Chronic Medical Research Articles

Development and Content Validation of the Patient's Qualitative Assessment of Treatment - Real-World (PQAT-RW): An Instrument to Evaluate Benefits and Disadvantages of Treatments in Real-World Settings.

Quantifying patient-perceived benefits and disadvantages of treatments in a real-world setting is increasingly important in healthcare decision-making. The Patient's Qualitative Assessment of Treatment (PQAT) assesses patient-perceived benefits and disadvantages of treatment, and associated trade-offs potentially influencing patients' willingness to continue treatment. It has then been modified to capture patients' perceived magnitude of benefits and disadvantages of treatment quantitatively, as well as qualitatively (PQATv2). However, the PQAT and the PQATv2 were designed for use and validated in a clinical trial setting. The objective of this study was to adapt and test the content validity of a version of the PQATv2 for use in real-world settings (PQAT-RW). The PQATv2 was adapted for use in real-world settings (PQAT-RW), and its content was validated in 16 patients with varied chronic medical conditions and medication regimens via semi-structured qualitative interviews. All participants reported that the PQAT-RW was "easy to understand". The majority (n = 11/16) reported that the items covered all important aspects of their treatment experience, and that no items needed to be removed or added to the instrument. Analysis of free-text responses identified eight global concepts considered by participants when evaluating the benefits and disadvantages of treatment: treatment effectiveness, side effects and method of administration were most frequently considered (as both benefits and disadvantages), followed by frequency of administration, financial considerations, storage, packaging and drug preparation. The results of this study support the content validity of the PQAT-RW. They also demonstrate that using qualitative responses to contextualize quantitative responses provides unique insight into diverse and individualized patient-perceived benefits and disadvantages, and their relative importance, in real-world settings.

Mental and behavioral health problems among displaced Myanmar adults exhibiting suboptimal adherence to chronic disease medication treatment in Thailand

Mental and behavioral health problems among displaced Myanmar adults exhibiting suboptimal adherence to chronic disease medication treatment in Thailand

Physician perspectives on statin continuation and discontinuation in older adults in primary cardiovascular prevention: a qualitative methods study

ObjectivesIn the context of limited evidence on statin use in primary cardiovascular prevention in older adults, we assessed physician perspectives on decision-making about statin continuation or discontinuation in this population.DesignQualitative...

Comparison of ََQuality of Life and Treatment Satisfaction among Sample of Iraqi Patients Using Anticoagulant Therapy (Warfarin or Non-Vitamin K Antagonist Oral Anticoagulants)

Background: Oral anticoagulation medication, warfarin and non-vitamin k antagonist oral anticoagulants (NOAC) may require long term use which may affect patients’ satisfaction with their treatment and their quality of life (QOL). Objective: To compare the quality of life and treatment satisfaction among groups of patients using different anticoagulant therapies (warfarin and NOAC). Patients and methods: A cross-sectional study was performed at Ibn Al-Bitar Hospital for cardiac surgery in Baghdad in the period between December 2022 to May 2023. The study population included a convenient sample of patients receiving either warfarin or non-vitamin k antagonist oral anticoagulants treatment. The Arabic version of the short form 12 (SF-12) questionnaire and the Anti-Coagulant Treatment Satisfaction Scale (ACTS) questionnaire were used to assess the quality of life and satisfaction with treatment respectively. Results: The study included 181 patients in total. The mean physical and mental quality of life scores for study participants were 42.3±9.92 and 52.6±10.36 respectively. There was no significant difference in the QOL between patients taking warfarin and those on non-vitamin k antagonist oral anticoagulants treatment. The mean total satisfaction score was 65.4±6.73. Patients receiving non-vitamin k antagonist oral anticoagulants had significantly higher satisfaction compared to those receiving warfarin (P=0.000). The physical score correlated significantly with gender, educational level, employment status, number of chronic medications and number of chronic diseases. The total satisfaction score correlated significantly with gender, number of chronic medications, number of side effects and duration of anticoagulation. There was a significant correlation between the QOL and treatment satisfaction (P=0.000). Conclusion: Treatment with non-vitamin k antagonist oral anticoagulants showed comparable QOL and higher treatment satisfaction than that of warfarin. Better treatment satisfaction can improve patients’ QOL which may ultimately enhance their adherence to treatment.

