Adherent Group Research Articles

Non-adherence to prescribed medications in ambulatory patients with heart failure assessed using liquid chromatography tandem mass spectrometry

Abstract Background Reported rates of medication non-adherence in patients with heart failure (HF) vary widely, ranging between 5-60%, depending on the method of assessment. Very few studies have assessed non-adherence objectively by measuring the plasma level of medications or metabolites; the true prevalence of medication non-adherence in HF patients is unknown. Objectives To report prevalence and clinical associates of medication non-adherence in a cohort of ambulatory HF patients assessed using liquid chromatography–tandem mass spectrometry analysis of plasma levels of prescribed, evidence-based treatments. Methods We assessed adherence in 172 consecutive patients with HF attending a routine clinic follow-up visit. We used liquid chromatography-tandem mass spectrometry to measure the presence of prescribed medications (angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blocker (ARB), beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), diuretics and digoxin) in plasma samples collected during the visit. No patient knew in advance that the blood test would be used to assess adherence. Results 69% were male; median (IQR) age 76 (67-82) years; median NTproBNP 1036 (433-2340) ng/L; 62% HF with reduced ejection fraction (HFrEF, LVEF <40%). 1 in 5 patients had severe symptoms (NYHA III/IV) and 38% patients had Clinical Frailty Scale ≥ 5. 120 (70%) had all prescribed medications of interest detectable in plasma; in 52 (30%) patients, at least one prescribed medication was not detected. In none of the patients were no prescribed medications detected (Figure 1). Among the 125 patients prescribed diuretics, 18 (14%) were non-adherent. Among the 106 patients with HFrEF, 25 (24%) were at least partially non-adherent to a disease modifying medication (ACEi/ ARB/BB/MRA). Amongst medication groups studied, the highest non-adherence rate was with ACEi/ARB and diuretics (14% for each) (Figure 2). Comparing non-adherent patients to those who were adherent, there was no significant difference in age, sex or number of medications prescribed. Frailty was more common in the non-adherent compared to adherent group (46% vs 34%). Systolic/ diastolic blood pressure and heart rate were higher in non-adherent patients [median (IQR) SBP: 150 (137-174) vs 140 (125-164) mmHg; median (IQR) DBP 80 (69-89) vs 75 (64-83) mmHg; median (IQR) HR 76 (67-85) vs 69 (60-77) mmHg, each p<0.05]. NTproBNP tended to be higher in those who were non-adherent [median (IQR): 1309 (673-2302) vs 891 (353-2391) ng/L]. Conclusion Medication non-adherence, assessed using a single spot plasma measurement of medication levels, appears to be common in ambulatory patients with HF. 1 in 3 patients were at least partially non adherent to prescribed medications. Our observations have implications for the assessment and management of patients with HF.

Abstract 14936: Integrated Text Messaging for Patients Attending Cardiac and Pulmonary Rehabilitation: A Multicentre Randomised Controlled Trial

Introduction: People living with cardiac and respiratory disease require improved post-hospital support that is readily available and efficient. Hypothesis/Aims: Support via text message alongside cardiac and pulmonary rehabilitation (rehab) improves clinical, lifestyle and attendance. Aim was to test effectiveness of an automated, semi-personalised text message support program on clinical and lifestyle outcomes among patients attending cardiac and pulmonary rehab and evaluate program acceptability and utility for patients. Methods: Multicentre randomised controlled trial (3:1, intervention:control) among patients attending cardiac and pulmonary rehab. Control received usual care. Intervention received a 6-month text message lifestyle and support program. Primary outcome was 6-minute walk distance (6MWD). Secondary outcomes included clinical measures, lifestyle, medication adherence and rehab program attendance. Results: Of the 316 participants (mean age±standard deviation, 66.7±10.1years) randomised, 60% were male (190/327), 156 were recruited from cardiac rehab. At 6 months, 6MWD improved in both groups and was significantly greater among intervention than control participants (unadjusted mean difference [95% CI]: 43.4m [4.3 to 82.4];p=0.0296). After adjustment for baseline values, there was no significant difference between intervention and control groups for 6MWD (adjusted mean difference 2.2m [-21.2 to 25.6];p=0·85), medication adherence or cardiovascular risk factors. At 6 months, intervention participants reported significantly lower depression scores (adjusted mean diff [95%CI] -1.3 [-2.2 to -0.3], p=0.012) and anxiety (adjusted mean diff [95%CI] -1.1 [-2.1 to 0.0], p=0.046). Sub-group analysis of cardiac rehab participants found a clinically meaningful increase in 6MWD at 6 months in the intervention compared to control group (mean diff 18.9m, 95% CI -29.2 to 67.1). The majority of participants found the messages easy to understand (99%) and useful (86%). Conclusion: An education and support-based text message program for cardiac and pulmonary rehab attendees improved anxiety and depression plus program attendance, was useful for patients and suitable for implementation.

