Medication Adherence Research Articles

Frailty, comorbidity, and multimorbidity and their relation with medications adherence in primary care older adults.

To assess and compare, through a retrospective cohort study, the relationships between frailty, comorbidity, multimorbidity, and levels of adherence to lipid-lowering drugs (LLDs), antihypertensives and antidepressants. In a primary care database, we selected a cohort of patients aged 60 or older on December 31, 2022. The date of the first prescription of the aforementioned medications was the study index date. Patients with Variable Medication Possession Ratio (VMPR) > = 80% were classified as properly adherent. Frailty (i.e. Primary Care-Frailty Index), comorbidity (i.e. Charlson Index) and multimorbidity (i.e. disease counts) alternatively entered multivariate logistic regressions along with age and sex. Models' performances in prediction of medications adherence were compared in terms of information (AIC; BIC) and discrimination values (AUC). Incident users of LLDs, antihypertensives or antidepressants were 4310 (mean age: 67.9 (SD: 6.9); 56.0% females), 5969 (mean age: 69.1 (SD: 7.6); 58.0% females), and 3834 (mean age: 68.7 (SD: 6.9); 66.5% females), respectively. Among users of LLDs (46% adherent) and antidepressants (22% adherent), those who were moderately or severely frail showed a significant 30-32% decrease in adherence. In contrast, users of antihypertensives (46% adherent) showed a 41% increase in adherence when multimorbid. As a whole, the three multivariate models were equally effective in informing on medication adherence, as per AIC and BIC. They also displayed similar discriminatory ability, with AUC scores ranging from 53 to 58%. Regarding the workload of GPs, the number of elderly patients classified as moderately/high frail was less than those with co-morbidities or multimorbidities. For instance, there were approximately 35 users of antihypertensive medications per GP for the moderately frail group, compared to 46 and 66 for the co-morbid and multi-morbid groups, respectively. These findings showed similar capacity for frailty, comorbidity, and multimorbidity in capturing medications adherence. Given the existence of a validated tool in primary care that aligns well with GPs' workload, frailty seems the most suitable measure for assessing the complexity of older adults in relation to their adherence to long-term medications.

Nurse-Led Multicomponent Behavioral Activation Intervention for Patients With Atrial Fibrillation: A Randomized Controlled Trial.

Patients with atrial fibrillation (AF) are often ill-equipped for shared decision-making. This study investigated the effects of a patient empowerment care model on patient-reported health outcomes and treatment decision-making in patients with AF. This randomized controlled trial prospectively randomized patients with AF to receive standard care (n=194) or a 13-week nurse-led multicomponent behavioral activation intervention (n=198). The intervention consisted of risk profile assessments, empowered shared decision-making regarding the use of oral anticoagulants (OACs), empowered AF self-management, and increased access to professional advice. The primary outcome was health-related quality of life measured after the completion of the intervention (T1), while the secondary outcomes were patient-physician decision concordance regarding OAC use, actual OAC use, AF knowledge, medication adherence, anxiety, and depression. The intervention group showed significantly greater improvements in health-related quality of life (β, -6.702 [95% CI, -9.556 to -3.847]; P<0.001), AF knowledge (β, -1.989 [95% CI, -2.342 to -1.635]; P<0.001), and medication adherence (β, 0.340 [95% CI, 0.148-0.532]; P<0.001) at immediate post-intervention compared with the control group, and the improvements were sustained at 6 months for all outcomes. A higher proportion of patients in the intervention group were prescribed an OAC compared with the control group at 6 months (odds ratio, 5.870 [95% CI, 1.957-12.331]; P=0.012). No significant between-group differences were detected for patient-physician decision concordance regarding OAC use, anxiety, or depression at both time points. The nurse-led multicomponent behavioral activation intervention improved patient-reported outcomes and increased OAC prescription among patients with AF.