Preparation and Characterization of Isradipine as Surfactant-Free Dry Emulsion

Background: Oral anticoagulation medication, warfarin, and non-vitamin K antagonist oral anticoagulants (NOAC) may require long-term use which may affect patients’ satisfaction with their treatment and their quality of life (QOL). Objective: To compare the quality of life and treatment satisfaction among groups of patients using different anticoagulant therapies (warfarin and NOAC). Methods: A cross-sectional study was performed at Ibn Al-Bitar Hospital for cardiac surgery in Baghdad in the period from December 2022 to May 2023. The study population included a convenient sample of patients receiving either warfarin or non-vitamin k antagonist oral anticoagulants treatment. The Arabic version of the short form 12 (SF-12) questionnaire and the Anti-Coagulant Treatment Satisfaction Scale (ACTS) questionnaire were used to assess the quality of life and satisfaction with treatment respectively. Results: The study included 181 patients in total. The mean physical and mental quality of life scores for study participants were 42.3±9.92 and 52.6±10.36 respectively. There was no significant difference in the QOL between patients taking warfarin and those on non-vitamin k antagonist oral anticoagulant treatment. The mean total satisfaction score was 65.4±6.73. Patients receiving non-vitamin k antagonist oral anticoagulants had significantly higher satisfaction compared to those receiving warfarin. The physical score correlated significantly with gender, educational level, employment status, number of chronic medications, and number of chronic diseases. The total satisfaction score correlated significantly with gender, number of chronic medications, number of side effects, and duration of anticoagulation. There was a significant correlation between the QOL and treatment satisfaction. Conclusion: Treatment with non-vitamin K antagonist oral anticoagulants showed comparable QOL and higher treatment satisfaction than that of warfarin. Better treatment satisfaction can improve patients’ QOL which may ultimately enhance their adherence to treatment.

Health Literacy and Adherence to Therapy in Type 2 Diabetes: A Cross-Sectional Study in Portugal.

Therapy adherence is a key factor in the control of type 2 diabetes mellitus (T2DM). Optimal self-care requires skills in health literacy (HL). This study aims to analyze the relationship between HL and adherence to therapy and to understand the possible influence of other sociodemographic and disease variables. A multicenter, cross-sectional study was conducted in Portuguese in 13 different primary health care units in both rural and urban environments. A sociodemographic questionnaire and two validated instruments, "Medical Term Recognition Test" and "Summary of Diabetes Self-Care Activities," were applied. The last value of hemoglobin A1c (HbA1c) and the number of chronic medications were collected from clinical records. Descriptive statistics and bivariate correlations were performed as well as multivariable linear regression to assess the association between HL and adherence to therapy. Participants (n = 354) were on average age 63.67 ± 10.39 years, 57.1% male and 42.9% female, 68.4% with inadequate HL and an average HbA1c of 7 ± 1.18%. Better HL was correlated with higher adherence to the total of self-care activities, nonpharmacological therapy, and foot care. In multivariable linear regression analyses, better HL (β = 0.176, p = .003), less than minimum wage (β = -0.197, p = .001) and insulin therapy (β = 0.272, p = .001) were independently associated with increased adherence to overall self-care activities. In a representative sample of people with T2DM in Portugal, HL was a key factor for greater adherence to demanding self-care activities. [HLRP: Health Literacy Research and Practice. 2024;8(4):e194-e203.].

