Barriers To Medication Adherence Research Articles

Association between ethnicity, language and metformin prescriptions in U.S. community health center patients with diabetes

BackgroundMetformin treatment is a recommended first-line medication for patients with type 2 diabetes. Latino patients are subject to factors that may modify their level of diabetes care, including medication prescription. We evaluated the odds of and times to metformin prescription among non-Latino whites, English-preferring Latinos, and Spanish-preferring Latinos with diabetes. MethodsWe constructed a retrospective cohort of 154,368 adult patients from 835 community health centers (CHCs) across 20 states who were diagnosed with diabetes during the study. Patients were from non-Latino white, English-preferring Latino, and Spanish-preferring Latino ethnic/language groups. We modeled adjusted odds of metformin prescription and adjusted hazards (time-to-event) of metformin prescription after diabetes diagnosis and high hemoglobin A1c (HbA1c > 9) test results. ResultsEnglish-preferring Latinos had similar odds of metformin prescription (Odds Ratio (OR) = 1.01 (95% CI = 0.93, 1.09)), slightly lower time to metformin prescription after diabetes diagnosis (Hazard Ratio (HR) = 1.06(95% CI = 1.04, 1.09)), and similar time to metformin prescription after a high HbA1c result (HR = 1.04 (0.99, 1.09)) compared to non-Latino whites. Spanish-preferring Latinos had higher odds of metformin prescription (OR) = 1.42 (95% CI = 1.33, 1.52), and less time to prescription after diabetes diagnosis (HR = 1.18 (1.15, 1.20)) and after a high HbA1c result (HR = 1.15 (1.11, 1.20)). ConclusionsOur analysis of metformin prescription patterns among non-Latino whites, English-preferring Latinos, and Spanish-preferring Latinos did not suggest a lower or slower tendency to prescribe metformin in Latino patients. Understanding disparities in diabetes diagnosis may require further investigation of medication adherence barriers, diet and exercise counseling, and multi-level influences on diabetes outcomes in Latino patients.

Barriers to Antiplatelet and Statin Adherence Following Major Vascular Intervention

Antiplatelets and statins therapies are associated with improved cardiovascular outcomes following major vascular intervention. Many vascular surgery institutions are reporting improved prescribing rates for aspirin (ASA), P2Y12 antagonists, and statins. Nevertheless, there remains limited publication describing rates and patient-perceived barriers for postoperative adherence. The purpose of this study is to investigate patient nonadherence to antiplatelet and statin therapies following major vascular intervention. A retrospective review of patients who underwent major vascular intervention at a single academic center was performed. The prescribing rates of ASA, P2Y12 antagonists, and statins were reviewed. Postoperative adherence, defined as consistent intake as prescribed, was evaluated at 1, 3, 6, 9, and 12months using electronic documentation of both follow-up clinic appointments and phone call assessments, then corroborated with pharmacy fulfilment records. Patient-reported barriers to medication adherence were also examined. A total of 101 subjects underwent major vascular intervention between January 2020 and July 2020, 98% of whom were discharged on at least 1 antiplatelet or statin agent. Approximately 90% of patients were discharged with ASA, 32% with a P2Y12 antagonist, and 96% with a statin. All patients who maintained adherence up to 6months continued to report adherence at 9 and 12months. Consistent adherence at 12months was documented in 76% of patients on ASA, 81% on P2Y12 antagonism therapy, and 73% on statins. New adverse drug reactions represented the most common barrier to achieving adherence (37% [n=20]). Preoperative therapy with ASA, P2Y12 antagonists, and statins were all independently predictive of postoperative adherence to the same regimen (P≤0.001). The female gender was also associated with higher rates of adherence to postoperative P2Y12 antagonism therapy (P≤0.05). The current prescribing rates for antiplatelet and statin agents are promising, but postoperative nonadherence remains a multifaceted issue.

Determinants of Health-Related Quality of Life in Outpatients with Myocardial Infarction.

