Assess Medication Adherence Research Articles

Development of a new hospital medication adherence scale in cardiovascular disorders: The Mascard

Non-adherence to prescribed cardiovascular drugs may leads to complications in both secondary and primary prevention. Thus, cardiovascular diseases lead to regular monitoring, which may require hospitalizations, making the hospital a place to re-evaluate both the patient's health and the medication adherence behavior in primary care. The objective of this study was to develop a new scale to assess medication adherence in patients with cardiovascular diseases usable during hospitalization. A cohort of 219 high-risk cardiovascular patients was included for this study. Data on reasons for non-adherence were collected using the newly developed Medication Adherence Scale in Cardiovascular disorders (Mascard) and compared with physician assessment and the control of their cardiovascular risk factors. The Mascard consists of 5 items concerning attitudes toward medication intake. It has good psychometric properties (alpha Cronbach: 0,49) and validity [positive predictive value (PPV): 0.96 and negative predictive value (NVP): 0.5] and correlated with physician assessment (Somers D = 0.34, P < 10 −4 ) and control of cardiovascular risk factors. This new free to use scale is rapid, easy to use and may be useful for health care practitioners to assess cardiovascular medication adherence in inpatients.

Multimodal Assessment of Medication Adherence Among Youth With Migraine: An Ancillary Study of the CHAMP Trial

Examine preventive medication adherence among youth with migraine. Adherence (self-report, pill count, and blood serum drug levels) was assessed as an ancillary study that utilized data from 328 CHAMP Study participants (ages 8-17). CHAMP was a multisite trial of preventive medications. Participants completed a prospective headache diary during a six-month active treatment period during which youth took amitriptyline, topiramate, or placebo pill twice daily. Self-reported medication adherence was collected via daily diary. At monthly study visits, pill count measures were captured. At trial month 3 (trial midpoint) and 6 (end of active trial), blood serum drug levels were obtained. Self-report and pill count adherence percentages were calculated for the active trial period, at each monthly study visit, and in the days prior to participants' mid-trial blood draw. Percentages of nonzero drug levels were calculated to assess blood serum drug level data. Adherence measures were compared and assessed in context of several sociodemographic factors. Multiple regression analyses investigated medication adherence as a predictor of headache outcomes. Self-report and pill count adherence rates were high (over 90%) and sustained over the course of the trial period. Serum drug level adherence rates were somewhat lower and decreased significantly (from 84% to 76%) across the trial period [t (198) = 3.23, p = .001]. Adherence measures did not predict headache days at trial end; trial midpoint serum drug levels predicted headache-related disability. Youth with migraine can demonstrate and sustain relatively high levels of medication adherence over the course of a clinical trial.

Prescriber Attitudes, Experiences, and Proclivities Toward Digital Medicine and How They Influence Adoption of Digital Medicine Platforms.

BackgroundPsychiatric prescribers (prescribers) typically assess medication adherence by patient or caregiver self-report. Despite likely clinical benefit of a new digital medicine technology, the role of specific prescriber attitudes, behaviors, and experiences in the likelihood of adoption is unclear.ObjectiveTo identify prescriber characteristics that may affect adoption of the ingestible event marker (IEM) platform.DesignA survey of prescribers treating seriously mentally ill patients was conducted. Factor analysis was performed on 11 items representing prescriber characteristics believed to be related to endorsement of the IEM platform. Four factors were extracted. Regression analysis was used to test the strength of the relationships between the factors and likelihood of adoption of the IEM platform.ResultsA total of 131 prescribers completed the survey. Most (84%) agreed that visits allow enough time to monitor adherence. Factor analysis revealed four underlying dimensions: 1) perspectives on the value of adherence; 2) concerns about measuring adherence; 3) views toward digital health technologies; and 4) views on payer role/reimbursement. Factors 1 and 3 were related to gender, the belief that computerization benefits prescribers, the presence of office support staff, and the belief that new digital medicine (DM) technology will be cost prohibitive. Willingness to adopt the IEM platform was related to gender (p < 0.05) and perspectives on the value of adherence (p < 0.05), with those scoring higher on that measure also being more likely to adopt.ConclusionPsychiatric prescribers are concerned about medication adherence, perceive current monitoring tools to be problematic, and are open to using digital technologies to improve accuracy of adherence assessment. Relationships among prescriber characteristics, beliefs, and experiences should be considered when developing educational materials, particularly when the goal is to encourage adoption and use of the IEM platform.

