Patient Adherence Rates Research Articles

Emerging RNAi Therapies to Treat Hypertension.

Hypertension (HTN), often dubbed the "silent killer," poses a significant global health challenge, affecting over 1.3 billion individuals. Despite advances in treatment, effective long-term blood pressure (BP) control remains elusive, necessitating novel therapeutic approaches. Poor control of BP remains a leading cause of cardiovascular morbidity and mortality worldwide and is becoming an even larger global health problem due to the aging population, rising rates of obesity, poorer dietary patterns and overall cardiometabolic health, and suboptimal rates of patient adherence and optimal BP control. Ribonucleic acid interference (RNAi) technology, which leverages the body's natural gene-silencing mechanism, has emerged as a promising strategy for several diseases and has recently been tested for its antihypertensive effects. We systematically reviewed peer-reviewed articles from databases including PubMed, EMBASE, and Scopus for studies examining RNAi's role in managing HTN, focusing on mechanisms, clinical utility, and safety profile. Key early-phase trials of some RNAi-leading candidate drugs are detailed. Also highlighted are challenges such as target specificity, delivery mechanisms, durability of effect, and immunogenicity. We conclude by summarizing how RNAi has a significant potential role in HTN therapy due to their unique benefits, such as long-term duration of action, infrequent dosing, and lack of major side effects.

A prospective, longitudinal study of health-related quality of life and contributing factors and its impact on medication adherence to oral anticancer agents in real-world patients with leukemia.

270 Background: Suboptimal rates of non-adherence have been reported in leukemia patients taking oral anticancer agents (OAAs), largely attributed to treatment-related symptoms (TRS). This survey was conducted to describe the complex relationship between adherence, TRS, and health-related quality of life (HRQOL). Methods: This is a single arm, observational, prospective, longitudinal study. Patients with acute myeloid leukemia (AML), acute lymphoid leukemia (ALL), chronic myeloid leukemia (CML), and chronic lymphoid leukemia (CLL) on OAAs completed a telephone survey, which included Wilson’s 3-item medication adherence measure, the PROMIS 10-item Global Health Scale (domains: overall QOL, physical/mental/social health), and assessment of TRS using PRO-CTCAE. This survey was repeated three times, two to three months apart. Optimal adherence was defined as greater than 90% per Wilson’s measure. Spearman’s correlation, chi-square tests, as appropriate, to evaluate the association between medication adherence and HRQOL. Results: 77 patients completed the first survey, of which 60.3% were male, with an average age of 62 years old. Diagnoses were: CML (n=28), CLL (n=19), AML (n=19), and ALL (n=11). Optimal adherence rates declined from 70.2% in the 1 st survey to 55% by the 3 rd survey, whereas HRQOL measures remained stable over time. Most patients (92.2%, n= 71) reported at least one TRS with 42.25% (n= 30) reporting ≥6 symptoms. Patients without TRS were more likely to be adherent than those with symptoms (100% vs. 67%, p=0.17). Specifically, patients with no pain were associated with higher adherence (p= 0.084). Those who rated their mental health and overall quality of life (QOL) as ‘excellent,’ ‘very good,’ or ‘good’ had numerically a higher adherence rate (73% with optimal adherence) than those rating it as ‘fair’ or ‘poor,’ (59-61% had optimal adherence), although not statistically significant. The number of TRS reported from PRO-CTCAE significantly affected patients’ reported QOL: patients reporting 0-5 number of TRS were more likely to report higher QOL (‘excellent,’ ‘very good,’ or ‘good’) than those reporting ≥6 TRS (p = 0.0004). Conclusions: Adherence rates in leukemia patients on OAAs were suboptimal and declined over time. TRS were common and inversely associated with HRQOL, even though adherence was not strongly correlated: patients with high adherence still reported fair or poor HRQOL. Given the numerous and varied factors contributing to non-adherence and HRQOL issues in leukemia patients, a multi-modality support program is essential.