The health-related quality of life (HRQOL) of patients with myocardial infarction (MI) is suboptimal because of the disease's life-threatening nature, the requirement for long-term lifestyle modifications, and the treatment regimens following MI. This study aimed to evaluate HRQOL and its associated factors in MI patients. This study was conducted on patients with MI who attended the outpatient cardiology clinic at a major teaching hospital in Jordan. The EQ-5D-3L questionnaire was used to assess HRQOL of the study participants. Quantile regression analysis was conducted to identify the variables associated with HRQOL. The study included 333 patients with a history of MI, with a median age of 58 (57-60). The median of the total EQ-5D score was 0.65 (0.216-0.805). Regression results revealed that male patients (Coefficient= 0.110, 95%Cl (0.022-0.197), P=0.014) and not being diagnosed with diabetes (Coefficient= 0.154, 95%Cl (0.042-0.266), P=0.007) were associated with increased HRQOL. On the other hand, low income (Coefficient= -0.115, 95%Cl (-0.203 - -0.026), P=0.011), not receiving DPP-4 (Dipeptidyl Peptidase -4) inhibitors (Coefficient= -0.321 95%Cl (-0.462 - -0.180), P<0.001), and having low (Coefficient= -0.271, 95%Cl (-0.395 - -0.147), P<0.001) or moderate (Coefficient= -0.123, 95%Cl (-0.202 - -0.044), P=0.002) medication adherence was associated with decreased HRQOL. The current study demonstrated diminished HRQOL among patients with MI, highlighting the necessity of tailoring interventions to tackle medication adherence barriers in this population. Personalized interventions such as educational programs, counseling, and reminders that consider each patient's needs and circumstances can greatly enhance medication adherence and, thus, the HRQOL of MI patients. Individuals with lower income levels, female patients, and those with diabetes should be the specific targets of these interventions.

Barriers to Medication Adherence Among Patients with Non-Communicable Disease in North Wollo Zone Public Hospitals: Socio-Ecologic Perspective, 2023.

The practice of taking medication as directed by a healthcare provider is known as medication adherence. Therefore, the application of a socio-ecological model to this study identifies multilevel factors on barriers of medication adherence on chronic non-communicable disease and provides information to develop scientific health communication interventional strategies to improve medication adherence. This study aimed to explore barriers of medication adherence on non-communicable disease prevention and care among patients in North Wollo Zone public hospitals, northeast Ethiopia. A phenomenological study design was carried out between February 5 and February 30, 2023. The study participants were chosen using a heterogeneous purposive sampling technique. In-depth interviews and targeted focus groups were used to gather data. The focus group discussions and in-depth interviews were captured on audio, accurately transcribed, and translated into English. Atlas TI-7 was utilized to do the thematic analysis. Four main themes, intrapersonal, interpersonal, community level, and health care related, as well as seven subthemes, financial problems, lack of family support, poor communication with healthcare providers, effects of social ceremonies, remote healthcare facility, and drug scarcity, were identified by this study. In this study participants reported that lack of knowledge about the disease and drugs were the main barrier for medication adherence. The study revealed that financial problems for medication and transportation cost were the main factor for medication adherence for non-communicable disease patients. This study explored that lack of knowledge, financial problem, lack of family support, poor communication with healthcare providers, social ceremony effects, remote healthcare facility, and scarcity of drugs were barriers of medication adherence among non-communicable disease patients. In order to reduce morbidity and mortality from non-communicable diseases, it is advised that all relevant bodies look for ways to reduce medication adherence barriers for patients at every level of influence.

Medication Adherence Barriers and Their Relationship to Health Determinants for Saudi Pediatric Dialysis Patients.

Medication adherence is critical for the treatment and improved outcomes of chronic diseases. However, there is little research on the medication adherence of pediatric dialysis patients in Saudi Arabia. This study examines medication adherence barriers and their relationship to health determinants among Saudi children on dialysis, to enhance treatment success. We conducted a hospital-based, cross-sectional survey of pediatric dialysis patients using a simple random sampling technique. There is a trend of higher medication adherence for peritoneal dialysis patients compared with hemodialysis patients (36.1 ± 12.9 vs. 34.7 ± 8.3, p = 0.07). The leading barriers to medication adherence for all patients included being tired of taking the medication (score = 3.0256), not feeling like taking the medicine sometimes (score = 2.7436), bad taste (score = 2.5513), and forgetfulness (score = 2.41). Determinants of health were associated with medication adherence. Lack of education (56.4%) (some children underage for school) and chronic disease requirements (16.7%) were common barriers. After adjusting for the common confounders, the adherence scores increased significantly with increasing patient age (β = 2.378, p < 0.001), patients with working parents (β = 8.726, p = 0.011), and those living outside Riyadh (β = 19.198, p < 0.001). Medication adherence among pediatric dialysis patients is influenced by sociodemographic factors, health systems, and access to care. Evidence-based targeted interventions can increase medication adherence in this group on frequent dialysis. Future efforts should utilize systematic frameworks and digital health technologies to provide quality alternatives to improve medication adherence.