Assessment of medication adherence among type-2 diabetes mellitus in a tertiary care hospital of North India.

Study was conductedutilizing a confirmed medication adherence scale to measure the socio-demographic profile, self-care, and medication adherence among Type-2 Diabetes Mellitus (T2DM) patients. The Fisher exact test was used to calculate the level of significance (P) using SPSS (Statistical Package for Social Sciences) Version 21.0. The research presented in this paper uses statistical evidence to assess the numerous aspects that may be linked to medication adherence. A prospective observational study was undertaken on participants visiting the outpatient department for 6months at a North Indian tertiary care hospital to investigate the pattern and quality of life associated with T2DM. The study examined those who had T2DM for more than 2years. At the time of the visit, subjects were interviewed using socio demographic information and a structured verified questionnaire. Fisher exact test was used to identify the parameters that were linked to medication adherence, with P0.05 being regarded statistically significant. A total of 350 T2DM outpatients were followed up on, with a male-to-female ratio of 1:0.95. A 13-item medication adherence scale was created and tested, revealing that approximately 32% of participants demonstrated high adherence to anti-diabetic drugs (score = 13). The P value was obtained using Fisher exact test for educational status, occupation, marital status, and the quantity and kind of anti-diabetic drugs was found to be 0.05. Only 32% of the respondents took their diabetes medication as prescribed, indicating the need to improve adherence among T2DM patients. The quantity and kind of anti-diabetic drugs, as well as the patients' educational status, occupation, and marital status, all demonstrated a statistically significant relationship with medication adherence.

A systematic literature review of existing tools used to assess medication adherence in connective tissue diseases: the state of the art for the future development of co-designed measurement tools.

Lack of medication adherence is frequent in chronic connective tissue diseases and is associated with poorer health outcomes, low quality of life and economic loss. This research is based on a systematic literature search and aims to identify the surveys and tools used for the assessment of medication adherence in patients with connective tissue diseases (CTDs) and in particular the tools co-designed with patients. A systematic literature review was performed in PubMed and Embase databases searching for studies concerning the application of surveys or tools designed for medication adherence assessment. A specific analysis was also performed to identify which of these existing tools were developed in co-design with patients affected by CTDs. 1958 references were identified, and 31 studies were finally included. Systemic lupus erythematosus was the most investigated disease, followed by the Behçet's disease. The tools used to assess adherence in CTDs were, in most cases, valid and useful. However, the results showed a certain degree of heterogeneity among the studies and the medication adherence assessment and measurement tools adopted, which were mostly based on selfreported questionnaire. No co-designed tools with patients were found. Low- and non-adherence were explored in some CTDs with valid and useful tools, while other CTDs still need to be assessed. Therefore, more efforts should be made to better understand the specific reasons for the low- and non-adherence in CTDs patients.

Validation of an Arabic Version of the Self-Efficacy for Appropriate Medication Use Scale.

Background: Medication adherence is essential for optimal treatment outcomes in patients with chronic diseases. Medication nonadherence compromises patient clinical outcomes and patient safety as well as leading to an increase in unnecessary direct and indirect medical costs. Therefore, early identification of non-adherence by healthcare professionals using medication adherence scales should help in preventing poor clinical outcomes among patients with chronic health conditions, such as diabetes and hypertension. Unfortunately, there are very few validated medication adherence assessment scales in Arabic. Thus, the aim of this study was to validate a newly translated Arabic version of the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) among patients with chronic diseases. Methods: In this single-center cross-sectional study that was conducted between March 2019 and March 2021 at the primary care clinics of King Saud University Medical City (KSUMC) in Riyadh, Saudi Arabia, the English version of SEAMS was translated to Arabic using the forward–backward method and piloted among 22 adults (≥18 yrs.) with chronic diseases. The reliability of the newly translated scale was examined using the test–retest and Cronbach’s alpha methods. Exploratory and confirmatory factor analyses were conducted to examine the construct validity of the Arabic version of SEAMS. Results: The number of patients who consented to participate and filled out the questionnaire was 202. Most of the participants were males (69.9%), aged ≥50 years (65.2%), and had diabetes (96.53%). The 13-item Arabic-translated SEAMS mean score was 32.37 ± 5.31, and the scale showed acceptable internal consistency (Cronbach’s alpha = 0.886) and reliability (Intraclass correlation coefficient = 0.98). Total variance of the 13-item Arabic-SEAMS could be explained by two factors as confirmed by the factor analysis. Conclusion: The Arabic version of SEAMS should help in detecting poor self-efficacy for medication adherence among Arabic-speaking patient populations with chronic diseases, such as diabetes and hypertension. Future studies should examine its validity among more diverse patient populations in different Arabic-speaking countries.