THE IMPACT OF COLLABORATIVE CARE ON COST OF TREATMENT FOR THE MANAGEMENT OF HYPERTENSION- A SYSTEMATIC REVIEW

Introduction: For evaluation of the long term costs and benefits of physician-pharmacist collaboration associated with physician management for the treatment of essential hypertension. Around the world the major cause of death is hypertension. It is an incurable condition that requires proper therapeutic regimens for its life-long management. Due to this, hypertension therapy can be financially burdensome to the patient, and the rates of non-compliance are increased. Aims and Objectives: To observe the results of collaborative, clinical, and interventive approaches to hypertension management, on the cost-effectiveness of therapy, this study aimed to collect and compare cost information on hypertension management, mortality, and morbidity across different countries and cost groups. Using this information, future healthcare expenses can be better planned; for example, by initial emergency response or by changing the way money is distributed. This will lead to more high-pressure jobs. Therefore, it will be more costly to control blood pressure. Method: A systematic review was conducted using 6 major electronic databases that investigated the influence of collaborative care upon healthcare expenses in hypertensive patients and hypertension therapy costs, before and after the intervention of medical personnel, was observed. Conclusions: It was concluded that interventions provided by the collaboration of medical personnel, in the management of hypertension, made the therapy more cost-effective and hence the rate of patient compliance and adherence to the therapy were increased. Peer Review History: Received 18 May 2024; Reviewed 11 July 2024; Accepted 26 August; Available online 15 September 2024 Academic Editor: Dr. Tamer Elhabibi, Suez Canal University, Egypt, tamer_hassan@pharm.suez.edu.eg Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Ogbonna B. Onyebuchi, Nnamdi Azikiwe University, Awka, Nigeria, summitpharm@yahoo.com Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com

Application of Individual Case Management Nursing Model in Blood Lipid Management of Patients with Coronary Heart Disease

Objective: To explore the effect of the case management nursing model on lipid management in patients with coronary heart disease. Methods: Coronary heart disease patients admitted to the cardiology department of a tertiary hospital in Henan Province from April 2023 to March 2024 were randomly divided into a conventional care group and a case management group. The case management model was implemented, and a 3-month follow-up was conducted. Data were collected and analyzed. Results: There were no statistically significant differences in baseline data between the two groups. After 3 months of case management, the case management group showed better medication adherence, greater reductions in lipid levels, and higher lipid control rates. Conclusion: The case management nursing model can improve medication adherence and lipid control rates in patients with coronary heart disease.

Harnessing Immunomodulatory Polymers for Treatment of Autoimmunity, Allergy, and Transplant Rejection.

Autoimmunity, allergy, and transplant rejection are a collection of chronic diseases that are currently incurable, drastically decrease patient quality of life, and consume considerable health care resources. Underlying each of these diseases is a dysregulated immune system that results in the mounting of an inflammatory response against self or an innocuous antigen. As a consequence, afflicted patients are required to adhere to lifelong regimens of multiple immunomodulatory drugs to control disease and reclaim agency. Unfortunately, current immunomodulatory drugs are associated with a myriad of side effects and adverse events, such as increased risk of cancer and increased risk of serious infection, which negatively impacts patient adherence rates and quality of life. The field of immunoengineering is a new discipline that aims to harness endogenous biological pathways to thwart disease and minimize side effects using novel biomaterial-based strategies. We highlight and discuss polymeric micro/nanoparticles with inherent immunomodulatory properties that are currently under investigation in biomaterial-based therapies for treatment of autoimmunity, allergy, and transplant rejection.

Comparison of Tegoprazan- and Lansoprazole-Based Fourteen-Day Triple Therapies as First-Line Treatments for Helicobacter pylori Eradication

