Compare Medication Adherence Research Articles

A real-world analysis of adherence, biochemical outcomes, and healthcare costs in patients treated with rosuvastatin/ezetimibe as single-pill combination vs. free combination in Italy.

To compare medication adherence, lipid goal attainment, and healthcare costs between patients receiving a single-pill combination (SPC) vs. a free combination treatment (FCT) of rosuvastatin/ezetimibe (ROS/EZE) in Italy. Administrative databases of healthcare entities covering ∼7 million individuals were used to identify adults prescribed with ROS/EZE as SPC or FCT between January 2018 and June 2020. Adherence was calculated as the proportion of days covered (PDC) after cohort balancing by propensity score matching. Patients with available LDL cholesterol testing were assessed for the proportion of those who at baseline were above lipid targets recommended by ESC/EAS Guidelines for their cardiovascular risk category and reached the target during follow-up. Among 25 886 patients on SPC and 7309 on FCT, adherent patients were more represented in SPC than FCT cohort (56.8 vs. 44.5%, P < 0.001), and this difference remained significant (P < 0.001) after stratification by cardiovascular risk (very high, high, and other). The proportion of patients reaching LDL cholesterol target at 1 year follow-up was significantly (P < 0.001) higher in SPC vs. FCT cohort: 35.4 vs. 23.8% for very high cardiovascular risk, 46.9 vs. 23.1% for high risk and 71.6 vs. 49.5% for other risk. Total healthcare costs per patient at 1 year follow-up were lower in SPC vs. FCT users (2337€ vs. 1890€, P < 0.001). In both cohorts, costs were mainly driven by drug expenses and hospitalizations. This real-world analysis in dyslipidaemic patients found that treatment with ROS/EZE as SPC resulted in better adherence, higher chances of reaching lipid goals, and cost savings over FCT, in all cardiovascular risk categories.

Medication adherence to sodium-glucose cotransporter-2 inhibitors versus glucagon-like peptide-1 receptor agonists: A meta-analysis.

To perform a meta-analysis comparing real-world medication adherence to sodium-glucose cotransporter-2 inhibitors (SGLT2is) versus glucagon-like peptide-1 receptor agonists (GLP-1RAs). A systematic search of Medline and Embase was conducted through October 2023. To meet inclusion criteria, articles had to be published in full text form and directly compare medication adherence to SGLT2is versus GLP-1RAs in adults. Only studies evaluating real-world data and utilizing the proportion of days covered (PDC) to measure adherence were included. Non-adherence, defined as the proportion of patients with a PDC <80%, was the primary outcome. A subgroup analysis evaluating results among studies conducted in the United States was performed. We identified eight studies evaluating 205 103 patients for inclusion. The most common country from which the data was derived was the United States (n = 5 studies). Upon meta-analysis, we observed no difference in non-adherence (i.e. PDC <80%) to SGLT2is versus GLP-1RAs (relative risk = 0.86; 95% confidence interval = 0.72-1.02). In the analysis, including only US studies, SGLT2i use was associated with a 23% lower risk of non-adherence compared with GLP-1RA use (relative risk = 0.77; 95% confidence interval = 0.72-0.82). In this meta-analysis of eight studies that included approximately 200 000 patients, there was no difference in adherence to SGLT2is versus GLP-1RAs. However, SGLT2i use was associated with higher adherence when the analysis was limited to US studies.

Comparison of medication adherence in patients with type 2 diabetes mellitus: a pre and post study

Background: Type 2 diabetes mellitus refers to a group of heterogeneous disorders with the common elements of chronic hyperglycemia. Diabetes medications play a crucial role in lowering blood sugar levels. The study aims to compare medication adherence in patients with type 2 diabetes mellitus from urban and rural areas during pre and post visit. Methods: This pre and post-study was conducted from March to August 2022. A total of 104 participants were enrolled. Details have been obtained through data collection form. Medication adherence was measured using Hill-Bone medication adherence scale, and patient education was provided through leaflet. Results: The study included 54 females and 50 males. The correlation between medication adherence versus disease knowledge and drug knowledge was found out using Pearson’s correlation and the result is statistically significant. The medication adherence was found to be increased by 17.3% and 21.2% in rural and urban areas respectively. Inadequate follow-up and financial barriers were most accounted for medication non-adherence. Conclusions: The majority of type 2 diabetes patients have suboptimal treatment adherence which is associated with poor blood sugar control. We clinical pharmacists can tackle this problem of adherence through quality patient education.

Trends in Opioid Medication Adherence During the COVID-19 Pandemic: Retrospective Cohort Study.

The recent pandemic had the potential to worsen the opioid crisis through multiple effects on patients' lives, such as the disruption of care. In particular, good levels of adherence with respect to medication for opioid use disorder (MOUD), recognized as being important for positive outcomes, may be disrupted. This study aimed to investigate whether patients on MOUD experienced a drop in medication adherence during the recent COVID-19 pandemic. This retrospective cohort study used Medicaid claims data from 6 US states from 2018 until the start of 2021. We compared medication adherence for people on MOUD before and after the beginning of the COVID-19 pandemic in March 2020. Our main measure was the proportion of days covered (PDC), a score that measures patients' adherence to their MOUD. We carried out a breakpoint analysis on PDC, followed by a patient-level beta regression analysis with PDC as the dependent variable while controlling for a set of covariates. A total of 79,991 PDC scores were calculated for 37,604 patients (age: mean 37.6, SD 9.8 years; sex: n=17,825, 47.4% female) between 2018 and 2021. The coefficient for the effect of COVID-19 on PDC score was -0.076 and was statistically significant (odds ratio 0.925, 95% CI 0.90-0.94). The COVID-19 pandemic was negatively associated with patients' adherence to their medication, which had declined since the beginning of the pandemic.

