Adherence-enhancing Interventions Research Articles

Interventions to Improve Long-Term Adherence to Physical Rehabilitation: A Systematic Review.

To evaluate the impact of physical rehabilitation interventions, supplemented with one or more adherence-enhancing components, on outcomes among adults with hip or knee osteoarthritis or chronic lower back pain. Primary literature search from inception of each database to July 27, 2021, guided by relevant search terms and keywords to search titles and abstracts. All articles meeting eligibility criteria were included for data abstraction. MEDLINE, CINAHL Complete, and Embase. Randomized and nonrandomized trials evaluating adherence-focused intervention components conducted in addition to an index usual care or usual care-like physical rehabilitation program among adults with hip or knee osteoarthritis or chronic low back pain. Eligible studies included a comparator group of the same index physical rehabilitation intervention without the adjunctive adherence components. Included studies measured outcomes at least 3 months after the rehabilitation course. Of the 10 studies meeting inclusion criteria, 6 interventions were delivered concurrent to an index rehabilitation program and 4 were delivered sequentially. Of the 3 studies that reported a positive effect on long-term adherence, only 1 was a low risk of bias study. There is very limited evidence of a beneficial treatment effect of adjunct adherence interventions on long-term physical function, self-efficacy, or adverse events. We found inadequate evidence evaluating adherence-enhancing interventions for the specific promotion of long-term adherence to home rehabilitation programs. Future studies should consider testing interventions specifically built to target behavioral maintenance of home rehabilitation programs.

Medication adherence in adults after hospitalization for heart failure: A cross-sectional study

BackgroundMedication non-adherence in heart failure (HF) leads to increased mortality, morbidity and healthcare costs. However, no study has investigated HF patients’ post-hospitalization medication non-adherence in Switzerland. ObjectivesOur primary aim was to assess the prevalence of post-discharge medication non-adherence in patients with HF. A secondary objective was to identify differences between fully and partially adherent patients regarding selected unplanned therapy-related inpatient/outpatient cardiology visits. MethodsA non-experimental cross-sectional study was applied. The prevalence of medication adherence was assessed with a German-translated version of the Medication Adherence Report Scale (MARS-5) and analyzed descriptively. Differences between adherent and partially adherent patients’ numbers of medications, dosing per day and 180-day unplanned inpatient stays or cardiology outpatient visits were explored. ResultsOf 153 recruited patients, 72 participated in the survey. Of these, 26.4 % were not fully adherent. Their most common reason was forgetfulness (23.7 %). There were no significant group differences regarding therapy-related variables or 180-day unplanned cardiology stays/visits. ConclusionsConsidering that over one-quarter of surveyed HF patients were not fully medication adherent, Swiss cardiology nurses need to be sensitized to this issue and trained in adherence-enhancing interventions. Reaching acceptable adherence levels in patients with HF will require further research and action.

Medication adherence in pediatric kidney transplantation: Howto build a bridge over troubled water.

Adhering to the immunosuppressive regimen remains one of the biggest challenges for children and adolescents after kidney transplantation. The first paper on nonadherence, co-authored by Dr. Fine, appeared in Pubmed over 45 years ago. Since then, many clinicians and researchers tried to better understand nonadherence and are looking for effective ways to support young people in implementing the complex medication regimen in their daily lives. As a tribute to Dr. Fine, we conducted a comprehensive review providing an overview of adherence-enhancing interventions in the field of pediatric kidney transplantation, thereby focusing on strategies that not only are effective but can also be embedded in daily clinical practice successfully and sustainably. This overview is preceded by a discussion about how to find out who is in need of supportive interventions. We will also argue that interventions should already start before pediatric kidney transplantation and discuss how to decide whether or not a young patient with nonadherence-induced graft loss should undergo retransplantation. We hope this comprehensive overview will rekindle the hope that we can finally turn the tide and beat one of pediatric kidney transplantation's main enemies.

