Patient Adherence Issues Research Articles

A Survey of Practice and Factors Affecting Physiotherapist-Led Health Promotion for People at Risk or with Cardiovascular Disease in Cameroon.

Cardiovascular diseases (CVDs) and associated risk factors are a growing concern in Cameroon. Physiotherapists (PTs) can play a crucial role in prevention and management. However, the extent of Cameroonian PT involvement in health promotion (HP) activities remains unclear. This study assessed Cameroonian physiotherapists' current HP practices for people at risk of or with CVDs (pwCVDs). A cross-sectional survey was administered online to PTs practising in Cameroon. Out of 181 PT responses, 95% reported providing a variety of HP activities, including weight management (74%), dietary advice (73%), physical activity (69%), smoking cessation (69%), stress management (61%), and sleep promotion (48%). While PTs were confident in lifestyle assessments, they felt less confident about sleep interventions. Strong beliefs, confidence, team support, and time allocation enhanced HP practice. However, preference for passive modalities, patient adherence issues, organisational challenges, role ambiguity among healthcare providers, inadequate training opportunities, and the absence of established guidelines for CVD prevention negatively affect HP practice. These findings highlight the challenges and opportunities for enhancing HP delivery within the physiotherapy profession in Cameroon. The findings are useful for future strategies by clinical practitioners and policy makers to address barriers and leverage facilitators effectively for scaling up HP initiatives in Cameroon.

Sex-based disparities with cost-related medication adherence issues in patients with hypertension, ischemic heart disease, and heart failure.

Identifying sources of sex-based disparities is the first step in improving clinical outcomes for female patients. Using All of Us data, we examined the association of biological sex with cost-related medication adherence (CRMA) issues in patients with cardiovascular comorbidities. Retrospective data collection identified the following patients: 18 and older, completing personal medical history surveys, having hypertension (HTN), ischemic heart disease (IHD), or heart failure (HF) with medication use history consistent with these diagnoses. Implementing univariable and adjusted logistic regression, we assessed the influence of biological sex on 7 different patient-reported CRMA outcomes within HTN, IHD, and HF patients. Our study created cohorts of HTN (n = 3891), IHD (n = 5373), and HF (n = 2151) patients having CRMA outcomes data. Within each cohort, females were significantly more likely to report various cost-related medication issues: being unable to afford medications (HTN hazards ratio [HR]: 1.68, confidence interval [CI]: 1.33-2.13; IHD HR: 2.33, CI: 1.72-3.16; HF HR: 1.82, CI: 1.22-2.71), skipping doses (HTN HR: 1.76, CI: 1.30-2.39; IHD HR: 2.37, CI: 1.69-3.64; HF HR: 3.15, CI: 1.87-5.31), taking less medication (HTN HR: 1.86, CI: 1.37-2.45; IHD HR: 2.22, CI: 1.53-3.22; HF HR: 2.99, CI: 1.78-5.02), delaying filling prescriptions (HTN HR: 1.83, CI: 1.43-2.39; IHD HR: 2.02, CI: 1.48-2.77; HF HR: 2.99, CI: 1.79-5.03), and asking for lower cost medications (HTN HR: 1.41, CI: 1.16-1.72; IHD HR: 1.75, CI: 1.37-2.22; HF HR: 1.61, CI: 1.14-2.27). Our results clearly demonstrate CRMA issues disproportionately affect female patients with cardiovascular comorbidities, which may contribute to the larger sex-based disparities in cardiovascular care. These findings call for targeted interventions and strategies to address these disparities and ensure equitable access to cardiovascular medications and care for all patients.

"Pharmacists' Role in Diabetes Management: A Qualitative Study on Contributions to Patient Education, Medication Management, and Interprofessional Collaboration"

This qualitative study investigates pharmacists’ roles in diabetes management, focusing on patient education, medication management, and interprofessional collaboration. Through semi-structured interviews with 15 pharmacists, the study reveals key themes: pharmacists significantly contribute to patient education, optimize medication regimens, and engage in collaborative care with other healthcare professionals. Challenges such as limited resources and patient adherence issues are also discussed. The findings highlight the crucial impact of pharmacists in diabetes care and provide recommendations for enhancing their role in the healthcare system.