Impact of anxiety symptoms on dialysis adherence and complication rates: A longitudinal observational study

BACKGROUND Anxiety is a common psychological comorbidity in patients undergoing dialysis, yet its impact on treatment adherence and complication rates remains understudied. We designed a longitudinal observational study to investigate these relationships, based on the hypothesis that higher anxiety symptoms would be associated with increased complication rates and negatively associated with adherence to the dialysis regimen. AIM To investigate the relationship between anxiety symptoms, dialysis adherence, and complication rates in patients undergoing dialysis over a 24-month period. METHODS This observational study analyzed data from 250 adult patients who underwent hemodialysis or peritoneal dialysis at three Affiliated Hospitals of Youjiang Medical University for Nationalities over a period of 24 months. Anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale-Anxiety subscale at baseline and every 6 months. Dialysis adherence was evaluated through attendance records, interdialytic weight gain, and patient-reported medication adherence. We recorded complications (infections, cardiovascular events, and hospitalizations) and used mixed-effects models and survival analyses to infer associations between anxiety symptoms, adherence measures, and complication rates. RESULTS Higher anxiety symptoms were significantly associated with poorer dialysis adherence, including increased missed sessions [incidence rate ratio = 1.32, 95% confidence interval (CI): 1.18-1.47, P &lt; 0.001], greater interdialytic weight gain (β = 0.24, 95%CI: 0.15-0.33, P &lt; 0.001), and lower medication adherence (odds ratio = 0.85, 95%CI: 0.78-0.93, P &lt; 0.001). Patients with clinically significant anxiety (Hospital Anxiety and Depression Scale-Anxiety subscale ≥ 8) had a higher risk of complications [hazard ratio (HR) = 1.68, 95%CI: 1.32-2.14, P &lt; 0.001], particularly infections (HR = 1.89, 95%CI: 1.41-2.53, P &lt; 0.001) and cardiovascular events (HR = 1.57, 95%CI: 1.18-2.09, P = 0.002). The relationship between anxiety and complications was partially mediated by adherence measures. CONCLUSION Anxiety symptoms in patients undergoing dialysis are associated with poorer treatment adherence and increased complication rates. Regular screening and targeted interventions to address symptoms may improve adherence and clinical outcomes.

Medication refills do not guarantee medication intake: translation and validation of the adherence to refills and medications scale in traditional Chinese among individuals with type 2 diabetes in Taiwan

ABSTRACT Objective This study aimed to translate and validate the Adherence to Refills and Medications Scale into Traditional Chinese (ChARMS-T) and to investigate common barriers to medication adherence among patients with type 2 diabetes (T2D) in Taiwan. Methods The ChARMS-T was developed through translation and application phases. During the translation phase, the scale underwent forward translation, backward translation, and cognitive debriefing. In the application phase, the finalized ChARMS-T was administered to patients with T2D at five Taiwan community pharmacies over nine months starting in September 2023. Psychometric properties were assessed using criterion validity, construct validity through confirmatory factor analysis, and reliability through McDonald’s omega. Results A total of 343 participants completed surveys. Factor analysis of the 12-item ChARMS-T revealed two dimensions: medication-taking (8 items) and medication refill (4 items). The instrument demonstrated acceptable internal consistency, with McDonald’s omega scores of 0.841 for medication-taking and 0.647 for medication refill. The medication refill subscale showed strong agreement with the objective refill measure, proportion of days covered, with a coefficient of 0.84, suggesting that these measures evaluate similar constructs. Evidence of known-groups validity was demonstrated by a significant difference between ChARMS-T scores and glycemic control (p = 0.047). Patients with good glycemic control had a significantly higher adherence rate to both refills and medication-taking compared to those with poor glycemic control. The most frequently reported barriers to medication-taking were carelessness (55.7%), forgetfulness (54.8%), and frequent dosing intervals (43.1%). For medication refills, 9.6% of the participants identified a lack of planning as the main reason for not refilling their diabetes medications on time, followed by forgetfulness (7.6%). Conclusions The ChARMS-T identified a broader range of non-adherence reasons and demonstrated good psychometric properties. It can be integrated into practice settings for screening and follow-up to enhance medication adherence through effective communication between healthcare professionals and patients, ultimately improving long-term patient health outcomes.

Factors Influencing Medication Adherence in Heart Failure Patients-A Survey among Cardiac Healthcare Providers.