Systematic Review of Outcomes for Assessment of Medication Adherence Enhancing Interventions: An ISPOR Special Interest Group Report

ObjectivesThe 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. MethodsWe 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. ResultsWe 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). ConclusionsVarious 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.

Adherence enhancing interventions for pharmacological and oxygen therapy in patients with COPD: protocol for a systematic review and component network meta-analyses

BackgroundChronic obstructive pulmonary disease (COPD) is characterised by hyperinflation and expiratory airflow limitation due to long-term exposure to irritants. The variety and complexity of COPD treatment and the possible added comorbidities may make the patients find it difficult to cope with the required medications. That is why supporting patients’ adherence is critical because not taking medications correctly increases the risk of complications and creates an additional financial burden. A range of interventions aiming to improve patient adherence were used, and most of them are complex since they involve a mix of elements. Furthermore, despite the variety of available tools, assessing adherence is challenging because clinicians usually do not get a concrete judgement if their patients followed their treatment plan reliably. We aim to evaluate the effectiveness of adherence-enhancing interventions for COPD patients, explore which intervention (component) works for which patients and check the factors influencing the implementation and participant responses.MethodsWe will perform a comprehensive literature search (Medline, Embase, Cochrane Library, trial registries) without restrictions on language and publication status, and we will include all controlled studies investigating the effect of adherence-enhancing intervention on patients with COPD. We plan to involve COPD patients in the systematic review development through two patient interviews (one before and one after the systematic review). Two reviewers will perform the screening, data extraction and risk of bias (ROB) assessment. For ROB, we will use ROB 2.0 to assess randomised controlled trials, and ROBINS-I to assess non-randomised studies. We will perform pair-wise random-effects meta-analyses and component network meta-analyses to identify the most effective components and combinations of components. We will use the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence. To determine the degree of complexity, we will use the iCAT_SR checklist, and then, following a logical model, we will group the interventions according to prespecified criteria.DiscussionThis systematic review aims to point out the most effective and implementable adherence-enhancing interventions by using methods for synthesising evidence on complex interventions and involving COPD patients all along with the review process.Systematic review registrationPROSPERO CRD42022353977

Modification of an Intervention to Improve Adherence in Adolescents and Young Adults With Bipolar Disorder

Managing bipolar disorder (BD) is particularly challenging for adolescents and young adults (AYAs) ages 16 to 21. Few interventions exist that address self-management in AYAs with BD. Thus, this study aimed to modify the customized adherence enhancement behavioral intervention for AYAs through an iterative, patient-centered process. The Obesity-Related Behavioral Intervention Trials (ORBIT) model was used for intervention development. In phase 1a, adherence barriers and facilitators were identified to refine intervention content. Phase 1b occurred following curriculum modification to ensure that the modified intervention was relevant and usable by the target population. Data were collected via focus groups and interviews with AYAs with BD, parents, and providers. Transcripts were analyzed using directed content analysis. Phase 1a included focus groups/interviews with AYAs (n = 10), parents (n = 4), and providers (n = 9) who described the difficulties and successes in managing BD symptoms, improving adherence, and transitioning care from caregivers. Phase 1b included an advisory board composed of 8 phase 1a participants who provided feedback on modified session activities, module delivery, and curriculum. Phase 1b involved usability testing with new participants (n = 8), revealing the need for modifiable language based on developmental level, more engaging visual images, and confirmation that topics were salient to AYAs with BD. Though sample sizes were small and not representative of the population of AYAs with BD, the ORBIT methodology informed the adaptation of the customized adherence enhancement intervention to improve adherence in AYAs with BD. Important next steps are to conduct a pilot randomized clinical trial of customized adherence enhancement for AYAs.

A Participatory Approach Involving Patients with Cystic Fibrosis and Healthcare Professionals for the Co-Design of an Adherence-Enhancing Intervention Toolkit.