Objectives: Tegoprazan, a novel potassium-competitive acid blocker with rapid and effective antisecretory activity, was approved for the treatment of <i>Helicobacter pylori</i> infections in Korea in March 2020. However, real-world data regarding tegoprazan-based therapies are scarce. We compared the efficacies of tegoprazan- and lansoprazole-based triple therapies (TTs).Methods: Between March 2020 and February 2023, this study enrolled patients diagnosed with <i>H. pylori</i> infections who were prescribed either 14-day tegoprazan- or lansoprazole-based TTs as first-line treatments. Their medical records were retrospectively reviewed to compare <i>H. pylori</i> eradication rates and the rates of patient adherence to the recommended therapy.Results: A total of 670 patients diagnosed with <i>H. pylori</i> infections were prescribed 14-day TT regimens between March 2020 and February 2023 at Ilsan Paik Hospital (Goyang, Korea). Of those enrolled in the study, 64 received tegoprazan-based TT and 295 received lansoprazole-based TT as their first-line treatment. The <i>H. pylori</i> eradication rates for tegoprazan- and lansoprazole-based TTs were 76.6% and 75.6%, respectively, in the intent-to-treat population; the rates were 88.9% and 88.4%, respectively, in the per-protocol population (non-inferiority test, <i>p</i>=0.03 and <i>p</i>=0.01 in the respective populations). No significant differences were observed between the two groups with regards to treatment adherence rates (84.4% vs. 85.1%, <i>p</i>=0.78).Conclusions: As a first-line treatment for <i>H. pylori</i> eradication, 14-day tegoprazan-based TT demonstrated non-inferior efficacy compared with 14-day lansoprazole-based TT.

Adherence for members taking oral oncolytic agents undergoing dose modification strategies.

e23058 Background: The use of oral oncolytic agents has transformed oncology care. Previous studies have reported that patient, treatment, and health system-related factors may influence adherence rates in patients prescribed oral oncolytic agents. The purpose of this study is to assess adherence rates in members of a large national pharmacy benefit manager taking oral oncolytic agents who experienced a modification to their dosing regimen. Methods: Adult members receiving palbociclib, abemaciclib, ribociclib, axitinib, lenvatinib, or cabozantinib between 01/01/2021 and 12/31/2022 were eligible for the study. Members who did not maintain continuous eligibility for 180 days prior to and 2 years after the first fill in the study period were excluded. Members were stratified by presence of dose modification, defined by a change in daily dose from one prescription to the next. Adherence was assessed via the proportion of days covered (PDC) which is the total days with medication coverage divided by the number of days between the index fill and exhaust of the final fill in the study period. Optimal adherence was defined as PDC ≥ 0.85. Standard statistical tests for continuous and categorical variables were utilized. Logistic regression was performed with the endpoint of optimal adherence. P values < 0.05 are significant. Results: 13,641 members were included in the final analysis, with 7,093 (52%) experiencing a modification to their dosing regimen during the study period. Several significant differences in sociodemographic variables were present in this study with members experiencing a dose modification being older (mean [standard deviation (SD)]: 65.7 [11.9] vs. 64.9 [13.0] yr; p < 0.001), more likely to be male (23.3% vs. 15.0%; p < 0.001), more likely to reside in high socioeconomic status (SES) regions (23.7% vs. 21.5%; p = 0.005) and more likely to receive tyrosine kinase inhibitors (TKIs) (37.6% vs. 23.6%; p < 0.001). Adherence was high overall with 74.6% of members achieving a PDC ≥ 0.85; however, members with dose modifications were less likely to be adherent (69.7% vs. 80.0%; p < 0.001). Holding other confounders constant, having a dose modification was associated with a decreased likelihood of adherence (Odds Ratio [95% Confidence Interval]: 0.6 [0.55-0.65]; p < 0.001). Conclusions: Dose modification was associated with significant decreases in adherence to oral oncolytic medications. Interventions designed to minimize dose modifications or to provide additional member support during a dose modification may optimize oral oncolytic adherence.

Level of antiretroviral therapy adherence and associated factors during COVID-19 pandemic era in public hospitals of Jigjiga City eastern Ethiopia: a cross-sectional study