Adhering to medication regimens is key behavior to alleviate symptoms and slow disease progression in heart failure (HF). This study explores cardiac healthcare providers' perceptions and experiences of factors influencing medication adherence (MA) in HF patients, with findings contributing to developing a HF-specific MA assessment scale. Using a cross-sectional, mixed methods design, we conducted an online survey with both closed and open-ended questions distributed to cardiac healthcare providers, working at the National University Hospital in Iceland. The survey consisted of 103 questions divided into 18 themes. Analysis included descriptive statistics of the participants' responses to closed responses with simplified scoring. Free-text responses were grouped into thematic categories and then into subthemes. Of 104 healthcare providers invited, 73 (70%) participated. Key factors identified as most beneficial for supporting MA included supportive patient-provider relationships (97%), selecting suitable drug formulation (96%), healthcare support at home (95%), and multi-dose dispensing from pharmacies (93%). The youngest and oldest HF patients were believed to be at the highest risk of medication non-adherence, particularly among males. Other patients estimated at increased risk included those with alcohol and/or substance abuse (89%), those with limited knowledge of medication effects (89%), those perceiving medication as useless (88%), and those with cognitive impairment (86%). Most participants (73%) agreed that healthcare providers should assess and document MA in clinical care. These findings provide a comprehensive overview of factors that cardiac healthcare providers believe influence non-adherence in HF patients, contributing to the development of a HF-specific MA scale.

Effectiveness of Telemedicine in Inflammatory Bowel Disease in Russia: TIGE-Rus (Telemonitoring for IBD Goodness Examination in Russia) Study Protocol of a Randomized Controlled Trial

Background: Inflammatory bowel diseases (IBD), associated with a significant burden on patients’ lives, are becoming increasingly common. Patients with IBD need continuous treatment and lifelong monitoring, which could be achieved by telemonitoring. Telemonitoring has been shown to be effective in improving outcomes for patients with IBD, and can provide a more convenient and accessible way for patients to receive care. However, the certainty of evidence remains low. This article outlines the methodology of a randomized control study that aims to assess the efficacy of telemonitoring compared to face-to-face follow-up for patients with IBD in Russia, hypothesizing that the implementation of telemonitoring will lead to improvement in clinical, social, and organizational areas. Methods: The TIGE-Rus study is a randomized controlled trial. The study consists of three stages, including selection of patients and random assignment into two groups with a ratio of 1:1, follow-up care using telemonitoring or face-to-face appointments, and evaluation and comparison of follow-up efficacy in both groups. In the first stage, all patients will undergo laboratory tests and instrumental examinations, and fill out questionnaires to measure disease activity, quality of life, medication adherence, psychological well-being, and satisfaction with medical care. In the second stage, the control group will receive standard care while the telemonitoring group will have access to a web platform where they can report their clinical activity, fill out questionnaires, and have online consultations with gastroenterologists. The gastroenterologists will also make monthly phone calls to each patient in the telemonitoring group to monitor their progress. In the third stage of the study, both the telemonitoring group and the control group will be re-hospitalized after six months of monitoring. IBD activity will be evaluated through laboratory and instrumental examinations. Additionally, all the participants will complete questionnaires to assess the disease activity, medication adherence, quality of life, psychological well-being, and satisfaction with medical care in both groups. Conclusions: The trial will explore whether telemonitoring is effective in improving clinical, social, and organizational aspects in the management of patients with IBD in the setting of the Russian healthcare system.

Beliefs of patients who visited community pharmacies about medicines and supplements, the need for drug therapy and medication adherence – a cross-sectional study

Beliefs of patients who visited community pharmacies about medicines and supplements, the need for drug therapy and medication adherence – a cross-sectional study

Chronic kidney disease and adherence improvement program by clinical pharmacist-provided medication therapy management; a quasi-experimental assessment of patients’ self-care perception and practice

RationaleOne of the critical roles of pharmacists in the field of community and hospitals is to provide medication therapy management (MTM) services and reconciliation.ObjectivesThis study aimed to assess the perceptions, adherence, and performance of the patients with chronic kidney disease (CKD) to the clinical pharmacist-provided MTM before and after receiving this service.MethodA cross-sectional survey was conducted from June 2023 to January 2024. A validated questionnaire assessed patients’ knowledge, attitude, and performance, and the Morisky medication adherence scale evaluated the medical adherence of the patients before and after the clinical pharmacist-provided MTM. Inclusion criteria were patients with CKD according to NKF KDOQI guidelines and GFR < 60 mL/min/1.73 m2. Before and after the MTM service, CKD patients’ knowledge, attitude, performance, and adherence to their pharmacotherapy were assessed.ResultsA total of 100 patients enrolled in the study and completed the questionnaire. Before and after the MTM service, total knowledge was 3.38 ± 1.82 and 7.59 ± 1.11, respectively. Before and after the MTM service, the attitude score was 54.53 ± 5.05 and 59.24 ± 4.68, respectively. Before and after the MTM service, the mean performance score was 30.15 ± 4.27 and 34.54 ± 2.56, respectively. Adherence score to medications before and after the MTM service was 4.86 ± 1.99 and 6.22 ± 1.39, respectively. In all fields, outcomes significantly improved (P < 0.05).ConclusionThe current study showed the critical role of clinical pharmacists in training patients about medications and improving adherence to their pharmacotherapy.