GPS Mobile Health Intervention Among People Experiencing Homelessness: Pre-Post Study.

BackgroundPeople experiencing homelessness are at risk for gaps in care after an emergency department (ED) or hospital visit, which leads to increased use, poor health outcomes, and high health care costs. Most people experiencing homelessness have a mobile phone of some type, which makes mobile health (mHealth) interventions a feasible way to connect a person experiencing homelessness with providers.ObjectiveThis study aims to investigate the accuracy, acceptability, and preliminary outcomes of a GPS-enabled mHealth (GPS-mHealth) intervention designed to alert community health paramedics when people experiencing homelessness are in the ED or hospital.MethodsThis study was a pre-post design with baseline and 4-month postenrollment assessments. People experiencing homelessness, taking at least 2 medications for chronic conditions, scoring at least 10 on the Patient Health Questionnaire-9, and having at least 2 ED or hospital visits in the previous 6 months were eligible. Participants were issued a study smartphone with a GPS app programmed to alert a community health paramedic when a participant entered an ED or hospital. For each alert, community health paramedics followed up via telephone to assess care coordination needs. Participants also received a daily email to assess medication adherence. GPS alerts were compared with ED and hospital data from the local health information exchange (HIE) to assess accuracy. Paired t tests compared scores on the Patient Health Questionnaire-9, Medical Outcomes Study Social Support Survey, and Adherence Starts with Knowledge-12 adherence survey at baseline and exit. Semistructured exit interviews examined the perceptions and benefits of the intervention.ResultsIn total, 30 participants were enrolled; the mean age was 44.1 (SD 9.7) years. Most participants were male (20/30, 67%), White (17/30, 57%), and not working (19/30, 63%). Only 19% (3/16) of the ED or hospital visit alerts aligned with HIE data, mainly because of patients not having the smartphone with them during the visit, the smartphone being off, and gaps in GPS technology. There was a significant difference in depressive symptoms between baseline (mean 16.9, SD 5.8) and exit (mean 12.7, SD 8.2; t19=2.9; P=.009) and a significant difference in adherence barriers between baseline (mean 2.4, SD 1.4) and exit (mean 1.5, SD 1.5; t17=2.47; P=.03). Participants agreed that the app was easy to use (mean 4.4/5, SD 1.0, with 5=strongly agree), and the email helped them remember to take their medications (mean 4.6/5, SD 0.6). Qualitative data indicated that unlimited smartphone access allowed participants to meet social needs and maintain contact with case managers, health care providers, family, and friends.ConclusionsmHealth interventions are acceptable to people experiencing homelessness. HIE data provided more accurate ED and hospital visit information; however, unlimited access to reliable communication provided benefits to participants beyond the study purpose of improving care coordination.

Vietnamese Version of the General Medication Adherence Scale (GMAS): Translation, Adaptation, and Validation.