BackgroundCoronavirus-19 disease is more severe in patients on antiretroviral therapy (ART). Low-income countries, such as those in Sub-Saharan Africa, are particularly vulnerable to the virus’ spread. However, there is little information on antiretroviral therapy (ART) use in Ethiopia during the pandemic, particularly in the study area. Therefore, this study aimed to assess the level of antiretroviral treatment adherence and associated factors during the COVID-19 pandemic era in public hospitals in Jigjiga City, Somalia, and Eastern Ethiopia.MethodsAn institution-based cross-sectional study was conducted among 382 randomly selected HIV patients on antiretroviral therapy (ART) follow-up in public hospitals in Jigjiga City from March 1–30, 2022. The data was collected through face-to-face interviews and a review of the patient’s record. To explore the relationship between variables, both bivariate and multivariable logistic regression analyses were performed. The adjusted odds ratio (AOR) was utilized, along with a 95% confidence interval, to assess the strength and direction of the association. Statistical significance was considered at p < 0.05.ResultsThe antiretroviral therapy (ART) adherence rate of HIV patients was 76.9% (95% CI, 71.9–82). Disclosing HIV status to sexual partners [AOR = 2.3, (95% CI (1.22–4.19)], having communication with health care providers’ [AOR = 3.2, (95% CI (1.57–6.53)], having no history of current substance use [AOR = 2.6, (95% CI (1.45–4.63)], and patients who did not fear COVID-19 infection [AOR = 5.8 (95% CI (11–10.98)] were significantly associated with antiretroviral therapy (ART) adherence.ConclusionIn this study, the level of antiretroviral therapy (ART) adherence was poor in comparison to the expected level. Patients’ adherence status was favorably related to disclosing their status to families and having contact with their healthcare providers, whereas worrying about COVID-19 pandemic infection and current substance use was adversely associated.

Adherence-Promoting Design Features in Pediatric Neurostimulators for ADHD Patients.

The emergence of remote health monitoring and increased at-home care emphasizes the importance of patient adherence outside the clinical setting. This is particularly pertinent in the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in pediatric patients, as the population inherently has difficulty remembering and initiating treatment tasks. Neurostimulation is an emerging treatment modality for pediatric ADHD and requires strict adherence to a treatment regimen to be followed in an at-home setting. Thus, to achieve the desired therapeutic effect, careful attention must be paid to design features that can passively promote and effectively monitor therapeutic adherence. This work describes instrumentation designed to support a clinical trial protocol that tests whether choice of color, or color itself, can statistically significantly increase adherence rates in pediatric ADHD patients in an extraclinical environment. This is made possible through the development and application of an internet-of-things approach in a remote adherence monitoring technology that can be implemented in forthcoming neurostimulation devices for pediatric patient use. This instrumentation requires minimal input from the user, is durable and resistant to physical damage, and provides accurate adherence data to parents and physicians, increasing assurance that neurostimulation devices are effective for at-home care.

Effect of a Long-Term Online Home-Based Supervised Exercise Program on Physical Fitness and Adherence in Breast Cancer Patients: A Randomized Clinical Trial

The purpose of the present study was to analyze the effect of a synchronous-supervised online home-based exercise program (HBG) during 24 weeks on body composition, physical fitness and adherence compared to an exercise recommendation group (ERG) without supervision with patients undergoing breast cancer treatment. Fifty-nine female breast cancer patients (31 in HBG and 28 in the ERG) undergoing cancer treatments participated in the present randomized clinical trial. The exercise program consisted of a 60 min combined resistance and aerobic supervised exercise session (6–8 points on Borg Scale CR-10, moderate intensity), twice a week during 24 weeks. The exercise recommendation group only received general recommendations to comply with the current ACSM guidelines. Body composition and physical fitness were assessed at baseline, 12 weeks and 24 weeks of the program. Adherence to the intervention was measured according to the minutes of exercise completed per session during each week. A general linear model of two-way repeated measures showed significant improvements (p < 0.05) in physical fitness that were observed in the home-based exercise group at the baseline, 12-week and 24-week assessments compared to the exercise recommendation group. Adherence was also higher in the home-based exercise group. However, no changes (p > 0.05) in body composition between groups and moments were observed. In this sense, supervised home-based exercise interventions can be an interesting strategy to improve physical fitness and adherence rates in breast cancer patients undergoing treatment.

Ketogenic Diet in the Treatment of Epilepsy.

