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Tung HR, Lawley SD. Understanding and Quantifying Network Robustness to Stochastic Inputs. Bull Math Biol 2024; 86:55. [PMID: 38607457 DOI: 10.1007/s11538-024-01283-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/18/2024] [Indexed: 04/13/2024]
Abstract
A variety of biomedical systems are modeled by networks of deterministic differential equations with stochastic inputs. In some cases, the network output is remarkably constant despite a randomly fluctuating input. In the context of biochemistry and cell biology, chemical reaction networks and multistage processes with this property are called robust. Similarly, the notion of a forgiving drug in pharmacology is a medication that maintains therapeutic effect despite lapses in patient adherence to the prescribed regimen. What makes a network robust to stochastic noise? This question is challenging due to the many network parameters (size, topology, rate constants) and many types of noisy inputs. In this paper, we propose a summary statistic to describe the robustness of a network of linear differential equations (i.e. a first-order mass-action system). This statistic is the variance of a certain random walk passage time on the network. This statistic can be quickly computed on a modern computer, even for complex networks with thousands of nodes. Furthermore, we use this statistic to prove theorems about how certain network motifs increase robustness. Importantly, our analysis provides intuition for why a network is or is not robust to noise. We illustrate our results on thousands of randomly generated networks with a variety of stochastic inputs.
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Affiliation(s)
- Hwai-Ray Tung
- 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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Datta BK, Coughlin SS, Fazlul I, Pandey A. COVID-19 and health care-related financial toxicity in the United States: Evidence from the 2022 National Health Interview Survey. Am J Infect Control 2024; 52:392-399. [PMID: 37956731 DOI: 10.1016/j.ajic.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 11/03/2023] [Accepted: 11/04/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Despite the common perception of the socioeconomic burden of the COVID-19 pandemic, quantification of the relationship between COVID-19 and indicators of health care-related financial toxicity in the general population has been limited. This study aimed to provide estimates of these relationships in a nationally representative sample of the US adult population. METHODS Using the data on 27,480 adults from the 2022 National Health Interview Survey, we fitted multivariable logistic regression models to assess the differential risks of financial toxicity as manifested by the financial hardship in paying medical bills, delayed and forgone medical care, and medication nonadherence, by COVID-19 diagnosis, severity, and duration of symptoms. RESULTS We found that compared to individuals not having COVID-19, individuals with severe symptoms of COVID-19 were 1.86, 1.50, 1.76, and 1.77 times more likely to experience financial hardship, delay medical care, forgo medical care, and skip/delay/take less medication, respectively. Similarly, individuals with symptoms lasting for 3 or more months were 1.94, 1.65, 1.87, and 2.20 times more likely to experience these measures of financial toxicity, respectively. CONCLUSIONS The estimates of the relationship between COVID-19 and financial toxicity will facilitate effective communications for policy actions aimed at alleviating the burden of the COVID-19 pandemic.
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Affiliation(s)
- Biplab Kumar Datta
- Institute of Public and Preventive Health, Augusta University, Augusta, GA; Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA.
| | - Steven S Coughlin
- Institute of Public and Preventive Health, Augusta University, Augusta, GA; Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA
| | - Ishtiaque Fazlul
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA
| | - Ajay Pandey
- Department of Biological Sciences, Augusta University, Augusta, GA
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Altuwayrib S, Win KT, Freeman M. Medication Adherence Support Applications for Chronic Arthritis Patients: Healthcare Providers' Perspective in Saudi Arabia. Stud Health Technol Inform 2024; 310:1056-1060. [PMID: 38269976 DOI: 10.3233/shti231126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Mobile health applications provide chronic disease patients with different capabilities and resources to support medication adherence. The study aims to understand the health care providers' (HCP) perceptions and recommendations about the design features and content of medication adherence support apps for individuals with chronic arthritis conditions in Saudi Arabia. Individual interviews were conducted with ten participants, such as rheumatologists, health educators, pharmacists, informaticians, and representatives from the Saudi Arthritis Association. The thematic analysis is utilised to code data and develop themes that help researchers in the design process. Four themes are identified: informational content, utilitarian, motivational, and socialisation features. The app content should improve arthritis patient awareness about medication management and adherence. Provide features that enable patients to set medication management and self-monitoring goals. The application design should be trustworthy, usable, enjoyable, and accessible for a diverse group of patients and respect patient privacy.
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Affiliation(s)
- Saleh Altuwayrib
- University of Wollongong, New South Wales, Australia
- University of Hail, Hail city, Saudi Arabia
| | - Khin Than Win
- University of Wollongong, New South Wales, Australia
| | - Mark Freeman
- University of Wollongong, New South Wales, Australia
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Clark ED, Lawley SD. How drug onset rate and duration of action affect drug forgiveness. J Pharmacokinet Pharmacodyn 2024:10.1007/s10928-023-09897-1. [PMID: 38198076 DOI: 10.1007/s10928-023-09897-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [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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Eaton CK, Comer M, Pruette CS, Riekert KA. Medication adherence in youths with CKD: habits for success. Pediatr Nephrol 2023; 38:3791-3802. [PMID: 37306720 DOI: 10.1007/s00467-023-05976-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Poor adherence habits are key contributors to nonadherence but there are few clinically feasible methods for evaluating adherence habits, particularly for youths with chronic kidney disease (CKD). This study investigated how participants' qualitative responses to three interview questions about adherence habits mapped to primary principles of habit formation and objectively measured medication adherence in youths with CKD. METHODS Participants (ages 11-21 years) were recruited from a pediatric nephrology clinic as part of a larger study. Participants' daily objective antihypertensive medication adherence was measured with an electronic pill bottle over a 4-week baseline period. Qualitative interviews about adherence habits and routines were conducted with a subset of participants (N = 18). RESULTS Clear qualitative differences emerged in how participants with high-medium adherence (80-100%) discussed adherence habits compared to participants with low adherence (0-79%). Participants with high-medium adherence discussed situational cues for taking medicine, including locations that cue adherence, step-by-step events leading up to taking medicine, and people who cue adherence. Participants with high-medium adherence regularly described taking medicine as "automatic," "second nature," and a "habit." Participants with low adherence rarely discussed these habit features nor did they explicitly acknowledge currently missing doses. Participants with low adherence tended to discuss challenges with organization and routines for taking medicine. CONCLUSIONS Evaluating patient responses to questions about adherence habits may uncover challenges with adherence habit formation, provide direction for habit-strengthening intervention focused on developing automatic cues for taking medication, and support adherence successes for youths with CKD. CLINICAL TRIAL REGISTRATION NUMBER NCT03651596. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Cyd K Eaton
- Johns Hopkins University School of Medicine, 4200 Eastern Avenue, Baltimore, MD, 21224, USA.
