Chronic Disease Adherence Research Articles

Real-world evidence and patient preference for subcutaneous versus intravenous natalizumab in the treatment of relapsing-remitting multiple sclerosis - initial results from the observational SISTER study.

The consideration of patient preference for a certain drug route of administration (RoA) plays an important role in promoting patient adherence in chronic diseases. Natalizumab is an established treatment for relapsing-remitting multiple sclerosis (RRMS) and can be administered as intravenous (IV) infusion or subcutaneous (SC) injection developed to enable a shorter and easier administration versus IV RoA. Primary objective is to compare patients' preference for RoA and satisfaction with SC versus IV natalizumab at baseline and subsequent visits up to 12 months. Secondary objectives include drug utilization, clinical outcomes, safety, and treatment satisfaction in a usual care setting. SISTER (Subcutaneous: Non-Interventional Study for Tysabri Patient Preference - Experience from Real World) is an ongoing, prospective, observational study where natalizumab is utilized according to local label. RRMS patients are included in three natalizumab cohorts: Patients switching from current IV to SC administration (switcher) and patients newly starting natalizumab on either SC or IV route (starter SC/IV). This interim analysis includes 262 patients (184 switchers, 39 SC starters, and 39 IV starters), median observation period was 9 months. 80.8% IV starters and 93.9% SC starters reported at baseline that they prefer the assigned RoA. Although initial satisfaction with chosen RoA was maintained over time from baseline through Month 12 in all three cohorts, the wish for change of the current RoA after 6 and 12 months was more frequently expressed among IV starters than in either SC cohort. Consistently, six patients (23.1%) starting with IV changed their RoA from IV to SC route.Mean global treatment satisfaction according to TSQM-II score at baseline remained high in the switcher group and increased through Month 12 in both IV and SC starter cohorts. Based on current data, there is a trend toward patients' preference for the natalizumab SC route over the IV route, which provides valuable insights into patients' preference for natalizumab RoA in routine care and complements available data from clinical studies with real-world data on SC natalizumab. This observational (non-interventional) study was registered in the local German PEI register for non-interventional studies (NIS-No. 611) and in the international CTgov register (NCT05304520).

Digging Deep: Medication Adherence in Chronic Diseases and Its Association With Patient Satisfaction and Stress in an Indian Metropolis.

Introduction Medication adherence is a critical aspect of managing chronic diseases. Poor medication adherence leads to therapeutic failures and increased health costs, and puts patients at potentially life-threatening risks.The impact is felt drastically by patients suffering from chronic diseases. Patient satisfaction is known to be strongly associated with medication adherence. Psychosocial factors such as depression have been proven to negatively affect medication adherence; however, to our best knowledge, the association of stress with adherence remains largely unexplored. Objectives The aim of this study is to explore or assess the relationship between medication adherence, patient satisfaction, and stress levels. Methods A cross-sectional observational study was conducted within an Indian metropolitan city (Mumbai) among adults diagnosed and treated for at least one chronic disease with a medication regimen spanning over three months. An online questionnaire was designed, incorporating validated scales such as the Adherence to Refills and Medications Scale, Short Assessment of Patient Satisfaction, and Perceived Stress Scale. Results In the study, 23.7% of participants (n=300) showed adherence to their prescribed treatment regimen. Adherence exhibited a positive association with age (p=0.009) and educational attainment (p=0.031). Additionally, a significant gender difference emerged, with males (28%) displaying higher adherence rates compared to females (16.7%) (p=0.036). Furthermore, participants reporting lower stress levels exhibited higher adherence (39.5%), while those experiencing moderate-to-high stress levels displayed reduced adherence rates (17-18.8%) (p<0.05). Patient satisfaction was also linked to adherence, as satisfied individuals demonstrated higher adherence levels (29.1%) in contrast to dissatisfied counterparts (15.7%) (p=0.011). Conclusion Level of medication adherence is much lower in India as compared to other developed nations. Various demographic factors such as age, sex, and education status influence adherence. Physician counselling plays an important role in adherence, and satisfied patients are far more adherent. Furthermore, a significant negative association was found between stress and adherence.

