adherence information across all aspects of prescribed use: 15 (75%) reported metrics for the initiation of therapeutic use, 16 (80%) reported metrics reporting adherence between the initiation and discontinuation of the therapeutic (implementation), and 4 (20%) reported the discontinuation of the therapeutic (persistence). The articles varied in the reported metrics. For trials that reported adherence or engagement, there were 4 definitions of initiation, 8 definitions of implementation, and 4 definitions of persistence. All articles studying a therapeutic with a prescribed use reported effectiveness estimates that might have been affected by nonadherence; only a few (2/20, 10%) used methods appropriate to evaluate efficacy. CONCLUSIONS This review identifies 5 areas for improving future SaMD trials and studies: use consistent metrics for reporting adherence, use reliable adherence metrics, preregister analyses for observational studies, use less biased efficacy analysis methods, and fully report statistical methods and assumptions.
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Affiliation(s)
- Emily Grayek
- Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Tamar Krishnamurti
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lydia Hu
- Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Olivia Babich
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Katherine Warren
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Baruch Fischhoff
- Department of Engineering and Public Policy, Institute for Politics and Strategy, Carnegie Mellon University, Pittsburgh, PA, United States
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25
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Lauffenburger JC, Tesfaye H, Solomon DH, Antman EM, Glynn RJ, Lee SB, Tong A, Choudhry NK. Investigating the ability to adhere to cardiometabolic medications with different properties: a retrospective cohort study of >500 000 patients in the USA. BMJ Open 2023; 13:e075840. [PMID: 37949625 PMCID: PMC10649612 DOI: 10.1136/bmjopen-2023-075840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE Poor medication adherence remains highly prevalent and adversely affects health outcomes. Patients frequently describe properties of the pills themselves, like size and shape, as barriers, but this has not been evaluated objectively. We sought to determine the extent to which oral medication properties thought to be influential translate into lower objectively-measured adherence. DESIGN Retrospective cohort study. SETTING US nationwide commercial claims database, 2016-2019. PARTICIPANTS Among patients initiating first-line hypertension, diabetes or hyperlipidaemia treatment based on clinical guidelines, we measured pill size, shape, colour and flavouring, number of pills/day and fixed-dose combination status as properties. OUTCOME MEASURES Outcomes included discontinuation after the first fill (ie, never filling again over a minimum of 1-year follow-up) and long-term non-adherence (1-year proportion of days covered <0.80). We estimated associations between each property and outcomes, by therapeutic class (eg, statins), with multivariable logistic regression. RESULTS Across 604 323 patients, 14.6% discontinued after filling once (ie, were non-persistent), and 54.0% were non-adherent over 1-year follow-up. Large pill size was associated with non-adherence, except for thiazides (eg, metformin adjusted OR (aOR): 1.12, 95% CI: 1.06 to 1.18). Greater pill burden was associated with a higher risk of non-adherence across all classes (eg, metformin aOR: 1.58, 95% CI: 1.53 to 1.64 for two pills/day). Taking less than one pill/day was also associated with higher risk of non-adherence and non-persistence (eg, non-persistence statin aOR: 1.29, 95% CI: 1.20 to 1.38). Pill shape, colour, flavouring and combination status were associated with mixed effects across classes. CONCLUSIONS Pill burden and pill size are key properties affecting adherence for almost all classes; others, like size and combination, could modestly affect medication adherence. Clinical interventions could screen patients for potential intolerance to medication and potentially implement more convenient dosing schedules.
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Affiliation(s)
- Julie C Lauffenburger
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Center for Healthcare Delivery Sciences, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Helen Tesfaye
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel H Solomon
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Elliott M Antman
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Robert J Glynn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Angela Tong
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Niteesh K Choudhry
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Center for Healthcare Delivery Sciences, Brigham and Women's Hospital, Boston, Massachusetts, USA
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26
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Mucherino S, Dima AL, Coscioni E, Vassallo MG, Orlando V, Menditto E. Longitudinal Trajectory Modeling to Assess Adherence to Sacubitril/Valsartan among Patients with Heart Failure. Pharmaceutics 2023; 15:2568. [PMID: 38004547 PMCID: PMC10674925 DOI: 10.3390/pharmaceutics15112568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
Medication adherence in chronic conditions is a long-term process. Modeling longitudinal trajectories using routinely collected prescription data is a promising method for describing adherence patterns and identifying at-risk groups. The study aimed to characterize distinct long-term sacubitril/valsartan adherence trajectories and factors associated with them in patients with heart failure (HF). Subjects with incident HF starting sac/val in 2017-2018 were identified from the Campania Regional Database for Medication Consumption. We estimated patients' continuous medication availability (CMA9; R package AdhereR) during a 12-month period. We selected groups with similar CMA9 trajectories (Calinski-Harabasz criterion; R package kml). We performed multinomial regression analysis, assessing the relationship between demographic and clinical factors and adherence trajectory groups. The cohort included 4455 subjects, 70% male. Group-based trajectory modeling identified four distinct adherence trajectories: high adherence (42.6% of subjects; CMA mean 0.91 ± 0.08), partial drop-off (19.6%; CMA 0.63 ± 0.13), moderate adherence (19.3%; CMA 0.54 ± 0.11), and low adherence (18.4%; CMA 0.17 ± 0.12). Polypharmacy was associated with partial drop-off adherence (OR 1.194, 95%CI 1.175-1.214), while the occurrence of ≥1 HF hospitalization (OR 1.165, 95%CI 1.151-1.179) or other hospitalizations (OR 1.481, 95%CI 1.459-1.503) were associated with low adherence. This study found that tailoring patient education, providing support, and ongoing monitoring can boost adherence within different groups, potentially improving health outcomes.
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Affiliation(s)
- Sara Mucherino
- CIRFF, Center of Pharmacoeconomics and Drug Utilization Research, Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy; (S.M.); (V.O.)
| | - Alexandra Lelia Dima
- Health Technology Assessment in Primary Care and Mental Health (PRISMA), Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain;
| | - Enrico Coscioni
- Division of Cardiac Surgery, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d’Aragona, 84131 Salerno, Italy; (E.C.); (M.G.V.)
| | - Maria Giovanna Vassallo
- Division of Cardiac Surgery, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d’Aragona, 84131 Salerno, Italy; (E.C.); (M.G.V.)
| | - Valentina Orlando
- CIRFF, Center of Pharmacoeconomics and Drug Utilization Research, Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy; (S.M.); (V.O.)
| | - Enrica Menditto
- CIRFF, Center of Pharmacoeconomics and Drug Utilization Research, Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy; (S.M.); (V.O.)
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27
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Lasala R, Santoleri F, Romagnoli A, Abrate P, Musicco F, Costantini A. Medication adherence reporting in pivotal clinical trials: overview of oral oncological drugs. Eur J Hosp Pharm 2023; 30:328-332. [PMID: 35058307 PMCID: PMC10647863 DOI: 10.1136/ejhpharm-2021-002998] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/20/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess how and to what extent adherence to medication is reported in pivotal clinical trials of oral cancer drugs. METHODS All drugs authorised by the European Medicines Agency from 1 January 2014 to 31 December 2019 were considered for analysis. For each pivotal trial we extracted the journal of publication, phase of the study, posology, mention of adherence within the main text of the published article or additional material and the terms in which the adherence was reported. RESULTS Thirty drugs were included in the analysis from 56 clinical trials. Eleven articles (19.6%) contained a mention of medication adherence in the main document, 26 (46.4%) in the supplementary material and 19 (33.9%) did not contain any reference to adherence. Seven studies reported medication adherence between the results, expressed as number of patients discontinuing treatment for non-compliance and mean or median percentage. CONCLUSIONS Medication adherence in pivotal clinical trials of oral oncological drugs is poorly represented. There should be a greater level of reporting in the results and it should be included among the minimum set of recommendations in reporting health research.
