Adherence Estimates Research Articles

The Impact of Prescribed Dosage Assumptions on the Evaluation of Adherence and Persistence to Medication in Patients After Acute Myocardial Infarction.

Medication adherence is a significant problem in public health. Prescription-level pharmacy databases have great potential for monitoring actual drug adherence patterns at the healthcare system level. Many research papers have reported adherence estimates in different settings and populations. However, comparison between studies is not always straightforward due to different approaches taken when computing adherence. A crucial component to accurately estimate adherence is the availability of days' supply information for each dispensing event. Reasonable assumptions regarding medication dosage have to be made, when this information is not available. In this study, we evaluate adherence and persistence to medication in patients after myocardial infarction and show that corresponding estimates differ significantly, when using different dosage assumptions, namely, when using defined daily dose or tablet per day dosage regimens. Moreover, we demonstrate that observed differences between medications might be a result of inaccurate dosage assumptions. We propose a comparison of distribution of days between dispensing events to that of days' supplied as a relatively simple visual inspection to validate dosage assumptions.

Use of an electronic medication monitoring device to estimate medication adherence in kidney transplant patients.

Electronic medication monitoring devices (EMD) have been used as a gold standard for assessing medication adherence. We used a wireless EMD (SimpleMed+), assessed its usability in patients after kidney transplantation (KTx), evaluated adherence, and analyzed concordance with other adherence measures. Fifty-five patients (53% female, mean age 46 years) at least 6 months after KTx agreed to use the EMD over a period of 8 weeks. Self-reported adherence was measured with the BAASIS, and immunosuppressant trough level variability was assessed prior to and again during the study period. Fourteen patients stopped using the EMD or were low users (<70%). These non-completers reported that using the EMD would interfere with their daily activities. Taking-adherence of the completers was high with 98.3% (±1.9) over the entire study period. Timing-adherence was somewhat lower (94.6% ± 7.9) and decreased during the second half of the study. We found statistically significant correlations between EMD results and self-reported adherence with moderate effect sizes, but no significant association with trough level variability. The low usage of the EMD supports the need to assess the practicability of an EMD before applying it in research and clinical routine. Taking- and timing-adherence of KTx patients using the EMD was satisfactory. Self-reported adherence might be a good enough estimate of medication adherence.

A Novel Adherence Sensor System for Valved Holding Chambers Suitable for Children and Adults With Asthma

Poor adherence to inhaled drug therapy is considered to be a major factor in asthma related morbidity and it has been shown, in a significant number of patients, that estimates of adherence by patients or parents of children is not accurate. Inaccurate reporting may lead to higher dose of drug or more potent drugs being prescribed. A number of adherence sensors are available for some commercial inhaler devices. However, existing adherence monitoring mainly focuses on how the hardware of an inhaler has been actuated and does not provide evidence of drug aerosol inhalation. Valved holding chambers are now first choice for aerosol drug delivery for young children, who inhale drug by breathing in and out of the device several times and are increasingly used by older children and adults who inhale drug aerosol by taking a single deep breath. To the best knowledge of the authors, there is no adherence sensor in the market that provides evidence of actuation of the drug into a valved holding chamber and evidence that it is inhaled by different age groups. We therefore developed a novel adherence sensor system embedded into a valved holding chambers to achieve this. Our customised algorithm ensures that correct use is recorded, and incorrect use flagged. It also distinguishes a deep breath from tidal breaths and in combination measurement of actuation into the device triggers different classifiers for registering usage as good technique or not. A good technique or poor technique is immediately fed back to users using a visual light signal, while the data recorded is Bluetoothed to a paired mobile device for historical recording and statistical analysis. The entire system, including battery, micro-controller, sensors and Bluetooth, is integrated on a 66 ×22 mm <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sup> printed circuit board and weighs only 8 grams. The system has been evaluated on a custom-made artificial lung which mimics the breathing patterns confirming recognition of tidal and deep breaths. The low-power device operates from a 3.3 V, 560 mAh battery and lasts 14 months if used daily.