How is Patient Adherence Possible? A Novel Mechanistic Model of Adherence Based on Humanities.

Patient non-adherence is a major contemporary medical issue because of its consequences in terms of frequency, morbidity and mortality, and health care costs. This article aims to propose a mechanistic model of adherence based on the tenet that non-adherence is the default option, as long-term adherence in chronic diseases requires sustained effort. The real question becomes, how is patient adherence possible? By focusing on adherent patients, the paper explains the mental mechanisms of adherence using concepts largely drawn from humanities, philosophy of mind, and behavioral economics and presents the findings of empirical studies supporting these hypotheses. The analysis first demonstrates the relationship between patient adherence and temporality and the influence of character traits. Further, it points out the importance of habit, which allows adherence to become non-intentional, thereby sparing patients' cognitive efforts. Finally, it points out the importance of the quality of the interaction between the person with a chronic disease and the health professional. These features explain why adherence is a syndrome (the healthy adherer phenotype), separating people into those who are safe and those who are at risk of non-adherence, non-control of diabetes, and complications. The concepts presented in this article summarize 20 years of personal clinical and philosophical reflection on patient adherence. They are mainly illustrated by examples from diabetes care but can be applied to all chronic diseases. This novel model of adherence has major practical and ethical implications, explaining the importance of patient education and shared medical decision-making in chronic disease management.

Factors predicting medication adherence among Omani patients with chronic diseases through a multicenter cross-sectional study

Management of chronic diseases is complex and requires a long-term commitment to therapeutic medications. However, medication adherence is suboptimal. There is limited understanding of factors predicting medication adherence in chronic diseases in Oman. This study aimed to examine predictors of medication adherence (i.e. patient clinical and demographic data, patient-physician relationship, health literacy, social support) among Omani patients with chronic diseases. This study used a cross-sectional correlation design. Data were collected from 800 participants using convenience sampling between December 2019 and April 2020. Arabic versions of the Brief Health Literacy Screening tool, Multidimensional Scale of Perceived Social Support, Patient-Doctor Relationship Questionnaire, and Adherence in Chronic Disease Scale were used to measure study variables. Descriptive statistics, independent t tests, one-way ANOVA, Pearson correlations, and multivariate linear regression were used for analysis. The study found that factors such as the patient-physician relationship, social support, disease duration, employment status, and medication frequency significantly predicted medication adherence. Medication adherence was higher among those who were unemployed, had a better patient-physician relationship, and greater social support. However, medication adherence was lower with longer disease duration and higher daily medication frequency. Additionally, medication adherence was positively associated with perceived social support and the patient-physician relationship, but not with health literacy. In conclusion, the study reveals that patient characteristics, social support, and patient-physician relationships are key factors in predicting medication adherence in patients with chronic diseases in the Middle East. It emphasizes the importance of improving these aspects, considering factors like employment status, disease duration, and medication frequency, and enhancing healthcare provider-patient relationships and social support systems to boost adherence.

Association between medication adherence to chronic diseases and shift-work schedules in the Korean working population

Shift-working schedules are closely linked to chronic diseases, and only a few studies have investigated the association between working schedules and medication adherence in chronic diseases targeting workers. This study aimed to investigate whether shift-work schedules are associated with medication adherence in a working population with chronic conditions. The study participants (n = 11,460 person-years) were identified from the Korea Health Panel Study conducted from 2008 to 2018. Medication adherence was classified as good (2+) or poor (0 or 1) based on the 4-item Morisky Medication Adherence Scale. Work schedules were categorized as shifts and fixed daytime work. Its association with medication adherence was investigated using a generalized estimating equation model, generating odds ratios (OR) with 95% confidence intervals (CI). According to work schedules, shift workers were more likely than fixed-day workers to have poor medication adherence (adjusted OR = 1.16, 95% CI: 1.02–1.33). Regarding occupational classification, manual workers had a significantly higher risk of poor medication adherence than those in other occupational categories (adjusted OR = 1.27, 95% CI: 1.13–1.43). Among shift workers, the major reason for poor medication adherence was forgetting to take medication (SPR = 1.23, 95% CI: 1.07–1.38). Workers with irregular shift times are more vulnerable to poor medication adherence. Future studies are required to understand the mechanisms underlying this association and develop strategies to enhance medication adherence in the working population.