Cystic fibrosis (CF) is an inherited life-shortening disease involving a significant treatment burden. Few interventions have been proven effective in improving adherence, and of these fewer have been adopted for implementation. Patient participation in research is increasingly desired in developing relevant health care services. A participatory approach was implemented in an adult CF center to co-design an adherence-enhancing intervention toolkit. We aimed to report on the participatory process and the results regarding the co-designed intervention. Two focus group sessions and four working sessions were conducted at 4-week intervals with three healthcare professionals (HCP; physician, nurse, physiotherapist), eight patients, and two researchers (sociologist, public health pharmacist). The two initial focus group sessions were dedicated to the collection of narratives about CF treatment experiences to identify drivers of adherence. The next four working sessions were dedicated to the reflection on solutions that could alleviate the difficulties identified and be used in current clinical practice. The researchers observed during all sessions the interactions between participants, group dynamics, and process of implementation of the collective reflection. The process facilitated an active participation of patients and HCP, who contributed equally to the intervention development. The co-design adherence-enhancing intervention toolkit consisted in a self-questionnaire to be completed by patients before the medical consultation and used as a communication support during the consultation, plus a toolkit of solutions to be proposed by the HCP for each barrier identified by patients, and to be followed up during the next consultation. This study demonstrated that a participatory approach involving CF patients and HCP lead to the development of an adherence-enhancing intervention toolkit, using a 6-session format; the benefits of the co-designed intervention on the medication adherence have yet to be tested in a multicenter, open-label study in 3 centers in France.

Viral load suppression in HIV-infected adolescents in cameroon: towards achieving the UNAIDS 95% viral suppression target

BackgroundAchieving the UNAIDS 95% sustained viral suppression (VS) rate requires considerable global efforts, particularly among adolescents living with HIV (ALHIV) who are often associated with high rates of virological failure (VF). In this study, we prospectively assessed the rate of VS, and the factors associated with VF in a cohort of adolescents followed up according to the WHO guidelines in Cameroon.MethodsA cross-sectional study was carried out in 2021 among adolescents (aged 10–19 years) receiving ART in the national program in Cameroon. Socio-demographic and clinical data were collected using patients’ medical files and a brief interview with the participant and/or his guardian. Thereafter, a first viral load test (VL1) was performed using the ABBOTT Platform. For adolescents with VL1 > 1000 copies/ml, adherence-enhancing interventions were routinely performed each month for 3 consecutive months, after which a second viral load (VL2) was measured. Adolescents with VL2 > 1000 copies/ml were considered in VF.ResultsOverall, 280 adolescents were enrolled, of whom 89.3% (250/280) acquired HIV infection via mother-to-child transmission. The median age was 16.0 (IQR: 13.0–18.0) years and the median duration on ART was 9.8 (IQR: 5.1–12.8) years. Females and males were almost equally represented, as 52.1% (146/280) were female, while 47.9% (134/280) were males (p = 0.47). The VS rate was 88.2% (CI: 83.8-91.7%) overall; 89.0% (CI: 82.0-93.1%) and 88.7% (CI: 81.2-93.0%) in females and males, respectively. Being on second or third-line ART, self-declared suboptimal adherence, and a history of past VF were independently associated with VF.ConclusionThe high rate of VS we report in this study is welcome in the era of the 95/95/95 UNAIDS goals, and indicates that improving treatment outcomes in this specific and fragile population that represent adolescents in Sub-Saharan Africa is achievable.Trial registration20/10/2020 NCT04593979 (https://clinicaltrials.gov/ct2/show/NCT04593979).

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?

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.

Abstract P4-03-18: Group-based trajectories of endocrine therapy adherence and risk of recurrence in a Danish premenopausal breast cancer cohort