Challenges in managing patients referred for eosinophilic esophagitis: A telephone survey and retrospective review.

Background: Eosinophilic esophagitis (EoE) in patients referred to allergists can be difficult to manage. This is due to multiple factors, including overlaps in presentation with gastroesophageal reflux disease and proton-pump inhibitor responsive eosinophilia, remaining uncertainties regarding the role of different forms of allergy testing, and a variety of patient adherence issues. Objective: To highlight, in an objectively studied fashion, complications that can be faced when managing patients referred for EoE. Methods: We conducted a telephone survey of 78 patients (pediatric and adult) who were referred to our academic allergy clinic for EoE. The survey focused on patients' perspectives regarding their symptoms and treatments. We then conducted a chart review to determine if there had been a proton-pump inhibitor (PPI) trial before diagnosis, and we compared patient responses with documented allergy test results, treatment plans, and biopsy results. Results: Only 22 of 78 patients (28%) had a ≥8-week PPI trial before diagnosis and/or referral. There was considerable variability in the type of allergy testing done for patients, and how the results were used to guide therapy. More than one-third of the patients reported being on a different treatment regimen (PPI, swallowed steroid, and/or diet) than planned, and the majority of patients on dietary therapy reported being on a different diet than planned. Also, nearly half of the adult patients did not have follow-up biopsies done despite recommendations for this. Conclusion: We identified several challenges in EoE management, including potential misdiagnosis or overtreatment, lack of standardization in testing and dietary recommendations, and patient adherence issues. We hope this information will prompt increased vigilance for these issues and promote solutions when needed.

Impact of an integrated oral chemotherapy program on patient adherence.

As the use of oral chemotherapy continues to rise, the issue of patient adherence is a concerning aspect of cancer treatment. In this concurrent prospective and retrospective study, we assessed oral chemotherapy adherence in patients receiving their prescriptions at an institutional specialty pharmacy, with an integrated oral chemotherapy program. The primary endpoint is medication possession ratio. Secondary endpoints include self-reported adherence comparing survey data before and after the introduction of the oral chemotherapy program to assess the impact of the comprehensive pharmacy services provided. Patients receiving their oral chemotherapy from the institutional specialty pharmacy have a mean medication possession ratio of 0.92, indicating excellent adherence rates. The oncology clinical pharmacist, in collaboration with the specialty pharmacy, has also decreased the rates of patient-reported non-adherence.

Treating rheumatoid arthritis to target: physician and patient adherence issues in contemporary rheumatoid arthritis therapy.

Development of the treat-to-target (T2T) strategy, the process whereby drug therapy is adjusted until the therapeutic goal is achieved, has revolutionized how rheumatoid arthritis (RA) patients are treated. With the advent of T2T, the management of RA is more effective than ever, with the possibility of remission and other favorable clinical and patient-reported outcomes. Effective implementation of a T2T strategy in routine clinical practice mainly depends on the long-term commitment of physician and patient to T2T treatment recommendations. However, as T2T is a complex process involving aggressive early management with several steps of therapy modifications requiring frequent close monitoring of disease activity and drug toxicities, it may be more liable to suboptimal adherence in real-life clinical practice. The aim of the review is to present key issues related to patient medication adherence and physician adherence to the current RA treatment recommendations and their importance in optimizing the outcome of treatment in RA treated according to T2T strategy.

Comprehensive Study of Patients' Compliance with Sublingual Immunotherapy in House Dust Mite Perennial Allergic Rhinitis.