Association between health literacy and medication adherence in chronic diseases: a recent systematic review.

Poor medication adherence is a serious barrier to successful chronic disease management. Previous reviews reported that low health literacy could be associated with medication non-adherence but conclusions were uncertain. The aim of this systematic review was to clarify the relationship between health literacy and medication adherence in adults with chronic diseases. A secondary objective was to identify the factors that influence medication adherence. Publications analyzing the relationship between health literacy and adherence in adults with chronic diseases were identified through 6 databases between 2015 and 2020. A quality assessment was conducted in order to improve the interpretation of the relationship between health literacy and medication adherence. A narrative synthesis was then performed to describe the relationship between health literacy and medication adherence. The factors influencing medication adherence were then analyzed as a secondary outcome. Among the 27 studies, 17 and 10 were considered to be of good and medium methodological quality, respectively. Concerning the relationship between health literacy and adherence, 14 reported a positive relationship, 1 study suggested a negative relationship, 3 found mixed results, and 9 reported not finding a relationship. Patient-related factors such as medication beliefs, self-efficacy, or medication knowledge, as well as demographic factors such as ethnic minority and incomes influence medication adherence. The present review confirms an unclear relationship between health literacy and medication adherence. Although health literacy plays a substantial role in medication adherence, other factors must be taken into account when addressing non-adherence.

Pediatric-Adult Care Transition: Perceptions of Adolescent and Young Adult Patients with Sickle Cell Disease and Their Healthcare Providers.

IntroductionThe pediatric-adult care transition, which takes place during adolescence, is a high-risk period for medical care adherence in chronic diseases, this encompasses treatment adherence, attending medical consultations and following healthcare advice. Studying perceptions is needed to get a more comprehensive picture of this care transition and to propose interventions to address the gaps. The authors analyzed perceptions from patients and caregivers in adolescents with sickle cell disease. Although this is the first step to improving the actual care management, to our knowledge, no study has explored perceptions from healthcare providers and compared it to patients’ perceptions. The purpose of this study was to provide an insight on the experience of adolescent and adult patients, pediatric and adult healthcare providers in the context of pediatric to adult care transition, and analyze those concerns in order to better understand medical care adherence and improve patient care.Material and MethodsSemi-structured interviews were conducted with adolescent and adult patients, as well as healthcare professionals (HCPs) in pediatric and adult departments. These interviews were audiotaped and transcribed before manual inductive content analysis.ResultsA total of 15 adolescent patients, 10 adult patients, 9 pediatric HCPs and 13 adult HCPs - including 12 nurses - were interviewed. Patients and healthcare providers all agreed that the pediatric-adult care transition was poorly experienced. This was mainly due to various changes in habits, physicians, and care organization. Anticipating this transition and acquiring new skills both for patients and HCPs are essential steps for improving medical care adherence during this challenging pediatric-adult care transition.ConclusionPropositions emerged from patients and healthcare providers to improve care and subsequently to improve medical care adherence in patients with sickle cell disease during and after the pediatric to adult care transition.

General self-efficacy and hypertension treatment adherence in Algerian private clinical settings.