Adherence to Vitamin D Supplementation during Infancy-A Single Pediatric Primary Practice Retrospective Study.

The risk of vitamin D deficiency is high in infants. Therefore, potential vitamin D deficiency should be prophylactically treated with vitamin D supplementation. Achieving good adherence to recommended prophylactic regimens is the goal of every primary pediatrician. The aim of this paper was to establish whether Croatian infants receive recommended prophylactic doses of vitamin D regularly. We analyzed the prescription rate of vitamin D preparation during the first year of life in one pediatric primary practice. Our research has shown, for the first time in Croatia, that there is low treatment adherence. Only 7.6% of infants received the recommended doses of vitamin D. The percentage of infants in the moderately irregular adherence group was 19.3%. There was no statistical difference regarding urban or rural place of living or parents' educational level. Based on these findings, a comprehensive public health campaign is needed to improve adherence to vitamin D supplementation during infancy. Also, further studies on larger samples and on a national level are warranted.

The Mediterranean Diet: Effects on Insulin Resistance and Secretion in Individuals with Overweight or Obesity.

High adherence to the Mediterranean Diet (MD) is associated with a lower risk of type 2 diabetes. However, it is less clear whether the different MD food items might influence specific biological functions related to glucose tolerance, i.e., insulin resistance (IR) and/or secretion (IS). Thus, this cross-sectional study aimed to investigate the relationship between adherence to MD and IR, insulin sensitivity, and IS in individuals with overweight/obesity. Participants (62 individuals; 7M/55F; mean age 49 ± 15 years; mean BMI 35.8 ± 6.7 kg/m²) underwent a 75 g oral glucose tolerance test (OGTT) to assess plasma glucose and insulin concentrations. These parameters were used for the calculation of validated IR indices (Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), Homeostatic Model Assessment for β-cell function (HOMA-β)), as well as insulin sensitivity indices (insulin sensitivity index (ISI), oral glucose insulin sensitivity (OGIS)). MD adherence was gauged using the PREDIMED questionnaire. Bivariate correlations were used to highlight the association between OGTT-derived indices and MD adherence (PREDIMED score) or specific foodstuffs related to MD. Despite there being no significant differences in BMI, impaired fasting glucose (IFG), and impaired glucose tolerance (IGT), the high MD adherence group presented lower HOMA-IR (p = 0.022) and higher ISI (p = 0.033) compared to other groups. High MD adherence was inversely correlated with HOMA-IR (r = -0.400; p = 0.004) and directly correlated with ISI (r = 0.296, p = 0.039). Fish consumption, a key component of MD, exhibited significant associations: it was directly correlated to ISI (r = 0.394, p = 0.005) and inversely related to HOMA-IR (r = -0.327, p = 0.019) and β-cell function (r = -0.489, p < 0.001). In conclusion, a high MD adherence, and in particular the consumption of fish, is associated with a decreased IR in individuals with overweight/obesity.

Concurrent Medication Adherence in Hypertensive Patients With High-Risk Comorbidities.

Hypertensive patients with high-risk comorbidities require medications for each condition, leading to greater burden. The number of chronic conditions can affect patients' concurrent medication adherence. We aimed to compare the characteristics of groups based on their concurrent medication adherence and investigate the association between the number of high-risk comorbidities and concurrent medication adherence for patients with hypertension and high-risk comorbidities. A secondary data analysis was performed with the 2018 Korea Health Panel Survey, including 2230 patients with hypertension and at least 1 high-risk comorbidity who were prescribed medications for at least 2 conditions. Using medication adherence for each condition, we identified 3 concurrent medication adherence groups: adherent, suboptimal, and nonadherent groups. Multinominal logistic regression was used to determine the association between the number of high-risk comorbidities and the concurrent medication adherence groups. Adherent, suboptimal, and nonadherent groups included 85%, 11%, and 4% of the patients, respectively. Whereas having more high-risk comorbidities was associated with belonging to the suboptimal group compared with the adherent group (adjusted odds ratio, 1.46), having fewer high-risk comorbidities was associated with belonging to the nonadherent group compared with the adherent group (adjusted odds ratio, 0.52). We identified 3 groups based on their concurrent medication adherence. Our results indicated that the relationship of the number of high-risk comorbidities with the concurrent medication adherence group was inconsistent.