Background: We aimed to translate, cross-culturally adapt, and validate the General Medication Adherence Scale (GMAS) into Vietnamese. Methods: We followed the guidelines of Beaton et al. during the translation and adaptation process. In Stage I, two translators translated the GMAS to Vietnamese. Stage II involved synthesizing the two translations. Stage III featured a back translation. Stage IV included an expert committee review and the creation of the pre-final version of the GMAS, and in stage V, pilot testing was conducted on 42 Vietnamese patients with type 2 diabetes. The psychometric validation process evaluated the reliability and validity of the questionnaire. The internal consistency and test–retest reliability were assessed by Cronbach’s alpha and Spearman’s correlation coefficients. The construct validity was determined by an association examination between the levels of adherence and patient characteristics. The content validity was based on the opinion and assessment score by the expert committee. The Vietnamese version of the GMAS was created, including 11 items divided into three domains. There was a good equivalence between the English and the Vietnamese versions of the GMAS in all four criteria. Results: One hundred and seventy-seven patients were participating in the psychometric validation process. Cronbach’s alpha was acceptable for all questionnaire items (0.817). Spearman’s correlation coefficient of the test–retest reliability was acceptable for the GMAS (0.879). There are significant correlations between medication adherence levels and occupation, income, and the Beliefs about Medicines Questionnaire (BMQ) score regarding construct validity. Conclusions: The Vietnamese version of GMAS can be considered a reliable and valid tool for assessing medication adherence in Vietnamese patients.

Validation of an Arabic Version of the Adherence to Refills and Medications Scale (ARMS).

Background: Medication non-adherence is a complex multifactorial phenomenon impacting patients with various health conditions worldwide. Therefore, its detection can improve patient outcomes and minimize the risk of adverse consequences. Even though multiple self-reported medication adherence assessment scales are available, very few of them exist in Arabic language. Therefore, the aim of this study was to validate a newly translated Arabic version of the Adherence to Refills and Medications Scale (ARMS) among patients with chronic health conditions. Methods: This is a single-center cross-sectional study that was conducted between October 10th 2018 and March 23rd 2021. ARMS was first translated to Arabic using the forward-backward translation method. The translated scale was then piloted among 21 patients with chronic health conditions (e.g., diabetes, hypertension, etc.…) to examine its reliability and comprehensibility using the test-retest method. Thereafter, the Arabic-translated ARMS was self-administered to adult patients aged ≥18 years with chronic health conditions visiting the primary care clinics of a university-affiliated tertiary care hospital in Riyadh, Saudi Arabia. Construct validity was examined using factor analysis with varimax rotation. Results: Of the 264 patients who were invited to participate, 202 (76.5%) consented and completed the questionnaire. Most of the participants were males (69.9%), married (75.2%), having a college degree or higher (50.9%), retired or unemployed (65.2%), aged ≥ 50 years (65.2%), and are diabetic (95.9%). The 12-item Arabic-translated ARMS mean score was 17.93 ± 4.90, and the scale yielded good internal consistency (Cronbach’s alpha = 0.802) and test-retest reliability (Intraclass correlation coefficient = 0.97). Two factors were extracted explaining 100% of the of the total variance (factor 1 = 52.94% and factor 2 = 47.06%). Conclusions: The 12-item Arabic version of ARMS demonstrated good validity and reliability. Therefore, it should help in the detection of medication non-adherence among Arabic-speaking patient population and minimize the risk of adverse consequences.

Assessment of Medication Adherence and Health-Related Quality of Life in Chronic Liver Disease Patients

Cirrhosis is a growing cause of morbidity and mortality in developed countries. It is associated with multiple life-threatening complications. Improving medication adherence could have a greater impact on the health of the population. Health-Related Quality of Life (HRQoL) has become a common outcome indicator in clinical and epidemiological studies. It is a multidimensional concept that includes self-reported measures of one's physical and mental health as well as their social well-being. This study aimed to assess the HRQoL and medication adherence in Chronic Liver Disease (CLD) patients. Medication adherence was determined using the Adherence to Refills and Medication Scale (ARMS) and RAND's SF-36 was used to assess HRQoL. A total of 102 Chronic Liver Disease patients were enrolled in the study, the majority of whom belonged to Child-Turcotte-Pugh class C (45.1%). The majority of the patients had a history of alcohol consumption (77.5%). The total average of four dimensions under PCS and MCS of SF-36 was 45.49 and 72.89 respectively and the overall average of all domains was 59.19. Concerning the Child-Turcotte-Pugh score of the patients, a significant correlation was obtained between physical functioning and RLPH domains. ARMS score had a significant impact on 3 of the PCS and all MCS domains of SF-36, indicating that the patient's medication adherence has an important role in HRQoL.