A randomized controlled trial of the dissemination of an mHealth intervention for improving health outcomes: the WiseApp for Spanish-speakers living with HIV study protocol

BackgroundWhile there is no cure for HIV, adherence to antiretroviral therapy can extend the lifespan and improve the quality of life of people with HIV. Despite the global reduction of HIV infection rates in recent years, New York City and La Romana, Dominican Republic, continue to report high infection rates among Latino populations. Many people with HIV remain virally unsuppressed in these geographic hotspots, suggesting a need for additional interventions to overcome medication adherence barriers. Tailored and culturally appropriate mobile health (mHealth) technology can be an engaging way to improve adherence. The primary objective of this trial is to test the effectiveness of an mHealth tool to improve HIV medication adherence among Spanish-speaking people living in New York City and the Dominican Republic.MethodsThe WiseApp study is a two-arm randomized controlled trial among 248 people with HIV across the New York and Dominican Republic sites over the course of 12 months. Participants are randomly assigned to either receive a CleverCap pill bottle that is linked to the WiseApp (intervention) or standard of care (control). All participants complete surveys at baseline, 3-month, 6-month, and 12-month follow-up visits and the study team obtains HIV-1 viral load and CD4 count results through blood draw at each study timepoint.DiscussionThe use of mHealth technologies to improve medication adherence among people with HIV has been implemented in recent years. Although some studies have found improvement in adherence to antiretroviral therapy in the short term, there is limited information about how these interventions improve adherence among Spanish-speaking populations. Disproportionate rates of HIV infection among Latinos in New York City suggest an existing inequitable approach in reaching and treating this population. Due to a lack of mHealth studies with Latino populations, and apps tailored to Spanish-speakers, the WiseApp study will not only demonstrate the effectiveness of this particular mHealth app but will also contribute to the mHealth research community as a whole.Trial registrationThis trial was registered with Clinicaltrials.gov (NCT05398185) on 5/31/2022.

Validation of the Identification of Medication Adherence Barriers Questionnaire (IMAB-Q); a Behavioural Science-Underpinned Tool for Identifying Non-Adherence and Diagnosing an Individual's Barriers to Adherence.

To validate the Identification of Medication Adherence Barriers Questionnaire (IMAB-Q) as a tool to guide practitioners to identify patients who require support to take their medicines as prescribed, their key barriers to adherence and select relevant behaviour change techniques. Adults prescribed medication for cardiovascular disease prevention were recruited from nine community pharmacies in England. Participants completed the IMAB-Q comprising 30 items representing potential barriers to adherence developed from our previous mixed methods study (scoping review and focus groups) underpinned by the Theoretical Domains Framework. Participants also self-reported their adherence on a visual analogue scale (VAS) ranging from perfect adherence (100) to non-adherence (1). A subgroup of 30 participants completed the IMAB-Q twice to investigate test-retest reliability using weighted Kappa. Mokken scaling was used to investigate IMAB-Q structure. Spearman correlation was used to investigate IMAB-Q criterion validity compared to the VAS score. From 1407 invitations, 608 valid responses were received. Respondents had a mean (SD) age of 70.12 (9.9) years and were prescribed a median (IQ) 4 (3, 6) medicines. Worry about unwanted effects (n = 212, 34.5%) and negative emotions evoked by medicine taking (n = 99, 16.1%) were most frequently reported. Mokken scaling did not organise related IMAB-Q items according to the TDF domains (scalability coefficient H = 0.3 to 0.6). Lower VAS self-reported adherence correlated with greater IMAB-Q reported barriers (rho = -0.14, p = 0.001). Test-retest reliability of IMAB-Q items ranged from kappa co-efficient 0.9 to 0.3 (p < 0.05). The IMAB-Q is valid and reliable for identifying people not adhering and their barriers to adherence. Each IMAB-Q item is linked to a TDF domain which in turn is linked to relevant behaviour change techniques. The IMAB-Q can therefore guide patients and practitioners to select strategies tailored to a patient's identified barriers.