Epilepsy is one of the most disabling neurological diseases. Despite proper pharmacotherapy and the availability of 2nd and 3rd generation antiepileptic drugs, deep brain stimulation, and surgery, up to 30-40% of epilepsy patients remain drug-resistant. Consequences of this phenomenon include not only decreased a quality of life, and cognitive, behavioral, and personal disorders, but also an increased risk of death, i.e., in the mechanism of sudden unexpected death in epilepsy patients (SUDEP). The main goals of epilepsy treatment include three basic issues: achieving the best possible seizure control, avoiding the undesired effects of treatment, and maintaining/improving the quality of patients' lives. Therefore, numerous attempts are made to offer alternative treatments for drug-resistant seizures, an example of which is the ketogenic diet. It is a long-known but rarely used dietary therapy for intractable seizures. One of the reasons for this is the unpalatability of the classic ketogenic diet, which reduces patient compliance and adherence rates. However, its antiseizure effects are often considered to be worth the effort. Until recently, the diet was considered the last-resort treatment. Currently, it is believed that a ketogenic diet should be used much earlier in patients with well-defined indications. In correctly qualified patients, seizure activity may be reduced by over 90% or even abolished for long periods after the diet is stopped. A ketogenic diet can be used in all age groups, although most of the available literature addresses pediatric epilepsy. In this article, we focus on the mechanisms of action, effectiveness, and adverse effects of different variants of the ketogenic diet, including its classic version, a medium-chain triglyceride diet, a modified Atkins diet, and a low glycemic index treatment.

Remote Symptom Monitoring Using Patient-Reported Outcomes in Patients With Chronic Kidney Disease: Process Evaluation of a Randomized Controlled Trial.

In Denmark, outpatient follow-up for patients with chronic kidney disease (CKD) is changing from in-hospital visits toward more remote health care delivery. The nonuse of remote patient-reported outcomes (PROs) is a well-known challenge, and it can be difficult to explain which mechanisms of interventions influence the outcome. Process evaluation may, therefore, be used to answer important questions on how and why interventions work, aiming to enhance the implications for clinical practice. This study aimed to provide insight into the intervention process by evaluating (1) the representativity of the study population, (2) patient and physician use patterns, (3) patient adherence to the intervention, and (4) clinical engagement. A process evaluation determining the reach, dose, fidelity, and clinical engagement was carried out, alongside a multicenter randomized controlled trial (RCT). We developed and implemented an intervention using PRO measures to monitor outpatients remotely. Data were collected for the PRO intervention arms in the RCT from 4 sources: (1) PRO data from the participants to determine personal factors, (2) the web-based PRO system to identify key usage intervention patterns, (3) medical records to identify clinical factors relating to the use of the intervention, and (4) semistructured interviews conducted with involved physicians. Of the 320 patients invited, 152 (47.5%) accepted to participate. The study population reflected the target population. The mean adherence rate to the PRO intervention arms was 82% (95% CI 76-87). The questionnaire response rate was 539/544 (99.1%). A minority of 13 (12.9%) of 101 patients needed assistance to complete study procedures. Physicians assessed 477/539 (88.5%) of the questionnaires. Contact was established in 417/539 (77.4%) of the cases, and 122/539 (22.6%) of the patients did not have contact. Physicians initiated 288/417 (69.1%) and patients requested 129/417 (30.9%) of all the contacts. The primary causes of contact were clinical data (242/417, 58%), PRO data (92/417, 22.1%), and medication concerns and precautionary reasons (83/417, 19.9%). Physicians found the use of PRO measures in remote follow-up beneficial for assessing the patient's health. The inclusion of self-reported clinical data in the questionnaire motivated physicians to assess patient responses. However, some barriers were emphasized, such as loss of a personal relationship with the patient and the risk of missing important symptoms in the absence of a face-to-face assessment. This study demonstrates the importance and practical use of remote monitoring among patients with CKD. Overall, the intervention was implemented as intended. We observed high patient adherence rates, and the physicians managed most questionnaires. Some physicians worried that distance from the patients made it unfeasible to use their "clinical glance," posing a potential risk of overlooking crucial patients' symptoms. These findings underscore key considerations for the implementation of remote follow-up. Introducing a hybrid approach combining remote and face-to-face consultations may address these concerns. ClinicalTrials.gov NCT03847766; https://clinicaltrials.gov/study/NCT03847766.

Three-year follow-up of a novel orthopedic ward fracture liaison services (OWFLS) model.