BackgroundThe purpose of this study was to investigate the connection between self-efficacy and treatment adherence, working on the assumption that self-efficacy plays a role in determining treatment adherence in chronic diseases. Hypertension affects one-third of the world’s population. In Africa, hypertension is a leading cause of death from a non-communicable disease. Modifications to lifestyle and behavior, as well as increased access to pharmaceuticals, are necessary for every African nation to bring the prevalence of hypertension and cardiovascular disorders under control.MethodsIn order to assess the predictive association between the two, we conducted research on 216 hypertensive patients who were treated in private clinics in Algeria. These patients were given two assessments to fill out: one was called the general self-efficacy scale (GSES), and the other was called the treatment adherence scale. Comparisons of male and female self-efficacy and adherence were made with the help of Pearson’s correlation coefficient and a sample independent t-test (selfefficacy, adherence to treatment).ConclusionsSelf-efficacy in general has been shown to be connected with adherence to hypertension therapy (r(214) = 0.496, p=0.01, <0.05). There is no significant difference between the sexes in either selfefficacy (t(214)=0.985, p=0.326, >0.05) or hypertension treatment adherence (t(214)=0.034, p=0.973, >0.05). A higher level of self-efficacy was found to have a positive correlation with a higher level of treatment adherence; it is possible to increase the medication adherence of hypertension patients by enhancing their level of self-efficacy. It is important for those working in health care to acknowledge the significance that self-care plays in overall health.

Adherence to Medications among Outpatient Adults with Multiple Sclerosis in Medina Province in Ksa (Cross-Sectional Study)

Multiple sclerosis (MS) is a chronic, inflammatory, progressive, demyelinating disease of the central nervous system. Treatment for MS involves long-term disease-modifying therapies (DMTs). Medication adherence in chronic diseases like MS plays an important role in predicting long-term outcomes. This is a cross-sectional, survey-based study was done to assess adherence to medications among adults suffering from MS in Medina Province, Saudi Arabia. The study sample included 90patients diagnosed with multiple sclerosis. These databases contain information about disease presentation, drug prescription, vital status, residency, and role of contact to patient. All the collected data were analyzed by an SPSS program, version 20, and p value &lt; 0.05 was considered significant. A response rate among the MS patients was 97.78%, and their mean age was 36.13±9.58. Most of the participants were above 35 years (55%) and were females. About 37.8% of patients was considered to be adherent to the drugs. The mean total score of BMQ Specific-Necessity was 3.25±0.70 and about 63.4% total score=3 and the mean total score of BMQ Specific-Concerns was (3.34±0.703). About 84.4% total score=3. The mean total score of BMQ General was 3.2727±0.31, and about 81.1% had a total score=3. The mean total score of compliance was 3.2023±0.393.We concluded that many factors affected the patient's adherence to the drug rather than of being dependence to the drugs as worrying about side effects and the cost of the drug.&#x0D;

Medication Adherence and Patients' Characteristics in Chronic Diseases: A National Multi-Center Study.

Chronic diseases constitute a significant threat to health. Worldwide, medication adherence in chronic diseases remains unsatisfactory. Understanding factors affecting adherence is essential. This study examined medication adherence by characteristics of patients with chronic diseases. This cross-sectional study included 800 patients. The Adherence to Chronic Diseases Scale was used to measure adherence. Descriptive statistics and logistic regression was used to examine factors influencing medication adherence. Low adherence was found in 19.5% of the patients, 45% had medium adherence, and 35.5% had high adherence. Logistic regression showed that retired (OR 0.496, 95% CI [0.33-0.75]), having COPD (OR 0.460, 95% CI [0.32-0.67]) and duration of disease ≤5 years (OR 1.554, 95% CI [1.11-2.17]) remain independent predictors for high adherence. Mixed findings regarding the relationship between medication adherence and patients' characteristics were noticed. Patients' characteristics should be examined with the individual population when examining and attempting to improve medication adherence in clinical practice.

Oral therapy adherence and satisfaction in patients with multiple myeloma.