Medication adherence and quality of life among type-2 diabetes mellitus patients in India.

BACKGROUNDDiabetes mellitus (DM) is a progressively increasing metabolic disorder and a significant public health burden that demands immediate global attention. However, there is a paucity of data about adherence to antidiabetic drugs among patients with type-2 (T2)DM in Uttarakhand, India. Outpatient research reported that more than 50% of patients do not adhere to the correct administration and appropriate medicine dosage. It has been reported that patients with chronic diseases who adhere to treatment may experience improvement in quality of life (QoL) and vice versa.AIMTo assess the adherence to antidiabetic medication and QoL among patients with T2DM.METHODSThis cross-sectional descriptive study was conducted at a tertiary care hospital in Uttarakhand, India. The Medication Adherence Rating Scale and World Health Organization QoL-BREF scale were used to assess medication adherence and QoL.RESULTSTwo hundred seventy-seven patients suffering from T2DM participated in the study. Their mean age was 50.80 (± 10.6) years, 155 (56%) had a poor adherence level and 122 (44%) had a good adherence level to antidiabetic medications. After adjusting for sociodemographic factors, multiple linear regression analysis found patients who were adherent to antidiabetic medications had significantly higher mean overall perception of QoL and overall perception of health, with beta scores of 0.36 and 0.34, respectively (both P = 0.000) points compared with nonadherent patients.CONCLUSIONThere was an association between medication adherence and QoL in patients with T2DM. Hence, there is a need to plan awareness and counseling programs followed by regular follow-up to motivate patient adherence to recommended treatment and lifestyle regimens.

Health Outcomes of Medication Nonadherence among Older Adults with Chronic Illnesses at an Outpatient Clinic of a Tertiary Care Hospital in Thailand

Objective: Nonadherence to medication is a frequent problem in geriatric patients. However, little is known regarding its impact on outpatients in tertiary care hospitals, who often have multiple comorbidities and complex of medication regimens. The objective of the present study was thus to evaluate the association between medication nonadherence and health outcomes. Materials and Methods: This was a cross-sectional study of geriatric patients who attended an outpatient clinic of a tertiary care hospital in Thailand between May 2019 and May 2020. Baseline characteristics and clinical outcomes, including falls, unplanned admission, and quality of life (using the World Health Organization quality of life-old module [WHOQOL-Old]) were collected. The 8-item Morisky Medication Adherence Scale (MMAS-8) was used to assess medication adherence. Results: Of the 250 patients enrolled, 36.4% were found to practice poor medication adherence. Number of falls and unplanned hospitalizations over the past 12 months were positively associated with poor adherence (adjusted odds ratio [AOR] of 3.02 and 1.74, respectively). WHOQOL-Old score was negatively associated with poor adherence (AOR 0.93). Conclusion: Nonadherence was common in these patients and significantly associated with a greater number of falls, lower quality of life, and increased hospitalization. This issue should be addressed in clinical practice to reduce unfavorable health outcomes. Keywords: Chronic disease; Elderly; Fall; Hospitalization, Quality of life

Improving Advanced Practice Provider Knowledge and Assessment of Medication Adherence in Patients with Cardiovascular Disease

Medication nonadherence is a widespread problem among cardiovascular patients. Advanced practice providers (APPs) play a critical role in assessing for medication adherence upon hospital admission. A pre–post intervention design was used to determine the effect of an education module on APP knowledge and assessment of medication adherence in cardiovascular patients over a 12-week period in the Division of Cardiology. We found a statistically significant increase in cardiology APP knowledge and assessment of medication adherence upon hospital admission using an education module and providing a valid and reliable assessment tool in the electronic health record.

Validation of EHR medication fill data obtained through electronic linkage with pharmacies.