We established an orthopedic ward fracture liaison services (OWFLS) model and evaluated its role in improving detection rates of bone metabolic markers, treatment rates, and long-term treatability. This observational retrospective cohort study included 120 patients aged >50 years hospitalized for primary osteoporotic fracture from January 2018 to January 2019 (group A: not included in OWFLS). Group B (included in OWFLS) comprised 120 patients from February 2019 to February 2020. We compared rates of bone metabolic index testing, treatment, and adherence; symptomatic improvement; and recurrent fracture between groups. Rates of bone metabolism index testing (50% vs. 0%) and medication use (94.2% vs. 64.2%) were significantly higher after OWFLS implementation. There was no significant difference in adherence rates at 3 months between groups (97.3% vs. 93.5%). Adherence rates at 1 and 3 years were better in group B than A (73.5% vs. 51.9%; 57.5% vs. 26%, respectively). Recurrence of bone pain at 1 and 3 years was significantly lower in group B than A (20.4% vs. 46.8%; 45.1% vs. 76.6%, respectively). OWFLS improved the detection rate of bone metabolism indicators, treatment rate, and patient adherence and reduced recurrence of bone pain. OWFLS may be suitable for settings lacking human resources.

Telehealth Potential in Pediatric Orthopaedics and Sports Medicine Care is Comparable to In-Person Care But Disparities Remain.

Understanding the challenges and potential of telehealth visits (THVs) in a large population can inform future practice and policy discussion for pediatric orthopaedic and sports medicine (OSM) care. We comprehensively assess telehealth challenges and potential in a large pediatric OSM population based on access, visit completion, patient satisfaction, and technological challenges. Demographics, address, insurance, visit information, patient feedback, experience with video visits, and technical challenges of all 2019 to 2020 visits at our hospital were assessed (3,278,006 visits). We evaluated the differences in rate of telehealth utilization, rate of patient adherence, disparities in care access and patient satisfaction, and technological issues. Compared with in-person prepandemic visits, THVs had lower ratios of non-White patients (by 5.8%; P <0.001), Hispanic patients (by 2.8%; P <0.001) and patients with public insurance (by 1.8%; P <0.001), and a higher mean distance between the patient's residence and clinic (by 18.8 miles; P <0.001). There were minimal differences in median household income (average $2297 less in THV; P <0.001) and social vulnerability index (average 0.01 points lower in THV; P <0.001) between groups. THVs had comparable patient satisfaction to in-person visits. Non-White patients, Hispanics, and those with public insurance had lower ratings for both in-person visits and THVs and had more technical difficulties during their THV. Telehealth is a viable method of care for a range of pediatric OSM conditions, providing a similar quality of care as in-person visits with a greater geographic reach. However, in its current format, reduced disparities were not observed in pediatric OSM THVs. Level III.

Treatment Adherence and Related Factors Among Children with Attention-Deficit/Hyperactivity Disorder in Saudi Arabia.

Attention-deficit/hyperactivity disorder (ADHD) is a common childhood psychiatric disorder. It frequently persists into adulthood and is a risk factor for other mental disorders and adverse outcomes, mainly if not managed optimally. This study aimed to assess ADHD treatment adherence and explore the underlying causes of non-adherence in ADHD children in Saudi Arabia. A cross-sectional study of a convenience sample of 221 participants. The survey included demographic characteristics of the child and parents, the child's medical history, quality of services evaluation, as well as medication adherence assessment by Medication Adherence Report Scale (MARS), the general beliefs about medicines questionnaire (General-BMQ), in addition to assessing the parents' beliefs about ADHD and provided/recommended treatment. The sample was primarily 6 to 8-year-old children (32.81%) and males (78.52%). Most subjects were prescribed extended-release agents (45.7%), and overall, high-quality services were provided to the patients. The adherence rate of ADHD patients to their medication was 89.77%. The mother's education correlated significantly with patient adherence (p=0.029), and the mother's age correlated significantly with their beliefs (p=0.021), in addition to the family income (0.033). Children on Methylphenidate Immediate Release had good compliance with the medication (p=0.008). Moreover, Methylphenidate Extended Release has shown continuity results, increasing the adherence rates (p=0.035). ADHD medication adherence was high and associated with older age, educational status, and type of medication used. Physicians should consider these factors to improve adherence in their patients.