Allergen immunotherapy is a long-term treatment that has been associated with patient adherence issues. The aim of the study was to increase the knowledge on compliance of patients allergic to house dust mites, receiving sublingual immunotherapy (SLIT). A retrospective observational study was performed in 53 Spanish allergy units. We enrolled patients undergoing the SLIT treatment for house dust mites including a scheduled control visit 12months after initiating the therapy. We conducted a comprehensive assessment of compliance using three methods. In the first step, an allergist evaluated the patients according to the results of an interview and the existing medical records. The subjects taking more than 80% of the overall prescription were defined as compliant. The remaining noncompliant patients were divided into groups taking less than 25%, 25-50%, and 50-80% of the prescribed SLIT. In the second stage, we conducted the Morisky-Green test. Finally, the noncompliant patients were asked to fill a self-report assessment form. Data were stratified into age groups. The potential factors affecting compliance were also investigated. Overall, 380 subjects participated in the study. The compliance rate was 79.7%, and the treatment discontinuation rate was 22.5%, while 66.8% of patients were adherent (both compliant and continuing with the treatment). The results showed that children were the most compliant and adolescents the least compliant (86.6% and 60.9%, respectively). The main reason for noncompliance was "forgetting some doses" in 31.0% of the children, 48.0% of the adolescents, and 53.2% of the adults. Compliance was associated with the following factors: age, number of annual control visits, and reduction in symptomatic medication. Our results showed that two out of three patients with house dust mite-induced allergic rhinitis adhered to the SLIT treatment. Multidisciplinary and integral solutions are needed to improve the compliance, with special attention paid to adolescents. Stallergenes Greer Spain.

A novel implantable device for the treatment of obstructive sleep apnea: clinical safety and feasibility.

ObjectiveMany cases of obstructive sleep apnea (OSA) involve collapse of the tongue base and soft palate during sleep, causing occlusion of the upper airway and leading to oxygen desaturation. Existing therapies can be effective, but they are plagued by patient adherence issues and the invasiveness of surgical approaches. A new, minimally invasive implant for OSA has been developed, which is elastic and contracts a few weeks after deployment, stabilizing the surrounding soft tissue. The device has had good outcomes in preclinical testing; this report describes the preliminary feasibility and safety of its implementation in humans.Patients and methodsA prospective, multicenter, single-arm feasibility study was conducted. Subjects were adults with moderate-to-severe OSA who had previously failed or refused conventional continuous positive airway pressure treatment. Intraoperative feasibility data, postoperative pain, and safety information were collected for a 30-day postoperative period.ResultsForty subjects participated (37 men, three women; average age of 46.1 years); each received two tongue-base implants and two soft-palate implants. Surgical procedure time averaged 43 minutes. Postsurgical pain resolved readily in most cases; at 30 days post implantation, <20% of subjects reported pain, which averaged less than two out of ten. Adverse events were generally the mild and expected sequelae of a surgical procedure with general anesthesia and intraoral manipulation. The device was well tolerated. Implant extrusions were reported with soft-palate implants (n=12), while tongue-base implants required few revisions (n=2). Quantitative and qualitative sleep effectiveness outcomes (including full-night polysomnographic and quality-of-life measures) will be presented in a subsequent report.ConclusionImplantation of the device was feasible. Although a relatively high rate of extrusions occurred in the now-discontinued palate implants, tongue-base implants were largely stable and well tolerated. The minimally invasive and maintenance-free implant may provide a new alternative to higher morbidity surgical procedures.

Patient after myocardial infarction: how to reduce the risk of recurrent ischemic events?

The review article highlights concerns related to a low survival rate in patients after myocardial infarction (MI) and factors affecting it. The pivotal role is given to the issue of patient adherence to therapy after acute coronary events. The options to improve it as well as mechanisms to optimize medical therapy for patients after myocardial infarction, particularly the need for prolonged dual antiplatelet therapy (DAPT), have been identified. The rationale for changing the current guidelines for the management of patients with acute coronary syndromes (ACS) is based on the findings of the recently completed international clinical trial PE- GASUS-TIMI 54 with ticagrelor (Brilinta®), utilized as part of a DAPT regimen, that have demonstrated the efficacy and safety of DAPT prolongation after 12-month period in post-MI patients.

Treatment milestones in chronic myelogenous leukemia: stay the course or change therapy?