Adherence to daily, oral TDF/FTC PrEP during periconception among HIV-exposed South African women.

Daily, oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) as pre-exposure prophylaxis (PrEP) reduces HIV acquisition for African women. Adherence is key to efficacy and patterns of adherence can be highly variable in real-world settings. Using group-based trajectory modeling (GBTM), we sought to identify distinct patterns of periconception PrEP adherence and evaluate potential baseline predictors of such adherence trajectories. We conducted a single-arm longitudinal study for women aged 18-35 years living in Durban, South Africa with personal or partner plans for pregnancy with a partner with HIV or of unknown serostatus. Participants were offered safer conception counseling, including daily oral PrEP; women who initiated PrEP were given a bottle with an electronic pillcap that recorded when device opens. Weekly adherence to daily PrEP was modeled using GBTM with a censored normal outcome distribution as a function of weeks since PrEP initiation. The number and functional form of the adherence trajectory groups were primarily selected based on Bayesian information criteria (BIC) and confirmed by mean estimated probabilities of group membership. A multivariable version of the selected model assessed baseline predictors of membership in adherence trajectory groups. Overall mean (95% CI) adherence to PrEP was 63% (60%, 67%). We identified four groups of women with distinct patterns of adherence: (1) high (i.e., ≥6 doses per week) steady adherence throughout follow-up (22% of PrEP initiators); (2) moderate (i.e., 4-5 doses per week), but steady adherence (31%); (3) initially high, but consistently declining adherence (21%); and (4) initially moderate adherence, followed by a rapid decline and subsequent rebound (26%). In multivariable-adjusted analyses, older age was associated with membership in the high, steady adherence group as compared to the group identified with an adherence trajectory of initially high, then decline, and finally a rebound. GBTM is useful for exploring potential heterogeneity in longitudinal patterns of medication adherence. Although a large proportion of women in this study achieved high levels of adherence by electronic pillcap initially, far fewer women maintained these levels consistently. Knowledge of different adherence trajectories could be used to develop targeted strategies for optimizing HIV prevention during periconception.

Impact of patient adherence on the efficacy of penetrating keratoplasty

Objective: to determine the relationship between adherence to treatment in patients undergoing penetrating keratoplasty (PKP) and corneal graft survival over a 12-month follow-up period. Material and methods. A retrospective analysis of 56 patients who underwent "high risk" PKP was performed. Patients were divided into 2 groups according to their compliance. The full compliance group included those with more than 90% of visits within the first year after the intervention; the poor compliance group included those with more than 10% of missed visits. Results. The high adherence group was characterised by a higher proportion of women (p=0.033), a mean 7 years younger age of the patients (p=0.021) and a predominance of higher education (p=0.014). One year after PKP, patients with complete compliance (74%) were more likely to have a favourable outcome than those with incomplete compliance (48%) (p=0.046). The calculation of the odds ratio (OR 3.52; Cl: 1.1362-10.88; p=0.045) indicated a statistically significant role of treatment adherence as a factor in keratoplasty efficacy. The high compliance group had a visual acuity gain of 2 lines at 12 months (p=0.003). Conclusion. Compliance after corneal transplantation has a significant impact on graft survival and clinical outcome. The development and implementation of a set of measures to increase adherence could significantly improve the safety and efficacy of this high-tech treatment for patients with disabling corneal pathology.