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Kindem IA, Åsberg A, Midtvedt K, Bjerre A. Optimizing medication adherence with home-monitoring - A feasibility study using capillary microsampling and mHealth in solid organ-transplanted adolescents. Pediatr Transplant 2023; 27:e14590. [PMID: 37543722 DOI: 10.1111/petr.14590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/08/2023] [Accepted: 07/25/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Reliable methods to detect and reduce medication nonadherence in solid organ-transplanted (SOT) adolescents are warranted. We aimed to evaluate the feasibility of combining a medication-manager application (TusenTac®-app) with home-sampling of tacrolimus (Tac) in young SOT recipients. METHODS Kidney and combined SOT recipients between 14 and 25 years were included. During an 8-week intervention period, the participants were instructed to use the transplant-specific, age-adapted TusenTac®-app daily and to perform weekly at-home Tac trough finger-prick microsampling. Microsample Tac concentrations were controlled against timed venous samples twice. Medication implementation and persistence adherence were measured with BAASIS© questionnaires, TusenTac®-registrations, Tac trough concentration coefficient of variation (CV%) and self-reporting by interview. For comparison, venous Tac trough CV% were obtained from the year before and after the short-term intervention. RESULTS Twenty-two recipients were included, two withdrawals, leaving 20; median age 17.9 (14.5-24.8) years, 12 females (60%). The participants registered their dosage intake 88% (1502/1703) of the expected times, and 90% (106/118) of the microsamples were obtained correctly. At inclusion, 11 recipients (55%) were nonadherent assessed with BAASIS© questionnaire, four of these (36%) turned adherent during the intervention period. At the end, 70% reported improved timing-adherence at the interview. There was no significant change in TacCV% from the year before to the year after the short-term intervention. Home-sampling was reliable and measured Tac concentrations accurately. CONCLUSIONS Home-monitoring, combining Tac finger-prick microsampling and a medication-manager app, is feasible in adolescent SOT recipients with 70% perceived improvement in medication timing-adherence. There were no significant long-term changes in TacCV% confirming the need for continuous use and individualized interventions.
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Affiliation(s)
- Ingvild Andrea Kindem
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Department of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anders Åsberg
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Karsten Midtvedt
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Anna Bjerre
- Department of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Kardas P, Aarnio E, Agh T, van Boven JFM, Dima AL, Ghiciuc CM, Kamberi F, Petrova GI, Nabergoj Makovec U, Trečiokienė I. New terminology of medication adherence enabling and supporting activities: ENABLE terminology. Front Pharmacol 2023; 14:1254291. [PMID: 37900155 PMCID: PMC10613051 DOI: 10.3389/fphar.2023.1254291] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction: Medication non-adherence negatively affects the effectiveness of evidence-based therapies and sustainability of healthcare systems. Lack of agreed terminology of medication adherence enabling and supporting activities leads to underuse of the available tools. The ENABLE COST Action was aimed at proposing a new terminology for these activities in order to help both scientific research and its clinical application. Methods: Initial discussions within the ENABLE Working Groups allowed for the conceptualization of four interlinked terms related to adherence, i.e., "medication adherence technology", "medication adherence enhancing intervention", "best practice" and "reimbursement". The iterative process of internal discussion was structured around two dedicated international workshops. Moreover, extensive stakeholder consultations have been organised, including an interactive online survey used to assess the level of agreement with, and the clarity of relevant terms and definitions proposed. Results: Detailed analysis of the results of this process allowed for fine-tuning of the items, and finally, for proposing the final set of definitions. Across all the three phases of this process, the definitions were substantially modified to better reflect the concepts, simplify the language, and assure completeness and cohesiveness of terminology. Feedback obtained from the stakeholders helped this process and confirmed that the final terms and definitions were well received by the experts active in the field of medication adherence. Discussion: Covering the gap in the existing terminology, this work proposes a cohesive set of terms and definitions applicable to medication adherence enabling and supporting activities. Promoting evidence-based approach to this field, this terminology may help research, clinical practice and policy.
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Affiliation(s)
- Przemyslaw Kardas
- Department of Family Medicine, Medical University of Lodz, Lodz, Poland
| | - Emma Aarnio
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tamas Agh
- Syreon Research Institute, Budapest, Hungary
| | - Job F. M. van Boven
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Alexandra Lelia Dima
- Health Technology Assessment in Primary Care and Mental Health (PRISMA), Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain
| | - Cristina Mihaela Ghiciuc
- Pharmacology, Clinical Pharmacology and Algeziology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, Iași, Romania
| | - Fatjona Kamberi
- Scientific Research Centre for Public Health, Faculty of Health, University of Vlore “Ismail Qemali”, Vlore, Albania
| | | | | | - Indrė Trečiokienė
- Pharmacy and Pharmacology Center, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Convertino I, Cazzato M, Tillati S, Giometto S, Gini R, Valdiserra G, Cappello E, Ferraro S, Bonaso M, Bartolini C, Paoletti O, Lorenzoni V, Trieste L, Filippi M, Turchetti G, Cristofano M, Blandizzi C, Mosca M, Lucenteforte E, Tuccori M. Assessing disease activity of rheumatoid arthritis patients and drug-utilization patterns of biologic disease-modifying antirheumatic drugs in the Tuscany region, Italy. Front Pharmacol 2023; 14:1244486. [PMID: 37818193 PMCID: PMC10561246 DOI: 10.3389/fphar.2023.1244486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/04/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction: The disease activity associated with the drug-utilization patterns of biologic Disease Modifying Anti-Rheumatic Drugs (DMARDs) is poorly investigated in real-world studies on rheumatoid arthritis (RA) patients. To investigate the relationship between biologic DMARD initiation/discontinuations in RA patients identified in the healthcare administrative databases of Tuscany and the Disease Activity Score 28 (DAS28) reported in the medical charts. Methods: This retrospective population-based study included RA's first-ever biologic DMARD users of the Pisa University Hospital from 2014 to 2016. Patients were followed up until 31 December 2019. We evaluated the DAS28 recorded before (T0) and after (T1) the biologic DMARD initiation and before (TD0) and after (TD1) discontinuations. Patients were classified as "off-target" (DAS28 > 3.2) or "in-target" (DAS28 ≤ 3.2). We described the disease activity trends at initiation and discontinuation. Results: Ninety-five users were included (73 women, mean age 59.6). Among 70 patients (74%) with at least three DAS28 measures, 28 (40.0%) were off-target at T0 and 38 (54.3%) in-target at T1. Thirty-three (47%) patients had at least one discontinuation, among those with at least three DAS28 assessments. In the disease activity trend, disease stability or improvement was observed in 28 out of 37 (75.7%) patients at initiation and in 24 out of 37 (64.9%) at discontinuation. Discussion: Biologic DMARD discontinuations identified in the healthcare administrative databasese of Tuscany are frequently observed in situations of controlled RA disease. Further studies are warranted to confirm that these events can be used in studies using healthcare administrative databases as proxies of treatment effectiveness.
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Affiliation(s)
- Irma Convertino
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Silvia Tillati
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sabrina Giometto
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rosa Gini
- Tuscan Regional Healthcare Agency, Florence, Italy
| | - Giulia Valdiserra
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Emiliano Cappello
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Ferraro
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Bonaso
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | | | - Leopoldo Trieste
- Institute of Management, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Matteo Filippi
- Direzione Medica di Presidio, University Hospital of Pisa, Pisa, Italy
| | | | | | - Corrado Blandizzi
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, Pisa, Italy
| | - Marta Mosca
- Unit of Rheumatology, University Hospital of Pisa, Pisa, Italy
| | - Ersilia Lucenteforte
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Tuccori
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, Pisa, Italy
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Sováriová Soósová M, Suchanová R, Parová V, Ulbrichtová A, Kopčová O, Rimárová K. Association Between Illness Perception and Adherence to Treatment in Slovak Patients With Hypertension: A Cross-sectional Study. J Cardiovasc Nurs 2023; 38:433-442. [PMID: 35420560 DOI: 10.1097/jcn.0000000000000913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lack of adherence to treatment in patients with arterial hypertension leads to poor blood pressure control, increased morbidity and mortality, and increased costs to health and social care. Regular assessment of treatment adherence as well as factors influencing it is important to improve patient adherence and consequently increase treatment efficacy. Personal beliefs, particularly illness representations, are significant factors that influence adherence. OBJECTIVE The aim of this study was to assess the associations between adherence to treatment, illness perception, and selected sociodemographic and clinical characteristics in patients with arterial hypertension. METHODS In this cross-sectional observational study, 235 patients with arterial hypertension completed the Hill-Bone Compliance to High Blood Pressure Therapy Scale and the Brief Illness Perception Questionnaire. Associations between variables were assessed by Spearman ρ and multiple linear regression analysis. RESULTS Younger age, male gender, overall number of drugs used, and poorer beliefs related to the timeline, treatment control, and understanding were associated with higher levels of nonadherence. The final regression model significantly ( P ≤ .05) explained 19.4% of the variance in diet adherence, 5.0% in appointment keeping, and 17.8% in medication adherence. CONCLUSION Comprehensive care aimed at regular evaluation of illness perceptions with an emphasis on increasing understanding of the disease and its treatment and reducing patient worries and negative emotions seems to be a relevant strategy for improving adherence to antihypertensive treatment in everyday clinical practice.