Abstract Background: Adjuvant endocrine therapy (AET) approximately halves the risk of recurrence among the two-thirds of premenopausal breast cancer patients whose tumors overexpress the estrogen receptor (ER+). AET is recommended for a minimum five-year duration, but many premenopausal women discontinue AET prematurely. Adherence to AET is dynamic and influenced by many behavioral, societal, clinical, and genetic factors. Describing longitudinal patterns of AET adherence is an important first step towards identifying patients at highest risk of nonadherence–-and therefore recurrence–-who may benefit from adherence-enhancing interventions. We used group-based trajectory models to (1) describe AET adherence patterns, and (2) estimate associations between AET adherence and breast cancer recurrence in a Danish premenopausal, ER+ breast cancer cohort. Methods: Our cohort included 4,487 premenopausal women diagnosed with ER+, stage I–III primary breast cancer registered in the Danish Breast Cancer Group (DBCG) clinical database and treated with AET (2002–2011). We followed all patients from initiation of AET until recurrence, mortality, 10 years of follow-up, another primary malignancy, or the end of available follow-up. We excluded individuals with less than 1.5 years of follow-up as breast cancer recurrences that occur in this time are unlikely to be related to AET. At semi-annual follow-up visits, women were registered as having received (or not) a six-month supply of AET. We created daily indicators to determine if a woman had at least 80% of days covered by an AET fill within each six-month period for the first 4.5 years following AET initiation, yielding 9 variables indicating time-varying adherence. We used these indicators to characterize adherence trajectory groups. We defined recurrence as local, regional or distant metastases or contralateral breast cancer registered in the DBCG using follow-up data through 2017. We fit Cox regression models, adjusted for age and clinical factors, to estimate the association between adherence trajectory groups and recurrence. Results: We identified distinct trajectory groups in the cohort (Table 1)—high adherence (69%), slow decline (23%), and quick decline (8%). Women with quick decline were more likely to have stage I disease, have no positive lymph nodes, to not be treated with chemotherapy, and to have lumpectomy instead of mastectomy when compared to women with high adherence. Compared with high adherence women, the estimated rate of breast cancer recurrence was higher among those with slow decline (HR=1.12, 95%CI=1.04–1.21) and those with quick decline (HR=1.38, 95%CI=1.22–1.56). Conclusions: Group-trajectory modeling facilitated empirical description of AET adherence patterns in a premenopausal breast cancer cohort. As expected, women who more rapidly became AET-nonadherent were at increased risk of breast cancer recurrence compared with those who remained adherent. Future analyses will explore the contribution of specific socioeconomic, genetic, and clinical factors to AET adherence patterns, which will inform the design of interventions to improve AET adherence and reduce recurrence risk in breast cancer patients. Table 1. Trajectory group and the observed proportion of individuals adherent to their adjuvant endocrine therapy (AET) over 4.5 years of follow-up Citation Format: Kirsten M. Woolpert, Julie A. Schmidt, Thomas P. Ahern, Timothy L. Lash, Lindsay J. Collin, Bent Ejlertsen, Deirdre Cronin-Fenton. Group-based trajectories of endocrine therapy adherence and risk of recurrence in a Danish premenopausal breast cancer cohort [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-03-18.

HTA193 Criteria for Value Assessment of Medication Adherence-Enhancing Interventions: Preliminary Results of a Systematic Review

HTA193 Criteria for Value Assessment of Medication Adherence-Enhancing Interventions: Preliminary Results of a Systematic Review

Within-Trial Cost-Effectiveness of an Adherence-Enhancing Educational Intervention for Glaucoma

PurposeTo assess the within-trial cost-effectiveness of a behavioral intervention to improve glaucoma medication adherence. DesignProspective cost-effectiveness analysis of randomized, controlled trial data. MethodsThe study setting was a Veterans Affairs (VA) eye clinic. The patient population comprised veterans with medically treated glaucoma and self-reported poor adherence. Participants were randomized to a personalized educational session with a reminder bottle to promote medication adherence or to a control session on general eye health. Costs were assessed from the perspective of the VA payor at 6 months using the VA Managerial Cost Accounting System. Probabilistic sensitivity analyses were conducted using bootstrapped samples. The main outcome measures were the proportion of participants attaining ≥80% adherence as measured by electronic monitor, total intervention and medical resource costs, and incremental cost-effectiveness ratios comparing intervention to control at 6 months. ResultsOf 200 randomized participants, 95 of 100 assigned to the intervention and 97 of 100 assigned to the control had adherence outcomes at 6 months, and the proportion of adherent patients was higher in the intervention group compared to control (0.78 vs 0.40, P < .0001). All participants had costs at 6 months. The total cost at 6 months was $1,149,600 in the intervention group (n = 100) compared to $1,298,700 in the control group (n = 100). Thus, in a hypothetical cohort of 100 patients, the intervention was associated with cost savings (−$149,100) and resulted in 38 additional patients achieving medication adherence. ConclusionsAn adherence-enhancing behavioral intervention was effective and cost saving at 6 months.