Adherence to the asthma pathway, including pre-triage bronchodilator history, reduces hospitalizations

Objective: To determine if adherence to an asthma treatment pathway is associated with a decrease in hospitalizations. Methods: A prospective cohort design was conducted of Thai children aged 2–15 years who visited the emergency department with severe asthma exacerbations, defined as a Buddhasothorn Asthma Severity Score ≥ 8. Patients who received systemic corticosteroids and nebulized short-acting beta-2 agonists combined with ipratropium bromides were classified as the adherence group. The timing of steroid and bronchodilator administration, length of hospital stay, and hospitalization rate were examined in relation to adherence to the asthma pathway. Multivariable logistic regression models and adjusted odds ratios were used to assess associations. Results: A total of 118 episodes of asthma exacerbations (EAEs) from 59 participants were included. Patients who adhered to the pathway had a significantly higher rate of systemic corticosteroid administration within 1 h of arrival at triage (88.6% vs. 41.9%, adjusted Odds Ratio: aOR 10.21; 95%CI 3.52–29.62). A higher proportion of the patients who adhered to the pathway also received inhaled ipratropium bromide ≥ 2 doses within 1 h of arrival at triage (72.7% vs. 12.2%, aOR 23.51; 95%CI 7.73–71.54) and it was administered significantly faster by 31 min (5 min vs. 36 min, p < 0.001) compared to non-adherence group. The hospitalization rate was significantly lower by almost half of EAEs for adherence group (36.4% vs. 63.5%, aOR 0.41; 95%CI 0.18–0.93). Conclusions: Accurate assessment of severity and adherence to the clinical pathway can reduce hospitalization in pediatric patients with severe asthma exacerbations.

Children-Dietary Inflammatory Index and Adherence to the Mediterranean Diet in Children with Overweight and Obesity: Are They Associated with Cardiometabolic Risk Parameters?

Purpose: This study was planned to assess the relationship between the children’s dietary inflammatory index (cDII), adherence to the Mediterranean diet (AMD), and metabolic control parameters in children with overweight and obesity.&#x0D; Methods: This cross-sectional was conducted in children with overweight and obesity aged 7-18 years. Sociodemographic, biochemical, dietary, and lifestyle data were collected using a questionnaire. Mediterranean Diet Quality Index (KIDMED) was used to evaluate AMD. Body weight, height, neck, waist, and hip circumference were measured. Dietary intake and cDII were assessed with a three-day food consumption record. &#x0D; Results: The mean cDII score was 2.2∓0.94 (range from -0.43 to 4.39). Of the total participants, 12% had high and 38.7% had low AMD. There were no significant differences between cDII and biochemical and anthropometric parameters. The proportion of participants with high insulin levels (53.4%) was higher in participants with low AMD group than in those with high AMD (32.6%) (p=0.011). The proportion of participants with insulin resistance was higher in the low AMD group than in the medium/high adherence group (53.4% vs. 37.0%, p=0.047). There was no significant relationship between AMD and lipid profile. Logistic regression analysis showed that participants with low AMD had high insulin levels to be 2.055 times (95% CI= 1.009-4.186. OR=2.055) compared to participants with moderate/high AMD (p=0.047). cDII scores and AMD were not associated with insulin resistance.&#x0D; Conclusion: This study showed that low AMD was associated with high insulin levels, but cDII was not associated with cardiometabolic risk factors in children with overweight and obesity.

Perampanel’s forgiveness factor in a variable medication adherence paradigm in a rat model of chronic epilepsy

BackgroundPoor medication adherence contributes to increased morbidity and mortality in patients with epilepsy and may be under-addressed in clinical practice. Ethical concerns make it impossible to study the impact of medication nonadherence in clinical trials, but our previous work emphasizes the importance of using preclinical approaches to address these questions. With over 30 clinically available antiseizure medicines (ASM’s), it remains an important question to understand the relationship between poor adherence and seizure incidence across mechanistically distinct ASM’s, including the broad-spectrum ASM, perampanel (PER).MethodsWe formulated PER into chow pellets to deliver to rats in a 100% fully adherent or 50% variable nonadherent paradigm via our novel automated medication-in-food delivery system. Chronic oral dosing was initiated in male rats with chronic epilepsy while monitoring 24/7 for videoEEG evidence of seizures during a 4-week placebo baseline and 4-week treatment phase. PER concentrations were monitored in plasma at 1-week intervals and correlated with degree of seizure control. The relationship between missed doses and extended patterns of nonadherence were correlated with breakthrough seizures.ResultsFully adherent rats demonstrated a median reduction in seizure frequency of 50%, whereas nonadherent rats had a median increase of 54%. Plasma concentrations of PER were stable over the 4-week treatment period in both fully adherent and nonadherent groups, with levels being twice as high in fully adherent animals. There was no correlation between a single missed dose or series of missed doses and the incidence of breakthrough seizures. However, those animals in the nonadherent group that received PER for every meal during a 24-h period had a reduced likelihood of seizure incidence.ConclusionsIf our preclinical data is supported in the clinic, PER’s favorable pharmacokinetic profile in humans, combined with a lowered risk of breakthrough seizures suggests that it may provide a certain forgiveness factor if a dose is missed within a 24-h window.