Medication Adherence in Patients With Severe Asthma Prescribed Oral Corticosteroids in the U-BIOPRED Cohort

Although estimates of suboptimal adherence to oral corticosteroids in asthma range from 30%to 50%, no ideal method for measurement exists; the impact of poor adherence in severe asthma is likely to be particularly high. What is the prevalence of suboptimal adherence detected by self-reporting and direct measures? Is suboptimal adherence associated with disease activity? Data were included from individuals with severe asthma taking part in the U-BIOPRED (Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes) study and prescribed daily oral corticosteroids. Participants completed the Medication Adherence Report Scale, a five-item questionnaire used to grade adherence on a scale from 1 to 5, and provided a urine sample for analysis of prednisolone and metabolites by liquid chromatography-mass spectrometry. Data from 166 participants were included in this study: mean (SD) age, 54.2 (± 11.9) years; FEV1, 65.1%(± 20.5%) predicted; female, 58%; 37%completing the Medication Adherence Report Scale reported suboptimal adherence; and 43%with urinary corticosteroid data did not have detectable prednisolone or metabolites in their urine. Good adherence by both methods was detected in 49 of the 142 (35%) of participants in whom both methods were performed; adherence detection did not match between methods in 53%. Self-reported high adherers had better asthma control and quality of life, whereas directly measured high adherers had lower blood eosinophil levels. Low adherence is a common problem in severe asthma, whether measured directly or self-reported. We report poor agreement between the two methods, suggesting some disassociation between self-assessment of medication adherence and regular oral corticosteroid use, which suggests that each approach may provide complementary information in clinical practice.

1018. Health Technology Assessment of New Long-Acting, Directly-Observed HIV Treatments in Canada: Impact of Real-World Adherence to Daily Oral Therapy on Treatment, Transmission and Cost-Effectiveness

BackgroundCurrent antiretroviral therapy (ART) has dramatically improved outcomes for people living with HIV (PLWHIV), however adherence to daily oral dosing remains a challenge for some. New, long-acting (LA) ARTs which are directly administered by physicians eliminate the need to adhere to daily oral dosing and may improve clinical outcomes. The study objective was to evaluate costs and QALYs associated with improved adherence achieved via a novel, directly-observed therapy (DOT) of a monthly LA injectable ART, compared to standard of care (SoC), daily oral therapy.MethodsA published Markov cohort state-transition model was adapted to model the impact of treatment adherence and subsequent disease transmission. Without the need to adhere to daily dosing, the efficacy of the injectable was modelled independent of adherence whereas virologic suppression in the SoC arm was adjusted to reflect published data on adherence to daily dosing (8.12% below optimal levels observed in clinical trials).ResultsThis evidence-based approach of accounting for adherence revealed an increase in lifetime costs for oral SOC of approximately $850, and QALY loss of 0.109 when compared to results without accounting for adherence. Disease transmission results yielded 3 cases averted of HIV per 1,000 patients with LA’s impact on adherence.ConclusionIn the absence of comparative adherence estimates between a LA, injectable DOT and daily oral therapy in the real world, an evidence-based approach provides a method to address the uncertainty around the true impact on costs and QALYs of a novel mode of administration.DisclosuresErin Arthurs, MSc, GlaxoSmithKline (Employee) Ben Parker, MSc, HEOR Ltd. (Employee) Ian Jacob, MSc, HEOR Ltd (Employee) Debbie Becker, MSc, GSK (Consultant) Amy Lee, MSc, PhD, GSK (Consultant) Olivia Hayward, PhD, HEOR ltd. (Employee) Vasiliki Chounta, MSc, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Sarah-Jane Anderson, PhD, GlaxoSmithKline (Employee, Shareholder) Nicolas Van de Velde, PhD, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee)

Adherence to Cognitive Behavior Therapy for Insomnia: An Updated Systematic Review.