| | - Margaret Comer
- Johns Hopkins University School of Medicine, 4200 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Cozumel S Pruette
- Johns Hopkins University School of Medicine, 4200 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Kristin A Riekert
- Johns Hopkins University School of Medicine, 4200 Eastern Avenue, Baltimore, MD, 21224, USA
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Allahverdipour H, Badri M, Shaghaghi A, Mahmoodi H, Heizomi H, Shirzadi S, Asghari-Jafarabadi M. Medications Non-adherence Reasoning Scale (MedNARS): Development and psychometric properties appraisal. Health Promot Perspect 2023; 13:212-218. [PMID: 37808946 PMCID: PMC10558970 DOI: 10.34172/hpp.2023.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/21/2023] [Indexed: 10/10/2023] Open
Abstract
Background Proper elucidation of medication non-adherence reasoning especially in older adults might pave the way for an auspicious therapeutic outcome. The main aim of this study was to develop and psychometrically test the Medications Non-adherence Reasoning (MedNARS) questionnaire for application in research and probably practice settings. Methods A mixed methods design was utilized to develop the MedNARS. The item pool was mainly generated based on a qualitative query and literature review. The expert panel approved version of the MedNARS was psychometrically assessed on a convenience sample of 220 older patients with chronic disease. The internal consistency, test-retest reliability, content and face validity of the scale were appraised and its construct validity was assed using exploratory and confirmatory factor analyses. Results A nine-item version of the MedNARS was drafted based on the classical item analysis procedures and its estimated internal consistency measure of the Cronbach's alpha (0.85) and test-retest reliability (0.96) were in the vicinity of acceptable range. The exploratory factor analysis (EFA) output revealed a unidimensional structure for the MedNARS and the conducted confirmatory factor analysis (CFA) indicated an acceptable data fit for the extracted one-factor model. The goodness of fit indices were as the followings: χ2 /df=1.63(90% CI: 0.02 to 0.11), root mean squared error of approximation (RMSEA)=(0.07), comparative fit index (CFI)=0.95, Tucker-Lewis index (TLI)=0.93 and standardized root mean squared residual (SRMSR)=(0.05). Conclusion The study findings were indicative of MedNARS's applicability and feasibility for use in assessment of medication non-adherence reasoning among the elderly patients with chronic diseases. The MedNARS as a brief and elder-friendly instrument can be applied both in research and practice settings to enhance efficiency, safety, and health outcomes of the therapeutic recommendations.
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Affiliation(s)
- Hamid Allahverdipour
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Health Education & Promotion Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid Badri
- Health Education & Promotion Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdolreza Shaghaghi
- Health Education & Promotion Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hassan Mahmoodi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Haleh Heizomi
- Health Education & Promotion Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shayesteh Shirzadi
- Department of Public Health, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Mohammad Asghari-Jafarabadi
- Cabrini Research, Cabrini Health, Malvern, VIC, 3144, Australia
- School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, 3004, Australia
- Department of Psychiatry, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, 3168, Australia
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Peabody JW, Paculdo D, de Belen E, Ganesan D, Cooney I, Trujillo N. Clinical utility of a novel test for assessing cardiovascular disease risk in type 2 diabetes: a randomized controlled trial. Diabetol Metab Syndr 2023; 15:155. [PMID: 37438853 DOI: 10.1186/s13098-023-01122-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/23/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND The risk for and treatment of cardiovascular disease (CVD) in type 2 diabetes (T2DM) is often incorrect and delayed. We wished to determine if a novel test improved physicians' ability to risk stratify, diagnose, and treat patients with T2DM. METHODS In a 2-phase randomized controlled trial comparing the clinical workup, diagnosis, and management of online, simulated patients with T2DM in a nationwide sample of cardiologists and primary care physicians, participants were randomly assigned to control or one of two intervention groups. Intervention participants had access to standard of care diagnostic tools plus a novel diagnostic CVD risk stratification test. RESULTS In control, there was no change in CV risk stratification of simulated patients between baseline and round 2 (37.1 to 38.3%, p = 0.778). Pre-post analysis showed significant improvements in risk stratification in both Intervention 1 (38.7 to 65.3%) and Intervention 2 (41.9 to 65.8%) (p < 0.01) compared to controls. Both intervention groups significantly increased prescribing SGLT2 inhibitors/GLP1 receptor agonists versus control, + 18.9% for Intervention 1 (p = 0.020) and 1 + 9.4% for Intervention 2 (p = 0.014). Non-pharmacologic treatment improved significantly compared to control (+ 30.0% in Intervention 1 (p < 0.001) and + 22.8% in Intervention 2 (p = 0.001). Finally, monitoring HgbA1C, blood pressure, and follow-up visit frequency improved by + 20.3% (p = 0.004) in Intervention 1 and + 29.8% (p < 0.001) in Intervention 2 compared with control. CONCLUSION Use of the novel test significantly improved CV risk stratification among T2DM patients. Statistically significant increases treatments were demonstrated, specifically SGLT2 inhibitors and GLP1 receptor antagonists and recommendations of evidence-based non-pharmacologic treatments. Trial registration ClinicalTrials.gov, NCT05237271.
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Affiliation(s)
- John W Peabody
- QURE Healthcare, 450 Pacific Ave., Suite 200, San Francisco, CA, 94133, USA.
- University of California, San Francisco, 550 16th Street, Third Floor, San Francisco, CA, USA.
- University of California, Los Angeles, 650 Charles E. Young Dr S, Los Angeles, CA, USA.
| | - David Paculdo
- QURE Healthcare, 450 Pacific Ave., Suite 200, San Francisco, CA, 94133, USA
| | - Enrico de Belen
- QURE Healthcare, 450 Pacific Ave., Suite 200, San Francisco, CA, 94133, USA
| | - Divya Ganesan
- QURE Healthcare, 450 Pacific Ave., Suite 200, San Francisco, CA, 94133, USA
| | - Isabella Cooney
- QURE Healthcare, 450 Pacific Ave., Suite 200, San Francisco, CA, 94133, USA
| | - Nelson Trujillo
- SomaLogic Operating Co., Inc., 2945 Wilderness Pl., Boulder, CO, USA
- Boulder Community Health, 4747 Arapahoe Ave., Boulder, CO, USA
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Peabody JW, Ganesan D, Valdenor C, Paculdo D, Schrecker J, Westerfield C, Heltsley R. Randomized prospective trial to detect and distinguish between medication nonadherence, drug-drug interactions, and disease progression in chronic cardiometabolic disease. BMC Prim Care 2023; 24:100. [PMID: 37061690 PMCID: PMC10105436 DOI: 10.1186/s12875-023-02042-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/21/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Disentangling nonadherence (NA), drug-drug interactions (DDIs), and disease progression from each other is an important clinical challenge for providers caring for patients with cardiometabolic diseases. NAs and DDIs are both ubiquitous and often overlooked. We studied a novel chronic disease management (CDM) test to detect medication adherence and the presence and severity of DDIs. MATERIALS AND METHODS We conducted a prospective, randomized controlled trial of 236 primary care physicians using computer-based, simulated patients, measuring clinical care with and without access to the CDM test. The primary outcomes were whether use of the CDM test increased the accuracy of diagnoses and ordering better treatments and how effective the intervention materials were in getting participants to order the CDM test. RESULTS Physicians given the CDM test results showed a + 13.2% improvement in their diagnosis and treatment quality-of-care scores (p < 0.001) in the NA patient cases and a + 13.6% improvement in the DDI cases (p < 0.001). The difference-in-difference calculations between the intervention and control groups were + 10.4% for NA and + 10.8% for DDI (p < 0.01 for both). After controlling for physician and practice co-factors, intervention, compared to control, was 50.4x more likely to recognize medication NA and 3.3x more likely to correctly treat it. Intervention was 26.9x more likely to identify the DDI and 15.7x more likely to stop/switch the interacting medication compared to control. We found no significant improvements for the disease progression patient cases. CONCLUSION Distinguishing between nonadherence, drug-drug interactions, and disease progression is greatly improved using a reliable test, like the CDM test; improved diagnostic accuracy and treatment has the potential to improve patient quality of life, medication safety, clinical outcomes, and efficiency of health delivery. TRIAL REGISTRATION clinicaltrials.gov (NCT05192590).