Medication adherence and environmental barriers to self-care practice among people with diabetes: A cross-sectional study in a lifestyle clinic in eastern India

ObjectiveThe study was conducted to estimate the prevalence of non-adherence to medications among patients with type 2 diabetes attending a lifestyle clinic in a tertiary care hospital in West Bengal, India; to identify the environmental barriers to self-care practices, including diet, exercise, glucose testing and medication; and to identify the socio-demographic and environmental determinants of medication non-adherence. MethodsA cross-sectional study was performed among the patients with type 2 diabetes taking oral hypoglycemic drugs and attending a lifestyle clinic of a teaching hospital in 2021. The participants were interviewed in clinical settings via a structured questionnaire in the local language. Medication adherence was assessed with Morisky Medication Adherence Scale-8 (MMAS), and environmental barriers were assessed with the Environmental Barrier Assessment Scale (EBAS). ResultsAmong 178 participants, a high level of adherence (MMAS score 8.0) was found among 3 (1.7%) participants, and moderate adherence (MMAS score 6.0 to 7.75) was found among 67 (37.6%; 95% CI 30.3%, 44.9%) participants. The prevalence of non-adherence was 60.7% (95% CI: 53.4%, 68.0%). The overall mean barrier score was 134 (SD 13). All environmental barrier components were distributed equally among the predictor variables except the diet score, which was lower among men (mean difference 1.3; 95% CI: 0.04, 2.5) and people with higher education (mean difference 1.8; 95% CI: 0.6, 3.1). ConclusionThe study indicated poor adherence to OHA in this population. Barriers to self-care practice and medication adherence were observed acrross all socio-economic strata. Poor medication adherence poses a major challenge to clinicians and public health experts in achieving treatment goals.

Medication Adherence and Common Barriers for Caregivers of Preschool Children with Pediatric Glaucoma.

To investigate the medication adherence among caregivers of preschool children with pediatric glaucoma and to elucidate common barriers leading to poor adherence. A cross-sectional study. Caregivers of preschool children with pediatric glaucoma completed a questionnaire on demographic information of caregivers, demographic and disease characteristics of children, caregivers-reported medication adherence (by an adapted Morisky Adherence Scale), and possible 13 barriers. Overall 132 questionnaires were considered valid. Thirty-six percent of all reported poor medication adherence. Caregivers' age and self-evaluated knowledge about pediatric glaucoma showed a significant difference between the adherent and nonadherent groups (P < 0.05). Nineteen percent of all reported only one barrier as important, 65% cited multiple barriers, and 16% cited no barriers. Anxiety and depression were cited as important by most caregivers in both groups. Univariate logistic regression analysis demonstrated that difficulty with the acquisition of medications (OR, 2.5; 95% CI, 1.1-5.7; P=0.025), difficulty with medication schedule (OR, 2.3; 95% CI, 1.0-5.0; P=0.043), and high expenses for medications (OR, 4.8; 95% CI, 1.4-15.9; P=0.011) were significantly associated with higher odds of poor adherence. Over one-third of caregivers of preschool children with pediatric glaucoma were in poor medication adherence. Nearly two-thirds of caregivers cited multiple barriers simultaneously as important hindrances to medication usage. Anxiety and depression, difficulty with the acquisition of medications, difficulty with the medication schedule, and high expenses for medications were prominent barriers. Individualized solutions should be provided according to reported barriers by each caregiver and the other most common barriers.

1269. End HIV with DOT: Maybe?

Abstract Background Directly observed Therapy (DOT) has proven to be a valuable asset used in ascertaining adherence to tuberculosis (TB) medications, methadone, psychiatric medications and HIV medications. Both HIV and TB share the need of adherence to treatment to avoid resistance. However, unlike TB, HIV treatment must be taken for life. Argus Community (Argus DOT) provides Directly Observed Therapy to assist with medication adherence to HIV positive patients with medication adherence barriers who are not virally suppressed as long as the patient is from an affiliated medical provider network which includes St. Barnabas Designated AIDS Center (SBH DAC). Methods SBH DAC started referring patients who have not been virally suppressed to Argus DOT March 2021 to help reach our goal of 90% virally suppressed rate (viral load &amp;lt; 200 copies/ml) by the end of 2021. Those who agreed to DOT were referred, accepted and enrolled in Argus. Argus DOT calls patients daily Monday to Friday to remind them to take their medications. We performed a retrospective chart review of SBH DAC/Argus DOT patients to see if this intervention improved our suppression rate from March 2021 to December 2021 and if there were any barriers for our patients in regards to receiving these benefits. Results 18 patients were approached by the DAC team to enroll in Argus DOT; of those 15 originally agreed to the program. 3 patients declined the enrollment. Of the 15 patients who agreed to the program, 6 patients discontinued the program and none of these 6 patients achieved viral load suppression. Results of 9 patients who stayed with Argus DOT: 8 out of 9 patients achieved a viral load &amp;lt; 200 copies/ml and one achieved 230 copies/ml from 2200 copies/ml. 2 patients achieve a viral load &amp;lt; 20 copies/ml (undetectable). Conclusion This small study shows Argus DOT as valuable asset in achieving decrease HIV viral load in patients with medication adherence barriers. 50% accepting and staying with the program achieved 89% viral suppression; close to the 90% needed to End the Epidemic. 9 out of 18 who did not agree or discontinued Argus DOT due to uncontrolled psychiatric, substance use, nonworking phones and distrust did not achieve viral suppression. Co-located psychiatric, substance use as well as in-house SBH DOT personnel is needed to achieve viral load suppression. Disclosures All Authors: No reported disclosures.