Reimbursed medication adherence enhancing interventions in 12 european countries: Current state of the art and future challenges.

Background: Medication non-adherence jeopardises the effectiveness of chronic therapies and negatively affects financial sustainability of healthcare systems. Available medication adherence-enhancing interventions (MAEIs) are utilised infrequently, and even more rarely reimbursed. The aim of this paper was to review reimbursed MAEIs across selected European countries. Methods: Data on reimbursed MAEIs were collected from European countries at the ENABLE Cost Action expert meeting in September 2021. The identified MAEIs were analysed and clustered according to their characteristics, direct vs. indirect relation to adherence, and the targeted adherence phase. Results: Out of 12 contributing countries, 10 reported reimbursed MAEIs, 28 in total, of which 20 were identified as MAEIs targeting adherence directly. Reimbursed MAEIs were most often performed by either doctors (n = 6), nurses (n = 6), or pharmacists (n = 3). The most common types of MAEIs were education (n = 6), medication regimen management (n = 5), and adherence monitoring feedback (n = 4). Only seven reimbursed MAEIs were technology-mediated, whereas 11 addressed two interlinked phases of medication adherence, i.e., implementation and persistence. Conclusion: Our review highlights the scarcity of reimbursed MAEIs across the selected European countries, and calls for their more frequent use and reimbursement.

Reimbursed Medication Adherence Enhancing Interventions in European Countries: Results of the EUREcA Study.

Introduction: Current literature lacks detailed understanding of the reimbursement framework of medication adherence enhancing interventions (MAEIs). As part of the ENABLE COST Action, the EUREcA (“EUropen REimbursement strategies for interventions targeting medication Adherence”) study aimed to provide an in-depth overview of reimbursed MAEIs currently available in European countries at national and regional levels and to pave the way for further MAEIs to be implemented in the future. Methods: A web-based, cross-sectional survey was performed across 38 European countries and Israel. The survey questionnaire was developed as a result of an iterative process of discussion informed by a desk review. The survey was performed among invited ENABLE collaborators from June to July 2021. Besides descriptive analysis, association between country income and health care expenditure, and the availability of reimbursed MAEIs were also assessed. Results: The survey identified 13 reimbursed MAEIs in nine countries: multi-dose drug dispensing (n = 5), medication review (n = 4), smart device (n = 2), mobile application (n = 1), and patient education (n = 1). The median GDP per capita of countries having ≥1 reimbursed MAEI was significantly higher compared to countries having no reimbursed adherence intervention (33,888 EUR vs 16,620 EUR, respectively; p = 0.05). Conclusions: Our findings highlight that to date only a small number of MAEIs have been reimbursed in European countries. Comprehensive health technology assessment recommendations and multi-stakeholder collaboration could help removing barriers related to the implementation and reimbursement of MAEIs.