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Affiliation(s)
- John W Peabody
- QURE Healthcare, San Francisco, CA, USA.
- University of California, San Francisco, CA, USA.
- University of California, Los Angeles, CA, USA.
- , 450 Pacific Avenue, Suite 200, San Francisco, CA, 94133, 415-321-3388, USA.
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Oladunjoye AF, Kaleem SZ, Suresh A, Sahni V, Thoonkuzhy MJ, Anugwom G, Oladunjoye O, Otuada D, Ikekwere J, Espiridion ED. Cannabis use and medication nonadherence in bipolar disorder: A nationwide inpatient sample database analysis. J Affect Disord 2022; 299:174-179. [PMID: 34863715 DOI: 10.1016/j.jad.2021.11.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/30/2021] [Accepted: 11/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Medication nonadherence among bipolar disorder (BD) is often linked with comorbid substance use disorders. This study aims to investigate cannabis use disorder (CUD) association with medication noncompliance in hospitalized BD patients. METHODS Using data on 266,303 BD hospitalizations between 2010 and 2014 from the US Nationwide Inpatient Sample database, we obtained medication noncompliance rates stratified by demographics and CUD. Logistic regression was used to evaluate factors associated with medication noncompliance. RESULTS Overall mean age, the prevalence of CUD, and medication nonadherence were 41.58 (± 0.11) years, 15.0% and 16.1%, respectively. There were 56.6% females in the overall population. There was a significant difference in the characteristics of those in the medication nonadherence vs adherence groups, including age, sex, race, comorbid substance use, income, insurance type, hospital region, and hospital teaching status (p < 0.001). After adjusting for other variables using multivariate analysis, there remained a statistically significant association of medication nonadherence in BD hospitalization and CUD (OR 1.42, 95% CI 1.36-1.48). LIMITATION Confounding multiple substance use could not be accounted for, and the retrospective nature of the database which includes only inpatients is prone to possible selection and reporting bias. CONCLUSION CUD statistically predicts increased rates of medication nonadherence among patients with BD. Given the possible association of CUD with medication nonadherence among BD patients, collaborative work between general adult psychiatry and addiction services is imperative in improving the management outcome of patients with BD and comorbid CUD.
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Affiliation(s)
- Adeolu Funso Oladunjoye
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX USA; Division of Medical Critical Care, Boston Children's Hospital, Boston, MA USA.
| | | | | | - Vikram Sahni
- Drexel University College of Medicine, Philadelphia, PA USA
| | | | | | - Olubunmi Oladunjoye
- Department of General Internal Medicine, Baylor College of Medicine, Houston, TX, USA; Department of Medicine, Reading Hospital -Tower Health System, West Reading, PA USA
| | - David Otuada
- Department of Psychiatry, Reading Hospital- Tower Health System, West Reading, PA USA
| | - Joseph Ikekwere
- Department of Psychiatry, University of Illinois, Chicago, IL USA
| | - Eduardo D Espiridion
- Department of Psychiatry, Reading Hospital- Tower Health System, West Reading, PA USA; Department of Psychiatry, Drexel University College of Medicine, Philadelphia, PA USA; Department of Psychiatry, Philadelphia College of Osteopathic Medicine, Philadelphia, PA USA; Department of Psychiatry, West Virginia University School of Medicine, Martinsburg, WV USA
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Rafi MA, Tahmin CI, Tashrik S, Bonna AS, Jannat F, Mily SJ, Shrestha AB, Seemanta S, Rashid A, Mahjabeen M, Nura N, Shahriar T, Mahadi AR, Ahmed K, Hasan MJ, Haque MA, Hossain MG. Adherence to inhalers and associated factors among adult asthma patients: an outpatient-based study in a tertiary hospital of Rajshahi, Bangladesh. Asthma Res Pract 2022; 8:1. [PMID: 35139927 DOI: 10.1186/s40733-022-00083-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adherence to inhaler medication is an important contributor to optimum asthma control along with adequate pharmacotherapy. The objective of the present study was to assess self-reported adherence levels and to identify the potential factors associated with non-adherence to the inhalers among asthma patients. METHODS This facility-based cross-sectional study was conducted in the medicine outpatient department of Rajshahi Medical College Hospital from November 2020 to January 2021. A total of 357 clinically confirmed adult asthma patients were interviewed. Inhaler adherence was measured using the 10-item Test of Adherence scale (TAI).. Both descriptive and inferential statistics were used to express the socio-demographic of the patients and predictors of poor adherence to inhaler. RESULTS A substantial number of participants were non-adherent (86%) to inhaler medication. Patients non-adherent to inhaler medication are often younger (23.15, 95% CI 3.67-146.08), lived in the rural area (23.28, 95% CI 2.43-222.66), less year of schooling (5.69, 95% CI 1.27-25.44), and belonged to the middle income (aOR 9.74, 95% CI 2.11-44.9) than those adherent with the inhaler. The presence of comorbidities (12.91, 95% CI 1.41-117.61), prolonged duration of inhaler intake (5.69, 95% CI 1.22-26.49), consulting non-qualified practitioners (13.09, 95% CI 3.10-55.26) were the significant contributor of non-adherence. CONCLUSION Despite ongoing motivation and treatment, non-adherence to inhalation anti-asthmatic is high and several factors have been found to contribute. Regular monitoring and a guided patient-centered self-management approach might be helpful to address them in long run.