BACKGROUND: Recent linkages between electronic health records (EHRs) and pharmacy data hold opportunity for up-to-date assessment of medication adherence at the point of care. OBJECTIVE: To validate linked EHR-pharmacy data, which can be used for point-of-care interventions for concordance with insurance claims data for patients in a large health care delivery system. METHODS: We performed a retrospective cohort study of adult patients with an active antihypertensive medication order and seen as outpatients between August 25, 2019, and August 31, 2019. Pharmacy fill information was obtained from the EHR via linkages with Surescripts pharmacy and pharmacy benefit manager data, as well as from insurance claims available at our institution. We matched antihypertensive medication fills observed in the linked EHR-pharmacy database with available fills in the insurance claims database and calculated the percentage of medication fills that were available in each database. We estimated medication adherence using proportion of days covered in the linked EHR-pharmacy database and in the insurance claims database. RESULTS: Of 26,679 patients with hypertension, 23,348 (87.5%) had at least 1 antihypertensive medication fill recorded in the linked EHR-pharmacy database. Of 1,501 patients matched with the insurance database and with a documented medication fill, a fill was present for 1,484 (98.9%) and 1,259 (83.9%) patients in the linked EHR-pharmacy and insurance databases, respectively. Of 12,109 medication fills recorded in the insurance data, we found an overlap of 11,060 (91.3%) fills with the linked EHR-pharmacy database. The linked EHR-pharmacy database also contained 18,232 of 19,281 (94.6%) medication fills present in either database. Measured medication adherence was higher for patients when based on linked EHR-pharmacy data compared with insurance claims data (42% vs 30%, P < 0.001). CONCLUSIONS: Linked EHR-pharmacy data captured medication fills for the vast majority of patients and resulted in higher estimates of adherence than insurance claims. Our results suggest that pharmacy fill data available in the EHR have sufficient reliability to be used for point-of-care assessment of medication adherence. DISCLOSURES: This study was supported by grant R01HL155149 from the National Heart, Lung, and Blood Institute. Allen Thorpe provided funding for the NYU Langone Health Learning Health System Program, which helped fund this project. The authors have nothing to disclose.

Improving oral chemotherapy compliance and documentation in a safety-net oncology clinic.

263 Background: Barriers to safe delivery of oral chemotherapy in a safety net hospital population include lack of health insurance, delays in medication delivery, and language barriers. Baseline chart review at the Lyndon B. Johnson Hospital oncology clinic revealed sparse documentation of oral chemotherapy education and compliance. Our team conducted the present quality improvement project to improve documentation of toxicity assessment, patient education, and compliance with the oral chemotherapy agents capecitabine, palbociclib, and sorafenib by 25% from October through December 2020. Methods: A set of standardized questions designed to assess for the above domains were generated in the form of an auto-populated electronic medical record phrase ("dot phrase," see Figure 1). Using weekly timed email notifications, physicians were reminded to incorporate these questions in their documentation during clinic visits. Chart review was performed to assess usage frequency of the dot phrase. A post-intervention survey was administered to assess providers' experience with use of the dot phrase, and assess barriers to consistent documentation. Results: 41 patients over 3 months were identified as taking the oral chemotherapy drugs capecitabine (68%), palbociclib (29%) or sorafenib (3%). 63% were non-English speakers. 49% had breast cancer, 39% GI cancers, and 12% other cancers. 12% of clinic visits correctly incorporated use of the dot phrase. Education on the dosing and schedule for oral chemo was addressed for 48% of patients, documentation of adverse effects was performed for 34% of patients, and assessment of medication adherence was documented for 22% of patients. While 73% of providers felt that documentation of oral chemotherapy compliance is important, 70% cited failure to remember to incorporate the dot phrase in real time as the primary reason for failure to use the dot phrase for oral chemotherapy documentation. Conclusions: Despite providers' view of documentation of oral chemotherapy toxicities and compliance as important, low uptake of the dot phrase was observed. The main barrier to use of the dot phrase was providers' forgetting to incorporate the dot phrase prior to and during their clinic charting. Future efforts should focus on automated reminders and regular assessments to increase compliance to this important quality domain. [Table: see text]

Implementation of therapeutic recommendations in high cardiovascular-risk patients. The Polish population of EUROASPIRE V survey