Digital Therapeutic Self-Management Intervention in Adolescents With Inflammatory Bowel Disease.

The objective of this study was to design, code, and test the feasibility, acceptability, and preliminary efficacy of a digital therapeutic self-management tool for pediatric inflammatory bowel disease (IBD). The Self-Management Assistance for Recommended Treatment (SMART) portal development involved an iterative co-design process with a series of focus group/interview sessions with key stakeholders. Subsequently, a pilot, single-arm, open-label trial was conducted with 22 patients; medication adherence was the primary outcome. Usage data for the SMART portal were good, with patients demonstrating better engagement than parents. Results from the trial demonstrated improvement in medication adherence ( M = 24%-31%; t = 7.94, P < 0.05) and self-management barriers as well as trends in health-related quality of life and symptoms. The SMART portal is a feasible digital therapeutic self-management tool for pediatric IBD that demonstrated preliminary efficacy in this pilot trial. Large, controlled trials are needed to definitively determine the clinical efficacy of this tool.

Facilitators and barriers of medication adherence amongst the geriatrics: a cross-sectional study

Abstract Objectives To assess the rate of medication adherence, facilitators and barriers to medication adherence among elderly. Methods A cross-sectional study was conducted to assess the medication adherence level and the patient reported facilitators and barriers using medication adherence rating scale and a prevalidated questionnaire, respectively amongst the geriatric patients who were hospitalised in a south India tertiary care hospital. Data thus collected were categorically analysed. Predictors were assessed using odds ratio at 95% confidence interval. Key Findings A total of 401 patients were enrolled, majority [220 (54.86%)] were adherent to the medications. The barriers identified included forgetfulness, carelessness, lack of awareness about the disease and medication, illiteracy, lack of regular follow up and visit, social stigma on disease, polypharmacy and adverse effects. The facilitators included good access to the health care system, patient counselling, regular follow-up, and refill. The age group of 71–80 years [OR 2.02 (95% CI, 1.31–3.13)], illiteracy [OR 2.34 (95% CI 1.38–3.98)], single as marital status [OR 3.64 (95% CI, 1.13–11.67)], comorbidities (≥5) [OR 3.91 (95% CI, 1.78–8.60)], discharge medications (&amp;gt;11) [OR 3.11 (95% CI, 1.55–6.26)], lack of awareness about the disease [OR 1.99 (95% CI, 1.30–3.032)] were found to be significant predisposing factors. Conclusions This study reveals as several predictive factors were identified for medication nonadherence which can aid in developing strategies to improve medication adherence.

"Without my medication, I'm a wreck": Photo-elicitation to explore medication use among people experiencing homelessness.