Metabolomics profiling reveals differences in proliferation between tumorigenic and non-tumorigenic Madin-Darby canine kidney (MDCK) cells.

Madin-Darby canine kidney (MDCK) cells are a cellular matrix in the production of influenza vaccines. The proliferation rate of MDCK cells is one of the critical factors that determine the vaccine production cycle. It is yet to be determined if there is a correlation between cell proliferation and alterations in metabolic levels. This study aimed to explore the metabolic differences between MDCK cells with varying proliferative capabilities through the use of both untargeted and targeted metabolomics. To investigate the metabolic discrepancies between adherent cell groups (MDCK-M60 and MDCK-CL23) and suspension cell groups (MDCK-XF04 and MDCK-XF06), untargeted and targeted metabolomics were used. Utilizing RT-qPCR analysis, the mRNA expressions of key metabolites enzymes were identified. An untargeted metabolomics study demonstrated the presence of 81 metabolites between MDCK-M60 and MDCK-CL23 cells, which were mainly affected by six pathways. An analysis of MDCK-XF04 and MDCK-XF06 cells revealed a total of 113 potential metabolites, the majority of which were impacted by ten pathways. Targeted metabolomics revealed a decrease in the levels of choline, tryptophan, and tyrosine in MDCK-CL23 cells, which was in accordance with the results of untargeted metabolomics. Additionally, MDCK-XF06 cells experienced a decrease in 5'-methylthioadenosine and tryptophan, while S-adenosylhomocysteine, kynurenine, 11Z-eicosenoic acid, 3-phosphoglycerate, glucose 6-phosphate, and phosphoenolpyruvic acid concentrations were increased. The mRNA levels of MAT1A, MAT2B, IDO1, and IDO2 in the two cell groups were all increased, suggesting that S-adenosylmethionine and tryptophan may have a significant role in cell metabolism. This research examines the effect of metabolite fluctuations on cell proliferation, thus offering a potential way to improve the rate of MDCK cell growth.

Medication Non-adherence Among Pediatric Liver Transplant Recipients

Background: More and more children are undergoing liver transplantation and reaching adolescence, even though they must take immunosuppressant drugs for their entire lives. Objectives: This study aimed to determine the non-adherence rate in liver transplant recipients and identify its potential etiologies. Methods: A cross-sectional survey was performed to assay medication adherence among pediatric liver transplant recipients in Shiraz, Iran. The patients' demographic, socioeconomic, and clinical characteristics were collected via interviews. Medication adherence was assessed using a validated Morisky 8-item Medication Adherence Questionnaire (MMAS-8). Results: A total of 157 patients with a mean age of 12.73 ± 4.02 participated in this study. Based on the Morisky adherence scores, 12.1% (n = 19), 25.5% (n = 40), and 62.4% (n = 98) were categorized as low, moderate, and high adherence groups, respectively. Among all studied variables, and follow-up time after transplant were significantly associated with adherence among children after liver transplantation in Iran. Conclusions: The rate and reported causes of non-adherence are similar to those found in previous studies, which is quite remarkable. Proper instruction, financial aid, and recruitment of new technologies are among the strategies to overcome non-adherence.