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Kherallah R, Al Rifai M, Kamat I, Krittanawong C, Mahtta D, Lee MT, Liu J, Nasir K, Valero-Elizondo J, Patel J, Al-Mallah MH, Petersen LA, Virani SS. Prevalence and predictors of cost-related medication nonadherence in individuals with cardiovascular disease: Results from the Behavioral Risk Factor Surveillance System (BRFSS) survey. Prev Med 2021; 153:106715. [PMID: 34242664 PMCID: PMC9125503 DOI: 10.1016/j.ypmed.2021.106715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/23/2021] [Accepted: 07/03/2021] [Indexed: 11/17/2022]
Abstract
Medication nonadherence is highly prevalent among patients with chronic cardiovascular disease. Poor adherence has been associated with increased morbidity and mortality. Medication cost is a major driver for medication nonadherence. Utilizing data from the 2016 to 2018 Behavioral Risk Factor Surveillance System (BRFSS) survey, we estimated the prevalence of cost-related medication nonadherence (CRMNA) among the overall population and among individuals who reported a history of diabetes, atherosclerotic cardiovascular disease (ASCVD), or hypertension. We then performed multivariable logistic regression to analyze sociodemographic factors associated with CRMNA. Our study population consisted of 142,577 individuals of whom 24% were older than 65 years, 47% were men, 66% were White, 17% Black, 35% had hypertension, 13% had diabetes mellitus, and 10% had ASCVD. CRMNA was reported in 10% of the overall population, 12% among those with hypertension, 17% among those with diabetes, and 17% among those with ASCVD. Age below 65 years, female gender, unemployment, lower income, lower educational attainment, having at least 1 comorbidity, and living in a state that did not expand Medicaid were independently associated with CRMNA. The prevalence of CRMNA increased with greater number of these high-risk sociodemographic factors. We conclude that the prevalence of CRMNA is 10% among U.S. adults overall and is higher among those with common chronic diseases. Risk factors associated with CRMNA should be addressed in order to improve adherence rates and health outcomes among high-risk individuals.
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Affiliation(s)
- Riyad Kherallah
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Ishan Kamat
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Chayakrit Krittanawong
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Dhruv Mahtta
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Michelle T Lee
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, United States of America
| | - Jing Liu
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Khurram Nasir
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States of America
| | - Javier Valero-Elizondo
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States of America
| | - Jaideep Patel
- Heart Center, Division of Cardiology, Virginia Commonwealth University Medical Center, Richmond, VA, United States of America
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States of America
| | - Laura A Petersen
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, United States of America; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America; Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, United States of America; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America.
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12
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Kronish IM, Thorpe CT, Voils CI. Measuring the multiple domains of medication nonadherence: findings from a Delphi survey of adherence experts. Transl Behav Med 2021; 11:104-113. [PMID: 31580451 DOI: 10.1093/tbm/ibz133] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Consensus on a gold-standard measure of patient medication nonadherence has been elusive, in part because medication nonadherence involves multiple, distinct behaviors across three phases (initiation, implementation, and persistence). To assess these behaviors, multiple measurement approaches may be needed. The purpose of this study was to identify expert-recommended approaches to measuring nonadherence behaviors. Thirty medication nonadherence experts were e-mailed two consecutive surveys. In both, respondents rated their agreement with definitions of nonadherence behaviors and measurement approaches. In the second survey, respondents rated the suitability of each measurement approach for assessing each behavior and identified the optimal measurement approach for each behavior. Consensus was achieved for eight patient medication nonadherence behaviors: not filling initial prescription and not taking first dose (noninitiation); refilling prescription late, missing doses, taking extra doses, taking doses at wrong time, and improperly administering medication (incorrect implementation); and discontinuing medication early (nonpersistence). Consensus was achieved for seven measurement approaches: self-report, prescription fill data, pill count, drug levels, electronic drug monitoring (EDM), smart technology, and direct observation. Self-report questionnaires were most commonly rated "at least somewhat suitable" for measuring behaviors. EDM was rated as optimal for measuring missing doses, taking extra doses, and taking doses at the wrong time. Prescription fill data were rated as optimal for not filling initial prescription, refilling late, and discontinuing. Direct observation was rated as optimal for measuring improper administration. Suitable and optimal measurement approaches varied across nonadherence behaviors. Researchers should select the measurement approach best suited to assessing the behavior(s) targeted in their research.
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Affiliation(s)
- Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Carolyn T Thorpe
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina, Eshelman School of Pharmacy, Chapel Hill, NC, USA.,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System's, Pittsburgh, PA, USA
| | - Corrine I Voils
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Center for Health Services Research in Primary Care, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
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13
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Donnenberg NS, Hernandez I, Normolle DP. Determining the prevalence and risk factors for prescription drug unaffordability. Res Social Adm Pharm 2021; 18:2904-2908. [PMID: 34219017 PMCID: PMC8714864 DOI: 10.1016/j.sapharm.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Prescription affordability is a key component of healthcare accessibility and a determinant of health outcomes. Prior studies indicate that up to 1 in 4 Americans report difficulty affording prescriptions. OBJECTIVE(S) This study aims to identify factors associated with cost-based prescription refusal. METHODS We identified 17,869 study participants from the 2017 National Health Interview Survey who had been prescribed at least one medication in the past 12 months. The outcome was defined as inability to afford at least one prescription medication. Covariates included demographic data, medical history, and social attitudes. Logistic regression models were constructed to identify predictors of cost-based prescription refusal. RESULTS Among 8223 study participants, 8.1% reported the inability to afford at least one prescription medication in the past 12 months. Twenty-seven covariates were correlated with prescription unaffordability, and 8 were selected by the LASSO: Income (Odds ratio (OR) 0.55), Concerned About Bills (OR 2.0), Emergency Department Visits past 12 months (OR 1.33), Dissatisfaction with Medical Care (OR 1.3), Seeking Insurance Through the Health Insurance Marketplace (OR 1.26), Feeling Sad Most of the Time (OR 1.24), History of Asthma (OR 1.26) and History of Diabetes (OR 1.24). CONCLUSIONS Prescription unaffordability remains a significant public health problem and is more common among low-income individuals and patients with, chronic medical conditions.
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Affiliation(s)
- N S Donnenberg
- Univ of Pittsburgh, School of Pharmacy, Department of Pharmacy and Therapeutics, Pittsburgh, PA, USA.
| | - I Hernandez
- Univ of California San Diego (UCSD), Skaggs School of Pharmacy, Department of Pharmaceutical Sciences, Division of Clinical Pharmacy, La Jolla, CA, USA
| | - D P Normolle
- Univ of Pittsburgh, Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA, USA
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14
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Madden JM, Araujo-Lane C, Foxworth P, Lu CY, Wharam JF, Busch AB, Soumerai SB, Ross-Degnan D. Experiences of health care costs among people with employer-sponsored insurance and bipolar disorder. J Affect Disord 2021; 281:41-50. [PMID: 33290926 DOI: 10.1016/j.jad.2020.10.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/02/2020] [Accepted: 10/12/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cost-sharing disproportionately affects people with chronic illnesses needing more care. Our qualitative study examined lived experiences navigating insurance benefits and treatment for bipolar disorder, which requires ongoing access to behavioral specialists and psychotropic medications. METHODS Forty semi-structured telephone interviews with individuals with bipolar disorder and employer-sponsored health insurance, or their family caregivers, explored health care needs, coverage details, out-of-pocket (OOP) costs, and perspectives on value. An iterative analytic approach identified salient themes. RESULTS Most individuals in our sample faced an annual insurance deductible, from $350-$10,000. OOP costs for specialist visits ranged from $0-$450 and for monthly psychotropic medications from $0-$1650. Acute episodes and care for comorbidities, including medication side effects, added to cost burdens. Medication nonadherence due to OOP costs was rare; respondents frequently pointed to the necessity of medications: "whatever it takes to get those"; "it's a life or death situation." Respondents also prioritized visits to psychiatrist prescribers, though visits were maximally spaced because of cost. Psychotherapy was often deemed unaffordable and forgone, despite perceived need. Interviewees cited limited networks and high out-of-network costs as barriers to specialists. Cost-sharing sometimes led to debt, skimping on nonbehavioral care or other necessities, exacerbated or prolonged mood symptoms, and stress at home. LIMITATIONS Volunteer respondents may not fully represent the target population. CONCLUSIONS Many people with bipolar disorder in US employer-sponsored plans experience undertreatment, hardship, and adverse health consequences due to high cost-sharing. More nuanced insurance benefit designs should accommodate the needs of individuals with complex conditions.