Behavioral problems in children with unoperated rheumatic heart disease at national referral hospital in Ethiopia: an observational study

BackgroundThe behavioral disorder is characterized by a profound abnormality in an individual’s cognition, emotion or behavior that reflects in psychological, biological or developmental dysfunction. Rheumatic heart disease (RHD) is a long-term sequel of single or recurrent acute rheumatic fever. Children with RHD are thought to be at increased risk for behavioral problems due to autoimmunity seen in pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Behavior disorder is not well studied among children with RHD. Hence, this study aimed to assess the pattern and predictors of behavioral problems among children with RHD enrolled in chronic care at a national cardiac referral Hospital.MethodsThis cross-sectional study used a validated parental-reported Amharic Strengths and Difficulties Questionnaire (SDQ) to assess behavior problems. Children with RHD aged 6–17 years on chronic outpatient cardiac care at Tikur Anbessa Specialized Hospital, Ethiopia between February and May 2023 were included. Factors associated with behavior problems were assessed using logistic regression models.ResultsThe study included 166 children with a median age of 15 years [Interquartile range (IQR):13–17 years]. One-fourth of children, 24.7% (95% CI: 18.34–31.98), had behavioral problems. Of these, 46.4% (77) emotional, 35.5% (59) peer, 18.1% (30) conduct and 6.6% (11) hyperactivity problems were documented. Children who had good medication adherence, adjusted odds ratio AOR 0.29(95% CI: 0.09–0.94, P 0.040) and on New York Health Association (NYHA) class I, AOR 0.28(95% CI: 0.11–0.79, P 0.016) had lower odds for behavioral problems.ConclusionOne-fourth of children with RHD had behavioral abnormalities. Medication adherence and NYHA predicted behavioral abnormality. Better physical symptom control was associated with fewer behavioral problems. Behavioral abnormalities should be considered and assessed among children with RHD. Further multi-center mixed studies are recommended to uncover the unseen behavioral problem and guide health policy action on modalities of integration of behavioral problems assessment tools in clinical care.

A new bandit setting balancing information from state evolution and corrupted context

We propose a new sequential decision-making setting, combining key aspects of two established online learning problems with bandit feedback. The optimal action to play at any given moment is contingent on an underlying changing state that is not directly observable by the agent. Each state is associated with a context distribution, possibly corrupted, allowing the agent to identify the state. Furthermore, states evolve in a Markovian fashion, providing useful information to estimate the current state via state history. In the proposed problem setting, we tackle the challenge of deciding on which of the two sources of information the agent should base its action selection. We present an algorithm that uses a referee to dynamically combine the policies of a contextual bandit and a multi-armed bandit. We capture the time-correlation of states through iteratively learning the action-reward transition model, allowing for efficient exploration of actions. Our setting is motivated by adaptive mobile health (mHealth) interventions. Users transition through different, time-correlated, but only partially observable internal states, determining their current needs. The side information associated with each internal state might not always be reliable, and standard approaches solely rely on the context risk of incurring high regret. Similarly, some users might exhibit weaker correlations between subsequent states, leading to approaches that solely rely on state transitions risking the same. We analyze our setting and algorithm in terms of regret lower bound and upper bounds and evaluate our method on simulated medication adherence intervention data and several real-world data sets, showing improved empirical performance compared to several popular algorithms.