Statin adherence in patients enrolled in the disease management program for coronary artery disease – comparison between patients’ and general practitioners’ self-reports and patient records

IntroductionPatients with coronary artery disease (CAD) should take a statin daily for secondary prevention. However, statin adherence in patients with CAD is low. This study investigated the proportion of adherent patients enrolled in the disease management program for CAD (DMP-CAD). Adherence was examined by comparing patients’ self-reports, general practitioners’ (GPs) self-reports, and prescription data.MethodsBetween October 2019 and March 2020, all patients enrolled in the DMP-CAD in three GP practices in Germany were invited to participate in the study. Participants completed a questionnaire on the tolerability of statins. Further, prescription data from patient records, low-density lipoprotein (LDL) levels, and GPs’ assessment of statin adherence were examined. The Medication Possession Ratio (MPR) served as a measurement tool for adherence.ResultsSeventy-four patients were included. MPR showed high statin adherence for most patients (83.8%). However, GPs did not reliably identify non-adherence in their patients. Generally, the mean LDL values were above the guideline recommendations (97.7 ± 27.9 mg/dl), with higher values in the non-adherent (123.6 ± 42 mg/dl) than in the adherent group (93.1 ± 22 mg/dl). Non-adherent patients were more likely to be employed (41.7% vs. 11.3%).DiscussionPatients in this study showed high statin adherence. However, the LDL target value was often not reached. Therefore, GPs should take advantage of the good adherence of their patients and try to lower LDL levels by adjusting the dosage and/or changing the statin prescribed. Future studies should investigate typical characteristics of non-adherent patients in DMP-CAD so that GPs can target these patient groups and improve their adherence.

Dikkat Eksikliği Hiperaktivite Bozukluğu Olan Çocuklarda Tedavi Uyumunun İstatistiksel Değerlendirilmesi

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder. Pharmacological treatment is the first option in the treatment of ADHD. Long-term treatment is required, as the course of the disease often continues throughout life. Long-term adherence to treatment in ADHD is important in terms of reducing the risk of substance use, accidents, and risk-taking behaviours. Medication adherence is very important for the successful outcome of the treatment. In this study, we aimed to evaluate the factors that may affect treatment adherence in the Turkish sample. We found that 39.6% of children with ADHD had high medication adherence accordingly Morisky Medication Adherence Scale. Medication adherence of boys and girls were similar. When the education level of mothers was compared, the education level of mothers with high medication adherence group was higher than those with poor medication adherence group, and this difference was statistically significant (p=0.013). We can say that highly educated families who learn that ADHD is a neurodevelopmental disorder and can realize the risks that may arise as a result of being untreated are more careful about drug use.

Efficacy of the Grit Scale Score in Predicting Voice Therapy Adherence and Outcomes

BackgroundVoice therapy generally is considered first-line treatment for dysphonia and vocal fold paresis. It requires a commitment of time, effort and resources; currently, there is no good indicator to identify which patients are good candidates for voice therapy. The Grit scale, developed by psychologist Angela Duckworth, provides a method to quantify perseverance and commitment to long-term goals. ObjectiveWe hypothesized that the Grit scale score could correlate with patient adherence to voice therapy and outcomes, by which subjects with higher Grit scale scores demonstrate greater adherence and better outcomes. MethodsSubjects were categorized into five groups, subjects who (1) were discharged from therapy after successful completion, (2) improved to normal, near-normal, or a level of voice function with which the patients were satisfied, and then stopped attending therapy (3) attended as at least the recommended number of sessions or greater than 8 sessions with some voice improvement (4) failed to improve to a voice function level satisfactory to the patient despite attending voice therapy, (5) failed to attend voice therapy as recommended. Subjects in groups 1–4 were considered adherent to voice therapy, whereas group 5 was considered not adherent. Category 1 was considered the most favorable outcome, whereas Category 5 was considered the least favorable outcome (1 > 2 > 3 > 4 > 5). ResultsEighty-nine subjects are included in the study. The average age of subjects was 44.9 years old, and there was a nearly equal split between male and female subjects. The mean Grit score (48) of the adherent group (categories 1–4) was not significantly different from that of the non-adherent group (47, P = 0.190). Spearman's rho between Grit scale score and the categories (1 > 2 > 3 > 4 > 5) was 0.0674, P = 0.530. ConclusionNeither the analysis by groups nor the Spearman correlation across all categories supported our hypothesis that higher Grit scale scores would be associated with better adherence and outcomes. The failure of the Grit scale score to predict adherence to voice therapy and outcomes emphasizes the need for further research to find a metric that will help predict and improve patient adherence with voice therapy and voice outcomes. Further research is needed to determine why it was unable to be predictive and to confirm or refute our findings.

Association between tooth loss and adherence to oral maintenance in a dental clinic: A retrospective study of more than 20 years.