The transition to oral therapies in patients with multiple myeloma (MM) offers potential benefits to patients; however, they must self-manage their medication and adherence plays an important role in patient care. It has been shown that patient satisfaction with their medication has a strong positive correlation with adherence in chronic diseases. The aim of this study was to estimate adherence rate of oral antimyeloma therapies and to identify risk factors for medication non-adherence. This observational, prospective, and multicentre survey based on a self-report questionnaire enrolled MM patients with at least 3months of oral therapy. The 6-item Girerd scale and the medication possession ratio (MPR) were used for measuring medication adherence and the SATMED-Q® questionnaire was used for measuring satisfaction. An analysis of risk factors for non-adherence to oral therapy was performed using univariate analysis. A total of 101 patients participated in the survey, yielding a response rate of 87%. The prevalence of adherence to oral antimyeloma therapy was estimated at 51.5% using the Girerd questionnaire. According to the MPR, adherence was evaluated at 96% (i.e. MPR ≥ 0.80). Both methods combined, adherence was estimated at 50.5%. One risk factor for medication non-adherence was identified: Eastern Cooperative Oncology Group Performance Status > 2 (p = 0.007). One predictive factor for high medication adherence was identified: high satisfaction with treatment (p = 0.01). Identifying patients at higher risk for non-adherence allows clinical pharmacists to personalise therapeutic information and education and to improve the quality of healthcare overall.

Exploring perceptions, attitudes and beliefs of Thai patients with type 2 diabetes mellitus as they relate to medication adherence at an out-patient primary care clinic in Chiang Mai, Thailand

BackgroundWithin the sphere of diabetes self-management, much emphasis has been placed on medication adherence. There has been a shift in thinking about medication adherence, moving from “compliance” and historically paternalistic models of care, to seeking better ways of characterizing dynamic and complex relationships that determine medication adherence and diabetes control. This study sought to understand the relationship between patient’s attitudes and medication adherence for oral anti-diabetics in Thailand.MethodsIn-depth interviews of patients with type 2 diabetes mellitus, taking oral anti-diabetic drugs, at the out-patient clinic run by the Department of Family Medicine, Chiang Mai University between May and December 2016. Thematic analysis followed the WHO framework for medication adherence in chronic disease to explore patient’s attitudes and their influence on medication compliance.ResultsOf 24 patients, 9 were men. The mean age was 62 years (SD 8.9 years). 67% had high compliance. Four themes were identified as important factors related to medication adherence: attitudes toward disease, attitudes toward treatment, attitudes toward family support and attitudes toward health care team. Specifically, symptoms at diagnosis, understanding and acceptance in taking medication, the presence of family support and the perception of concern by the doctor relate to improved medication compliance.ConclusionsMedication adherence in Thai patients with diabetes requires support from both the health care providers and the family. The patient’s perception of the doctor’s concern creates greater patient trust in the health care team. This trust, along with family support, helps deepen patients’ understanding of the disease, accept the chronic nature of their disease, and engenders a positive attitude towards taking medication that can improve medication adherence.

Assessment of medication adherence in chronic diseases

Majority of people with chronic diseases have poor adherence to their therapeutic regimen. It can result in various complications physialogically with undesirable metabolic conditions. The main objective of this study is to assess the level of satisfaction attained after medication in comorbidities (either having diabetes only or having hypertension only or having Hypertension and Diabetes) and also focussed on creating awareness in patients who do not follow the medication. A prospective cross sectional study was conducted at tertiary care hospital, Khammam, Telangana. 200 patients were approached and were interviewed with their consent. The purpose of the same was to collect the information on socio demographics, medication that is followed, and behavioural characteristics. A structured questionnaire MMAS-8 an eight itemed scale was involved to identify individuals, determine their levels, the reliability and validity of the medication followed. The scrutiny of this study found that there is a better medication adherence in individual’s diseases (Hypertension, Diabetes) whereas in hypertension and diabetes condition high and low adherence were reported because of their awareness, negligence and risk factors respectively. The study concludes that there is an increase in Medication adherence in individual diseases whereas in hypertension and diabetes there are equal ranges of both low and high adherence.