People experiencing homelessness (PEH) live with a high burden of chronic illness, functional and cognitive impairments, and serious mental illness. Many PEH are prescribed complex medication regimens to manage symptoms and improve health and functioning. However, medication use within the context of homelessness is complicated, and adherence is often suboptimal. To document medication use within the context of homelessness and explore experiences of medication use among people experiencing homelessness (PEH). This study used mixed methods including photo-elicitation interviews. Participants were given a digital camera and asked to take pictures of people, places, things, and situations that represented every day medication use. Participants were also asked to write down reasons for taking the pictures. After two weeks, participants returned the camera and notes. At a subsequent interview, the photographs and notes were reviewed and discussed. Demographic and health-related information was also collected for each participant. An interpretive description approach was used for qualitative data analysis. Quantitative data were analyzed using descriptive statistics in order to describe the sample. Seven PEH completed this study. Mean age was 45 years (SD=11.3) and length of homelessness was 6.1 years (SD=11.3). All reported multiple chronic conditions (≥2) and reported taking 6.6 (SD=2.6) medications. Participants reported medication adherence barriers with mean score of 37 (SD=5.5) on the ASK-12, a 12-item scale with a range of 12-60 (higher scores indicate more barriers). Qualitative analysis identified four categories: medication-related burdens, medication-related beliefs, connectedness, and stigmatizing encounters. Medication use among PEH is complex and cannot be considered separately from daily life or from struggles to meet basic needs. Multi-level interventions are needed to optimize medication use among PEH, and healthcare professionals including community pharmacists should reinforce beliefs that medication-related benefits outweigh the burdens and then tailor services to the context of homelessness.

Using mHealth to improve adherence and reduce blood pressure in individuals with hypertension and bipolar disorder (iTAB-CV): study protocol for a 2-stage randomized clinical trial

BackgroundCardiovascular disease in individuals with mental health conditions such as bipolar disorder is highly prevalent and often poorly managed. Individuals with bipolar disorder face significant medication adherence barriers, especially when they are prescribed multiple medications for other health conditions including hypertension. Poor adherence puts them at a disproportionate risk for poor health outcomes. As such, there is a need for effective interventions to improve hypertension medication adherence, particularly in patients that struggle with adherence due to mental health comorbidity.MethodsThis 5-year project uses a 2-stage randomized controlled trial design to evaluate a brief, practical adherence intervention delivered via interactive text messaging (iTAB-CV) along with self-monitoring of medication taking, mood, and home blood pressure (N = 100) compared to self-monitoring alone (N = 100). Prior to randomization, all participants will view an educational video that emphasizes the importance of medication for the treatment of hypertension and bipolar disorder. Those randomized to the texting intervention will receive daily text messages with predetermined content to address 11 salient domains as well as targeted customized messages for 2 months. This group will then be re-randomized to receive either a high (gradual taper from daily to weekly texts) or low booster (weekly texts) phase for an additional 2 months. All participants will be monitored for 52 weeks. The primary outcomes are systolic blood pressure and adherence to antihypertensive medication as determined by a self-reported questionnaire and validated with an automated pill-monitoring device. Secondary outcomes include adherence to bipolar disorder medications, psychiatric symptoms, health status, self-efficacy for medication-taking behavior, illness beliefs, medication attitudes, and habit strength.DiscussionThis study specifically targets blood pressure and mental health symptom control in people with bipolar and includes implementation elements in the study design intended to inform future scale-up. Promising pilot data and a theoretical model, which views sustained medication-taking behavior in the context of habit formation, suggests that this remotely delivered intervention may help advance care for this high-risk population and is amenable to both scale up and easy adaptation for other groups with poor medication adherence.Trial registrationThe study was registered at ClinicalTrials.gov (NCT04675593) on December 19, 2020.

Facilitators and Barriers of Medication Adherence Based on Beliefs of Persons with Bipolar Disorder: A Qualitative Study

One of the big challenges in treating individuals with bipolar disorder (BD) is nonadherence to medication. This is the principal factor associated with a worse prognosis or outcome of the disease. This study aimed to explore and analyze the individual perceptions that people with BD have about the positive and negative aspects when taking medication. A descriptive and interpretative study was carried out using the qualitative research paradigm with the use of the analytical technique of discourse analysis, extracting the data through the completion of focus groups. Participants’ speech was digitally audio-recorded in digital format. In order to complete the codification of the participants’ speech content, we relied on the qualitative data analysis (using the QRS NVivo 10 computer software). Thirty-six participants diagnosed with bipolar disorder took part in our study. In the participants’ speech concerning the main barriers to pharmacological treatment, three key topics were identified. Perceived facilitators were summarized in four factors. The main facilitators regarding the use of pharmacological treatment in individuals with BD were the ones related with the perceived need for treatment in the acute phase, the recognition of the illness, the shared clinical decision, and the causal biological attribution in the chronic phase. In terms of perceived barriers, social control was identified in both phases, adverse effects in the acute phase, and the absence of effective treatment in the chronic state.