The success of various generations of tyrosine kinase inhibitors in chronic myelogenous leukemia (CML) is well-known, with many patients experiencing long-term benefits from treatment. However, not every patient with CML can tolerate this therapy, shows response to initial treatment, or avoids disease progression or drug resistance. During his presentation at the NCCN 20th Annual Conference, Jerald Radich, MD, shared his thoughts and some supportive data on the critical role of monitoring response at 3 months, the often-neglected yet key issue of patient adherence to therapy, the recommended timing for mutational analysis, and the pressing need to prevent patients from going from chronic-phase disease into accelerated phase/blast crisis.

Patient adherence issues in the treatment of hepatitis C.

The current standard-of-care treatments for chronic hepatitis C, based on a bitherapy that combines peginterferon alpha-2a or -2b and ribavirin for all genotypes, and on a triple therapy with the addition of an antiprotease specifically for genotype 1, are associated with a limited adherence that decreases their efficacy. The main factors limiting adherence are difficulties in taking the treatment and side effects that worsen the quality of life of the patients. Programs of therapeutic education are essential to improve adherence, quality of life, likelihood of viral suppression, improvement of liver disease, and decrease of late complications. Therapeutic education should be understood as an acquisition of decisional, technical, and social competency with the purpose of making the patient able to make health choices, realize their own life plans, and use health care resources in the best manner. The patient should be placed in the center of an organization, comprising various care workers who include social service professionals and medical staff. For hepatitis C, therapeutic education may be separated into three phases: a first phase corresponding to the educative diagnosis; a second phase corresponding to support during treatment; and the third phase corresponding to support after treatment. Therapeutic education is performed using various instruments and methods specifically adapted to the needs and expectations of individual patients. Upcoming treatments for hepatitis C, with evidence for high efficacy, few side effects, and shorter duration, will certainly change the landscape of adherence and the management of therapeutic education.

Medication adherence issues in patients: focus on cost

Correspondence: Doreen Matsui Children’s Hospital, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, N6C 2V5 Canada, Tel +1 519 685 8268 Fax +1 519 684 8156 Email dmatsui@uwo.ca Abstract: Advances in drug therapy have resulted in efficacious treatments being available; however, the benefit may be lost if prescribed medications are not taken properly. Unfortunately, poor medication adherence is common and widespread, affecting all age groups and disease conditions. Adherence is a factor in health outcomes of pharmacotherapy with possible failure to achieve therapeutic goals and worsening of illness. Higher health care costs may result from more frequent physician and emergency department visits and increased hospitalization rates. The cost of medications may play a role in whether patients do or do not take their medication with increased cost sharing leading to poorer adherence with prescription drugs. Given the possible adverse consequences of nonadherence, interventions to improve medication-taking behavior are encouraged although not consistently successful. Surprisingly, there is relatively little information on the cost-effectiveness of these interventions and more methodologically sound research is needed in this area. Alternative strategies that have been proposed are valuebased insurance design and the use of financial incentives, although the former has not been widely accepted, and the latter is ethically controversial. This article reviews some of the main issues with regards to adherence with drug therapy including some of the cost implications of less than optimal medication adherence.

The Meaning of Antipsychotic Medication to Patients With Schizophrenia

To explore the meaning of taking antipsychotic medication in a population with schizophrenia. A literature review of publications on the meaning of medication was conducted using PsycINFO, Medline, and SOCINDEX databases (2001-2012) and search terms attitude or meaning plus antipsychotics or neuroleptics. Based on this search, 110 articles were found, 60 of which were judged relevant to the goal of this article. A recently published expert consensus guideline was also used to better understand current thinking about medication adherence issues in patients with severe mental illness. Quotations from patients attending a women's clinic for psychosis were used to expand on themes found in the literature. Themes extracted from the reviewed literature fell into three main categories: a) control by and of medication, b) dependence on medication and on the prescriber, and c) stigma resulting from medication use. These themes contrast with the usual medical associations with medication (e.g., symptom relief or side effects). Shared discussion of beliefs about medication between patient and care provider allows wider exploration of personal meanings that can help establish therapeutic relationships and integrate psychological therapy with psychopharmacology.