Comorbidities, medications, depression, and physical performance measures associated with severe cognitive impairments in community-dwelling adults

Cognitive impairment negatively impacts health, psychological, social, and economic domains. Cognitive impairment commonly affects physical functions in older adults, whereas these are deteriorated. However, the prevalence and associated factors of cognitive impairment among community-dwelling adults in Saudi Arabia have not been investigated yet. This study aimed to examine the prevalence of severe cognitive impairment and its associated factors in community-dwelling older adults in Saudi Arabia. This cross-sectional study involved adults aged ≥50 years. Demographic data and clinical data, including number of medications and body mass index (BMI), were collected. Cognitive impairment and depressive symptoms were measured using Arabic versions of the Montreal Cognitive Assessment (MoCA) and Patient Health Questionnaire-9 (PHQ-9), respectively. The participants were divided into severe cognitive impairment and mild cognitive impairment or normal cognitive function groups based on a score of <20 or ≥20, respectively, using the MoCA. Physical measures included dynamic gait index (DGI) scores, timed up-and-go (TUG), 5 times sit-to-stand (5XSST), functional reach test, and 6-minute walk test. A total of 206 participants (female: n = 96) were included. The prevalence of severe cognitive impairment in the community-dwelling older adults was 12.6%. The number of chronic conditions (odds ratio [OR]: 2.31, p<0.001), number of medications (OR: 1.36, p = 0.003), and depressive symptoms using PHQ-9 (OR: 1.11, p = 0.009) were significantly associated with severe cognitive impairment after adjustment for other covariates, including age, sex, and BMI. Based on the physical function measures, only the scores for DGI (OR: 0.86, p = 0.003), TUG (OR: 1.16, p = 0.035) and 5XSST (OR: 1.25, p <0.001) were significantly associated with severe cognitive impairment. This study revealed a high prevalence of severe cognitive impairment among community-dwelling adults in Saudi Arabia. Its major risk factors include depressive symptoms, number of chronic conditions and medications, and physical measures, including DGI, TUG, and 5XSST.

Extent and causes of unused medications among patients in rural Ethiopia: a prospective multicenter cohort study

BackgroundMedication waste poses health, economic, and environmental challenges. However, the extent among patients living in rural areas is underexplored. This study assessed the proportion of prescribed medications remaining unused by patients living in rural areas of Ethiopia, and identify the causes thereof and disposal practices.MethodsA prospective multicenter cohort study was conducted in 5 rural health centers in Ethiopia. Patients (≥ 18 years), who received a prescription for acute or chronic medication for pick up from the outpatient pharmacy were included. After 3 months, participants received a house visit by a health employee during which a questionnaire was verbally administered to assess the quantity of unused medication, reason thereof, and disposal practices used. Data were analyzed using descriptive statistics and multivariate logistic regression to identify factors associated with presence of unused medications.ResultsIn total, 178 patients participated. Up to 136 out of 601 (22.6%) dispensed medications ended up unused, mainly antibiotics and analgesics, with an average economic value of $0.37. Of 178 patients, 72 (40.4%) ended up with unused medication, and 15 (8.4%) did not use 80% or more of the prescribed quantity. Early discontinuation of therapy was the main reason (61.8%) for patients’ ending with unused medication. Patients reported to primarily dispose of unused medication either through the toilet (43.6%), household garbage (22.7%), burning (13.6%), or returning it to the pharmacy (2.7%). Medications dispensed to be administered with two or more-unit doses at a time were more likely to remain unused (adjusted OR 1.6 [1.0–3.4]) compared to medications dispensed to be administered one-unit dose.ConclusionA substantial amount of prescribed medications remains unused by patients in rural areas, frequently not properly disposed. Interventions are needed to ensure medications are not wasted and reduce the unwanted consequences.

Efficacy and Safety of Erenumab for Nonopioid Medication Overuse Headache in Chronic Migraine