TeleDiet study: A randomised controlled study investigating the impact of smartphone-supported dietary education and counselling on secondary prevention of coronary heart disease

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Daiichi Sankyo Introduction Dietary habits are a key factor influencing cardiovascular risk and its progression. Dietary counselling as part of current cardiac rehabilitation programmes has certain limitations: it is often intermittent with a delay between feedback on nutritional intake and reassessment by the dieticians. Digital technology could offer a solution. Purpose The purpose of this study was to investigate the impact of smartphone-supported feedback on dietary pattern and outcomes in a population with coronary heart disease (CHD). Methods Of 129 successive patients with CHD, 16 patients who agreed to participate in the study were randomised to either a TeleDiet group or a control group. Patients in the TeleDiet group participated in smartphone-supported diet education in addition to usual in-person education by dietitians. The patients were asked to take pictures of their meals and send them to dietitians using a messaging application. The dietitians then sent them feedback about their diet. The patients in the control group received the usual education only. The primary outcome was the change of Mediterranean Diet score (MedDiet score) between the two groups during three months. The secondary outcomes were the estimate of self-efficacy, medication adherence, and heart-related quality of life (the change of the General Self-Efficacy Scale [GSES], the Identification of Medication Adherence Barriers Questionnaire [IMAB-Q], and the HeartQoL). A total of 14 patients were included in the analysis. Results As a whole, 113 patients did not participate in the study. The most common reason of rejection was "no interest in the study" and the second one was "unable to use a smartphone". Table 1 showed the characteristics of the 14 patients separated into two groups: the TeleDiet group (n = 6) and the control group (n = 8). There was no difference of baseline characteristics between the two groups. The changes of the MedDiet score were not significantly different between the TeleDiet group and the control group (2.0 ± 4.5 vs. 1.3 ± 5.2, p = 0.783). In terms of the secondary outcomes, there were no significant differences between the two groups (Table 2). There were no significant differences of these outcomes in within-group analysis, neither. Conclusion Using a smartphone application is a hurdle for CHD patients at the moment, and these preliminary results do not show a benefit of dietary intervention with mobile health. These are the intermediate results of the whole TeleDiet study, and the study should be expanded to a larger population.

Abstract 217: Assessing Medication Non-Adherence In Heart Failure Patients: A Resident Driven Quality Improvement Initiative

Introduction: Non-adherence to guideline directed medical therapies (GDMT) is responsible for significant health care costs, morbidity, and mortality in heart failure (HF) patients. Assessing and improving medication adherence (MA) is challenging in this patient population given its multifactorial nature. We aimed to evaluate trainee assessment of MA in HF patients while identifying potential barriers to addressing MA during patient encounters. Methods: This was a single-institution study performed at a large safety net hospital in Atlanta. An anonymous questionnaire was used to assess MA strategies of interns, residents, and medical students for HF patients. This data was compiled and analyzed to identify the most commonly perceived barriers to medication non-adherence. Results: 100 surveys were returned. 99% (99/100) noted that addressing MA is important in HF patients. However, only 83% (83/100) reported that they discussed the specific reasons for non-adherence with their HF patients, with 9%, 12%, and 78% addressing MA in the outpatient, inpatient, and both settings, respectively; the lack of time was reported as the most common contributor in all settings. The most common reasons reported by trainees for patient non-adherence include misunderstanding of their regimen (71%), cost (62%), and polypharmacy (57%). Although, 40% (40/100) of survey responders believed that ≥50% of their HF patients were nonadherent, strikingly, only 12% (12/100) discussed these MA barriers at all HF patient visits. Conclusion: Improving outcomes in HF patients is multifactorial. Medicine teaching teams can play a crucial role in this process by recognizing and addressing the specific barriers to MA in HF patients while promoting GDMT adherence. Our study demonstrates that although trainees recognize the importance of MA, the unique patient characteristics that contribute to non-adherence are under appreciated. Our long-term goal is to not only identify these barriers, but to implement educational interventions, then re-assess trainee comfort level with discussing MA, to demonstrate that trainee driven interventions can improve MA in HF patients while simultaneously reducing HF related re-admissions and hospital costs.

Effectiveness of a Pharmacist-Led Web-Based Medication Adherence Tool With Patient-Centered Communication: Results of a Clustered Randomized Controlled Trial.