This article discusses information extracted from 53 studies that have measured adherence to cognitive behavior therapy for insomnia. There has been an increase in more complex and less biased methods for assessing adherence that move beyond simply asking the patients whether they have adhered to the intervention or not. There is a need for a consensus around how to measure adherence, if clinicians want to arrive at an estimate of optimal adherence. Heterogeneity of studies, particularly in the way adherence is operationalized, prohibited conclusions about the relationship between adherence and outcome, as well as about predictors of adherence.

LONELINESS AND PHYSICAL ACTIVITY IN OLDER AGE: RESULTS OF THE RANDOMISED CONTROLLED STUDY OF PHYSICAL ACTIVITY INTERVENTION FOR LONELINESS (PAIL) IN COMMUNITY-DWELLING OLDER ADULTS

Study objective. The aim of this study was to examine the feasibility of a Physical Activity Intervention for Loneliness (PAIL) in community-dwelling older adults at risk of loneliness. Methods. Study design was a 12-week randomized controlled feasibility trial (RCT). Participants were 25 (mean age 68.5(8.05) years, range 60-92) healthy, inactive, community-dwelling older adults at risk for loneliness. The intervention consisted of group outdoor walking sessions with health education workshops once weekly, with a wait-list control condition. Estimation of recruitment, retention and adherence were feasibility outcomes. Body mass index, blood pressure, physical activity, and psychosocial variables were secondary outcomes. Results. Forty-eight participants were recruited over 4 months with a recruitment rate of 52.1% (25/48); 52% (25/48) met the inclusion criteria and 100% (25/25) were randomized into the intervention (N=12) and wait-listed (WL) control groups (N=13). At 12 weeks, 10/12 (83.3%; 95% CI 55.20 to 95.30) intervention and 10/13 (76.9%; 95% CI 49.74 to 91.82) control participants completed final assessments. The average attendance rate was 69.2% for the intervention group (range 25% – 91.7%) and 55% (range 25% – 91.7%) among controls. The a priori recruitment criteria for progression was not met. The retention rate satisfied the criteria of the study. No serious adverse events occurred. Conclusions. Community-dwelling older adults at risk of loneliness can safely participate in physical activity intervention for loneliness. However, to progress into a large-scale RCT, the design and methodology would need to be changed.

Modern methods for estimation of dietary adherence and quality of life for patients with coeliac disease

Rationale: Coeliac disease (CD) impacts health-related quality of life (QOL) due to the requirement to follow a strict lifelong gluten free diet, a number of nutritional deficiencies and clinical manifestations of CD. The aim of our study is to monitor the dietary adherence and to estimate QOL in patients with CD using translated questionnaires.

An Analysis of the GIQuIC Nationwide Quality Registry Reveals Unnecessary Surveillance Endoscopies in Patients With Normal and Irregular Z-Lines.

Population-based estimates of adherence to Barrett's esophagus (BE) guidelines are not available. Using a national registry, we assessed surveillance intervals for patients with normal and irregular Z-lines based on the presence or absence of intestinal metaplasia (IM) and among patients with suspected or confirmed BE. We analyzed data from the GI Quality Improvement Consortium Registry. Endoscopy data, including procedure indication, demographics, endoscopy and histology findings, and recommendations for further endoscopy, were assessed from January 2013 through December 2019. Patients with an indication of BE screening or surveillance or an endoscopic finding of BE were included. Biopsy and surveillance practices were assessed based on the length of columnar epithelium (0 cm, <1 cm, 1-3 cm, and >3 cm) and diagnosis based on histology findings. A total of 1,907,801 endoscopies were assessed; 135,704 endoscopies (7.1%) performed in 114,894 patients met the inclusion criteria (men 61.4%, Whites 91%, and mean age of 61.7 years [SD 12.5]). Among patients with normal Z-lines, surveillance endoscopy was recommended for 81% of patients with IM and 20% of individuals without IM. Among patients with irregular Z-lines, surveillance endoscopy was recommended for 81% with IM and 24% without IM. Approximately 30% of patients with confirmed nondysplastic BE (lengths 1-3 and >3 cm) had recommended surveillance intervals of <3 years. An analysis of data from a nationwide quality registry demonstrated that patients without BE are receiving recommendations for surveillance endoscopies and many patients with nondysplastic BE are reexamined too soon.