Patients with chronic migraine and medication overuse headaches (CM-MOH) represent a particularly burdened subpopulation. This trial provides first, to our knowledge, American Academy of Neurology class I evidence for a preventive therapy in CM-MOH. To assess erenumab efficacy and safety in patients with nonopioid CM-MOH. This randomized, double-blind, parallel-group, placebo-controlled trial took place at 67 centers in North America, Europe, and Australia from October 7, 2019, to November 2, 2022. This report reflects the primary analysis conducted in January 2023, using a database snapshot from December 1, 2022, which contains the complete dataset of the double-blind treatment period (DBTP). Participants included adults with CM-MOH who had 1 or more preventive treatment failure(s). There were 992 participants screened and 620 participants enrolled (584 in nonopioid cohort and 36 in opioid cohort). Erenumab, 70 mg, 140 mg, or placebo, once monthly for 24 weeks. The primary end point was MOH remission at month 6. Secondary end points included change from baseline in mean monthly acute headache medication days (AHMD) at month 6 and sustained MOH remission throughout the DBTP. Safety end points were adverse events and changes in vital signs. The primary analysis population included 584 participants in the nonopioid-treated cohort with a mean age of 44 years and 482 participants were female (82.5%). Baseline demographics and disease characteristics were balanced across groups. At month 6, 134 participants in the erenumab, 140 mg group (69.1%) (odds ratio [OR], 2.01; 95% CI, 1.33-3.05; P < .001 vs placebo) and 117 in the erenumab, 70 mg group (60.3%) (OR, 1.37; 95% CI, 0.92-2.05; P = .13 vs placebo) achieved MOH remission vs 102 participants in the placebo group (52.6%). AHMD use was also reduced in the erenumab groups vs placebo. Least squares mean (standard error) change from baseline in average monthly AHMD was -9.4 (0.4) days in the erenumab, 140 mg group (difference from placebo, -2.7; 95% CI, -3.9 to -1.6; P < .001) and -7.8 (0.4) days in the erenumab, 70 mg group (difference from placebo, -1.2; 95% CI, -2.4 to -0.1; P = .03), vs -6.6 (0.4) days in the placebo group. MOH remission throughout the DBTP was sustained in 119 participants (61.3%,) 96 participants (49.5%), and 73 participants (37.6%) in the erenumab, 140 mg, 70 mg, and placebo groups, respectively. Adverse events were consistent with the known safety profile of erenumab. Treatment-emergent adverse events incidence in the combined erenumab group was 66.8% (259 participants; constipation 15.2% (59 participants) and COVID-19 13.9% (54 participants) were most common. In this study, monthly, 140 mg, erenumab injections safely and effectively achieved MOH remission in patients with nonopioid CM-MOH within 6 months. ClinicalTrials.gov Identifier: NCT03971071.

The effects of multifactorial pharmacist-led intervention protocol on medication optimisation and adherence among patients with type 2 diabetes: A randomised control trial.

Patient-related factors and limited medication adherence in patients with chronic diseases, are associated with poor clinical outcomes, long-term complications, and increased overall disease costs. Many methods have been tested with mixed results, and innovative approaches are needed to encourage patients to adhere to their prescribed drug regimens. This randomised controlled trial examined a new multifactorial pharmacist-led intervention protocol (MPIP), including a medication therapy management (MTM) program with face-to-face counselling, patient-specific medication booklets, and a mobile application, from July 2021 to September 2022 in the Oud Al Touba diagnostic and screening ambulatory centre in 192 patients with type 2 diabetes in the United Arab Emirates. Medication adherence was assessed using the fixed medication possession ratio of medication refills and the medication adherence questionnaire. At 12 months follow-up, participants in the MPIP showed significant improvement in overall medication adherence with total (composite) medication possession ratio (MPRt) of mean (±SD) 0.95 (±0.09) compared to 0.92 (± 0.09) in the control group with mean difference of 0.03 (95%, CI 0.01-0.06), P =0.02. In addition, improvement trend was evident in the MPIP group for all medication regimens with P value <0.01. Comparable results were noticeable in adherence questionnaire scores at the end of the study, with 66 participants in the intervention group scored zero on the questionnaire, suggesting high adherence to medication compared to the control group (48 participants only). The MTM program performed 41 clinical interventions on drug-related problems, compared to six interventions in the control group, and the use of mobile application and medication booklet have increased to 45.7% compared to 21.4% before study exit. The pharmacy intervention protocol effectively improved medication adherence and optimised medication regimens in diabetic patients with chronic medication regimens in an ambulatory healthcare centre.

Aetiology of patient dissatisfaction following primary total knee arthroplasty in the era of robotic-assisted technology.