Medication adherence in the older adults with chronic multimorbidity: a systematic review of qualitative studies on patient's experience.

Medication non-adherence represents a socially relevant challenge, particularly when interlinked to multiple chronic diseases and polypharmacy. Non-adherence rates affect treatment efficacy and increase health care costs. The aim of the study was to identify factors influencing medication adherence in the older adults through a systematic review of qualitative studies on patients' experience. Two electronic databases were searched for qualitative studies on medication adherence in chronic diseases (hypertension, heart disease, COPD, asthma) involving people aged 65 + . The systematic review was performed according to the PRISMA statement guidelines, employing theoretical frameworks of the ABC Taxonomy of patient adherence and Three Factor model of determinants of behaviour. The initial database search identified 1234 records, of which 39 studies were considered eligible. Most of the studies focused on hypertension and were conducted in English-speaking countries. According to the ABC Taxonomy, Persistence and Implementation were the most often considered phases. Considering the Three Factor model, the most often reported themes were Information and Strategies upon being adherent. Stemming from the review findings and the patients' narratives, a new integrated model was proposed. It reports the patient's decisional flowchart describing barriers and facilitators (personal, social and environmental) to adherence. Medication adherence is a complex and multifaceted process. The implementation of theoretical frameworks along with a patient-centred perspective may provide clinicians with useful suggestions for clinical practice, enhancing the patient's ability to adhere.

Association between non-adherence behaviors, patients’ experience with healthcare and beliefs in medications: a survey of patients with different chronic conditions

Objective: The objective of the current work was to assess the frequency of non-adherence behaviors and potential association with patients’ experience with healthcare and beliefs in medicines self-reported by patients with four different chronic conditions.Methods: Patients responded anonymously to a survey comprising five non-adherence behaviors (based on physician and patient input), an assessment of patients’ experience with healthcare using the validated Instrument to Evaluate the EXperience of PAtients with Chronic diseases (IEXPAC), and a validated Spanish version of the Beliefs about Medicines Questionnaire (BMQ). Associations of non-adherence behavior were analyzed using logistic regression models.Results: Of 1530 respondents, 53.1% reported ≥1 non-adherence behavior. Non-adherence rates were 59.8% in diabetes mellitus (DM), 56.0% in rheumatic disease, 55.6% in inflammatory bowel disease, and 42.8% in human immunodeficiency virus (HIV) infection patients (p < .001). IEXPAC and BMQ scores were higher in adherent vs. non-adherent patients. In multivariate analysis, non-adherence behavior was strongly associated with lower overall BMQ, lower BMQ Necessity scores and higher BMQ Concerns scores (p < .001 for all), and with a lower IEXPAC self-management score (p = .007), but not with the overall IEXPAC score. Non-adherence was more frequent in DM patients compared with HIV infection patients (p < .001).Conclusions: Patients’ beliefs in medicines-a lower perception for the necessity of medication, and higher concerns in taking medication-and low patient self-management experience score were associated with non-adherence behavior. These are modifiable aspects that need to be addressed to increase medication adherence in chronic disease.

Assessment of medication adherence among patients with chronic diseases: a descriptive cross-sectional study