Assuming one dose per day yields a similar estimate of medication adherence in patients with stroke: An exploratory analysis using linked registry data.

Prescribed daily dose (PDD), the number of doses prescribed to be taken per day, is used to calculate medication adherence using pharmacy claims data. PDD can be substituted by (i) one dose per day (1DD), (ii) an estimate based on the 75th percentile of days taken by patients to refill a script (PDD75 ) or (iii) the World Health Organization's defined daily dose (DDD). We aimed to compare these approaches for estimating the duration covered by medications and whether this affects calculated 1-year adherence to antihypertensive medications post-stroke. We conducted a retrospective review of prospective cohort data from the ongoing Australian Stroke Clinical Registry linked with pharmacy claims data. Adherence was calculated as the proportion of days covered (PDC) for 1DD, PDD75 and DDD. Differences were assessed using Wilcoxon rank-sum tests. Among 12 628 eligible patients with stroke, 10 057 (80%) were prescribed antihypertensive medications in the year after hospital discharge (78.2% aged ≥65 years, 45.2% female). Overall, the 75th percentile of patient time until next medication refill was 39 days. The greatest variations in dose regimens, estimated using person- and dose-level refill times, were for beta blockers (11.4% taking two tablets/day). There were comparable levels of adherence between 1DD and the PDD75 (median PDC 91.0% vs 91.2%; P = 0.70), but adherence was slightly higher using DDD (92.3%; both P < 0.001). However, this would represent a clinically nonsignificant difference. Adherence to antihypertensive medications shows similar estimates across standard measures of dosage in patients during the first year after an acute stroke.

Dietary Sodium Intake and Sodium Density in the United States: Estimates From NHANES 2005-2006 and 2015-2016.

In the United States, current guidelines recommend a total sodium intake <2,300 mg/day, a guideline which does not consider kilocalorie intake. However, kilocalorie intake varies substantially by age and sex. We hypothesized that compared with sodium density, total sodium intake overestimates adherence to sodium recommendations, especially in adults consuming fewer kilocalories. In the National Health and Nutrition Examination Survey (NHANES), we estimated the prevalence of adherence to sodium intake recommendations (<2,300 mg/day) and corresponding sodium density intake (<1.1 mg/kcal = 2,300 mg at 2,100 kcal) by sex, age, race/ethnicity, and kilocalorie level. Adherence estimates were compared between the 2005-2006 (n = 5,060) and 2015-2016 (n = 5,266) survey periods. In 2005-2006, 23.1% (95% confidence interval [CI]: 21.5, 24.9) of the US population consumed <2,300 mg of sodium/day, but only 8.5% (CI: 7.6, 9.4) consumed <1.1 mg/kcal in sodium density. In 2015-2016, these figures were 20.9% (CI: 18.8, 23.2) and 5.1% (CI: 4.4, 6.0), respectively. In 2015-2016, compared with 2005-2006, adherence by sodium density decreased more substantially (odds ratio = 0.59; CI: 0.48, 0.72; P < 0.001) than adherence by total sodium consumption (odds ratio = 0.85; CI: 0.73, 0.98; P = 0.03). The difference in adherence between total sodium and sodium density goals was greater among those with lower kilocalorie intake, namely, older adults, women, and Hispanic adults. Adherence estimated by sodium density is substantially less than adherence estimated by total sodium intake, especially among persons with lower kilocalorie intake. Further efforts to achieve population-wide reduction in sodium density intake are urgently needed.

NHANES 2011-2014 Reveals Cognition of US Older Adults may Benefit from Better Adaptation to the Mediterranean Diet.