P896 You Can Lead a Horse to Water But You Can’t Make it Drink: A Study on Medication Adherence of Inflammatory Bowel Disease Patients in Ireland

Abstract Background Medication adherence is important in ensuring adequate treatment of Inflammatory Bowel Disease (IBD). The High Tech Hub (HTH) is an online system used in Ireland to prescribe and monitor the ordering of High-Tech Medication, specifically oral small molecules and subcutaneously-delivered biologics. We aimed to observe compliance rates of treatment in our centre, observe trends between different medication and identify factors associated with adherence. Methods We extracted prescribing and medication dispensing information from the HTH database for our centre between May and November 2023. We collected information on patient demographics such as age and gender, patient disease subtype, medication class and duration of prescription given against the duration of prescription collected by the patient with an 85% threshold as a marker of compliance to treatment. Statistical analysis was used to compare differences in adherence between subsets of the population and a multivariate regression model was used to identify factors associated with adherence. Results We extracted information from 824 prescriptions from 644 unique patients. The median age was 42 years (IQR 32-52) with 52.2% males. 60.7% (n=391) had Crohn’s Disease, 33.4% (n=215) had Ulcerative Colitis and 3.1% (n=20) had IBD-U. Majority of patients, 77.3% (n=498), were on Anti-TNF medication, followed by 13.2% (n=75) on anti-Interleukins, 6.2% (n=40) on JAK Inhibitors and 3.3% (n=21) Anti-Integrins. 6.5% (n=42) of patients required dose optimization during the 6-month observation and 1.7% (n=11) required a change of medication. 9.5% (n=61) of patients collected prescriptions for steroids. Further analysis demonstrated no significant difference in adherence within gender (Male: 61.0% vs. Female 53.6%, p=0.056), age (&amp;lt;25 years: 66.2%, 25-39 years: 55.0%, 40-54 years: 58.6%, ≥55 years: 54.6%, p=0.346), disease type (Crohn’s: 58.6%, Ulcerative Colitis: 56.7%, IBD-U: 50%, p=0.776), medication class (Anti-TNF: 56.4%, Anti-Interleukin: 65.9%, Anti-Integrin: 57.1%, JAK Inhibitor: 52.5%, p=0.378). However, we found significant lower adherence rates in patients who required dose optimization (21.4% vs. 60.0%, p&amp;lt;0.001) and those who required a change in medication (18.2% vs. 58.1%, p=0.008) in the observation window. There was also a lower rate of adherence noted in those who received prescriptions for steroids (45.9% vs 58.9%, p=0.051). Conclusion There was a high rate of non-adherence noted in our IBD population, worse in those who ended up requiring dose optimization or change in therapy. Addressing compliance by monitoring the online dispensing of medication may be a useful way to ensure adequate treatment and avoid unnecessary treatment escalation.

Tuân thủ điều trị ở người bệnh tăng huyết áp được quản lý điều trị tại các trạm Y tế huyện Hòa Vang, thành phố Đà Nẵng năm 2023 và một số yếu tố liên quan

Objectives: To describe the treatment adherence among hypertensive patients and to determine some related factors to treatment adherence. Research methods: An analytical cross-sectional study was carried out on 360 hypertensive patients being managed and treated at health stations in Hoa Vang district. Result: The overall treatment adherence rate of patients was 16,7%; the highest rate was regular health checkups (84,2%), and the lowest rate was the blood pressure measuring at home (22,5%). The treatment time, education level, support of medical facilities and knowledge are factors related to the hypertension treatment adherence of patients. Conclusion: The hypertension treatment adherence rate of patients was low, 16,7%.

Medical behaviours and medication adherence of older hypertensive patients in different medical insurance programs in Beijing, China: a cross-sectional study