Background: Adherence is a key factor associated with effectiveness of all pharmacological therapies. Medication non-adherence is a significant barrier to achieve positive health outcomes especially for patients suffering from chronic diseases. Improving medication adherence is a public health priority and could reduce economic and health burdens. The aim of the present study was to assess medication adherence to some common chronic ailments.Methods: Pre-validated questionnaires were distributed among 300 patients suffering from chronic illnesses, by simple randomization out of which 240 patients returned completely filled questionnaires. The analysis was done by manual calculators, VassarStats, and SPSS V20. Results were calculated using univariate linear regression, with each patient’s adherence score as the dependent variable and each predictor as the independent variable. Results are expressed in frequencies and percentages.Results: In this study, 46.66% patients were males and 53.33% females. The mean age was 56.69 years ranging from 24 to 90 years.65.00% patients were uneducated.40.00% were taking one drug, 53.33% two to four drugs and 6.66% more than four drugs. 63.33% had low medication adherence, 35.00% medium and only 1.66% had high adherence. Compared to 14.28% men, 43.75% women were moderately adherent to medications. 41.02% uneducated patients had medium adherence as compared to 14.28% educated patients. 92.30% young patients had low adherence as compared to 53.25% in adults. 44.79% of patients receiving a single drug had medium adherence as compared to 25.00% in those receiving multiple drugs. Linear regression analysis demonstrated that the level of medication adherence was associated with patient gender, age, educational level, and number of prescribed drugs.Conclusions: There are many challenges in understanding the reasons for non-adherence. In this study medication adherence in chronic diseases was found suboptimal and associated with patient`s socio-demographic characteristics. Patient-tailored interventions are required to achieve sufficient adherence to therapeutic drug regimens.

Medication adherence and barriers among low-income, uninsured patients with multiple chronic conditions.

Poor adherence to long-term therapies is a public health concern that affects all populations. Little is known about the context of adherence in chronic diseases for the uninsured population in the United States. To evaluate medication adherence and barriers among low-income, uninsured adults recently initiating new therapy for a chronic disease. A cross-sectional study in two Community Health Centers located in Chatham County, Georgia, was performed between September and December 2015. Patients, randomly selected for inclusion in the study, were eligible if they had been prescribed medication for 2 or more chronic conditions and had recently started a new medication regimen. The Morisky-Green-Levine questionnaire was used to assess adherence. Potential barriers were analyzed using the Multidimensional Model proposed by the World Health Organization-social and economic, healthcare team and system-related, condition-related, therapy-related, and patient-related factors. Multivariate logistic regression models were used to analyze factors associated with non-adherence. A total of 150 participants were interviewed at 6 months after treatment initiation. Non-adherence was reported by 52% of the participants. Higher adjusted odds of non-adherence were observed in participants who did not receive information about their medications (adjusted odds ratio [AOR] = 2.40, 95% confidence interval [CI] = 1.01-5.74), did not regularly visit a primary health-care provider (AOR = 2.74, 95% CI = 1.09-6.88), and had changes in their treatment (AOR = 3.75, 95% CI = 1.62-8.70). Alternatively, adjusted odds of non-adherence were lower for patients who reported using pillboxes (AOR = 0.31, 95% CI = 0.10-0.95), having help from a caregiver (AOR = 0.15, 95% CI = 0.04-0.60), and integrating medication dosing into daily routines (AOR = 0.18, 95% CI = 0.06-0.59). Medication non-adherence was common among low-income, uninsured patients initiating therapy for chronic conditions. Several modifiable barriers highlight opportunities to address medication non-adherence through multidisciplinary interventions.

Impact of an Electronic Monitoring Intervention to Improve Adherence to Inhaled Medication in Patients with Asthma and Chronic Obstructive Pulmonary Disease: Study Protocol for a Randomized Controlled Trial.