Immunosuppressant nonadherence profile in kidney transplant recipients and the impact of medication adherence on transplant outcomes

BackgroundDespite the fact that 1-year graft and recipient survival rates are above 90% in most transplant centers, improving long-term graft survival remains an important challenge. Immunosuppressant nonadherence has been recognized as one of the important risk factors for long-term graft failure. Understanding the modifiable correlates and risk factors for medication non-adherence is essential to develop interventions to improve adherence and thus long-term transplantation outcomes.MethodsThis study conducted a questionnaire survey on 431 renal transplant recipients who were followed up in the outpatient clinic between January 2022 and January 2023, and 409 valid questionnaires were returned. The BAASIS questionnaire was used to assess the prevalence of nonadherence to immunosuppressive therapy (implementation phase) in Chinese renal transplant recipients and to explore the multilevel correlates of immunosuppressive nonadherence. The BAASIS questionnaire was used to categorize renal transplant recipients into adherent (n = 239) and non-adherent (n = 170) groups, and a prospective cohort study with a 1-year follow-up was conducted to explore the impact of immunosuppressant non-adherence on clinical outcomes.ResultsThe prevalence of nonadherence to immunosuppressant therapy in renal transplant recipients in this study was as high as 41.6%. The number of years post-transplant (OR: 1.240, 95% CI: 1.136–1.353, p &amp;lt; 0.001) and the frequency of twice-daily dosing (OR: 5.145, 95% CI: 2.690–9.840, p &amp;lt; 0.001) were positively correlated with immunosuppressive nonadherence. There was a significant difference in TAC IPV (Intra-individual Variability) between the adherent and nonadherent groups (22.7 ± 8.7 vs. 25.4 ± 11.6, p = 0.010). Renal function remained stable during the follow-up period in the recipients in the adherence group and tended to decrease in the recipients in the non-adherence group (F = 4.932, p = 0.001). The rates of graft loss (7.1% vs. 1.7%, p = 0.006) and rejection (12.4% vs. 4.2%, p = 0.002) were higher in the nonadherent group than in the adherent group.ConclusionLonger time post-transplant and higher frequency of immunosuppressive dosing were positively associated with nonadherence to immunosuppressives medication. Immunosuppressant nonadherence was associated with adverse graft outcomes.

Serum fatty acid profiles in systemic lupus erythematosus and patient reported outcomes: The Michigan Lupus Epidemiology &amp; Surveillance (MILES) Program

IntroductionDespite progress in systemic lupus erythematosus (SLE) treatment, challenges persist in medication adherence due to side effects and costs. Precision nutrition, particularly adjusting fatty acid intake, offers a cost-effective strategy for enhancing SLE management. Prior research, including our own, indicates that increased consumption of omega-3 polyunsaturated fatty acids (PUFAs) correlates with improved outcomes in SLE patients. Here we build upon these findings by investigating associations between serum fatty acids—grouped as PUFAs, monounsaturated fatty acids (MUFAs), and saturated fatty acids (SFAs)—and lupus activity, pain, and sleep disturbance.MethodsUsing data from 418 participants with SLE in the Michigan Lupus Epidemiology and Surveillance (MILES) Cohort, we examined associations between serum levels of 25 fatty acids determined by GC-MS and patient-reported outcomes. Disease activity, pain, and sleep quality were assessed using standardized questionnaires. Generalized additive models and partial residual plots were utilized to examine the linearity of fatty acid effects. Variable selection was performed using Least Absolute Shrinkage and Selection Operator (LASSO), followed by multiple linear regression adjusting for sociodemographic factors.ResultsFindings indicated favorable associations between ω-3 PUFAs—and, to a lesser extent, ω-6 PUFAs—and patient-reported outcomes, while MUFAs and SFAs showed unfavorable associations. Docosahexaenoic acid (DHA), an omega-3 PUFA, exhibited the most robust favorable associations across all outcomes. Additionally, the omega-3 α-linolenic acid (ALA) was linked to reduced pain, whereas eicosapentaenoic acid (EPA), another omega-3, was associated with worsened disease activity and pain. Among omega-6 PUFAs, dihomo-γ-linolenic acid (DGLA) was favorably associated with disease activity, while the omega-9 PUFA Mead acid was linked to increased pain.DiscussionThese findings underscore the prospect that increased tissue levels of long-chain omega-3 PUFAs, particularly DHA, are favorably associated with SLE outcomes. Although further research is needed to establish causal relationships, existing evidence supports the role of omega-3 PUFAs in managing cardiovascular and chronic kidney disease, common SLE comorbidities. Most study participants exhibited low omega-3 PUFA status, suggesting substantial potential for improvement through targeted dietary interventions and supplementation. This study supports a potential role for precision nutrition in comprehensive SLE management, considering the impact of PUFAs, SFAs and MUFAs.