Although the Mediterranean diet (MedD) has gained interest for potential Alzheimer’s disease (AD) prevention, it is unknown how well US older adults follow a MedD. We used two National Health and Nutrition Examination Survey (NHANES) cycles (2011–2014) to conduct our primary aim of reporting population estimates of MedD adherence among older adults (60+ years) in the US (n = 3068). The mean MedD adherence score for US older adults was 5.3 ± 2.1 (maximum possible = 18), indicating that older adults in the US do not adhere to a MedD. There were various differences in MedD scores across demographic characteristics. We also assessed the cross-sectional relationship between MedD adherence and cognitive performance using survey-weighted ordinary least squares regression and binary logistic regression models adjusted for 11 covariates. Compared to the lowest MedD adherence tertile, the highest tertile had a lower odds ratio of low cognitive performance on three of five cognitive measures (p < 0.05 for each). Sensitivity analyses within participants without subjective memory complaints over the past year revealed similar results on the same three cognitive measures. We conclude that MedD interventions are a departure from usual dietary intake of older adults in the US and are a reasonable approach for AD prevention trials.

Lower socioeconomic status and co-morbid conditions are associated with reduced continuous positive airway pressure adherence among older adult medicare beneficiaries with obstructive sleep apnea.

To examine rates of adherence to continuous positive airway pressure (CPAP) therapy among a representative sample of older adult Medicare beneficiaries with obstructive sleep apnea (OSA), and to identify demographic and health-related factors associated with CPAP adherence. Using a 5% sample of Medicare claims data, we utilized Medicare policy and CPAP machine charges as a proxy for CPAP adherence. A cumulative logit model was used to identify demographic, medical, and psychiatric predictors of CPAP adherence status. Of beneficiaries who initiated CPAP (n = 3,229), 74.9% (n = 2,417) met the so-called "90-day Medicare adherence criteria," but only 58.8% of these individuals (n = 1,420) continued to use CPAP throughout the entire 13-month rent-to-own period. Anxiety, anemia, fibromyalgia, traumatic brain injury, and lower socioeconomic status (SES) were all associated with reduced CPAP adherence. These results provide the first national estimates of CPAP adherence among older adult Medicare beneficiaries in the United States. In addition, findings highlight the salience of medical and psychiatric comorbidity, as well as SES, as important markers of CPAP adherence among older adults in the United States. Future studies should seek to evaluate interventions to improve CPAP adherence among older adults of lower SES.

A simulation–optimization framework for short-term underground mine production scheduling

Mine operations are supported by a short-term production schedule, which defines where and when mining activities are performed. However, deviations can be observed in this short-term production schedule because of several sources of uncertainty and their inherent complexity. Therefore, schedules that are more likely to be reproduced in reality should be generated so that they will have a high adherence when executed. Unfortunately, prior estimation of the schedule adherence is difficult. To overcome this problem, we propose a generic simulation–optimization framework to generate short-term production schedules for improving the schedule adherence using an iterative approach. In each iteration of this framework, a short-term schedule is generated using a mixed-integer linear programming model that is simulated later using a discrete-event simulation model. As a case study, we apply this approach to a real Bench and Fill mine, wherein we measure the discrepancies among the level of movement of material with respect to the schedule obtained from the optimization model and the average of the simulated schedule using the mine schedule material’s adherence index. The values of this index decreased with the iterations, from 13.1% in the first iteration to 4.8% in the last iteration. This improvement is explained because the effects of the operational uncertainty within the optimization model can be considered by integrating the simulation. As a conclusion, the proposed framework increases the adherence of the short-term schedules generated over iterations. Moreover, these increases in the adherence of schedules are not obtained at the expense of the Net Present Value.