BackgroundGrowing numbers of people use medication for chronic conditions; nonadherence is common, leading to poor disease control. A web-based tool to identify an increased risk for nonadherence with related potential individual barriers might facilitate tailored interventions and improve adherence.ObjectiveThis study aims to assess the effectiveness of a newly developed tool aimed at improving medication adherence.MethodsWe performed a cluster randomized controlled trial in patients initiating cardiovascular or oral blood glucose–lowering medication. Participants were recruited from community pharmacies. They completed an online questionnaire comprising assessments of their risk for medication nonadherence and subsequently of barriers to adherence. In pharmacies belonging to the intervention group, individual barriers displayed in a graphical profile on a tablet were discussed by pharmacists and patients with high nonadherence risk in face-to-face meetings and shared with their general practitioners and practice nurses. Tailored interventions were initiated by pharmacists. Barriers of control patients were not presented nor discussed and these patients received usual care. The primary outcome was the effectiveness of the intervention on medication adherence at 8 months’ follow-up between patients with an increased nonadherence risk from the intervention and control groups, calculated from dispensing data.ResultsData from 492 participants in 15 community pharmacies were available for analyses (intervention 253, 7 pharmacies; control 239, 8 pharmacies). The intervention had no effect on medication adherence (B=–0.01; 95% CI –0.59 to 0.57; P=.96), nor in the post hoc per-protocol analysis (B=0.19; 95% CI –0.50 to 0.89; P=.58).ConclusionsThis study showed no effectiveness of a risk stratification and tailored intervention addressing personal barriers for medication adherence. Various potential explanations for lack of effectiveness were identified. These explanations relate, for instance, to high medication adherence in the control group, study power, and fidelity. Process evaluation should elicit possible improvements and inform the redesign of intervention and implementation.Trial RegistrationThe Netherlands National Trial Register NTR5186; https://tinyurl.com/5d8w99hk

Caregivers' Experience of Medication Adherence Barriers during Pediatric Hematopoietic Stem Cell Transplant: A Qualitative Study.

Medications are critical for reducing morbidity and mortality risk in pediatric hematopoietic stem cell transplant (HCT). Nonetheless, medication adherence is suboptimal in this population. Identifying and managing barriers to medication management (i.e., medication barriers) is a key component of supporting medication adherence. However, understanding how medication barriers uniquely impact the pediatric HCT population and which barriers characterize each treatment stage remain unclear. Therefore, this study examined caregiver-perceived medication barriers over the course of pediatric HCT. Semi-structured qualitative interviews and demographic questionnaires were completed by 29 caregivers of children (≤12 years) who had received an HCT in the past 24 months and were either still admitted to, or had been discharged from, the hospital. Grounded methodology revealed 21 qualitative themes grouped into 6 hierarchical categories. Findings reflected barriers to be present across HCT treatment but to differ based on treatment stage with only child medication refusal being a consistent barrier across all stages. Barriers were particularly prevalent after hospital discharge post-HCT when caregivers assumed full responsibility for medication management. In addition, families approaching hospital discharge often lacked insight about these post-discharge barriers such that they did not report anticipating the range of barriers described by caregivers who had already been discharged from the hospital and taken on full responsibility for medication management. Findings support the benefit of medication barrier assessment across HCT treatment. These results suggest that families may benefit from intervention to address the specific barriers they experience around medication adherence especially during the post-HCT outpatient period.

Racial Disparities in Medication Adherence Barriers: Pediatric Epilepsy as an Exemplar.

To evaluate how racial disparities in medication adherence barriers relate to key clinical outcomes (i.e., seizure control and adherence) in pediatric epilepsy and to identify the most critical barriers in determining health outcomes in Black youth and White youth. This observational study included a sample of youth aged 2-17 years with epilepsy obtained by combining data from four different studies. A total of 226 caregivers and 43 adolescents reported on adherence barriers. An electronic monitor was used to measure adherence to the primary antiepileptic drug. Racial disparities in individual barriers were examined. The relative importance of different types of barriers in determining clinical outcomes was evaluated in both Black and White youth. Adherence barriers, including running out of medications, access to pharmacies, competing demands, and difficulty swallowing, disproportionally affected Black children with epilepsy compared to White children. System- and community-level barriers emerged as the most important in determining seizure outcomes among Black youth. Both system- and individual-level barriers, on the other hand, were important for adherence outcomes. System- and community-level barriers, as opposed to individual-level barriers, are more highly endorsed by Black families compared to White families. These barriers are also the most critical in driving seizure outcomes among Black youth. There is a critical need to shift from a primary focus on individual-level barriers to an approach that deliberately targets larger systemic barriers to reduce the existing adherence and health disparities that affect Black children with pediatric conditions.