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Affiliation(s)
- Jeanne M Madden
- Northeastern University School of Pharmacy, USA; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, USA.
| | - Carina Araujo-Lane
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, USA
| | | | - Christine Y Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, USA
| | - J Frank Wharam
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, USA
| | - Alisa B Busch
- McLean Hospital and Department of Health Care Policy, Harvard Medical School, USA
| | - Stephen B Soumerai
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, USA
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, USA
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15
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Pinhati RR, Ferreira RE, Carminatti M, Tavares PL, Marsicano EO, Sertório ES, Colugnati FAB, de Paula RB, Sanders-Pinheiro H. The prevalence and associated factors of nonadherence to antihypertensive medication in secondary healthcare. Int Urol Nephrol 2021; 53:1639-1648. [PMID: 33454860 DOI: 10.1007/s11255-020-02755-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 12/15/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Non-adherence (NA) to medication is a major contributor to treatment failure in hypertensive patients. Factors of the ecological model, at family/healthcare professional, service, and system levels, are rarely evaluated as correlates of NA in hypertensive patients. METHODS This crossectional study assessed the prevalence of and associated factors of NA to antihypertensive medication among 485 hypertensive patients upon receiving secondary healthcare. The Morisky Green Levine Scale (MGLS) measured the implementation phase of adherence, and the Short Assessment of Health Literacy for Portuguese-speaking Adults (SAHLPA) instrument, health literacy. Multivariate analysis to NA included variables according to the levels of the ecological model. RESULTS Most patients were female (56.3%), white (53.2%), mean age of 62.0 ± 12.6 years, illiterate (61.6%), with low health literacy (70.9%), and low income (65.4%). Uncontrolled BP was frequent (75.2%); 57.1% of patients were nonadherent. In multivariate analysis based on the ecological model, adjusted for micro, meso- and macro-level correlates, NA was associated only with variables of patient-level: low health literacy (OR 1.62, CI 1.07-2.44, p = 0.020), income ≥ two reference wages (OR 0.46, CI 0.22-0.93, p = 0.031), lack of homeownership (OR 1.99, CI 1.13-3.51, p = 0.017), sedentarism (OR 1.78, CI 1.12-2.83, p = 0.014), and complexity of treatment (number of medications taken ≥ two times/day) (OR 1.56, CI 1.01-2.41, p = 0.042). CONCLUSION In this group of severely hypertensive patients with high cardiovascular risk, only patient-related characteristics were associated with NA. Our findings highlight the need for effective actions to optimize clinical outcomes in similar healthcare programs.
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Affiliation(s)
- Renata Romanholi Pinhati
- Division of Nephrology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.,Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Rua Benjamin Constant, 1044/1001, Juiz de Fora, Minas Gerais, 36015-400, Brazil
| | - Renato Erothildes Ferreira
- Division of Nephrology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.,Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Rua Benjamin Constant, 1044/1001, Juiz de Fora, Minas Gerais, 36015-400, Brazil
| | - Moisés Carminatti
- Division of Nephrology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.,Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Rua Benjamin Constant, 1044/1001, Juiz de Fora, Minas Gerais, 36015-400, Brazil
| | - Paula Liziero Tavares
- Division of Nephrology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.,Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Rua Benjamin Constant, 1044/1001, Juiz de Fora, Minas Gerais, 36015-400, Brazil
| | - Elisa Oliveira Marsicano
- Division of Nephrology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.,Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Rua Benjamin Constant, 1044/1001, Juiz de Fora, Minas Gerais, 36015-400, Brazil
| | - Emiliana Spadarotto Sertório
- Division of Nephrology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.,Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Rua Benjamin Constant, 1044/1001, Juiz de Fora, Minas Gerais, 36015-400, Brazil
| | - Fernando Antonio Basile Colugnati
- Division of Nephrology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.,Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Rua Benjamin Constant, 1044/1001, Juiz de Fora, Minas Gerais, 36015-400, Brazil
| | - Rogério Baumgratz de Paula
- Division of Nephrology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.,Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Rua Benjamin Constant, 1044/1001, Juiz de Fora, Minas Gerais, 36015-400, Brazil
| | - Helady Sanders-Pinheiro
- Division of Nephrology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil. .,Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Rua Benjamin Constant, 1044/1001, Juiz de Fora, Minas Gerais, 36015-400, Brazil.
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16
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Chapman S, Sibelli A, St-Clair Jones A, Forbes A, Chater A, Horne R. Personalised Adherence Support for Maintenance Treatment of Inflammatory Bowel Disease: A Tailored Digital Intervention to Change Adherence-related Beliefs and Barriers. J Crohns Colitis 2020; 14:1394-1404. [PMID: 32379303 DOI: 10.1093/ecco-jcc/jjz034] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Interventions to improve adherence to medication may be more effective if tailored to the individual, addressing adherence-related beliefs about treatment and overcoming practical barriers to daily use. We evaluated whether an algorithm, tailoring support to address perceptual and practical barriers to adherence, reduced barriers and was acceptable to patients with inflammatory bowel disease [IBD]. METHODS Participants with IBD, prescribed azathioprine and/or mesalazine, were recruited via patient groups, social media, and hospital clinics and allocated to Intervention or Control Groups. The online intervention comprised messages tailored to address beliefs about IBD and maintenance treatment and to provide advice on overcoming practical difficulties with taking regular medication. The content was personalised to address specific perceptual and practical barriers identified by a pre-screening tool. Validated questionnaires assessed barriers to adherence and related secondary outcomes at baseline and at 1 and 3 months of follow-up. RESULTS A total of 329 participants were allocated to the Intervention [n = 153] and Control [n = 176] Groups; just under half [46.2%] completed follow-up. At 1 and 3 months, the Intervention Group had significantly fewer concerns about IBD medication [p ≤0.01]; and at three months, fewer doubts about treatment necessity, fewer reported practical barriers, and higher reported adherence [p <0.05]. Relative to controls at follow-up, the Intervention Group were more satisfied with information about IBD medicines, and viewed pharmaceuticals in general more positively. Questionnaires, interviews, and intervention usage indicated that the intervention was acceptable. CONCLUSIONS Personalised adherence support using a digital algorithm can help patients overcome perceptual barriers [doubts about treatment necessity and medication concerns] and practical barriers to adherence.