Pitfalls of medication adherence approximation through EHR and pharmacy records: Definitions, data and computation

Background and purposePatients’ adherence to medication is a complex, multidimensional phenomenon. Dispensation data and electronic health records are used to approximate medication-taking through refill adherence. In-depth discussions on the adverse effects of data quality and computational differences are rare. The purpose of this article is to evaluate the impact of common pitfalls when computing medication adherence using electronic health records. ProceduresWe point out common pitfalls associated with the data and operationalization of adherence measures. We provide operational definitions of refill adherence and conduct experiments to determine the effect of the pitfalls on adherence estimations. We performed statistical significance testing on the impact of common pitfalls using a baseline scenario as reference. FindingsSlight changes in definition can significantly skew refill adherence estimates. Pickup patterns cause significant disagreement between measures and the commonly used proportion of days covered. Common data related issues had a small but statistically significant (p < 0.05) impact on population-level and significant effect on individual cases. ConclusionData-related issues encountered in real-world administrative databases, which affect various operational definitions of refill adherence differently, can significantly skew refill adherence values, leading to false conclusions about adherence, particularly when estimating adherence for individuals.

Opening the black box of the group-based trajectory modeling process to analyze medication adherence patterns: An example using real-world statin adherence data.

The rationale for choosing a final group-based trajectory modeling (GBTM) specification and evaluations of patient adherence patterns within groups are often omitted in the GBTM medication adherence literature. We aimed to (1) reveal the complexity of GBTM and (2) assess model discrimination of patient medication adherence patterns. Medicare administrative claims were used to measure statin medication adherence as a continuous value in the 6 months before an acute myocardial infarction (AMI) hospitalization. Different GBTM specifications beyond default settings were constructed and compared with the Bayesian information criterion. Spaghetti plots were used to compare individual adherence patterns with group averages. Overall, 113,296 prevalent statin users met eligibility criteria. Four adherence groups were identified: persistently adherent, moderately adherent, progressively nonadherent, and persistently nonadherent. Spaghetti plots showed the persistently adherent and persistently nonadherent groups had relatively homogeneous adherence patterns that matched predicted trajectories well. Spaghetti plots also showed that, while adherence patterns in the progressively nonadherent group were not as homogeneous, most patients in this group appeared to be discontinuing statin therapy pre-AMI. Subjective decisions are necessary to identify a final trajectory model. Greater transparency and disclosure of these decisions in the medication adherence literature are needed. Individual patient adherence patterns from spaghetti plots provided additional diagnostic information about trajectory models beyond standard model-fit assessments to determine if group-average adherence estimates represent homogeneous patterns of medication adherence.

A Computerized Decision Support Tool To Implement Asthma Guidelines for Children and Adolescents

To evaluate performance of a computerized decision support tool to standardize usual care regimens for asthma management in randomized controlled trials (RCTs).The study included a total of 1443 participants with persistent, uncontrolled asthma who were enrolled in 3 published Inner-City Asthma Consortium multicenter trials; the trials were the Asthma Control Evaluation, the Inner-City Anti-IgE Therapy for Asthma, and the Preventative Omalizumab or Step-Up Therapy for Severe Falls Exacerbations trials. Participants were between 6 and 20 years of age, predominantly black or Hispanic, and highly sensitized to common aeroallergens, and a majority resided in households with annual incomes of <$15 000.Children and adolescents with persistent uncontrolled asthma living in urban areas in the United States were recruited into 3 multicenter RCTs of the Inner-City Asthma Consortium between 2004 and 2014, each with a usual care arm. A computerized decision support tool, the Asthma Control Evaluation and Treatment (ACET) Program, scored asthma control on the basis of parent- and patient-provided answers to questions about daytime and nighttime symptoms, along with forced expiratory volume in 1 second, and assigned an appropriate treatment step on the basis of National Asthma Education and Prevention Program guidelines. Control-level determinants were composed of symptoms, rescue medication use, pulmonary function measure, and adherence estimates; these data were collected at visits and entered into the ACET tool. Changes in control levels and treatment steps were evaluated during the trials.At screening, a majority of participants were assessed as asthma that was not well controlled or poorly controlled. There was a significant increase in the proportion of participants who gained good control between screening and random assignment in all 3 trials. There were 51% to 70% of participants who had symptoms well controlled by random assignment with careful adherence to ACET Program step recommendations, and the proportion of participants with well-controlled asthma remained constant or improved slightly from random assignment until the last posttreatment visit. Nighttime symptoms were the most common control-level determinant contributing to asthma control level compared with daytime symptoms and pulmonary function (forced expiratory volume in 1 second). Study physicians agreed with the ACET step recommendations in 90% or more visits, and there were few instances in which there was a study physician override. Poor medication adherence affected treatment algorithm in 5% to 10% of visits.Investigators in the study found that the application of the ACET computerized decision support tool enabled standardized asthma assessment and treatment in RCTs and was associated with attaining and maintaining good asthma in control in most participants.The study is the largest to examine performance of a computerized decision support tool to standardize usual care regimens for asthma management in RCTs among high-risk populations. This tool allowed for an algorithmic approach based on published guidelines to rate control and assign a treatment step. And furthermore, it allowed monitoring of treatment decisions longitudinally, minimized variability in decision-making across multiple centers, studied the alignment of decision support with clinical judgment, and determined when adjustments were made on the basis of adherence versus symptom or exacerbation occurrences. Although thus far focused on clinical trials, there is no reason that this approach could not eventually be applied clinically, better equipping health care providers to assess asthma control and link with evidence-based guidelines for asthma management, especially if integrated into the electronic health record.