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Garcia-Cardenas V, Hughes D, Aguilar-Palacio I, Benrimoj SI, Rabanaque MJ, Martinez-Martinez F, Malo S. Spanish translation of the ABC taxonomy for medication adherence. Res Social Adm Pharm 2023; 19:1292-1297. [PMID: 37321926 DOI: 10.1016/j.sapharm.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/10/2023] [Accepted: 05/18/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND The Ascertaining Barriers to Compliance (ABC) taxonomy was developed aiming at systematizing definitions and operationalizations of medication adherence. Its translation is crucial to improve the generalizability, application and comparison of study findings. OBJECTIVE To provide a consensus translation of the ABC taxonomy from English to Spanish. METHODS A two-phased approach was used, according to the Preferred Methods for the Translation of the ABC Taxonomy for Medication Adherence. Two literature reviews were conducted: to identify Spanish synonyms and definitions of the ABC taxonomy, and to identify a panel of Spanish-speaking experts in medication adherence. A Delphi survey was designed based on the synonyms and definitions found. The experts previously identified were invited to participate in the Delphi. A consensus of ≥85% was established for the first round. A moderate consensus (50-75%), a consensus (75-95%) or a strong consensus (>95%) were considered to be necessary in the second round. RESULTS Forty potential synonyms of the ABC taxonomy terms were identified from a total of 270 papers. The response rate during the first Delphi round was 32% (63/197) and in the second round 86% (54/63). A strong consensus was reached for the term "inicio del tratamiento" (96%) and consensus for the term "implementación" (83%). A moderate consensus was obtained for "adherencia a la medicación" (70%), "interrupción del tratamiento" (52%), "manejo de la adherencia" (54%) and "disciplinas relacionadas con la adherencia" (74%). No consensus was reached for the term persistence. Five out of the seven definitions reached a consensus in the first round, and two definitions a moderate consensus after the second round. CONCLUSION The adoption of the Spanish taxonomy will increase transparency, comparability and transferability of results in the field of medication adherence. This may facilitate benchmarking of adherence strategies between Spanish-speaking researchers and practitioners, and other language speakers.
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Affiliation(s)
- Victoria Garcia-Cardenas
- Pharmacy and Pharmaceutical Technology Department, Faculty of Pharmacy, University of Granada, Granada, Spain.
| | - Dyfrig Hughes
- School of Medical and Health Sciences, Bangor University, Bangor, Gwynedd, UK.
| | - Isabel Aguilar-Palacio
- Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain; Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain.
| | - Shalom Isaac Benrimoj
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Granada, Spain.
| | - Maria Jose Rabanaque
- Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain; Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain.
| | | | - Sara Malo
- Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain; Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain.
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Wawruch M, Petrova M, Tesar T, Murin J, Schnorrerova P, Paduchova M, Celovska D, Havelkova B, Trnka M, Alfian SD, Aarnio E. Factors associated with non-adherence to angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in older patients with peripheral arterial disease. Front Pharmacol 2023; 14:1199669. [PMID: 37637425 PMCID: PMC10448819 DOI: 10.3389/fphar.2023.1199669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/31/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction: As in other chronic conditions, medication adherence is important in the treatment of peripheral arterial disease (PAD). Our study aimed at a) analysing non-adherence to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in groups of older ACEI and ARB users with PAD, and b) identifying characteristics associated with non-adherence. Methods: We focused on the implementation phase of adherence (i.e., after treatment initiation and before possible discontinuation of treatment). The study cohort included ACEI/ARB users aged ≥65 years in whom PAD was newly diagnosed during 2012. Non-adherence was defined as Proportion of Days Covered (PDC) < 80%. Results: Among 7,080 ACEI/ARB users (6,578 ACEI and 502 ARB users), there was no significant difference in the overall proportion of non-adherent patients between ACEI and ARB users (13.9% and 15.3%, respectively). There were differences in factors associated with non-adherence between the groups of persistent and non-persistent (i.e., discontinued treatment at some point during follow-up) ACEI and ARB users. Increasing age, dementia and bronchial asthma were associated with non-adherence in persistent ACEI users. General practitioner as index prescriber was associated with adherence in the groups of non-persistent ACEI users and persistent ARB users. Conclusion: Identified factors associated with non-adherence may help in determining the groups of patients who require increased attention.
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Affiliation(s)
- Martin Wawruch
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Miriam Petrova
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Tomas Tesar
- Department of Organisation and Management of Pharmacy, Faculty of Pharmacy, Comenius University, Bratislava, Slovakia
| | - Jan Murin
- 1st Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Patricia Schnorrerova
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | | | - Denisa Celovska
- 1st Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | | | - Michal Trnka
- Institute of Medical Physics, Biophysics, Informatics and Telemedicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Sofa D. Alfian
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Emma Aarnio
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
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Phillips LA, Pironet A, Vrijens B. Evaluating Objective Metrics of habit strength for taking medications. J Behav Med 2023; 46:632-641. [PMID: 36662351 DOI: 10.1007/s10865-023-00392-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 01/03/2023] [Indexed: 01/21/2023]
Abstract
Habit strength for taking medication is associated with medication adherence. However, habit strength is typically measured via self-reports, which have limitations. Objective sensors may provide advantages to self-reports. To evaluate whether habit-strength metrics derived from objective sensor data (MEMS® Caps; AARDEX Group) are associated with self-reported habit strength and adherence (objective and self-reported) and whether objective and self-reported habit strength are independently associated with adherence. Patients (N = 79) on oral medications for type 2 diabetes completed self-reports of habit strength and medication adherence and used MEMS® Caps to take their prescribed medication for one month. MEMS® Caps data were used to create five objective metrics of habit strength (e.g., individual-level variance in pill timing) and quantify medication adherence (% days correct dosing). Consistency in behavior from week to week (versus across each day) had the greatest association with self-reported habit strength (r(78) = 0.29, p = 0.01), self-reported adherence (r(78) = 0.32, p = 0.005), and objective adherence (r(78) = 0.61, p < 0.001). Objective and self-reported habit strength were independently associated with adherence. Weekly pill-timing consistency may be more useful than daily pill-timing consistency for predicting adherence and understanding patients' medication-taking habits. Self-reports and objective metrics of habit strength may be measuring different constructs, warranting further research.
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Kamimura-Nishimura K, Bush H, Amaya de Lopez P, Crosby L, Jacquez F, Modi AC, Froehlich TE. Understanding Barriers and Facilitators of Attention-Deficit/Hyperactivity Disorder Treatment Initiation and Adherence in Black and Latinx Children. Acad Pediatr 2023; 23:1175-1186. [PMID: 36997150 PMCID: PMC10524141 DOI: 10.1016/j.acap.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVE Despite evidence that consistent treatment is important for Attention-Deficit/Hyperactivity Disorder (ADHD) management, ADHD treatment initiation and adherence remains suboptimal in minoritized children. The goal of this study was to explore barriers and facilitators to ADHD treatment initiation/adherence for minoritized children to further inform development of our family navigation intervention. METHODS Using a virtual platform, we completed 7 focus group sessions (total n.ß=.ß26) and 6 individual interviews with representatives from 4 stakeholder groups: experienced caregivers of children with ADHD, caregivers of children newly diagnosed with ADHD, family navigators, and clinicians who care for children with ADHD. All caregivers identified as Black and/or Latinx. Separate sessions were conducted for each stakeholder group and caregivers had the option to attend an English or Spanish session. Using a thematic analysis strategy, barriers and facilitators to ADHD treatment initiation and/or adherence were coded in focus group/interview data and themes were identified across groups. RESULTS The primary barriers to ADHD treatment initiation and/or adherence identified for minoritized children were lack of support from school/healthcare/family members, cultural barriers, limited resources, limited access, and treatmentconcerns, with variability in endorsement across participants. Reported facilitators included caretakers having experience with ADHD, strong support, access to resources, andwitnessing their child...s functional improvement with treatment. CONCLUSIONS Caregiver experience with and knowledge about ADHD, support, and access to resources facilitate ADHD treatment in minoritized children. The results from this study have the potential to improve ADHD treatment initiation/adherence and outcomes for minoritized children through the development of culturally tailored, multipronged interventions.