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Affiliation(s)
- Sarah Chapman
- UCL School of Pharmacy, Centre for Behavioural Medicine, London, UK.,Department of Pharmacy & Pharmacology, University of Bath, Bath, UK
| | - Alice Sibelli
- UCL School of Pharmacy, Centre for Behavioural Medicine, London, UK.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anja St-Clair Jones
- Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Pharmacy Department, Brighton, UK
| | - Alastair Forbes
- Institute for Digestive Diseases, University College London, London, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Angel Chater
- UCL School of Pharmacy, Centre for Behavioural Medicine, London, UK.,Centre for Health, Wellbeing and Behaviour Change, Faculty of Education and Sport, University of Bedfordshire, Bedford, UK
| | - Rob Horne
- UCL School of Pharmacy, Centre for Behavioural Medicine, London, UK
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17
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Laba TL, Cheng L, Kolhatkar A, Law MR. Cost-related nonadherence to medicines in people with multiple chronic conditions. Res Social Adm Pharm 2020; 16:415-21. [PMID: 31253501 DOI: 10.1016/j.sapharm.2019.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/30/2019] [Accepted: 06/18/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Multimorbidity is common and frequently associated with medicine nonadherence. Although cost is a common reason for nonadherence, very little research has quantified cost-related nonadherence (CRNA) to medicines specifically in people with multimorbidity, the prevalence of CRNA for different conditions nor the impact of cost when prioritising treatment between conditions. OBJECTIVE To determine the extent of CRNA in people with multimorbidity and the patient characteristics associated with these behaviours. DESIGN AND SETTING People reporting two or more chronic conditions responding to a rapid response module regarding prescription drug affordability fielded between January 1 and June 30 2016 in the Canadian Community Health Survey, a cross-sectional household survey. METHODS Ordinal logistic regression, adjusted for key sociodemographic, clinical and treatment related variables, of weighted population estimates of self-reported CRNA within one group of conditions, across multiple groups of conditions, or no CRNA. RESULTS 10.2% of 8420 Canadians with multimorbidity reported CRNA. The majority (61%) reported CRNA within one group of conditions, especially respiratory (16%) and mental health disorders (17%). CRNA was more common in younger adults, people without employer or association drug insurance plans, poorer health status, more chronic conditions, and increased out-of-pocket prescription costs. Having no prescription insurance was associated with a higher probability of CRNA across multiple groups of conditions. CONCLUSIONS People with multimorbidity primarily forego medicines because of cost within one group of conditions. However, those without drug insurance extended these behaviours to multiple condition groups. Further work is needed to determine how people prioritise the conditions and treatments that are foregone because of cost, and how to best incorporate this information into treatment plans.
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18
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Glusman M, Bruce A, Thelen J, Smith J, Lynch S, Catley D, Bennett KK, Bruce J. Discontinuing Treatment Against Medical Advice: The Role of Perceived Autonomy Support From Providers in Relapsing-Remitting Multiple Sclerosis. Ann Behav Med 2019; 53:283-289. [PMID: 29771271 DOI: 10.1093/abm/kay035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Long-term medication adherence is problematic among patients with chronic medical conditions. To our knowledge, this was the first study to examine factors associated with nonadherence among patients with relapsing-remitting multiple sclerosis who discontinue disease-modifying treatments against medical advice. PURPOSE To examine differences in perceived provider autonomy support between disease-modifying treatment-adherent relapsing-remitting multiple sclerosis patients and relapsing-remitting multiple sclerosis patients who discontinued disease-modifying treatments against medical advice. METHODS Self-report questionnaires and a neurologic exam were administered to demographically matched adherent (n = 50) and nonadherent (n = 79) relapsing- remitting multiple sclerosis patients from the Midwest and Northeast USA. RESULTS Adherent patients reported greater perceived autonomy support from their treatment providers, F(1, 124) = 28.170, p < .001, partial η2 = .185. This difference persisted after controlling for current multiple sclerosis healthcare provider, education, disease duration, Expanded Disability Status Scale, perceived barriers to adherence, and prevalence of side effects, F(1, 121) = 9.61, p = .002, partial η2 = .074. Neither depressive symptoms, F(1, 124) = 1.001, p > .05, partial η2 = .009, nor the occurrence of a major depressive episode, χ2(1, N = 129) = .288, p > .05, differed between adherent and nonadherent patients. CONCLUSIONS Greater perceived autonomy support from treatment providers may increase adherence to disease-modifying treatments among patients who discontinue treatment against medical advice. Results may inform interventions for patients who discontinue treatment against medical advice.
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Affiliation(s)
- Morgan Glusman
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Amanda Bruce
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.,Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Hospital, Kansas City, MO, USA
| | - Joanie Thelen
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Julia Smith
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Sharon Lynch
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Delwyn Catley
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Hospital, Kansas City, MO, USA
| | - Kimberley K Bennett
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jared Bruce
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA.,Department of Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, MO, USA
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19
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Blalock DV, Bosworth HB, Reeve BB, Voils CI. Co-occurring reasons for medication nonadherence within subgroups of patients with hyperlipidemia. J Behav Med 2018; 42:291-299. [PMID: 30027389 DOI: 10.1007/s10865-018-9954-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/14/2018] [Indexed: 12/16/2022]
Abstract
Medication nonadherence is a significant clinical problem among individuals taking statins. Poor adherence is often attributable to several reasons, yet most adherence interventions target a single reason. Baseline data were examined from a randomized clinical trial of 236 patients with hyperlipidemia. A latent class analysis was then performed on patients reporting any nonadherence (n = 109). A 4-class solution provided the most optimal fit and differentiation of classes. Class 1 (N = 59, 54%) included patients who reported occasionally forgetting. Class 2 (N = 16, 14%) represented patients who were concerned about side effects. Class 3 (N = 17, 16%) represented patients who reported out-of-routine life events as contributing to nonadherence. Class 4 (N = 17, 16%) represented patients who endorsed a large number reasons indiscriminately. Class membership was almost uniformly unrelated to any patient demographic factors or treatment arm. Each cluster of reasons defining these patients may be best addressed through different intervention strategies.
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Affiliation(s)
- Dan V Blalock
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA. .,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, USA.
| | - Hayden B Bosworth
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, USA.,School of Nursing, Duke University Medical Center, Durham, USA
| | - Bryce B Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, USA
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, USA.,Department of Surgery, University of Wisconsin-Madison, Madison, USA
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20
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Giugliano D, Maiorino MI, Bellastella G, Esposito K. Glycemic control in type 2 diabetes: from medication nonadherence to residual vascular risk. Endocrine 2018; 61:23-27. [PMID: 29322300 DOI: 10.1007/s12020-017-1517-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 12/29/2017] [Indexed: 01/07/2023]
Abstract
Despite the availability of many new treatment options for type 2 diabetes, the proportion of patients achieving the HbA1c target < 7.0% remains around 50%. We put forward the hypothesis that the unchanged HbA1c results, observed in the last decade in type 2 diabetes patients, are also a consequence of medication nonadherence and clinical inertia. Poor medication-taking behavior is usually defined as medication nonadherence and is responsible for uncontrolled hemoglobin A1c level in 23% of cases. Medication nonadherence may also affect clinical outcomes, as diabetic patients with good adherence (≥80%) had a significant 10% lower rate of hospitalization events and a significant 28% lower rate of all-cause mortality when compared with patients with poor adherence (<80%). Residual vascular risk may be defined as the risk of macrovascular (major cardiovascular events) and microvascular (retinopathy, nephropathy, neuropathy) complications that remains after intensive and successful glycemic control in type 2 diabetes. For major cardiovascular events, risk reduction following intensive glycemic control is 9% and, therefore, residual vascular risk is 91%. For microvascular complications, as nephropathy, residual vascular risk is as high as 80%. Residual vascular risk remains high in type 2 diabetes despite intensive glycemic control. Medication nonadherence by the diabetic patient and clinical inertia by the clinician may have contributed to the high level of residual vascular risk (both macro and microvascular) of type 2 diabetic patients.