A Dilute and Shoot LC-MS/MS Method for Antipsychotics in Urine.

Adherence to prescribed antipsychotics is an ongoing problem. Traditionally, estimates of adherence have been made from patient interviews, pill counting and blood testing. A number of methods for the analysis of antipsychotics in blood have been reported for both therapeutic drug monitoring and postmortem testing for toxicity. This report details a dilute and shoot method for the analysis of 19 different antipsychotics and metabolites. The method takes advantage of earlier reports demonstrating unique, prevalent urine metabolites for aripiprazole, brexpiprazole, haloperidol and lurasidone to enhance sensitivity for these analytes. With a fast analysis time and minimal sample preparation, this method can be used for quantitation of antipsychotics in urine. Finally, this method has been used to test samples for over a year with the results summarized in this report. While further improvements are certainly possible, this method is selective and sensitive for this group of important compounds.

Celiac Dietary Adherence Test simplifies Determining Adherence to a Gluten-free Diet in Swedish Adolescents.

The aims of the study were to ascertain whether the Celiac Dietary Adherence Test (CDAT) could contribute in determining adherence to a gluten-free diet in patients with celiac disease and to evaluate the diet adherence and well being of a study population 5 years after a celiac disease screening known as "Exploring the Iceberg of Celiacs in Sweden." Through the screening, 90 adolescents (born 1997) were diagnosed with biopsy-proven celiac disease at 12 years of age. Of them, 70 (78%) came to a 5-year follow-up where anti-tissue transglutaminase antibodies 2 was tested and a questionnaire was filled in, including CDAT, which consists of 7 questions related to adherence. Nonparametrical tests were used to determine associations between adherence measures. Among the adolescents, 86% were adherent to a gluten-free diet 5 years after screening, 38% reported their general well being as excellent, 50% very well, and 12% well. Statistically significant associations were seen between anti-tissue transglutaminase antibodies 2 and the CDAT score (P = 0.033), and the self-reported adherence question and the CDAT score (P < 0.001). The screening-detected adolescents reported a high level of well being and adherence to a gluten-free diet 5 years after screening. We conclude that the CDAT can be used in clinical practice as an estimation of adherence to a gluten-free diet. It would be most suitable to use in conjunction with currently used adherence measures, but can also be used as a stand-alone method when others are not accessible.

AdhereR: An Open Science Approach to Estimating Adherence to Medications Using Electronic Healthcare Databases.

Adherence to medications is a key performance indicator and behavioral outcome in healthcare. Electronic healthcare databases represent rich data sources for estimating adherence in both research and practice. To build a solid evidence base for adherence management across clinical settings, it is necessary to standardize adherence estimation and facilitate its appropriate use. We present the recent development and oportunities offered by AdhereR, an R package for visualisation of medication histories and computation of adherence.