BackgroundDespite progress in pharmacological and non-pharmacological treatment in recent years, the burden of disease among patients with asthma and chronic obstructive pulmonary disease (COPD) is high and patients are frequently hospitalized due to exacerbations. Reasons for uncontrolled diseases are manifold, but are often associated with poor inhalation technique and non-adherence to the prescribed treatment plan. This causes substantial mortality, morbidity, and costs to the healthcare system. In this respect, the study of causes for non-adherence and the development of measures to increase and maintain treatment adherence in chronic diseases is of major clinical importance.ObjectiveThe primary objective of this study is to investigate the impact of using specific, validated electronic devices on adherence to inhaled medication in patients with chronic obstructive lung diseases such as asthma and COPD. Furthermore, it aims to assess the impact of a reminder and close supervision of the course of disease and quality of life.MethodsIn this ongoing prospective, single-blind, randomized controlled study, adherence to inhaled medication is analyzed over a 6-month period in at least 154 in- and outpatients with asthma or COPD who have experienced at least 1 exacerbation during the last year. Adherence is measured using electronic data capture devices, which save the date and time of each inhalative device actuation and transfer these data daily via a wireless connection to a Web-based database. Patients are randomly assigned to either the intervention or the control group. The clinical intervention consists of an automated and personal reminder. The intervention group receives an audio reminder and support calls in case medication has not been taken as prescribed or if rescue medication is used more frequently than pre-specified in the study protocol. During the study, participants are assessed every 2 months in the form of clinical visits.ResultsRecruitment started in January 2014. To date, a total of 169 patients have been recruited. Follow-up assessments are still ongoing. The study will be concluded in the first quarter of 2017. Data analysis will take place during 2017.ConclusionsFew studies have investigated medication adherence in patients with chronic obstructive lung diseases. With this prospective study design and the use of state-of-the-art devices for measuring adherence, we expect scientifically relevant and clinically meaningful results that will have a substantial and positive impact on the provision of healthcare in chronically ill patients suffering from asthma or COPD.Trial RegistrationClinicalTrials.gov: NCT02386722; https://clinicaltrials.gov/ct2/show/NCT02386722 (Archived by WebCite at http://www.webcitation.org/6oJq1fel0)

Evaluation of medication adherence in chronic disease at a federally qualified health center.

While medication adherence in chronic disease has been evaluated in the general population, limited data are available among Medicaid recipients, especially within federally qualified health centers (FQHCs). This study determined baseline medication adherence for Medicaid recipients receiving care in an FQHC for first-line medications used in hypertension, hyperlipidemia, and diabetes. Secondary outcomes included baseline adherence for individual patient factors. Patients from the Salud Family Health Centers, an FQHC with a large percentage of both Spanish-speaking patients and providers, were included in this study. Using retrospective prescription claims reports from 1 January 2015 to 1 October 2015, medication possession ratios (MPRs) and proportion of days covered (PDC) were calculated for each medication group. Patients with adherence ⩾0.80 were considered adherent. From 1034 individual patients, 1788 medications were evaluated. Using MPRs, adherence rates were highest among medications for hypertension (67.2% adherent), followed by hyperlipidemia (67.0%), and lastly diabetes (58.0%); p < 0.001. Likewise, using PDC, adherence rates were highest for medications for hypertension (56.6%), followed by hyperlipidemia (52.2%), and lastly diabetes (45.0%); p = 0.010. Lower rates of adherence were seen among men, patients age 18-29 years old, African Americans, and patients with English documented as their preferred language. Although overall medication adherence rates within our FQHC patients were comparable with those in previous literature, differences seen among medication groups and patient individual factors suggest that there is still much to be learned in improving adherence. Future efforts will require a multifaceted approach, tailored to patient-specific needs.

Role of pharmacists in the application of the transtheoretical model approach to enhance medication adherence in chronic diseases

AbstractAdherence to prescribed medications is one of the most important aspects contributing to successful treatment. Medication adherence through self‐management of chronic diseases is thought to be necessary to achieve improvements in quality of life for patients. Many models and interventions have been tested to enhance self‐management, but to date none have been convincingly successful. The challenges inherent to disease self‐management are fundamentally socio‐behavioural issues, and the use of a model such as the transtheoretical model (TTM) has potential to be of assistance. Described here is a brief summary of a systematic review that was conducted to assess the potential for the use of the TTM in improving disease self‐management activities for patients with chronic diseases, particularly type 2 diabetic patients. Seven studies describing the effect of the TTM on different aspects of medication adherence were reviewed. All the studies reviewed suggest that a TTM approach can help patients with chronic diseases change their behaviour to incorporate more desirable characteristics that will help them manage chronic conditions. However, at present there are still not enough studies to definitively determine whether pharmacists could practically use the TTM to enhance medication adherence.