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Affiliation(s)
- Dario Giugliano
- Division of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Luigi Vanvitelli University, Naples, Italy.
| | - Maria Ida Maiorino
- Diabetes Unit, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Luigi Vanvitelli University, Naples, Italy
| | - Giuseppe Bellastella
- Division of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Luigi Vanvitelli University, Naples, Italy
| | - Katherine Esposito
- Diabetes Unit, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Luigi Vanvitelli University, Naples, Italy
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21
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Goto T, Camargo CA, Gimenez-Zapiola C, Pallin DJ, Shapiro NI, Ferro TJ, Rainville C, Stoyanov S, Hasegawa K. Comparing Ran-Out Status of Inhaled Short-Acting Beta-Agonists in Emergency Department Patients with Acute Asthma: 1996-1998 versus 2015-2017. J Allergy Clin Immunol Pract 2018; 6:1999-2005.e3. [PMID: 29653218 DOI: 10.1016/j.jaip.2018.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/27/2018] [Accepted: 04/02/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Medication nonadherence, including running out of inhaled asthma medications, is an important problem. OBJECTIVE The objective of this study was to examine the changes in the proportion of adults with acute asthma who ran out of their short-acting beta-agonist (SABA) inhalers before presenting to the emergency department (ED) between 1996--1998 and 2015-2017. METHODS We analyzed data from prospective multicenter observational cohort studies of ED adult patients (aged 18-54 years) with acute asthma. Within the same 3 EDs, we performed a structured interview during 2 time periods: 1996-1998 and 2015-2017. We fitted multivariable models to compare ran-out status between the 2 periods, adjusting for the baseline patient demographics, socioeconomic status, chronic asthma factors, and health care utilization factors. We further adjusted for the presence of a written action plan-an intervenable factor. RESULTS The analytic cohort comprised 353 patients (150 from the 1996-1998 studies and 203 from the 2015-2017 study). Over the approximately 20-year period, the proportion of patients who ran out of SABA inhalers increased (18% in 1996-1998 vs 26% in 2015-2017). In the multivariable model, compared with patients in 1996-1998, those in 2015-2017 had a significantly higher risk of running out of their SABA inhalers (adjusted odds ratio [OR] 2.01; 95% confidence interval [CI] 1.06-3.81; P = .03). With further adjustment for the presence of a written action plan, this difference attenuated (adjusted OR 1.66; 95% CI 0.75-3.68; P = .21). CONCLUSIONS Between 1996 and 2017, the proportion of ED patients with asthma who ran out of SABA inhalers significantly increased. The increase was explained, at least partially, by a lack of a written action plan.
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Affiliation(s)
- Tadahiro Goto
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass.
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass
| | | | - Daniel J Pallin
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Mass
| | | | | | | | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass
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22
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Sanders-Pinheiro H, Colugnati FAB, Marsicano EO, De Geest S, Medina JOP. Prevalence and correlates of non-adherence to immunosuppressants and to health behaviours in patients after kidney transplantation in Brazil - the ADHERE BRAZIL multicentre study: a cross-sectional study protocol. BMC Nephrol 2018; 19:41. [PMID: 29463231 PMCID: PMC5819659 DOI: 10.1186/s12882-018-0840-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 02/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-adherence to immunosuppressive therapy is a prevalent risk factor for poor clinical and after kidney transplantation (KT), and has contributed to the lack of improvement in long-term graft survival over the past decade. Understanding the multilevel correlates and risk factors of non-adherence is crucial to determine the optimal level for planning interventions, namely at the patient, health care provider, KT centre, and health care system level. Brazil, having the largest public transplantation program in the world and with regional differences regarding access to health services and service implementation, is in a unique position to study this multilevel approach. Therefore, the Adhere Brazil Study (ADHERE BRAZIL) was designed to assess the prevalence and variability of non-adherence to immunosuppressants and to health behaviours among adult KT recipients in Brazil, and to assess the multilevel correlates of non-adherence to immunosuppressive medication. We describe the rationale, design, and methodology of the ADHERE BRAZIL study. METHODS/DESIGN This is an observational, cross-sectional, multicentre study that includes 20 Brazilian KT centres. A stratified sampling approach is used, based on strata, with the following characteristics considered: geographical region and transplant activity (number of KTs per year). A random sample of patients (proportional to the size of the centre within each stratum) is selected from each centre. The prevalence of different health behaviours is assessed through self-report. The assessment of multilevel correlates of non-adherence is guided by the ecological model that considers factors at the level of the patient, health-care professional, and transplant centre, using established instruments or instruments developed for this study. Data will be collected over an 18-month period, with information obtained during the regular follow-up visits to the transplant outpatient clinic and directly entered into the Research Electronic Data Capture (RedCap) system. Data entry is performed by a trained professional who is part of the transplant team. The data collection began in December 2015. DISCUSSION This multicentre study is the first to evaluate multilevel correlates of non-adherence in KT patients and will provide a reliable estimate of non-adherence in Brazilian KT patients. TRIAL REGISTRATION ClinicalTrials.gov on 10/10/2013, NCT02066935 .