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Affiliation(s)
- Kelly Kamimura-Nishimura
- Department of Pediatrics (K Kamimura-Nishimura, P Amaya de Lopez, L Crosby, AC Modi, and TE Froehlich), University of Cincinnati College of Medicine, Cincinnati Children...s Hospital Medical Center,.ßOhio.
| | - Hannah Bush
- Department of Pediatrics (H Bush), Cincinnati Children...s Hospital Medical Center, Ohio.
| | - Paola Amaya de Lopez
- Department of Pediatrics (K Kamimura-Nishimura, P Amaya de Lopez, L Crosby, AC Modi, and TE Froehlich), University of Cincinnati College of Medicine, Cincinnati Children...s Hospital Medical Center,.ßOhio.
| | - Lori Crosby
- Department of Pediatrics (K Kamimura-Nishimura, P Amaya de Lopez, L Crosby, AC Modi, and TE Froehlich), University of Cincinnati College of Medicine, Cincinnati Children...s Hospital Medical Center,.ßOhio.
| | - Farrah Jacquez
- Department of Psychology (F Jacquez), University of Cincinnati, Ohio.
| | - Avani C Modi
- Department of Pediatrics (K Kamimura-Nishimura, P Amaya de Lopez, L Crosby, AC Modi, and TE Froehlich), University of Cincinnati College of Medicine, Cincinnati Children...s Hospital Medical Center,.ßOhio.
| | - Tanya E Froehlich
- Department of Pediatrics (K Kamimura-Nishimura, P Amaya de Lopez, L Crosby, AC Modi, and TE Froehlich), University of Cincinnati College of Medicine, Cincinnati Children...s Hospital Medical Center,.ßOhio.
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Marston MT, Berben L, Dobbels F, Russell CL, de Geest S. Prevalence and Patient-Level Correlates of Intentional Non-Adherence to Immunosuppressive Medication After Heart-Transplantation-Findings From the International BRIGHT Study. Transpl Int 2023; 36:11308. [PMID: 37492859 PMCID: PMC10363605 DOI: 10.3389/ti.2023.11308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/15/2023] [Indexed: 07/27/2023]
Abstract
After heart transplantation (HTx), non-adherence to immunosuppressants (IS) is associated with poor outcomes; however, intentional non-adherence (INA) is poorly understood regarding its international variability in prevalence, contributing factors and impact on outcomes. We investigated (1) the prevalence and international variability of INA, (2) patient-level correlates of INA, and (3) relation of INA with clinical outcomes. Secondary analysis of data from the BRIGHT study-an international multi-center, cross-sectional survey examining multi-level factors of adherence in 1,397 adult HTx recipients. INA during the implementation phase, i.e., drug holiday and dose alteration, was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale© (BAASIS©). Descriptive and inferential analysis was performed with data retrieved through patient interview, patient self-report and in clinical records. INA prevalence was 3.3% (n = 46/1,397)-drug holidays: 1.7% (n = 24); dose alteration: 1.4% (n = 20); both: 0.1% (n = 2). University-level education (OR = 2.46, CI = 1.04-5.83), insurance not covering IS costs (OR = 2.21, CI = 1.01-4.87) and barriers (OR = 4.90, CI = 2.73-8.80) were significantly associated with INA; however, clinical outcomes were not. Compared to other single-center studies, this sample's INA prevalence was low. More than accessibility or financial concerns, our analyses identified patient-level barriers as INA drivers. Addressing patients' IS-related barriers, should decrease INA.
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Affiliation(s)
- Mark T. Marston
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
- Pediatric Intensive Care Unit, University Children’s Hospital Basel, Basel, Switzerland
| | - Lut Berben
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
- Pediatric Intensive Care Unit, University Children’s Hospital Basel, Basel, Switzerland
| | - Fabienne Dobbels
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Cynthia L. Russell
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Sabina de Geest
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Cabral AC, Lavrador M, Castel-Branco M, Figueiredo IV, Fernandez-Llimos F. Development and validation of a Medication Adherence Universal Questionnaire: the MAUQ. Int J Clin Pharm 2023:10.1007/s11096-023-01612-x. [PMID: 37329432 PMCID: PMC10366321 DOI: 10.1007/s11096-023-01612-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/29/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Different questionnaires assess self-reported medication adherence and others quantify aspects of patients attitudes towards medication, but not together in a single instrument. Gathering these two aspects in a single instrument could reduce patients survey burden. AIM The aim of this study was to develop the Medication Adherence Universal Questionnaire (MAUQ) using the Maastricht Utrecht Adherence in Hypertension short version (MUAH-16) factorial structure as the hypothesized model. METHOD A multistep process started with the modification of the MUAH-16 to obtain the MAUQ. Patients using at least one antihypertensive medicine were recruited. The two questionnaires, the MUAH-16 and MAUQ, were applied. A confirmatory factor analysis (CFA) was performed using the initial MUAH-16 s-order 4-factor model. An additional bifactor model with four uncorrelated factors and an overall score was tested. The comparative fit index (CFI), root mean square error of approximation (RMSEA) with confidence intervals (CIs), and standardized root mean squared residual (SRMR) were used to assess both models. RESULTS A sample of 300 hypertensive patients completed the instruments. The CFA with the second-order 4-factor solution resulted in similar results for the MUAH-16 and MAUQ: CFIs of 0.934 and 0.930, RMSEAs of 0.043 [CI 0.030-0.056] and 0.045 [CI 0.031-0.057] and SRMRs of 0.060 and 0.061, respectively. The CFA with the bifactor model showed slightly better results for both the MUAH-16 and MAUQ: CFIs of 0.974 and 0.976, RMSEAs of 0.030 [CI 0.005-0.046] and 0.028 [CI 0.001-0.044], and SRMRs of 0.043 and 0.044, respectively. CONCLUSION CFA demonstrated that the MAUQ presented a better fit to both models than the MUAH-16, obtaining a robust universal free instrument to assess medicine-taking behaviour and four medicine beliefs components.
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Affiliation(s)
- Ana C Cabral
- Pharmacology and Pharmaceutical Care Laboratory, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Marta Lavrador
- Pharmacology and Pharmaceutical Care Laboratory, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Margarida Castel-Branco
- Pharmacology and Pharmaceutical Care Laboratory, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Isabel Vitória Figueiredo
- Pharmacology and Pharmaceutical Care Laboratory, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Fernando Fernandez-Llimos
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal.
- Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal.