An interventional pilot of customized adherence enhancement combined with long-acting injectable antipsychotic medication (CAE-L) for poorly adherent patients with chronic psychotic disorder in Tanzania

BackgroundChronic psychotic disorders (CPD) impose a particularly significant burden in resource-limited settings. Combining long-acting antipsychotic medication (LAI) with a customized adherence enhancement intervention (CAE-L) has potential to advance care.MethodsNineteen adults ≥ age 18 with CPD who self-reported missing ≥20% of antipsychotic medication within the last month were stabilized on oral haloperidol prior to transitioning to monthly haloperidol decanote for 25 weeks. Outcome evaluations were conducted at baseline and Week 25. Primary outcomes were oral medication adherence assessed via the Tablet Routines Questionnaire (TRQ) and LAI injection frequency. Secondary outcomes included CPD symptoms measured by the Brief Psychiatric Rating Scale and Clinical Global Impressions, functioning evaluated using the Social and Occupational Functioning Scale, and medication attitudes assessed with the Drug Attitudes Inventory.ResultsMean sample age was 38.79 (SD = 9.31) with 18 individuals completing the study. There was one serious adverse event, a relapse into substance use, not deemed study-related. Mean endpoint LAI dosage was 65.79 mg (SD = 22.38). TRQ mean scores were 21.84 (SD =13.83) and 12.94 (SD = 11.93) at screen and baseline respectively. For only two individuals who were on concomitant oral medication at 25 weeks, TRQ change was not calculated. LAI injection frequency was 100%. Medication attitudes scores significantly improved from 7.89 (SD = 2.72) to 9.83 (SD = 0.52) (p = .001.) Changes in CPD symptoms and functioning were non-significant.ConclusionsCAE-L appears to be preliminarily feasible and acceptable in Tanzanians with CPD.Trial registrationThe study was registered on ClinicalTrials.gov (NCT04327843) on March 31, 2020.

Monitoring and Improving Adherence to Tyrosine Kinase Inhibitors in Patients with Chronic Myeloid Leukemia: A Systematic Review.

PurposeSuboptimal adherence to tyrosine kinase inhibitors (TKIs) is a widely recognized issue compromising the disease control and survival of patients with chronic myeloid leukemia (CML). A recently published review by Heiney et al reported inconclusive findings on the effects of a broad range of adherence enhancing interventions. The current systematic review aimed to identify studies that evaluated adherence-enhancing interventions implemented by healthcare professionals and determine their effect on CML patients’ medication adherence and clinical outcomes.MethodsA systematic literature search was performed in 5 databases for articles published between 2002 and 2021. Studies that compared adherence enhancing interventions implemented by healthcare professionals with a comparison group were included. Relevant data on study characteristics were extracted. Medication adherence and clinical outcomes between intervention and control arms were compared.ResultsNine studies were included in two randomised controlled trials, four cohort studies, and three before-and-after comparison studies. All the included studies incorporated complex interventions, including intensive education or consultation with pharmacists, nurses or multidisciplinary team, in combination with one or more other strategies such as structured follow-up, written materials or video, psychotherapy, medication reminder or treatment diary, with the overall goal of monitoring and improving TKI adherence. Most (7 out of 9) studies demonstrated significantly better adherence to TKIs in the intervention group than the comparison group. The relative proportion of participants who adhered to TKIs ranged from 1.22 to 2.42. The improvement in the rate of TKI doses taken/received ranged from 1.5% to 7.1%. Only one study showed a significant association between intervention and clinical outcomes, with a 22.6% higher major molecular response rate and improvement in 6 out of 20 subscales of health-related quality-of-life.ConclusionComplex interventions delivered by healthcare professionals showed improvement in adherence to TKIs in CML patients. Further studies are required to clarify the cost-effectiveness of adherence-enhancing interventions.

7.1 Development of the Customized Adherence Enhancement Intervention for Adolescents and Young Adults to Improve Medication Adherence in Bipolar Disorder

7.1 Development of the Customized Adherence Enhancement Intervention for Adolescents and Young Adults to Improve Medication Adherence in Bipolar Disorder

Adherence to Inhaled Therapy in Patients with COPD Associated to Pneumoconiosis.