Patient dissatisfaction following primary total knee arthroplasty (TKA) with manual jig-based instruments has been reported to be as high as 30%. Robotic-assisted total knee arthroplasty (RA-TKA) has been increasingly used in an effort to improve patient outcomes, however there is a paucity of literature examining patient satisfaction after RA-TKA. This study aims to identify the incidence of patients who were not satisfied following RA-TKA and to determine factors associated with higher levels of dissatisfaction. This was a retrospective review of 674 patients who underwent primary TKA between October 2016 and September 2020 with a minimum two-year follow-up. A five-point Likert satisfaction score was used to place patients into two groups: Group A were those who were very dissatisfied, dissatisfied, or neutral (Likert score 1 to 3) and Group B were those who were satisfied or very satisfied (Likert score 4 to 5). Patient demographic data, as well as preoperative and postoperative patient-reported outcome measures, were compared between groups. Overall, 45 patients (6.7%) were in Group A and 629 (93.3%) were in Group B. Group A (vs Group B) had a higher proportion of male sex (p = 0.008), preoperative chronic opioid use (p < 0.001), preoperative psychotropic medication use (p = 0.01), prior anterior cruciate ligament (ACL) reconstruction (p < 0.001), and preoperative symptomatic lumbar spine disease (p = 0.004). Group A was also younger (p = 0.023). Multivariate analysis revealed preoperative opioid use (p = 0.012), prior ACL reconstruction (p = 0.038), male sex (p = 0.006), and preoperative psychotropic medication use (p = 0.001) as independent predictive factors of patient dissatisfaction. The use of RA-TKA demonstrated a high rate of patient satisfaction (629 of 674, 93.3%). Demographics for patients not satisfied following RA-TKA included: male sex, chronic opioid use, chronic psychotropic medication use, and prior ACL reconstruction. Patients in these groups should be identified preoperatively and educated on realistic expectations given their comorbid conditions.

Estimating the economic impact of blister-packaging on medication adherence and health care costs for a Medicare Advantage health plan.

Medication nonadherence is a persistent challenge in the United States, leading to increased health care resource utilization (HCRU) and health care costs and worsened health outcomes. Medicare Star Ratings is a program developed by the Centers for Medicare and Medicaid Services (CMS) to evaluate Medicare health plan quality and performance. Three of the Medicare Part D Star Ratings quality measures assess medication adherence, showing the importance CMS places on improving medication adherence in older adults. Although a variety of medication adherence-enhancing interventions are available to help promote adherence among patients, one intervention that has shown success historically is blister-packaging. To model the potential impact of blister-packaging chronic medications on HCRU and health care costs in the Medicare population. An economic model was developed to assess the potential impact of blister-packaging the 3 Medicare Star Ratings adherence measure medication classes: renin-angiotensin system antagonists (RASAs), statins, and noninsulin antidiabetics. The model perspective was that of a hypothetical Medicare Advantage health plan with a plan size of 100,000 members. A 12-month time horizon was used in the model. The dichotomous adherence threshold in the model was set at 80% or greater of the proportion of days covered (PDC). Literature-based references were used to inform both the impact of blister-packaging on the number of patients who become adherent as well as the impact of medication adherence on HCRU and health care costs for each of the medication classes. One-way sensitivity analyses and several scenario analyses were conducted to assess model uncertainty. Owing to increased adherence from the blister-packaging intervention, the hypothetical health plan in the analysis saw 776 additional members adherent to RASAs, 1,651 additional members adherent to statins, and 414 additional members adherent to oral antidiabetics. Although medication expenditure increased for all 3 medication classes (RASAs: $274,963; statins: $730,083; oral antidiabetics: $100,529), medical costs decreased across all classes (RASAs: -$4,098,848; statins: -$5,549,699; oral antidiabetics: -$917,968). Total net health care costs decreased by $3,823,885 for RASAs (-$3.19 per member per month [PMPM]), $4,819,616 for statins (-$4.02 PMPM), and $817,438 for oral antidiabetics (-$0.68 PMPM). The entire Medicare Advantage population scenario analysis saw reductions in total health care costs of $1,081,394,737 for RASAs, $1,362,987,376 for statins, and $231,171,496 for oral antidiabetics. Dispensing chronic medications with blister-packaging for Medicare Advantage health plan patients was modeled to reduce HCRU and health care costs. Future studies are needed to assess whether the impact of blister-packaging medications is tied to reductions in HCRU and health care costs in real-world settings.