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Essien UR, Singh B, Swabe G, Johnson AE, Eberly LA, Wadhera RK, Breathett K, Vaduganathan M, Magnani JW. Association of Prescription Co-payment With Adherence to Glucagon-Like Peptide-1 Receptor Agonist and Sodium-Glucose Cotransporter-2 Inhibitor Therapies in Patients With Heart Failure and Diabetes. JAMA Netw Open 2023; 6:e2316290. [PMID: 37261826 PMCID: PMC10236237 DOI: 10.1001/jamanetworkopen.2023.16290] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/18/2023] [Indexed: 06/02/2023] Open
Abstract
Importance Type 2 diabetes (T2D) and heart failure (HF) prevalence are rising in the US. Although glucagon-like peptide-1 receptor agonists (GLP1-RA) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve outcomes for these conditions, high out-of-pocket costs may be associated with reduced medication adherence. Objective To compare 1-year adherence to GLP1-RA and SGLT2i therapies by prescription co-payment level in individuals with T2D and/or HF. Design, Setting, and Participants This retrospective cohort study used deidentified data from Optum Insight's Clinformatics Data Mart Database of enrollees with commercial and Medicare health insurance plans. Individuals aged 18 years or older with T2D and/or HF who had a prescription claim for a GLP1-RA or SLGT2i from January 1, 2014, to September 30, 2020, were included. Exposures Prescription co-payment, categorized as low (<$10), medium ($10 to<$50), and high (≥$50). Main Outcomes and Measures The primary outcome was medication adherence, defined as a proportion of days covered (PDC) of 80% or greater at 1 year. Logistic regression models were used to examine the association between co-payment and adherence, adjusting for patient demographics, medical comorbidities, and socioeconomic factors. Results A total of 94 610 individuals (mean [SD] age, 61.8 [11.4] years; 51 226 [54.1%] male) were prescribed GLP1-RA or SGLT2i therapy. Overall, 39 149 individuals had a claim for a GLP1-RA, of whom 25 557 (65.3%) had a PDC of 80% or greater at 1 year. In fully adjusted models, individuals with a medium (adjusted odds ratio [AOR], 0.62; 95% CI, 0.58-0.67) or high (AOR, 0.47; 95% CI, 0.44-0.51) co-payment were less likely to have a PDC of 80% or greater with a GLP1-RA compared with those with a low co-payment. Overall, 51 072 individuals had a claim for an SGLT2i, of whom 37 339 (73.1%) had a PDC of 80% or greater at 1 year. Individuals with a medium (AOR, 0.67; 95% CI, 0.63-0.72) or high (AOR, 0.68; 95% CI, 0.63-0.72) co-payment were less likely to have a PDC of 80% or greater with an SGLT2i compared with those with a low co-payment. Conclusions and Relevance In this cohort study of individuals with T2D and/or HF, 1-year adherence to GLP1-RA or SGLT2i therapies was highest among individuals with a low co-payment. Improving adherence to guideline-based therapies may require interventions that reduce out-of-pocket prescription costs.
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Affiliation(s)
- Utibe R. Essien
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Balvindar Singh
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Gretchen Swabe
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Amber E. Johnson
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Lauren A. Eberly
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia
- Penn Cardiovascular Center for Health Equity and Social Justice, University of Pennsylvania, Philadelphia
| | - Rishi K. Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jared W. Magnani
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Center for Research on Health Care, University of Pittsburgh Department of Medicine, Pittsburgh, Pennsylvania
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Schulz M, Laufs U. Not obtaining a medication the first time it is prescribed: primary non-adherence to cardiovascular pharmacotherapy. Clin Res Cardiol 2023:10.1007/s00392-023-02230-3. [PMID: 37209148 DOI: 10.1007/s00392-023-02230-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/08/2023] [Indexed: 05/22/2023]
Abstract
Primary medication non-adherence describes the situation when a first prescription for a new medication is never filled. Primary non-adherence is an important, yet understudied aspect of reduced effectiveness of pharmacotherapy. This review summarizes the frequency, impact, reasons, predictors, and interventions regarding primary non-adherence to cardiovascular/cardiometabolic drugs. The current literature reveals a high prevalence of primary non-adherence. The individual risk of primary non-adherence is determined on multiple factors, e.g., primary non-adherence of lipid-lowering drugs is higher compared to antihypertensive medications. However, the overall rate of primary non-adherence is > 10%. Additionally, this review identifies specific areas for research to better understand why patients forgo evidence-based beneficial pharmacotherapy and to explore targeted interventions. At the same time, measures to reduce primary non-adherence-once proven to be effective-may represent an important new opportunity to reduce cardiovascular diseases.
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Affiliation(s)
- Martin Schulz
- Institute of Pharmacy, Freie Universität Berlin, Kelchstraße 31, 12169, Berlin, Germany.
- Drug Commission of German Pharmacists (AMK), Heidestraße 7, 10557, Berlin, Germany.
- German Institute for Drug Use Evaluation (DAPI), Heidestraße 7, 10557, Berlin, Germany.
| | - Ulrich Laufs
- Department of Cardiology, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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Seesaghur A, Egger P, Warden J, Abbasi A, Levick B, Riaz M, McMahon P, Thompson M, Cheeseman S. Assessment of bone-targeting agents use in patients with bone metastasis from breast, lung or prostate cancer using structured and unstructured electronic health records from a regional UK-based hospital. BMJ Open 2023; 13:e069214. [PMID: 37156580 PMCID: PMC10410833 DOI: 10.1136/bmjopen-2022-069214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 04/13/2023] [Indexed: 05/10/2023] Open
Abstract
UNLABELLED ObjectiveTo assess use of bone-targeting agents (BTA) in patients with confirmed bone metastases (BM) from breast cancer (BC), non-small cell lung cancer (NSCLC) or prostate cancer (PC). DESIGN Retrospective cohort study. SETTING Regional hospital-based oncology database of approximately 2 million patients in England. PARTICIPANTS Patients aged ≥18 years with a diagnosis of BC, NSCLC or PC as well as BM between 1 January 2007 and 31 December 2018, with follow-up to 30 June 2020 or death; BM diagnosis ascertained from recorded medical codes and unstructured data using natural language processing (NLP). MAIN OUTCOMES MEASURES Initiation or non-initiation of BTA following BM diagnosis, time from BM diagnosis to BTA initiation, time from first to last BTA, time from last BTA to death. RESULTS This study included 559 BC, 894 NSCLC and 1013 PC with BM; median age (Q1-Q3) was 65 (52-76), 69 (62-77) and 75 (62-77) years, respectively. NLP identified BM diagnosis from unstructured data for 92% patients with BC, 92% patients with NSCLC and 95% patients with PC. Among patients with BC, NSCLC and PC with BM, 47%, 87% and 88% did not receive a BTA, and 53%, 13% and 12% received at least one BTA, starting a median 65 (27-167), 60 (28-162) and 610 (295-980) days after BM, respectively. Median (Q1-Q3) duration of BTA treatment was 481 (188-816), 89 (49-195) and 115 (53-193) days for patients with BC, NSCLC and PC. For those with a death record, median time from last BTA to death was 54 (26-109) for BC, 38 (17-98) for NSCLC and 112 (44-218) days for PC. CONCLUSION In this study identifying BM diagnosis from both structured and unstructured data, a high proportion of patients did not receive a BTA. Unstructured data provide new insights on the real-world use of BTA.
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Affiliation(s)
- Anouchka Seesaghur
- Centre for Observational Research, Amgen Ltd Uxbridge, Uxbridge, Middlesex, UK
| | - Peter Egger
- Real World Studies, IQVIA Europe, London, UK
| | | | - Ali Abbasi
- Centre for Observational Research, Amgen Ltd Uxbridge, Uxbridge, Middlesex, UK
| | | | - Majid Riaz
- Real World Studies, IQVIA Europe, London, UK
| | | | | | - Sue Cheeseman
- REAL Oncology, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Wendl J, Simon A, Kistler M, Hapfelmeier J, Schneider A, Hapfelmeier A. Medication Adherence and Healthcare Costs in Chronically Ill Patients Using German Claims Data. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:477-487. [PMID: 36933181 PMCID: PMC10119243 DOI: 10.1007/s40258-023-00797-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Despite the importance of medication adherence for chronically ill patients and the vast literature on its relationship to costs, this field suffers from methodological limitations. These are caused, amongst others, by the lack of generalizability of data sources, varying definitions of adherence, costs, and model specification. We aim to address this with different modeling approaches and to contribute evidence on the research question. METHODS We extracted large cohorts of nine chronic diseases (n = 6747-402,898) from German claims data of stationary health insurances between 2012 and 2015 (t0-t3). Defined as the proportion of days covered by medication, we examined the relationship of adherence using several multiple regression models at baseline year t0 with annual total healthcare costs and four sub-categories. Models with concurrent, and differently time-lagged measurements of adherence and costs were compared. Exploratively, we applied non-linear models. RESULTS Overall, we found a positive association between the proportion of days covered by medication and total costs, a weak association with outpatient costs, positive with pharmacy costs, and frequently negative with inpatient costs. There were major differences by disease and its severity but little between years, provided adherence and costs were not measured concurrently. The fit of linear models was mainly not inferior to that of non-linear models. CONCLUSIONS The estimated effect on total costs differed from most other studies, which highlights concerns about generalizability, although effect estimates in sub-categories were as expected. Comparison of time lags indicates the importance of avoiding concurrent measurement. A non-linear relationship should be considered. These methodological approaches are valuable in future research on adherence and its consequences.