Home-based blood pressure interventions for blacks.

Efforts to increase blood pressure (BP) control rates in blacks, a traditionally underserved high-risk population must address both provider practice and patient adherence issues. The home-based BP Intervention for blacks study is a 3-arm randomized controlled trial designed to test 2 strategies to improve hypertension management and outcomes in a decentralized service setting serving a vulnerable and complex home care population. The primary study outcomes are systolic BP, diastolic BP, and BP control; secondary outcomes are nurse adherence to hypertension management recommendations and patient adherence to medication, healthy diet, and other self-management strategies. Nurses (n=312) in a nonprofit Medicare-certified home health agency are randomized along with their eligible hypertensive patients (n=845). The 2 interventions being tested are (1) a "basic" intervention delivering key evidence-based reminders to home care nurses and patients while the patient is receiving traditional postacute home health care; and (2) an "augmented" intervention that includes that same as the basic intervention, plus transition to an ongoing Hypertension Home Support Program that extends support for 12 months. Outcomes are measured at 3 and 12 months after baseline interview. The interventions will be assessed relative to usual care and to each other. Systems change to improve BP management and outcomes in home health will not easily occur without new intervention models and rigorous evaluation of their impact. Results from this trial will provide important information on potential strategies to improve BP control in a low-income chronically ill patient population.

Levodopa/carbidopa/entacapone 200/50/200 mg (Stalevo® 200) in the treatment of Parkinson's disease: a case series

Levodopa continues to be the most efficacious and widely used treatment for Parkinson’s disease. Levodopa dosing is understood to be critical for the optimal control of symptoms, and increasing the levodopa dose is a common method to treat advancing disease. Escalating levodopa dosages coupled with disease progression is associated with increasing likelihood of developing levodopa-induced dyskinesia. Moreover, frequent and complicated dosing schemes, combined with limited dose availability, leads to increasing pill burden and its associated impairment of patient adherence issues. Levodopa/carbidopa/entacapone has been shown to improve the pharmacokinetic profile of levodopa and provide superior symptomatic control compared with conventional levodopa/dopa decarboxylase inhibitor therapy. We report four case histories describing clinical experience of using levodopa/carbidopa/entacapone 200/50/200 mg, one of the latest doses of this formulation, in a range of patients with Parkinson’s disease. These cases illustrate that levodopa/carbidopa/entacapone 200/50/200 mg provides improvements in symptomatic control and convenience, and that switching to this dose was not associated with safety concerns.

Compliance, adherence, and the treatment of multiple sclerosis

With the availability of disease-modifying, immunomodulatory therapies (DMT) for multiple sclerosis (MS) and the first long-term studies, it became obvious that problems of compliance to complex treatment regimens under chronic conditions would also apply to these approaches. In a selective overview, problems and findings of adherence research are depicted. Based on a discussion of basic concepts, issues of operationally defining and measuring adherence are outlined. Descriptive findings on adherence to DMTs and empirical predictors of nonadherence are then discussed. Referring to theoretical models of treatment motivation, selected problems (e. g., indication) and strategies of promoting adherence are described. Finally, implications of modern concepts of the patient-therapist relationship for the issue of patient adherence are considered.

Medication adherence issues in patients treated for COPD

Although medical treatment of COPD has advanced, nonadherence to medication regimens poses a significant barrier to optimal management. Underuse, overuse, and improper use continue to be the most common causes of poor adherence to therapy. An average of 40%-60% of patients with COPD adheres to the prescribed regimen and only 1 out of 10 patients with a metered dose inhaler performs all essential steps correctly. Adherence to therapy is multifactorial and involves both the patient and the primary care provider. The effect of patient instruction on inhaler adherence and rescue medication utilization in patients with COPD does not seem to parallel the good results reported in patients with asthma. While use of a combined inhaler may facilitate adherence to medications and improve efficacy, pharmacoeconomic factors may influence patient's selection of both the device and the regimen. Patient's health beliefs, experiences, and behaviors play a significant role in adherence to pharmacological therapy. This manuscript reviews important aspects associated with medication adherence in patients with COPD and identifies some predictors of poor adherence.