Beliefs of Pentecostal pastors concerning the use of antiretroviral treatment among Pentecostal Christians living with HIV in a suburb of Cape Town-South Africa: a community health systems lens.

The global public health community accepts antiretroviral therapy (ART) for controlling and managing HIV. However, within some communities, claims of faith or miraculous healing of HIV and AIDS by Pentecostal pastors continue to spark controversies. This paper reports on an exploratory qualitative study to explore the beliefs held by Pentecostal pastors regarding the use of ART among Pentecostal Christians who are living with HIV (PCLH). Twenty Pentecostal pastors from two informal settlements in Cape Town, South Africa, were purposefully selected. Open-ended, semi-structured, in-depth individual interviews were conducted on their religious beliefs concerning ART adherence. Interviews were conducted in English, audiotaped, and transcribed verbatim before being imported to the Atlas-ti 2023 software program for thematic data analysis. Since our study was guided by the relational community health system (CHS) model a hybrid deductive-inductive thematic analysis was used. Two contrasting themes about the influence of the religious beliefs of Pentecostal pastors were identified: The first theme and its associated subthemes highlight the lack of basic HIV and ART knowledge among pastors. Consequently, these pastors tend to nudge their Christians to rely more on faith and spiritual healing at the expense of adherence to ART. The second theme and the associated sub-themes suggest that some pastors possess some basic HIV knowledge and understand the role of ART and how it works. This group of pastors advise their congregants to use ART and other healthcare services in tandem with spiritual rituals, faith, and prayers. Our findings highlight the need for functional community-based structures, such as community health committees (CHCs) and health facility management committees (HFMCs), in settings where complex interaction within the belief systems, practices, and norms of some stakeholders can influence people's health-seeking behaviours such as adhering to chronic medications like ART.

Health status of senior netball players, their medication use and attitudes towards doping.

Limited research exists on the health and injuries of South African senior netball players. Senior netball players may be at greater risk of injuries and chronic disease due to their age. To treat these conditions, they may use prescription and over-the-counter (OTC) medications and, therefore, may be more vulnerable to unintentional doping. The primary aim of this study was to determine the health status, medication use and attitudes towards doping of South African senior netball players. A cross-sectional descriptive design was employed to collect data by means of an online survey. The validated 8-item Performance Enhancement Attitudes Scale (PEAS) was used to gather information on the netball player's attitudes towards doping. Descriptive statistics were used to describe the data using proportions (categorical), means (normally distributed, continuous) and medians (non-normal distributed, continuous). Doping prevalence and accompanying 95% confidence interval were calculated. Sixty senior netball players consented and completed the self-report questionnaire. The prevalence of chronic disease was 11.67%. Asthma and other conditions such as depression and attention-deficit/hyperactivity (ADHD) had the highest prevalence of 3.33%. The prevalence of chronic prescription medication use was 8.33% and 66.67% of the netball players reported receiving prescription injections, medications or utilizing OTC medications for treating injury or illness suffered 1-6 weeks before or during competition. The netball players do not have a lenient attitude towards doping. The prescription and OTC medication use could put this cohort of netball players at risk of unintentional doping. Anti-doping education aimed at senior athletes may be beneficial to reduce the risk of unintentional doping due to prescription and OTC medication use for injury or illness.

Tooth Loss and Systemic Diseases in the Slovenian Elderly Population: A Cross-Sectional Study of the Associaton Between Oral and Systemic Health.