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Affiliation(s)
- Johannes Wendl
- Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University of Munich, Orleansstraße 47, 81667, Munich, Germany.
| | | | | | | | - Antonius Schneider
- Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University of Munich, Orleansstraße 47, 81667, Munich, Germany
| | - Alexander Hapfelmeier
- Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University of Munich, Orleansstraße 47, 81667, Munich, Germany
- Institute of AI and Informatics in Medicine, TUM School of Medicine, Technical University of Munich, Munich, Germany
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Adelakun AR, Turgeon RD, De Vera MA, McGrail K, Loewen PS. Oral anticoagulant switching in patients with atrial fibrillation: a scoping review. BMJ Open 2023; 13:e071907. [PMID: 37185198 PMCID: PMC10151984 DOI: 10.1136/bmjopen-2023-071907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Oral anticoagulants (OACs) prevent stroke in patients with atrial fibrillation (AF). Several factors may cause OAC switching. OBJECTIVES To examine the phenomenon of OAC switching in patients with AF, including all available evidence; frequency and patterns of switch, clinical outcomes, adherence, patient-reported outcomes, reasons for switch, factors associated with switch and evidence gaps. DESIGN Scoping review. DATA SOURCES MEDLINE, Embase and Web of Science, up to January 2022. RESULTS Of the 116 included studies, 2/3 examined vitamin K antagonist (VKA) to direct-acting OAC (DOAC) switching. Overall, OAC switching was common and the definition of an OAC switch varied across. Switching from VKA to dabigatran was the most prevalent switch type, but VKA to apixaban has increased in recent years. Patients on DOAC switched more to warfarin than to other DOACs. OAC doses involved in the switches were hardly reported and patients were often censored after the first switch. Switching back to a previously taken OAC (frequently warfarin) occurred in 5%-21% of switchers.The risk of ischaemic stroke and gastrointestinal bleeding in VKA to DOAC switchers compared with non-switchers was conflicting, while there was no difference in the risk of other types of bleeding. The risk of ischaemic stroke in switchers from DOAC versus non-switchers was conflicting. Studies evaluating adherence found no significant changes in adherence after switching from VKA to DOAC, however, an increase in satisfaction with therapy were reported. Reasons for OAC switch, and factors associated with OAC switch were mostly risk factors for stroke and bleeding. Clinical outcomes, adherence and patient-reported outcomes were sparse for switches from DOACs. CONCLUSIONS OAC switching is common in patients with AF and patients often switch back to an OAC they have previously been on. There are aspects of OAC switching that have received little study, especially in switches from DOACs.
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Affiliation(s)
- Adenike R Adelakun
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Science, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ricky D Turgeon
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Science, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Science, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, The University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter S Loewen
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Science, The University of British Columbia, Vancouver, British Columbia, Canada
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Kardas P, Ágh T, Dima A, Goetzinger C, Potočnjak I, Wettermark B, van Boven JFM. Half a Century of Fragmented Research on Deviations from Advised Therapies: Is This a Good Time to Call for Multidisciplinary Medication Adherence Research Centres of Excellence? Pharmaceutics 2023; 15:pharmaceutics15030933. [PMID: 36986794 PMCID: PMC10053985 DOI: 10.3390/pharmaceutics15030933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/09/2023] [Accepted: 03/12/2023] [Indexed: 03/16/2023] Open
Abstract
Medication adherence is a key precondition of the effectiveness of evidence-based therapies. However, in real-life settings, non-adherence to medication is still very common. This leads to profound health and economic consequences at both individual and public health levels. The problem of non-adherence has been extensively studied in the last 50 years. Unfortunately, with more than 130,000 scientific papers published on that subject so far, we are still far from finding an ultimate solution. This is, at least partly, due to fragmented and poor-quality research that has been conducted in this field sometimes. To overcome this deadlock, there is a need to stimulate the adoption of best practices in medication adherence-related research in a systematic way. Therefore, herein we propose the establishment of dedicated medication adherence research Centres of Excellence (CoEs). These Centres could not only conduct research but could also create a profound societal impact, directly serving the needs of patients, healthcare providers, systems and economies. Additionally, they could play a role as local advocates for good practices and education. In this paper, we propose some practical steps that might be taken in order to establish such CoEs. We describe two success stories, i.e., Dutch and Polish Medication Adherence Research CoEs. The COST Action “European Network to Advance Best practices & technoLogy on medication adherencE” (ENABLE) aims to develop a detailed definition of the Medication Adherence Research CoE in the form of a list of minimal requirements regarding their objectives, structure and activities. We hope that it will help to create a critical mass and catalyse the setup of regional and national Medication Adherence Research CoEs in the near future. This, in turn, may not only increase the quality of the research but also raise the awareness of non-adherence and promote the adoption of the best medication adherence-enhancing interventions.
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Affiliation(s)
- Przemysław Kardas
- Medication Adherence Research Center, Department of Family Medicine, Medical University of Lodz, 90-419 Lodz, Poland
- Correspondence:
| | - Tamás Ágh
- Syreon Research Institute, 1145 Budapest, Hungary
- Center for Health Technology Assessment and Pharmacoeconomic Research, University of Pécs, 7623 Pécs, Hungary
| | | | - Catherine Goetzinger
- Deep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, Strassen, 1445 Luxembourg, Luxembourg
- Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, 4365 Luxembourg, Luxembourg
| | - Ines Potočnjak
- Institute for Clinical Medical Research and Education, University Hospital Center Sisters of Charity, 10000 Zagreb, Croatia
| | - Björn Wettermark
- Department of Pharmacy, Faculty of Pharmacy, Uppsala University, Husargatan 3, 752 37 Uppsala, Sweden
- Faculty of Medicine, Vilnius University, Universiteto g. 3, LT-01513 Vilnius, Lithuania
| | - Job F. M. van Boven
- Department of Clinical Pharmacy and Pharmacology, Medication Adherence Expertise Center of the Northern Netherlands (MAECON), University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
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Mucherino S, Maffoni M, Cena C, Armando LG, Guastavigna M, Orlando V, Orofino G, Traina S, Giardini A, Menditto E, The Collaborative Working Group. Italian Translation and Validation of the Original ABC Taxonomy for Medication Adherence. Healthcare (Basel) 2023; 11:846. [PMID: 36981503 PMCID: PMC10048001 DOI: 10.3390/healthcare11060846] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/17/2023] Open
Abstract
Medication adherence represents a complex and multifaceted process. Standardized terminology is essential to enable a reproducible process in various languages. The study's aim was to translate and adapt the original Ascertaining Barriers for Compliance (ABC) Taxonomy on medication adherence, first proposed in 2012, into Italian language. The study was carried out according to the Preferred Methods for Translation of the ABC Taxonomy for Medication Adherence adopted by the ESPACOMP. Key steps included: (1) a systematic literature review using PubMed and Embase according to the PRISMA Guidelines to identify published Italian terms and definitions, and Italian adherence experts; (2) a forward translation of terms and definitions; (3) panelists' selection; (4) a three-round Delphi survey. From the systematic review, 19 studies allowed detection of 4 terms, 4 definitions and 767 Italian experts. To these, Italian ESPACOMP members and experts though snowball sampling were added. The identified Italian adherence experts received the Delphi questionnaire. The Italian ABC Taxonomy was achieved after three rounds of Delphi survey by reaching at least a moderate consensus on unambiguous naming and definition of medication adherence-related terms. The Taxonomy is intended to be used in research, academic, and professional fields in order to harmonize adherence terminology and avoid confusion in comparing research findings.