Introduction: Poor medication adherence is associated with unsatisfactory health outcomes, elevated mortality, and high costs of medical care. This study aimed to assess the implementation of therapeutic recommendations in high cardiovascular-risk patients based on self-report questionnaires. Material and methods: The study included 194 patients from the Cardiology Outpatient Clinic. Two self-reported questionnaires were used to assess medication adherence: the Medication Adherence Questionnaire (MAQ) and the Adherence in Chronic Diseases Scale (ACDS). Results: Antihypertensive drugs were prescribed to 65.46% of the patients. According to the MAQ, 54.33% of them reported high adherence, 21.26% medium adherence, and 24.41% low adherence to the treatment. Lipid-lowering drugs were prescribed to 46.39% of the patients, all of whom were treated with statins. Among this group, 34.44% reported high adherence, 27.78% medium adherence, and 37.78% low adherence to pharmacotherapy. According to the ACDS, the majority of patients (45.55%) received a score indicating medium adherence (21–26 points), 39.27% high adherence ( &gt; 26 points), and 16.75% low adherence to treatment ( &lt; 21 points). A high level of adherence was declared by 61.54% of the patients that reached the therapeutic goal of lipid-lowering therapy, defined as LDL-C of &lt; 2.6 mmol/L ( &lt; 100 mg/dL). On the other hand, among the patients whose LDL-C remained elevated, 23.44% declared high adherence to treatment. There were no significant differences in achieving the intended therapeutic goal of blood pressure (BP ≤ 140/90 mmHg) in the groups with high, medium and low adherence (26.53% vs. 23.47% vs. 50.00%; p = 0.1880). Conclusion: Despite higher adherence to treatment in the patients with hypertension compared to patients with hyperlipidemia, the latter more often achieved the therapeutic goal. Declarations regarding high adherence to medication in the MAQ and in the ACDS are consistent in patients with hyperlipidemia and hypertension.

Voice Assistant Reminders and the Latency of Scheduled Medication Use in Older Adults With Pain: Descriptive Feasibility Study.

BackgroundPain is difficult to manage in older adults. It has been recommended that pain management in older adults should include both nonpharmacologic and pharmacologic strategies. Unfortunately, nonadherence to pain medication is more prevalent than nonadherence to any other chronic disease treatment. Technology-based reminders have some benefit for medication adherence, but adherence behavior outcomes have mostly been verified by self-reports.ObjectiveWe aimed to describe objective medication adherence and the latency of medication use after a voice assistant reminder prompted participants to take pain medications for chronic pain.MethodsA total of 15 older adults created a voice assistant reminder for taking scheduled pain medications. A subsample of 5 participants were randomly selected to participate in a feasibility study, in which a medication event monitoring system for pain medications was used to validate medication adherence as a health outcome. Data on the subsample’s self-assessed pain intensity, pain interference, concerns and necessity beliefs about pain medications, self-confidence in managing pain, and medication implementation adherence were analyzed.ResultsIn the 5 participants who used the medication event monitoring system, the overall latency between voice assistant reminder deployment and the medication event (ie, medication bottle cap opening) was 55 minutes. The absolute latency (before or after the reminder) varied among the participants. The shortest average time taken to open the cap after the reminder was 17 minutes, and the longest was 4.5 hours. Of the 168 voice assistant reminders for scheduled pain medications, 25 (14.6%) resulted in the opening of MEMS caps within 5 minutes of the reminder, and 107 (63.7%) resulted in the opening of MEMS caps within 30 minutes of the reminder.ConclusionsVoice assistant reminders may help cue patients to take scheduled medications, but the timing of medication use may vary. The timing of medication use may influence treatment effectiveness. Tracking the absolute latency time of medication use may be a helpful method for assessing medication adherence. Medication event monitoring may provide additional insight into medication implementation adherence during the implementation of mobile health interventions.

Randomized Community Trial Comparing Telephone versus Clinic-Based Behavioral Health Counseling for People Living with HIV in a Rural Setting.