This study aimed to assess the prevalence of edentulism and tooth loss in the Slovenian elderly population, along with the associated risk factors, and investigate the association between systemic and oral health. The study included 445 individuals aged 65 or older (average age: 79.7±8.9 years). Data on preserved teeth, dental history, chronic diseases, and medications were collected through clinical examinations. Height and weight were recorded in order to calculate body mass index (BMI), and the education level was also collected. Chronic systemic diseases and medications were categorized. Statistical analysis was conducted using linear regression and nonparametric tests. Participants had an average of 4.7±7.7 teeth, with no significant gender differences. Higher age (β=-0.185, p<0.001) and lower education level (p<0.001) were associated with fewer teeth, while higher BMI showed no correlation (β=-0.085, p=0.325). Diabetes mellitus (p=0.031), cardiovascular diseases (p=0.025), and thyroid diseases (p=0.043) were inversely related to retained teeth. This inverse relationship also applied to individuals who recovered from malignancies, not including head and neck malignancies (p=0.019). No significant relationship was found between osteoporosis and the number of teeth (p=0.573). Notably, antidiabetic drug use was inversely related to the number of teeth (p=0.004), while analgesics showed a positive relationship (p=0.022). This study highlights the association between specific sociodemographic factors, chronic diseases, and retained teeth among elderly individuals in Slovenia. High edentulism rates among the elderly emphasize the need for enhanced preventive measures and risk factor management, particularly for high-risk groups like the elderly.

Tensions in caring for chronic patients' medication adherence: A qualitative study in Cyprus.

Medication adherence (MA) to recommended treatment is a multi-faceted problem and an ongoing challenge for healthcare providers (HCPs) to monitor. This qualitative study with 10 HCPs in Cyprus aims to explore HCPs' perceptions and strategies used on addressing medication non-adherence (MNA) in patients with chronic conditions. Two main themes emerged from the analysis reflecting the ways that HCPs described their reactions to MNA of their patients: (1) "Relying on information provision to improve MA" and (2) "Trying to understand patients' perspective." HCPs reported empathizing with patients and engaging in discussions to understand patients' perspective and reasons for MNA, so as to explore alternative solutions. Simultaneously, some HCPs reflected that the techniques used to improve MA are solely centered around information on medication and side-effects. HCPs experienced an internal conflict between providing patient-centered care versus using directive approaches to improve MA. Findings suggest how HCPs could thoroughly address patients' individual barriers.

Mindfulness-Based Therapy for Military Populations with Chronic Pain: A Systematic Review.

Background: Due to the limited role of chronic pain medication in military personnel and the distress caused to the military population, mindfulness-based therapy has been considered for the follow-up treatment of military personnel with chronic pain. The purpose of this review is to explore the effect and the implementation of mindfulness-based therapy for the military population with chronic pain. Methods: The keywords for the search included "mindfulness" AND ("pain" OR "chronic pain") AND ("military" OR "veteran"). The PubMed, Embase, and Cochrane Library databases were searched. The Cochrane Collaboration tool was used to independently assess the risk of bias of the included randomized controlled trials, and the Newcastle-Ottawa Scale was used to independently assess the risk of bias of the included case-control studies. Results: A total of 175 papers were identified; 65 duplicates were excluded, and 59 papers that did not meet the inclusion criteria were excluded after reading the titles and abstracts. The remaining 51 papers were read in full, 42 of which did not meet the inclusion criteria. Nine papers met the inclusion criteria and were included in the study. The nine studies included 507 veterans and 56 active-duty female military personnel. All pain interventions were mindfulness-based therapy, and all of them were integrated into or adapted from standard mindfulness courses. The results all showed that after mindfulness-based therapy, the relevant indicators improved. Conclusions: Mindfulness-based therapy is an effective treatment method for the military population with chronic pain. The review indicates that future research should focus on the best setting for mindfulness-based therapy, including the course content and time.

Associations between sex, race/ethnicity, and age and the initiation of chronic high-risk medication in US older adults.