A retrospective study of compliance (adherence) with a care pathway in periodontal therapy in a primary care setting

Recently the issue of patient adherence with prolonged periodontal therapy and the importance of smoking and its influence as a significant co-factor in the outcome of treatment for patients with periodontal disease has been of interest to health care professionals. This paper is an audit of adherence in regard to both smoking cessation for those who admitted to a smoking habit at the initial examination and patient compliance with a periodontal treatment protocol. During the initial examination, patients referred to the practice with periodontal problems were photographed both with and without lip retractors as part of their clinical record, and a charting of the teeth made with any 5 mm or greater probing depths recorded. Tooth mobility and furcation involvement of molar teeth were also charted. Two separate time periods (Series 1 and Series 2) were audited in this study. Patients enrolled in Series 2 were routinely asked about their smoking habits at the initial examination. Two time periods were audited, as the initial purpose of the investigation was to audit the success of the practice in treating this group of patients, and to identify any improvements that could be made in care provision as each audit cycle was completed. Primary care setting. Patient adherence rates were high through all the various stages of periodontal therapy, even though the treatment protocol took over 18 months to complete. Approximately 55% of patients in both time periods presented for the one-year post treatment re-evaluation appointments. 56.5% of the patients reported they had smoked to within five years of their initial consultation, of which 38% reported that they had stopped by the time they had completed the initial hygiene phase of treatment. With a comprehensive and clearly defined supportive periodontal care programme (SPC), this paper demonstrates that high adherence levels can be achieved in a primary care setting. The results suggest that treatment should include not only the teaching of an effective oral hygiene regime, but also include giving advice in relation to smoking cessation for those patients who admit to a smoking habit at the initial examination. Patients who smoked and chose to have treatment for their periodontal condition went on to report good adherence with smoking cessation advice. Continuing supportive smoking cessation (SSC) advice should be part of any effective SPC programme. New methods of treating periodontal disease that become available to practitioners in the future should use established benchmarks against which to evaluate the success of any new treatment strategy.

The Value and Challenges of Improving Adherence to Antiretroviral Therapy for Human Immunodeficiency Virus

Empirical support for the cost of human immunodeficiency virus (HIV) treatment adherence interventions offers a timely contribution to the HIV treatment research and clinical literature. The issue of patient adherence or compliance, however, is not new. Clinicians and researchers have grappled with

How Can Osteoporosis Patients Benefit More from Their Therapy? Adherence Issues with Bisphosphonate Therapy

To review the evidence on adherence with bisphosphonates and evolving dosing strategies for osteoporosis treatment. Articles were identified by searching MEDLINE (1975-December 2005) using the following terms: osteoporosis, postmenopausal, fracture, adherence, compliance, persistence, drug therapy, bisphosphonates, alendronate, risedronate, ibandronate, and zoledronate. Additional data included bibliographies from identified articles. All pertinent English-language articles that discussed adherence issues in patients with osteoporosis were included. Both those that reviewed overall issues of medication adherence in osteoporosis and those that focused specifically on adherence to bisphosphonates were included, as were articles that addressed strategies for overcoming nonadherence. Inadequate diagnosis and treatment of osteoporosis result in a higher risk of fractures than is necessary. Even patients who are diagnosed and beginning treatment often do not persist with their osteoporosis medication because they perceive their fracture risk to be low and, given the asymptomatic nature of osteoporosis, do not experience the benefit of symptom reduction after taking the drugs. Factors that affect adherence to osteoporosis therapy include drug costs, adverse effects, dosing frequency, disease education, patient follow-up, and patient involvement in treatment decisions. By considering and implementing strategies that can improve adherence and persistence, primary care providers and pharmacists (via counseling) may enhance long-term outcomes for patients with osteoporosis.