To test the efficacy of a theory-based behavioral intervention delivered via telephone versus clinic-based counseling to improve HIV outcomes and reduce alcohol consumption for people at-risk for treatment failure in a rural setting. Patients receiving HIV care (N = 240) were randomized using a computer-generated scheme to one of three conditions: (a) telephone behavioral health counseling, (b) clinic-based behavioral health counseling, or (c) attention control nutrition education. Behavioral counseling was delivered by either a community nurse or a paraprofessional patient navigator, with differences examined. Participants were followed for 12 months to assess medication adherence using unannounced pill counts and alcohol use measured by electronic daily text message assessments, and 18 months for HIV viral load and retention in care extracted from medical records. There was evidence for telephone and office-based counseling demonstrating greater medication adherence than the control condition but only in the short term. Clinic-based behavioral counseling significantly reduced alcohol use to a greater degree than telephone counseling and the control condition. There were no other differences between conditions. There were also no discernable differences between counseling delivered by the community nurse and the patient navigator. Telephone and clinic-based counseling demonstrated improved medication adherence in the short term, while clinic-based counseling demonstrated reductions in alcohol use. The modest outcomes suggest that intensive intervention strategies are needed for patients that clinicians identify as at-risk for treatment discontinuation and treatment failure.

Self-Reported Medication Use and Urinary Drug Metabolites in the German Chronic Kidney Disease (GCKD) Study.

Polypharmacy is common among patients with CKD, but little is known about the urinary excretion of many drugs and their metabolites among patients with CKD. To evaluate self-reported medication use in relation to urine drug metabolite levels in a large cohort of patients with CKD, the German Chronic Kidney Disease study, we ascertained self-reported use of 158 substances and 41 medication groups, and coded active ingredients according to the Anatomical Therapeutic Chemical Classification System. We used a nontargeted mass spectrometry-based approach to quantify metabolites in urine; calculated specificity, sensitivity, and accuracy of medication use and corresponding metabolite measurements; and used multivariable regression models to evaluate associations and prescription patterns. Among 4885 participants, there were 108 medication-drug metabolite pairs on the basis of reported medication use and 78 drug metabolites. Accuracy was excellent for measurements of 36 individual substances in which the unchanged drug was measured in urine (median, 98.5%; range, 61.1%-100%). For 66 pairs of substances and their related drug metabolites, median measurement-based specificity and sensitivity were 99.2% (range, 84.0%-100%) and 71.7% (range, 1.2%-100%), respectively. Commonly prescribed medications for hypertension and cardiovascular risk reduction-including angiotensin II receptor blockers, calcium channel blockers, and metoprolol-showed high sensitivity and specificity. Although self-reported use of prescribed analgesics (acetaminophen, ibuprofen) was <3% each, drug metabolite levels indicated higher usage (acetaminophen, 10%-26%; ibuprofen, 10%-18%). This comprehensive screen of associations between urine drug metabolite levels and self-reported medication use supports the use of pharmacometabolomics to assess medication adherence and prescription patterns in persons with CKD, and indicates under-reported use of medications available over the counter, such as analgesics.

Rating scales for medication adherence in people living with Parkinson's disease: a systematic review protocol.

The objective of the review is to evaluate the measurement properties of rating scales that have been used to assess the components of medication adherence in patients with Parkinson's disease. Drug therapy is a central strategy in the control of Parkinson's disease symptoms. Measuring behaviors related to medication adherence in patients with Parkinson's disease is vital to understanding the therapeutic response. Consequently, it is necessary to define which instrument offers the most reliable and valid screening. This review will consider studies in English and Portuguese using structured rating scales to assess medication adherence in people with Parkinson's disease. Studies including data from patients with different diseases in addition to Parkinson's disease will be included only if data are clearly available for each disorder covered. Study protocols, letters to the editors, reviews, and studies with clinical judgment scales but no operationally defined anchor points will be excluded. A three-step search strategy will be utilized. Databases will include MEDLINE (PubMed), LILACS (BVS Portal), PsycINFO (APA PsycNet), CINAHL (EBSCO), Web of Science (Clarivate Analytics), Embase, and Scopus (Elsevier). The search strategy will be presented using a PRISMA flow diagram. Eligible studies will be critically appraised for methodological quality using the COSMIN Risk of Bias checklist. Criteria for good measurement properties of the selected scales will be summarized narratively using COSMIN, the Movement Disorder Society Rating Scale Program Committee methodology, the World Health Organization concepts, and the ABC taxonomy of medication adherence. The certainty of the evidence will be determined using the modified GRADE recommendations. PROSPERO (CRD42021211099).