What is the role of patient safety in the implementation of ambulatory care models?A systematic review

Purpose: Ambulatory care services provide animportant model for accessing healthcare withouthospitalization. However, while patient safetyinitiatives have traditionally focused on inpatientsettings, recent research has begun to addressoutpatient care. This study aims to systematicallyexamine the role and importance of patient safety inambulatory care models.Materials and Methods: The study data wereobtained from international studies available throughthe Web of Science, EBSCO Host, and Scopusdatabases, using the keywords "Ambulatory carenursing," "Ambulatory care model and patientsafety," and "Ambulatory care nursing and patientsafety" for the period between 2014 and 2024. Thissystematic review included all English full-textrandomized controlled trials. A total of 1010 recordswere identified through the screening process. Thequality of the studies was assessed using the JBI andomized controlled trial quality assessment tool.Five publications that met the inclusion criteria wereincluded in the study.Results: The results indicated that technologicalmodels are predominantly used in ambulatorysupportive care models. Among the models used instudies, TSN (Technological Support Nursing) hasimproved self-care, while MAP (My Asthma Portal)has strengthened asthma management. PRISMS hasenhanced symptom management, virtual wards havereduced readmissions, and eKidneyCare hasincreased medication adherence. These findingshighlight the positive impacts of technologicalmodels on patient safety.Conclusion: Monitoring patient outcomes is ofcritical importance for ensuring patient safety andenhancing the quality of healthcare services.

Health Education with Videos on Drug Adherence in the Elderly with Hypertension

Adherence to medication in the elderly with hypertension is often a challenge, which can increase the risk of complications. The purpose of this study is to evaluate the effect of health education through video on medication adherence in the elderly at Puskesmas I East Denpasar. This study uses a quantitative research design with a pre-experimental approach. The subjects of the study were 53 elderly people with hypertension. Data collection was carried out before and after the intervention using educational videos, with instruments in the form of medication compliance questionnaires. Data analysis was carried out using the Wilcoxon statistical test. Before the education, the majority of respondents showed low compliance (52.8%). After the intervention, the high compliance rate increased significantly to 67.9%, while the low compliance decreased to 13.2%. The results of the Wilcoxon test showed a p-value = 0.000, indicating a significant influence of video education on medication adherence. Health education through videos is effective in increasing medication adherence in the elderly with hypertension. The implications of this study encourage the application of similar educational methods to improve therapy adherence in various health settings.

Validation of the Patient Activation Measure in kidney stone disease patients.

We aimed to validate the Patient Activation Measure (PAM) within a kidney stone disease (KSD) population, determine the variability of patient activation within this population, and characterize relationships between activation and variables such as health literacy, quality of life, and demographics. This cross-sectional study includes individuals 18 years or older followed for KSD at University of Montreal Hospital Center. Demographic data and responses for the PAM, Wisconsin Stone Quality of Life scale, and health literacy questionnaire (HLQ) were acquired. Females and those with poor medication adherence were found to have significantly lower activation. The HLQ dimensions "Actively managing my health," "Navigating the healthcare system," and "Understand health information well enough to know what to do" were associated with significantly higher activation. Rasch analysis revealed an item reliability of 0.81, a person reliability of 0.98, and a Cronbach's alpha of 0.88. Regarding item fit, only item 1 (When all is said and done, I am the person who is responsible for taking care of my health) fit poorly with the model. Principle component analysis revealed evidence of a second dimension, accounting for 9.0% of the variation in observed responses. Female sex and poor medication adherence were associated with significantly lower activation. Aspects of health literacy concurring with the precise definition of "activation" were associated with significantly higher PAM scores. The PAM was found to have good person and item reliability, and good internal consistency; however, principal component analysis revealed that construct validity is possibly threatened by multidimensionality.

Effective Strategies for Enhancing Medication Adherence and Compliance to Improve Patient Outcomes

In order to improve patient outcomes, it examines practical methods for boosting drug adherence and compliance. Medication adherence is critical to attaining intended treatment outcomes and is impacted by a number of variables, such as the nature of the medical illness, patient-related features, therapy-related complications, and the dynamics of the healthcare system. The World Health Organization highlights the significance of adherence programs in the field of public health, positing that enhanced adherence may yield greater benefits than improvements in specific medical treatments. This review addresses the obstacles to adherence. It promotes a patient-centered care strategy that strengthens the bond between doctors and patients and invites them to actively participate in their care decisions. And also emphasizes the potential for improved medication adherence to result in better health outcomes and lower healthcare costs by putting in place customized training tools, enhancing communication tactics, and addressing systemic healthcare challenges. In the end, a multimodal strategy is necessary to get over obstacles and encourage adherence, which will enhance public health in general. Key words Medication Adherence , Patient –Centered Care, Healthcare Communication, Barriers to compliance, Health Outcomes, Health Literacy, Chronic Conditions