BackgroundGrassroots medical institutions are the primary “battlefield” of hypertension management based on hierarchical diagnosis and treatment policies in China. There is a considerable difference in the insured population and reimbursement ratio between different medical insurance programs. The management of hypertension directly affects the development trend of cardiovascular and cerebrovascular diseases.MethodsTo understand the difference between different medical insurance programs regarding the management of older hypertensive patients, all outpatients aged 60 and above with hypertension in the basic medical insurance database of Beijing, China, from April 1, 2019, to January 31, 2020, were included. Medical behaviours included patients’ choice of hospital level, type of hospital, number of hospitals visited, grassroots medical institutions and cross-district visits. Medication adherence was evaluated by calculating the medication possession ratio of antihypertensive medications. First, we adopted a statistical description for medical behaviours and medication adherence. Then, multivariate logistic regression was used to analyse the influencing factors of medication adherence.ResultsThis study included 1.29 million patients with Urban Employee Basic Medical Insurance (UEBMI) and 0.31 million patients with Urban‒Rural Resident Basic Medical Insurance (URRBMI). The proportions of patients with UEBMI who chose tertiary hospitals, comprehensive hospitals, grassroots medical institutions and cross-district visits were 25.84%, 56.09%, 57.34% and 39.32%, respectively, while those of patients with URRBMI were 11.14%, 60.59%, 81.28% and 6.07%, respectively. The medication adherence rates of men and women taking one medication were 61.04% and 55.86%, respectively. UEBMI patients who took their medication accounted for 62.36%, while only 40.27% of URRBMI patients adhered to their medication. The percentages of young-old, old-old and oldest-old patients who took their antihypertensive medications were 58.05%, 59.09% and 56.78%, respectively. The adherence to taking ≥ 2 medications (35.47%) was lower than that to taking one medication (58.33%). The medication adherence rates of patients with UEBMI and URRBMI for taking ≥ 2 medications were 37.21% and 27.45%, respectively.ConclusionsPatients with UEBMI were more inclined to choose tertiary hospitals and cross-district visits than patients with URRBMI. The adherence of patients with UEBMI was better than that of patients with URRBMI in China.

Effect of patient education and healthcare campaigns on medication adherence in co-morbid patients

Co-morbidities are characterized by the presence of multiple chronic diseases within a single individual. They pose an escalating healthcare challenge and managing this growing burden, particularly with non-communicable diseases, has become a major concern. However, a significant impediment to effective management lies in medication nonadherence. The importance of medication adherence has long been a focus of healthcare literature, yet many comorbid patients tend to underestimate its significance, leading to health deterioration. Research studies indicate alarmingly low adherence rates in comorbid patients. To address this issue, patient education and healthcare campaigns have become essential tools in enhancing adherence. The research, which commenced on October 19, 2023, was initiated after an exhaustive review of existing academic literature. Multiple databases, such as PubMed, Web of Science, and Cochrane, were employed for this comprehensive literature review, utilizing a wide array of medical terminology combinations. The study aims to shed light on potential strategies and educational approaches to enhance medication adherence in comorbid patients. Findings from this research have the potential to influence healthcare policy, the design of tailored interventions, and overall healthcare delivery improvements for co-morbid patients, ultimately leading to enhanced health outcomes, reduced costs, and an improved quality of life.

Patients with severe mental illness and their carers' expectations for GPs' communication skills: a qualitative approach in Spain.

Effective communication with GPs (General Practitioners) enables higher rates of patient satisfaction and adherence to treatment plans. People with severe mental illness (SMI) and their caregivers present unique characteristics that present difficulties in the GP-carer-patient communication process. To explore the expectations of patients with SMI and their caregivers regarding GPs' communication skills in primary care consultations. Face-to-face interviews, using focus group methodology, which were undertaken in southern Spain. Forty-two participants took part in 21 paired semi-structured interviews with an average duration of 19±7.2 minutes. Information was audio-recorded and transcribed verbatim. Qualitative content analysis was undertaken, obtaining a codification in categories by means of triangulation. Four themes emerged from the analysis. Theme 1 was interviewer communication characteristics. The ability of GPs to use a language that was colloquial and adapted to each person was perceived as a determinant of the quality of care provided. An empathetic attitude, low reactivity, and efficient time management were the most valued communication skills. Theme 2 was telemedicine: telephone consultation and video consultation. The telephone consultation was perceived as a useful tool to care for people with SMI. Video consultation was valued as a requirement in isolated rural areas. Theme 3 was the role of the caregiver during the clinical interview. The caregiver was considered by the patients as an ally who improves the clinical interview. Theme 4 was the perceived barriers and facilitators during the clinical interview. The continuity of care, defined by a low turnover of GPs, determined the quality perceived by those who required care. Themes emerging from this study have suggested that people with SMI require an inclusive, collaborative, and personalised approach in the care they receive from the public health system. Improved communication between GPs and patients with SMI is an essential requirement for quality medical care.