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Affiliation(s)
- Sara Mucherino
- CIRFF, Center of Pharmacoeconomics and Drug Utilization, Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy
| | - Marina Maffoni
- Psychology Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, 27040 Montescano, Italy
| | - Clara Cena
- Department of Drug Science and Technology, University of Turin, 10125 Turin, Italy
| | | | - Marta Guastavigna
- S.C. Malattie Infettive e Tropicali I, ASL Città di Torino, Amedeo di Savoia Hospital, 10149 Turin, Italy
| | - Valentina Orlando
- CIRFF, Center of Pharmacoeconomics and Drug Utilization, Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy
| | - Giancarlo Orofino
- S.C. Malattie Infettive e Tropicali I, ASL Città di Torino, Amedeo di Savoia Hospital, 10149 Turin, Italy
| | - Sara Traina
- Department of Drug Science and Technology, University of Turin, 10125 Turin, Italy
| | - Anna Giardini
- Information Technology, Istituti Clinici Scientifici Maugeri IRCCS Pavia, 27100 Pavia, Italy
| | - Enrica Menditto
- CIRFF, Center of Pharmacoeconomics and Drug Utilization, Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy
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Vaisbourd Y, Dahhou M, Zhang X, Sapir-Pichhadze R, Cardinal H, Johnston O, Blydt-Hansen TD, Tibbles LA, Hamiwka L, Urschel S, Birk P, Bissonnette J, Matsuda-Abedini M, BScPhm JH, Schiff J, Phan V, De Geest S, Allen U, Avitzur Y, Mital S, Foster BJ. Differences in medication adherence by sex and organ type among adolescent and young adult solid organ transplant recipients. Pediatr Transplant 2023; 27:e14446. [PMID: 36478059 DOI: 10.1111/petr.14446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/26/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Identification of differences in medication adherence by sex or organ type may help in planning interventions to optimize outcomes. We compared immunosuppressive medication adherence between males and females, and between kidney, liver and heart transplant recipients. METHODS This multicenter study of prevalent kidney, liver and heart transplant recipients 14-25 years assessed adherence 3 times (0, 3, 6 months post-enrollment) with the BAASIS self-report tool. At each visit, participants were classified as adherent if they missed no doses in the prior 4 weeks and non-adherent otherwise. Adherence was also assessed using the coefficient of variation (CV) of tacrolimus trough levels; CV < 30% was classified as adherent. We used multivariable mixed effects logistic regression models adjusted for potential confounders to compare adherence by sex and by organ. RESULTS Across all visits, males (n = 150, median age 20.4 years, IQR 17.2-23.3) had lower odds of self-reported adherence than females (n = 120, median age 19.8 years, IQR 17.1-22.7) (OR 0.41, 95% CI 0.21-0.80) but higher odds of adherence by tacrolimus CV (OR 2.50, 95% CI 1.30-4.82). No significant differences in adherence (by self-report or tacrolimus CV) were noted between the 184 kidney, 58 liver, and 28 heart recipients. CONCLUSION Females show better self-reported adherence than males but greater variability in tacrolimus levels. Social desirability bias, more common in females than males, may contribute to better self-reported adherence among females. Higher tacrolimus variability among females may reflect biologic differences in tacrolimus metabolism between males and females rather than sex differences in adherence. There were no significant differences in adherence by organ type.
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Affiliation(s)
| | - Mourad Dahhou
- Research Institute of The McGill University Health Centre, Quebec, Canada
| | - Xun Zhang
- Research Institute of The McGill University Health Centre, Quebec, Canada
| | - Ruth Sapir-Pichhadze
- Research Institute of The McGill University Health Centre, Quebec, Canada.,Department of Medicine, McGill University, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada
| | | | - Olwyn Johnston
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tom D Blydt-Hansen
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lee Anne Tibbles
- Department of Medicine and Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lorraine Hamiwka
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simon Urschel
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Patricia Birk
- Section of Pediatric Nephrology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Mina Matsuda-Abedini
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Harrison BScPhm
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Ajmera Transplant Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Jeffrey Schiff
- Ajmera Transplant Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Sabina De Geest
- Department Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland.,Department of Primary Care and Public Health, Academic Center of Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Upton Allen
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
| | - Yaron Avitzur
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
| | - Seema Mital
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
| | - Bethany J Foster
- Department of Pediatrics, McGill University, Quebec, Canada.,Research Institute of The McGill University Health Centre, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada
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46
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Peeters LEJ, Kappers MHW, Boersma E, Massey EK, van Dijk L, van Gelder T, Koch BCP, Versmissen J. The effect of combining therapeutic drug monitoring of antihypertensive drugs with personalised feedback on adherence and resistant hypertension: the (RHYME-RCT) trial protocol of a multi-centre randomised controlled trial. BMC Cardiovasc Disord 2023; 23:87. [PMID: 36788491 PMCID: PMC9926861 DOI: 10.1186/s12872-023-03114-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Adherence to antihypertensive drugs (AHDs) is important for adequate blood pressure control. Not taking these drugs as prescribed is one of the main underlying causes for resistant hypertension (RH), which in turn leads to an increased risk of cardiovascular events, stroke and kidney damage. Therefore, correct identification of patients that are non-adherent to AHDs is crucial to improve clinical outcome. For this goal, therapeutic drug monitoring is the most reliable method. The primary objective of this trial is to investigate whether monitoring of drug concentrations with a dried blood spot (DBS) sampling method combined with personalised feedback leads to a decrease in prevalence of RH after 12 months due to an increase in adherence. Secondary objectives include the difference over time in the number of required AHDs as well as the defined daily dose (DDD). Lastly, the cost-utility of SoC versus the intervention in RH is determined. METHODS This is a multi-centre single-blinded randomised controlled trial (RHYME-RCT). First, at an eligibility visit, DBS sampling, to monitor drug concentrations in blood, and a 24-h ambulatory blood pressure measurement (24-h ABPM) are performed simultaneously. Patients with a daytime systolic blood pressure (SBP) > 135 and/or diastolic blood pressure (DBP) > 85 mmHg are randomised to SoC or intervention + SoC. The intervention is performed by the treating physician and includes information on drug concentrations and a comprehensive personalised feedback conversation with the use of a communication tool. The follow-up period is one year with visits at 3, 6 and 12 months randomisation and includes 24-h ABPM and DBS sampling. DISCUSSION This will be the first trial that focusses specifically on patients with RH without taking into account suspicion of non-adherence and it combines monitoring of AHD concentrations to identify non-adherence to AHDs with a comprehensive feedback to improve non-adherence. Furthermore, if this trial shows positive outcomes for the intervention it can be directly implemented in clinical practice, which would be a great improvement in the treatment of RH. TRIAL REGISTRATION RHYME-RCT is registered in the Dutch Trial Register on 27/12/2017 (NTR6914) and can be found in the International Clinical Trials Registry Platform.
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Affiliation(s)
- L. E. J. Peeters
- grid.5645.2000000040459992XDepartment of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,grid.5645.2000000040459992XDepartment of Hospital Pharmacy, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - M. H. W. Kappers
- grid.413711.10000 0004 4687 1426Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands
| | - E. Boersma
- grid.5645.2000000040459992XDepartment of Cardiology, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - E. K. Massey
- grid.5645.2000000040459992XDepartment of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - L. van Dijk
- grid.416005.60000 0001 0681 4687Department Pharmaceutical Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands ,grid.4830.f0000 0004 0407 1981Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - T. van Gelder
- grid.5645.2000000040459992XDepartment of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,grid.5645.2000000040459992XDepartment of Hospital Pharmacy, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - B. C. P. Koch
- grid.5645.2000000040459992XDepartment of Hospital Pharmacy, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J. Versmissen
- grid.5645.2000000040459992XDepartment of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,grid.5645.2000000040459992XDepartment of Hospital Pharmacy, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Reinitiation and Subsequent Discontinuation of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers among New and Prevalent Users Aged 65 Years or More with Peripheral Arterial Disease. Biomedicines 2023; 11:biomedicines11020368. [PMID: 36830904 PMCID: PMC9953445 DOI: 10.3390/biomedicines11020368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/11/2023] [Accepted: 01/23/2023] [Indexed: 01/28/2023] Open
Abstract
Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) are recommended in the treatment of arterial hypertension in patients with peripheral arterial disease (PAD). The aims of our study were: (a) to analyse the extent of reinitiation and subsequent discontinuation in older hypertensive PAD patients non-persistent with ACEIs/ARBs; (b) to determine patient and medication factors associated with reinitiation and subsequent discontinuation; and (c) to compare these factors between prevalent and new users. The analysis of reinitiation was performed on a sample of 1642 non-persistent patients aged ≥65 years with PAD newly diagnosed in 2012. Patients reinitiating ACEIs/ARBs were used for the analysis of subsequent discontinuation identified according to the treatment gap period of at least 6 months without any prescription of ACEI/ARB. In the group of non-persistent patients, 875 (53.3%) patients reinitiated ACEIs/ARBs during a follow-up (24.8 months on average). Within this group, subsequent discontinuation was identified in 414 (47.3%) patients. Being a new user was associated with subsequent discontinuation, but not with reinitiation. Myocardial infarction during non-persistence and after reinitiation was associated with reinitiation and lower likelihood of subsequent discontinuation, respectively. Being a prevalent or a new user is associated with the use of medication also after initial discontinuation.