Use of HIV pre-exposure prophylaxis among men who have sex with men: low uptake and retention despite high-risk indications

ABSTRACT HIV PrEP is over 99% effective in preventing HIV when medication adherence is high. Despite this, uptake and retention in PrEP care remains less than optimal. We investigated whether gbMSM with objective risk factors for HIV who were automatically offered PrEP would have higher uptake and retention in PrEP care. For this, gbMSM with clinical evidence of HIV risk received a reflexive offer for PrEP from a nurse. The number of offers, referral acceptance, presentation to the first appointment, initiation and retention at 6 months were examined. Of 1181 gbMSM with objective HIV risk factors who were offered PrEP, only 50% accepted, 28% initiated and 16% remained on PrEP at 6 months. Loss across the cascade was more pronounced for youth. We found a notable disconnect between recent STI diagnosis and acceptance, initiation and retention in PrEP. This notwithstanding, 137 at-risk individuals were retained on PrEP because of an active offer. PrEP delivered by nurses was as effective as that delivered by infectious disease physicians. While active offer PrEP successfully brought at-risk individuals into care, more work is required to understand the perceptions of risk, the benefits and challenges of PrEP use, and how stigma and structural barriers affect retention among diverse groups affected by HIV.

Insight and Violence: An Overview of the Possible Link and Treatment Options in Forensic Psychiatric Settings

The belief that people suffering from psychiatric disorders are more violent, in particular psychotic patients that do not have insight into their illness, is very common in the general population. Therefore, this review aimed to present a more accurate depiction of the link between lack of insight and violent behavior, by evaluating the existing scientific literature on the topic. For this purpose, a literature search on PubMed, Embase, and Google Scholar was conducted, selecting the relevant papers published during a 20-year period (2004–2024). The paper defined insight as a multi-dimensional concept and discussed its classification, explanatory models, and clinical implications, followed by a presentation of several insight-measuring scales. The meaning of violent behavior, its prevalence, underlying mechanisms, and different measuring scales were discussed, followed by the confounding factors that influence the relationship between insight and violent behavior, treatment options for violence in forensic psychiatry settings, and methods to improve medication adherence. Contrasting results were observed regarding the impact of each factor on leading to violent acts, which suggested that the relationship between insight and violence is more complex than previously thought. In conclusion, increased attention must be paid to the investigated dimensions of both the concepts and the confounding factors, with further research required on this topic.

Cost-effectiveness of a Low-cost Educational Messaging and Prescription-fill Reminder Intervention to Improve Medication Adherence Among Individuals With Intellectual and Developmental Disability and Hypertension.

Adults with intellectual and developmental disabilities (IDDs) have a similar prevalence of hypertension as the general population, but a higher rate of medication nonadherence at 50% compared with the average of 30%. To assess the cost-effectiveness of educational messaging and prescription-fill reminders to adults with IDD and hypertension and their helpers among Medicaid members in a randomized control trial. The authors calculated net cost savings by subtracting per-participant intervention costs from differences in spending between preintervention/postintervention cases versus controls. Using bootstrap samples, they assessed the probability of positive cost savings. They used quantile and logistic regression to examine which members contributed to the cost savings and to identify future high-cost members at baseline. Four hundred twelve members with IDD and their helpers were recruited from the South Carolina Medicaid agency in 2018. Intervention costs were determined using labor and communication costs. Health expenditures were obtained from South Carolina's all-payer claims database, using actual Medicaid expenditures and total all-payer expenditures estimated with cost-to-charge ratios. The intervention, which cost $26.10 per member, saved $1008.02 in all-payer spending and $1126.42 in Medicaid payments per member, respectively, with 78% and 91% confidence. Cost savings occurred among members above the 85th percentile of spending, and those using the emergency department or inpatient services at least twice at baseline were predicted to be future high-cost members. The intervention is cost-saving, and insurers can prospectively identify and target members who will likely benefit.

Despite the pandemic: upward trajectories of medication adherence and persistence in patients with dyslipidemia

Despite the pandemic: upward trajectories of medication adherence and persistence in patients with dyslipidemia