The relationship between adherence to professional oral maintenance visits and tooth loss is generally accepted in periodontal treatment; however, this relationship has not been clarified in general dental practices. We evaluated the effectiveness of adherence to professional maintenance by a retrospective survey in a private practice. We retrospectively extracted data of 395 patients in a general dental practice who had been followed for more than 20 years. For comparisons, two patient groups were created based on oral maintenance rates: a high- (≥75%) and a low- (<75%) adherence groups. Additionally, multiple logistic regression analysis for tooth loss was conducted with the same two adherence groups and three adherence groups (<50%, ≥50% and <75% and ≥75%), adjusting with risk factors including sex, age, decayed, missing, and filled teeth (DMFT), periodontal status, smoking status, and diabetes at the beginning of maintenance. The number of teeth lost and increased DMFT over time were significantly lower in the high-adherence group than in the low-adherence group. Multiple logistic regression analysis for tooth loss in the two adherence groups yielded an odds ratio (95% confidence interval) of 6.50 (3.73-11.32) in the low-adherence group relative to the high-adherence group. Further analysis with the three adherence groups showed highest risk in the low-adherence group and a higher risk in the moderate-adherence group than the high-adherence group. Patients with high adherence to maintenance schedules for more than 20 years demonstrated significantly less tooth loss. Dental practitioners should promote high adherence to professional maintenance in general dental practices.

Adherence patterns to medications and their association with subsequent hospitalization in adult Egyptian patients with systemic lupus erythematosus.

The aim of this study was to evaluate the adherence pattern to medications and the influence of non-adherence on hospitalization rate among Egyptian patients who were diagnosed with systemic lupus erythematosus (SLE). This cross-sectional interview-based study was conducted in an Egyptian rheumatology outpatient clinic. Individuals with SLE who were prescribed oral medications were included in the study. The 19-item Compliance Questionnaire of Rheumatology (CQR) was employed to evaluate drug adherence. Patients were classified as non-adherent and adherent group based on their CQR score Sociodemographic variables, clinical and therapeutic data, and the frequency of outpatient visits and hospitalization were collected and compared between the two groups. In total, there were 161 SLE patients who participated in the study with mean age 30.70 ± 9.62 years, 129 females and 32 males (F:M 5.4:1). Of them, 93 patients were assigned to the non-adherent group, whereas 68 patients were assigned to the adherent group. There was a statistically significant difference in terms of marital status (p = 0.009), employment (p = 0.032), and the frequency of physical activity (p = 0.045) between the two groups. The adherents had a higher rate of administration of antimalarials (88.2% vs 75.3%, p = 0.039). The frequency of recurrent fever was lower in adherents (23.5% vs 38.7%, p = 0.042), lymphadenopathy (11.8% vs 31.2%, p = 0.004), recurring oral ulcers (25% vs 50.5%, p = 0.001), and substantial hair loss (87.1% vs 98.5%, p = 0.009) in comparison to non-adherents. The number of yearly outpatient visits was considerably greater in adherents (p = 0.007), while the number of prior hospitalizations was higher in non-adherents (p < 0.001). Non-adherents believed that taking medicines disrupt patients' daily routine (p < 0.001) and were more afraid of the occurrence of an adverse drug reaction (p < 0.001). Egyptian SLE patients have an alarmingly high percentage of medication non-adherence. There is a strong association between medication non-adherence and frequency of hospitalization and cumulative clinical manifestations.

Adherence to tyrosine kinase inhibitor and clinical outcomes in patients with chronic myeloid leukemia

PurposeTo ensure optimal care for patients with chronic myeloid leukemia (CML), adherence to tyrosine kinase inhibitors (TKIs) has emerged as a critical component. The objective of this study was to assess the impact of TKIs adherence on clinical outcomes in a cohort of Chinese CML patients who received treatment with TKIs. MethodsThis retrospective study employed a cross-sectional design utilizing questionnaires to assess adherence to TKIs in a sample of 398 patients diagnosed with CML. Adherence was measured using the Morisky Medication Adherence Scale (MMAS-8), which dichotomizes patients into low, medium, and high adherence groups. ResultsOf the patients included in this study, 34.2% were classified as highly adherent, with 43.2% and 22.6% of patients categorized as having medium and low adherence, respectively. Compared to the low-adherence group, patients in the medium- and high-adherence groups exhibited significantly higher rates of achieving major molecular response (MMR) and lower rates of switching TKIs. Moreover, patients who failed to adhere to TKIs treatment demonstrated significantly lower event-free survival and failure-free survival compared to those in the high-adherence group. Notably, regular molecular monitoring and utilization of the “CML Academy” mobile application were positively associated with increased TKI adherence. On the other hand, patients receiving third-generation or above first-line TKIs treatment displayed reduced adherence. ConclusionThe findings suggest that high adherence to TKIs treatment confers clinical benefits to patients with CML. Accordingly, the implementation of effective guidance and intervention measures aimed at promoting adherence to TKIs therapy in real-world settings is imperative.