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Adherence to the CDK 4/6 Inhibitor Palbociclib and Omission of Dose Management Supported by Pharmacometric Modelling as Part of the OpTAT Study. Cancers (Basel) 2023; 15:cancers15010316. [PMID: 36612312 PMCID: PMC9818079 DOI: 10.3390/cancers15010316] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023] Open
Abstract
The cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) palbociclib is administered orally and cyclically, causing medication adherence challenges. We evaluated components of adherence to palbociclib, its relationship with pharmacokinetics (PK), and drug-induced neutropenia. Patients with metastatic breast cancer (MBC) receiving palbociclib, delivered in electronic monitors (EM), were randomized 1:1 to an intervention and a control group. The intervention was a 12-month interprofessional medication adherence program (IMAP) along with monthly motivational interviews by a pharmacist. Implementation adherence was compared between groups using generalized estimating equation models, in which covariates were included. Model-based palbociclib PK and neutrophil profiles were simulated under real-life implementation scenarios: (1) optimal, (2) 2 doses omitted and caught up at cycle end. At 6 months, implementation was slightly higher and more stable in the intervention (n = 19) than in the control (n = 19) group, 99.2% and 97.3% (Δ1.95%, 95% CI 1.1−2.9%), respectively. The impact of the intervention was larger in patients diagnosed with MBC for >2 years (Δ3.6%, 95% CI 2.1−5.4%), patients who received >4 cycles before inclusion (Δ3.1%, 95% CI 1.7−4.8%) and patients >65 (Δ2.3%, 95% CI 0.8−3.6%). Simulations showed that 25% of patients had neutropenia grade ≥3 during the next cycle in scenario 1 versus 30% in scenario 2. Education and monitoring of patient CDK4/6i cycle management and adherence along with therapeutic drug monitoring can help clinicians improve prescription and decrease toxicity.
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49
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Kelly D, Koay A, Mineva G, Volz M, McCool A, McLoughlin E, Ó Conluain R, Sharma M, Kerr A, Franklin BD, Grimes T. A scoping review of non-professional medication practices and medication safety outcomes during public health emergencies. Public Health 2023; 214:50-60. [PMID: 36521272 DOI: 10.1016/j.puhe.2022.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/06/2022] [Accepted: 10/18/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Public health emergencies (PHE) can disrupt personal medication practices and increase the risk of medication-related harm and other negative medication-related outcomes. Our aim was to examine the extent and nature of published research on this topic to guide future research and practice. STUDY DESIGN Scoping review. METHODS Standard electronic databases were searched. PRISMA-ScR guidelines were followed. Extracted data were organised in response to review questions and narrative accounts developed. RESULTS A total of 129 studies were included, conducted across 32 countries, mostly in the USA (n = 42). Sixty-eight (53%) reported on infectious events, 49 (39%) climatological or ecological events and the remainder a mixture of terrorism, war or other disasters. The studies described several medication safety outcomes (medication-related harm, adherence, supply) and adaptive medication practices (self-altering prescribed medications, sharing medications and changing healthcare providers). Challenges to maintaining routine medication practices during a PHE included transport, finance, quarantine and knowledge-related issues. Twenty-eight studies (22%) examined health inequalities pertaining to adverse medication-related outcomes, with findings suggesting that gender, age, ethnicity, educational and socio-economic status may be related to inequalities. Research gaps identified included carers', children's and minority communities' experiences and intervention studies. CONCLUSIONS There is considerable evidence of disruptions to routine personal medication practices during PHEs and of medication-related harm and other negative outcomes. Maintaining medication supply for the management of chronic conditions is a universal problem across all emergency types. Research is needed to address these disruptions, particularly amongst people who experience health inequalities who may need additional support.
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Affiliation(s)
- Dervla Kelly
- School of Medicine, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland
| | - Aaron Koay
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Gabriela Mineva
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Monika Volz
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Aoibhin McCool
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Eavan McLoughlin
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | | | - Manuj Sharma
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Aisling Kerr
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
| | - Bryony Dean Franklin
- Imperial College Healthcare NHS Trust, London, UK; NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, UK; UCL School of Pharmacy, London, UK
| | - Tamasine Grimes
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland.
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50
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Bonsu KO, Young SW, Lee T, Nguyen HV, Chitsike RS. Self-reported adherence to direct oral anticoagulants versus warfarin therapy in a specialized thrombosis service-a cross-sectional study of patients in a Canadian Health Region. Eur J Clin Pharmacol 2023; 79:117-125. [PMID: 36399203 DOI: 10.1007/s00228-022-03418-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Direct oral anticoagulants (DOACs) have a better safety and efficacy profile than warfarin and are currently recommended for stroke prevention in non-valvular atrial fibrillation (AF) and treatment of venous thromboembolism (VTE). Given that DOACs do not require regular laboratory monitoring compared to warfarin, patients' interactions with the health care system is reduced. Adequate adherence to DOACs is important and reported adherence to anticoagulation is unclear in clinical practice. This study aims to assess self-reported adherence to oral anticoagulants in a specialized Adult Outpatient Thrombosis Service (TS). METHODS: This cross-sectional study included patients aged ≥ 18 years who were prescribed an oral anticoagulant and had attended at least one appointment with an Adult Outpatient Thrombosis Service (TS) between October 10, 2017, and May 31, 2019. Adherence to oral anticoagulant therapy was assessed using the 12-item validated Adherence to Refills and Medications Scale (ARMS) score. Logistic regression analyses were used to evaluate association between patient characteristics and medication adherence. Adherence rates in DOACs and warfarin were compared. RESULTS Three hundred and ninety-nine patients completed and returned the survey. Of the 399 who completed the survey, 74% were prescribed DOACs and 26% received warfarin. Most of the patients (89.3%) were ≥ 50 years of age and half (57.3%) were male. About two-thirds (67%) had at least post-secondary education. The duration of anticoagulation use differed between patients on DOAC and warfarin; a greater proportion of those who had used anticoagulants for less than 1 year was on DOACs compared to warfarin (20.9% vs 4.9%, p = 0.001). For patients who had been on anticoagulation for > 5 years, the proportion of warfarin patients was greater than DOAC (57.8% vs 20.5%, p = 0.001). Self-reported adherence to oral anticoagulant therapy using the 12-item ARMS scale for warfarin and DOACs were 87.3% and 90.9%, respectively. Among the warfarin users, patient satisfaction with TS was associated with medication adherence (OR = 0.22; 95% CI: 0.05-0.89). CONCLUSIONS Self-reported medication adherence was similar between warfarin and DOACs. Since suboptimal adherence is associated with poor clinical outcomes and increased costs, various stakeholders should emphasize the importance of medication adherence to oral anticoagulants at each patient encounter.
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Affiliation(s)
- Kwadwo Osei Bonsu
- School of Pharmacy, Memorial University of Newfoundland, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada.
| | - Stephanie W Young
- School of Pharmacy, Memorial University of Newfoundland, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada.,Pharmacy Program, Eastern Region Health Authority, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada
| | - Tiffany Lee
- School of Pharmacy, Memorial University of Newfoundland, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada.,Pharmacy Program, Eastern Region Health Authority, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada
| | - Hai V Nguyen
- School of Pharmacy, Memorial University of Newfoundland, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada
| | - Rufaro S Chitsike
- Division of Hematology, Eastern Region Health Authority, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada.,Division of Medicine (Hematology), Memorial University of Newfoundland, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada
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