BackgroundPneumoconiosis has high prevalence of chronic obstructive pulmonary disease (COPD), respiratory morbidity, and mortality.ObjectiveThe aim of the present study was to examine patient characteristics and adherence to inhaled therapy among pneumoconiosis with COPD in a real-world clinical setting.MethodsA cohort of pneumoconiosis patients with COPD prescript with at least one type of long-acting inhaled drug was followed for adherence for 2 years. Demographic and COPD-related characteristics were collected in baseline.ResultsIn baseline, after adjusting for age, dust exposure duration positively correlated with number of acute exacerbation (AE) frequency in the last year. There were close associations among COPD Assessment Tool (CAT) score, modified Medical Research Council Dyspnea Scale (mMRC) grade, number of AE, and pre-FEV1 value. Of 296 participants originally recruited, 213 participants finished the 2-year follow-up for adherence. 122 (57.28%) were non-adherent to inhaled therapy. The most common reason for non-adherence was “relief of symptoms after short-term controller medication use” (53.28%). Patients who were non-adherent reported higher body mass index (BMI), less AE events in the last year, higher pre-FEV1 value, higher post-FEV1 value and low CAT, mMRC scores compared to adherent in baseline. High pre-FEV1 value (OR = 1.04, CI = 1.018–1.064) and low mMRC scores (OR = 0.406, CI = 0.214–0.771) were risk factors found associated with non-adherence.ConclusionA majority of pneumoconiosis patients complicated with COPD have suboptimal inhaled therapy adherence. Evidence-based, adherence-enhancing interventions should be targeted on less severe subjects.

Personalized Medication Adherence Management in Asthma and Chronic Obstructive Pulmonary Disease: A Review of Effective Interventions and Development of a Practical Adherence Toolkit

The management of medication nonadherence of patients with asthma or chronic obstructive pulmonary disease (COPD) remains challenging. Given the multitude of underlying causes, a personalized approach is required. The Test of Adherence to Inhalers (TAI) can identify reasons for nonadherence, but it does not provide guidance regarding how to act effectively after results. To develop a practical, evidence-based decision support toolkit for health care professionals managing adult patients with asthma and/or COPD, by matching TAI-identified adherence barriers to proven effective adherence-enhancing interventions. We performed a literature review in PubMed and Embase identifying interventions that enhanced medication adherence in adult patients with asthma and/or COPD. Randomized controlled trials published in English with full texts available were included. Effective interventions assessed by the Cochrane risk of bias tool were categorized, matched with specific TAI responses, and developed into a practical TAI Toolkit. The Toolkit was assessed for content and usability (System Usability Scale) by a multidisciplinary group of health care professionals. In total, 40 randomized controlled trials were included in the review. Seven effective interventions categories were identified, informing the TAI Toolkit: reminders, educational interventions, motivational strategies, feedback on medication use, shared decision-making, simplifying the medication regimen, and multiple component interventions. Health care professionals rated the TAI Toolkit with a mean System Usability Scale score of 71.4 (range, 57.5-80.0). Adherence can be improved using the different interventions that the TAI Toolkit helps select. The TAI Toolkit was well-received by health care professionals. Further research is required to test its validity, practicality, and effectiveness in practice.

Investigating Treatment Adherence of British and Greek Patients With Type 2 Diabetes Mellitus

Abstract. Background: Treatment adherence is associated with a number of personal characteristics (e.g., self-esteem, self-efficacy, locus of control) and illness perceptions. However, there is a lack of studies for Type 2 Diabetes Mellitus (T2DM). Aims: The aim of this study was to compare adherence behavior of British and Greek people with T2DM and examine the association between personal characteristics, illness perceptions, and adherence. Method: This was a cross-cultural, cross-sectional study. Five hundred eighty participants completed questionnaires, 208 males (35.9%) and 372 females (64.1%) with a mean age of 49 years. Regression analyses and t-tests were used. Results: Personal characteristics and illness perceptions predicted adherence and British patients reported better exercise adherence while Greek patients reported better diet and medication adherence; both groups reported suboptimal adherence. Self-efficacy, Health Locus of Control (HLoC), and illness perceptions were the main adherence determinants. Limitations: The use of self-reports and the convenience sampling method are the main limitations of this study. Conclusion: The findings address a significant gap in research and can inform future adherence-enhancing interventions to promote the well-being of people with T2DM.