Attendance-Based Adherence and Outcomes of Obesity Management Program in Arab Adolescents.

Pediatric obesity has become a global pandemic in the last century, contributing to short and long-term medical conditions that heighten the risk of morbidity and mortality in children. The 12-month school-based obesity management educational program aims to assess the effect of adherence to the lifestyle educational program and target outcomes, obesity, and hypertension. A total of 363 (nonadherent, N = 179; adherent, N = 184) Saudi school adolescents aged 12-18 were recruited from 60 schools in Riyadh City, Saudi Arabia. Anthropometrics, lipid profile, and blood glucose were measured at baseline and post-intervention. The level of adherence was based on the number of attended educational sessions, and participants were grouped accordingly into two groups: adherent group (attended ≥ 3 sessions) and nonadherent group (attended 1-2 sessions) out of a total of five sessions. Results demonstrated that significantly more participants in the adherent group achieved the primary program goal of reducing obesity indices [body weight, body mass index (BMI), and BMI z-score] than the nonadherent group. Additionally, among adherent obese participants, BMI z-score significantly decreased after the 12-month intervention (post-intervention: 1.5 ± 0.7 vs. baseline: 1.7 ± 0.6, p < 0.05), while the trend in BMI z-score modestly increased in the nonadherent obese participants post-intervention (post-intervention: 1.8 ± 0.7 vs. baseline: 1.7 ± 0.6, p > 0.05). Moreover, there was a substantial reduction in hypertension prevalence only in the adherent group (p = 0.003) and among adherent obese participants in particular (p = 0.03). Furthermore, adherence to session attendance was higher in girls than boys, which led to better outcomes among girls than boys. For the secondary outcomes, lipid profile indices increased in both groups, while no changes were observed in the glycemic profile. In conclusion, greater adherence to educational sessions achieved modest but favorable weight changes and improved blood pressure among obese adolescents. Future intervention studies should take into consideration the need to improve attendance to enhance adherence to the program among adolescents at risk.

WTP2.1 Predictors Of Non -Adherence To Immunosuppression In Transplant Patients At A University Teaching Hospital

Abstract Introduction To assess the degree of immunosuppressive medication adherence in kidney transplant patients (KTPs) and to determine the predictors of non-adherence. Methods From a total of 106 KTPs treated at the RLBUHT (Jan 2020- June 2021), N= 20 (18%) patients were identified as being non-adherent on two or more hospital incident episodes identified by the continued care clinic, clinicians, and pharmacy. Statistical analysis was performed using the Student t-test. The predictors were data mined with Cox Regression, with the time-variable being time to graft dysfunction or Tacrolimus level abnormality &amp;gt; 50% variance of average trough level (6-8 ng/ml). Results Non-Adherence was observed in 20 (18.6%) patients; the estimated glomerular filtration rate was significantly lower in the no-adherence group (28.52 ± 17.62 ml/min) than in the adherence group (62.43 ± 11.72 ml/min, p &amp;lt; 0.05). About the Tacrolimus trough level, a significant difference was found between the adherers and the Nonadherers (5.10 ± 2.19 vs. 3.06 ± 1.04 ng/ml, p &amp;lt; 0.05). Non-adherers were interrogated during clinical encounters by clinicians and interpreter requirements. Polypharmacy (N=15), (Interpreter requirement) (N=11), young patients age 18-21 (N=05), and old age&amp;gt;70 (N=04) were the predictors of non-adherence. The patients were re-counseled and social services were involved to minimize recurrence. Conclusion The KTPs in this study demonstrated that non-adherence was associated with worse graft function and a lower Tacrolimus level. Knowledge about the degree of adherence could help identify non-adherent patients early and develop strategies to improve outcomes.