High-risk medication use is associated with an increased risk of adverse events, but little is known about its chronic utilization by key demographic groups. We aimed to study the associations between age, sex, and race/ethnicity with new chronic use of high-risk medications in older adults. In this retrospective cohort study, we analyzed data from older adults aged ≥65 years enrolled in a national health insurer who started a high-risk medication between 2017 and 2022 across 16 high-risk medication classes. We used generalized estimating equations to estimate the associations between sociodemographic classifications and the onset of chronic high-risk medication use after initiation (≥90 days' supply across ≥2 fills within 180 days). We adjusted the analyses for sociodemographic and clinical patient characteristics and added three-way interaction terms for race/ethnicity, sex, and age to explore whether the outcome varied across different subgroups of race/ethnicity, age, and sex. Across 2,751,069 patients (mean age: 74 years [SD = 7], 72% White, 60% Female), 406,075 (15%) became new chronic users of ≥1 high-risk medication. Compared to White older adults, Asian (RR = 0.81, 95% CI: 0.79-0.84), Black (RR = 0.92, 95% CI: 0.90-0.94), and Hispanic (RR = 0.85, 95% CI: 0.83-0.86) older adults had a lower risk of becoming new chronic users. Men had a higher risk compared to women (RR = 1.09, 95% CI: 1.08-1.10). Age was not significantly associated with new chronic high-risk medication use (≥75 years: RR = 1.00, 95% CI: 1.00-1.01). We observed differences across some medication classes, like benzodiazepines, first-generation antihistamines, and antimuscarinics for which non-White older adults were at a higher risk. The joint presence of specific age, sex, and race/ethnicity characteristics decreased the risk of becoming a new chronic user (e.g., Hispanic/Female/65-74 years: RR = 0.96, 95% CI: 0.94-0.99). New chronic high-risk medication use varied across older adults by sociodemographic characteristics, suggesting the need to individualize medication optimization approaches and better understand how systematic barriers in access to health care may influence differences in high-risk medication use in older adults.

Managing medications for patients with cancer and chronic conditions: It's time for collaboration between primary care and oncology pharmacists.

To provide a rationale for a collaborative care model involving oncology and primary care pharmacists to improve the coordination of care of medications for cancer patients with multiple chronic conditions. A review of selected literature and the authors' own research was used. Studies illustrating the gaps in care for medications and pharmacists' roles in oncology and primary care settings from PubMed were reviewed. There has been a substantial increase in the development and utilization of oral anticancer agents (OAAs). Although OAAs offer convenience and flexibility, they also introduce challenges related to medication adherence, monitoring, and managing side effects. Up to 17.5% of patients experience moderate to severe symptoms from OAAs and about 30% report less than excellent medication adherence. Further, studies showed that 30% to 53% of adult cancer patients have at least one chronic condition that complicates their treatment plan due to the need for medications, increasing the risk of drug interactions, side effects, and non-adherence. The Primary Care Oncology Model (PCOM) incorporates both primary care and oncology pharmacists with comprehensive medication review and patient-reported outcome measure, respectively, to enhance medication appropriateness and effectiveness, and improve overall patient experience. Implementing PCOM may improve the medication management of patients taking OAAs for active cancer treatment and chronic medications for their multiple chronic conditions. This collaborative approach can transform patient care by leveraging the expertise of both primary care and oncology pharmacists.

Anxiety Disorder in Jordan during the COVID-19 Pandemic: A Cross-Sectional Study

Background and Aims: To determine the prevalence of generalized anxiety disorder among university students in Jordan and its relationship with different socio-demographic factors and coronavirus-related anxiety during the COVID-19 pandemic. Materials and Methods: Over a period of four months, a cross-sectional research design was implemented using a Google Forms online survey, which was comprised of questions relating to socio-demographic factors, chronic illnesses, the Generalized Anxiety Disorder 7-item questionnaire, and the Coronavirus Anxiety Scale. The survey was conducted with 470 participants. Results: The prevalence of generalized anxiety disorder was found to be 41.3%, with females (n=155) being approximately four times more susceptible than males (p=0.000). Individuals with chronic medical conditions or those taking chronic medication were found to be at a higher risk of developing generalized anxiety disorder (63%, p=0.007 and 65.7%, p=0.002 respectively). Unexpectedly, participants living alone (n=15, 24.2%) were less likely to experience generalized anxiety disorder (p=0.003) compared to those living with family (n=179, 43.9%). Lastly, compared to the smoker group, generalized anxiety disorder was more common in the non-smokers (33.3% vs 43.8% respectively, p=0.048). Conclusions: Due to the burden of the current pandemic and its correlation with socio-demographic factors and chronic illnesses, the prevalence of generalized anxiety disorder among university students has increased significantly. Therefore, there is a pressing need to raise awareness among healthcare professionals about the prevalence, diagnosis, and management of generalized anxiety disorder.