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Affiliation(s)
- Helady Sanders-Pinheiro
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Rua Benjamin Constant, 1044/1001, Juiz de Fora, MG 36015-400 Brazil
- Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia [NIEPEN], Rua Benjamin Constant, 1044/1001, Juiz de Fora, MG 36015-400 Brazil
| | - Fernando Antonio Basile Colugnati
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Rua Benjamin Constant, 1044/1001, Juiz de Fora, MG 36015-400 Brazil
- Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia [NIEPEN], Rua Benjamin Constant, 1044/1001, Juiz de Fora, MG 36015-400 Brazil
| | - Elisa Oliveira Marsicano
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Rua Benjamin Constant, 1044/1001, Juiz de Fora, MG 36015-400 Brazil
- Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia [NIEPEN], Rua Benjamin Constant, 1044/1001, Juiz de Fora, MG 36015-400 Brazil
| | - Sabina De Geest
- Institute of Nursing Science, Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine, KU-Leuven, Leuven, Belgium
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23
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Abstract
Objective: To evaluate adherence to medication and study factors associated with non-adherence in chronic kidney disease (CKD) patients. Methods: A prospective, cross-sectional, questionnaire based study was conducted in Nephrology department of a super specialty hospital. Patients above 18 years of age, suffering from CKD from six months or more were interviewed using self-designed, semi-structured questionnaire to get information about adherence to medication, diet restriction and lifestyle modification (n = 150). Morisky medication adherence questionnaire was used to calculate overall adherence. In this higher score indicates poor adherence. Main outcome measures included prevalence of non-adherence and factors associated with the same. Results: Average number of medicines taken by each patient was 8.0+1.612 (mean+SD) per day. Non-adherence to medication schedule was reported in 34% patients. Common causes of non-adherence were high cost (21.3%), complex dosing schedule (20%), fear of adverse effects (16%). Sixty-eight% patients were not aware about importance of taking each medicine. Sixteen% stopped taking medicines due to high cost. Forty-two% suggested that government should adopt measures to provide free medicines to poor patients. In Morisky medication adherence questionnaire high, medium and low adherence was reported in 7.3%, 55.3% and 37.3% of patients, respectively. Moderately positive correlation was observed between poor adherence and number of concurrent illnesses and number of medicines taken. Conclusion: Since majority of patients were not aware about importance of taking each medicine, creating awareness about the same is essential for improving adherence to therapy. Measures to provide free medicines to non-affording patients need to be implemented since high cost was other major cause of non-adherence.
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Affiliation(s)
- Smita Sontakke
- Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India
| | - Ritu Budania
- Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India
| | - Chaitali Bajait
- Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India
| | - Kavita Jaiswal
- Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India
| | - Sonali Pimpalkhute
- Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India
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Coe AB, Moczygemba LR, Gatewood SBS, Osborn RD, Matzke GR, Goode JVR. Medication adherence challenges among patients experiencing homelessness in a behavioral health clinic. Res Social Adm Pharm 2015; 11:e110-20. [PMID: 23218849 PMCID: PMC3733792 DOI: 10.1016/j.sapharm.2012.11.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 11/16/2012] [Accepted: 11/16/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Behavioral health medication nonadherence is associated with poor health outcomes and increased healthcare costs. Little is known about reasons for nonadherence with behavioral health medications among homeless people. OBJECTIVES To identify reasons for medication nonadherence including the sociodemographic, health-related factors, and behavioral health conditions associated with medication nonadherence among behavioral health patients served by a Health Care for the Homeless center (HCH) in Virginia. METHODS The study sample was selected from an existing database that included sociodemographic, health-related information, and medication-related problems identified during a pharmacist-provided medication review conducted during October 2008-September 2009. Patients experiencing or at risk of homelessness who were ≥18 years old with at least one behavioral health condition who had a medication review were eligible for the study. A qualitative content analysis of the pharmacist documentation describing the patient's reason(s) for medication nonadherence was conducted. The Behavioral Model for Vulnerable Populations was the theoretical framework. The outcome variable was self-reported medication nonadherence. Descriptive and multivariate (logistic regression) statistics were used. RESULTS A total of 426 individuals met study criteria. The mean age was 44.7 ± 10.2 years. Most patients were African-American (60.5%) and female (51.6%). The content analysis identified patient-related factors (74.8%), therapy-related factors (11.8%), and social or economic factors (8.8%) as the most common reasons for patients' medication nonadherence. Patients with post-traumatic stress disorder (PTSD) (adjusted odds ratio: 0.4; 95% CI: 0.19-0.87) were less likely to have a medication adherence problem identified during the medication review. CONCLUSIONS The content analysis identified patient-related factors as the most common reason for nonadherence with behavioral health medications. In the quantitative analysis, patients with a PTSD diagnosis were less likely to have nonadherence identified which may be related to their reluctance to self-report nonadherence and their diagnosis, which warrants further study.
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Affiliation(s)
- Antoinette B Coe
- School of Pharmacy, Virginia Commonwealth University, 410 North 12th Street, PO Box 980533, Richmond, VA 23298-0533, United States.
| | - Leticia R Moczygemba
- School of Pharmacy, Virginia Commonwealth University, 410 North 12th Street, PO Box 980533, Richmond, VA 23298-0533, United States
| | - Sharon B S Gatewood
- School of Pharmacy, Virginia Commonwealth University, 410 North 12th Street, PO Box 980533, Richmond, VA 23298-0533, United States
| | | | - Gary R Matzke
- School of Pharmacy, Virginia Commonwealth University, 410 North 12th Street, PO Box 980533, Richmond, VA 23298-0533, United States
| | - Jean-Venable R Goode
- School of Pharmacy, Virginia Commonwealth University, 410 North 12th Street, PO Box 980533, Richmond, VA 23298-0533, United States
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Wei YJ, Palumbo FB, Simoni-Wastila L, Shulman LM, Stuart B, Beardsley R, Brown C. Relationships between antiparkinson medication nonadherence, regimen modifications, and healthcare utilization and expenditures. Parkinsonism Relat Disord 2014; 21:36-41. [PMID: 25465748 DOI: 10.1016/j.parkreldis.2014.10.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/13/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To examine 1) the effect of prior antiparkinson drug (APD) nonadherence on subsequent APD regimen modifications; and 2) the influence of modifications on healthcare utilization and costs by patients with Parkinson's disease (PD). METHODS This retrospective cohort study included 7052 PD patients with ≥2 APD prescriptions who initiated a modification of APD regimens in 2007. Modification was assessed as changing from one APD to another and/or adding a new APD to an existing regimen. Nonadherence was measured using Medication Possession Ratio <0.8. Discrete-time survival analyses were used to estimate the effect of prior nonadherent behavior on initiating APD modifications. Generalized linear models were used to estimate the effect of initiating medication modifications on subsequent 3-month medical use and costs. RESULTS Initiation of APD modifications in any given month was higher among patients who were nonadherent to APDs in the preceding month (adjusted hazard ratio [HR] = 1.23), compared to their adherent counterparts. Modifications significantly predicted higher risk of all-cause and PD-related hospitalizations (adjusted relative risk [RR] = 1.22 and 1.83, respectively), home health agency utilization (RR = 1.18 and 1.52), and use of physician services (RR = 1.14 and 1.41), as well as higher total all-cause healthcare expenditures (mean = $1064) in any given 3-month interval. CONCLUSIONS Prior nonadherence to APDs might influence initiation of APD modification. APD modifications were associated with increased health care utilization and expenditures, with the caveats that indications of modifications and disease severity may still play roles. Prescribers should consider patients' medication adherence when changing APD regimens to lower the costs of medical services.
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Affiliation(s)
- Yu-Jung Wei
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
| | - Francis B Palumbo
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA; Center on Drugs and Public Policy, University of Maryland School of Pharmacy, Baltimore, MD, USA.
| | - Linda Simoni-Wastila
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA; Peter Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy, Baltimore, MD, USA.
| | - Lisa M Shulman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Bruce Stuart
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA; Peter Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy, Baltimore, MD, USA.
| | - Robert Beardsley
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
| | - Clayton Brown
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
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