Impact of continuous pharmaceutical care led by clinical pharmacists during transitions of care on medication adherence and clinical outcomes for patients with coronary heart disease: a prospective cohort study.

Objectives: The study aimed to explore the impact of a continuous pharmaceutical care (CPC) program during care transitions on medication adherence and clinical outcomes for patients with coronary heart disease (CHD). Methods: A prospective cohort study was conducted from April 2020 to February 2021. Patients diagnosed with CHD were selected and divided into intervention (CPC) and usual care (UC) groups by nurses at equal intervals based on admission time. The intervention group received CPC services provided by clinical pharmacists (including medication reconciliation, disease education, medication guidance, lifestyle counseling, and follow-up services) and usual care. The UC group received only routine medical care. The study compared medication adherence, clinical indicators (low-density lipoprotein cholesterol [LDL-C], blood pressure [BP], glycated hemoglobin [HbA1c] control rates), the incidence of adverse drug reactions (ADRs), and readmission rates (overall, major adverse cardiovascular events [MACEs]-related, and CHD risk factors-related) at admission and 1, 3, and 6 months after discharge between the two groups. Results: A total of 228 patients with CHD completed the study, including 113 patients in the CPC group and 115 patients in the UC group. There were no significant differences (p > 0.05) in both groups in demographic and clinical characteristics at baseline. A total of 101 drug-related problems were identified in the CPC group (an average of 0.89 per person). The CPC group showed significantly higher medication adherence at 1, 3, and 6 months after discharge than the UC group (p < 0.05). At 3 and 6 months after discharge, the intervention group had significantly higher control rates of LDL-C (61.11% vs. 44.64% at 3 months, 78.18% vs. 51.43% at 6 months), and BP (91.15% vs. 77.39% at 3 months, 88.50% vs. 77.19% at 6 months). The CPC group had higher HbA1c control rates (53.85% vs. 34.21% at 3 months, 54.05% vs. 38.46% at 6 months) than the UC group. However, the differences were not statistically significant. The incidence of ADRs 6months after discharge was significantly lower in the CPC group than in the UC group (5.13% vs. 12.17%, p < 0.05). The CPC group had a lower overall readmission rate (13.27% vs. 20.00%), MACE-related readmission rate (5.31% vs. 12.17%), and readmission rate related to CHD risk factors (0.88% vs. 2.61%) 6months after discharge compared to the UC group. However, these differences were not statistically significant (p > 0.05). Conclusion: CPC led by clinical pharmacists during care transitions effectively improved medication adherence, safety, and risk factor control in patients with CHD.

PCR58 Comparing Adherence in Patients with Type 2 Diabetes Initiating Glucagon-like Peptide-1 Receptor Agonists or Sodium-Glucose Cotransporter-2 Inhibitors

Non-adherence to antidiabetic medications is associated with worse clinical outcomes including poorer hemoglobin A1c (HbA1c). Both sodium-glucose cotransporter 2 (SGLT2I) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists demonstrate clinical benefits in type 2 diabetes (T2DM) patients with an increased risk for cardiovascular disease. However, differences in route of administration and side effect profile may affect adherence. Therefore, the objective of this study is to evaluate and compare medication adherence among new adult users of SGLT2I and GLP-1 agonists.

A real-world analysis of adherence and biochemical outcome of patients on rosuvastatin/ezetimibe free vs single-pill combination in italy

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Servier. Background/Introduction One of the most effective strategies for cardiovascular (CV) disease prevention is lipid level control. To achieve this control, a satisfactory level of adherence to effective lipid-lowering medications is required. Purpose To evaluate and compare medication adherence and plasma levels of low-density lipoprotein cholesterol (LDL-C) among 2 cohorts of patients treated with rosuvastatin and ezetimibe (ROS/EZE) as free (FC) or single-pill combination (SPC), in an Italian real-world setting. Methods A retrospective analysis was performed using administrative databases linked to laboratory database, covering approximately 7 million health-assisted subjects. Adults prescribed with ROS/EZE as SPC or FC during January 2018-June 2020 were included and categorized in 2 cohorts. Index date (ID) was the first prescription of SPC or first simultaneous prescription of the 2 drugs (within 30 days interval). Patients were characterized during all available periods prior to ID and followed-up to end of data availability. Propensity score matching (PSM) was applied to minimize selection bias between cohorts; adherence was calculated as proportion of days covered (PDC): PDC&amp;lt;25% non-adherence; PDC=25-75% partial adherence; PDC&amp;gt;75% adherence, after PSM. Based on ESC/EAS 2019 guidelines, patients were stratified by CV risk profile. For a subgroup of patients (n=3,846) with plasma-LDL-C data availability (at ID and during first year of follow-up), the percentages of patients being above 55 mg/dl LDL-C for very-high risk, 70 mg/dl for high risk, and 116 mg/dl for other CV risk patients, and who reached these levels during follow-up were reported. Results The analysis included 25,886 patients in SPC cohort and 7,309 in FC. Post-PSM cohorts were balanced for their characteristics, including CV risk, and comprised 21,927 (SPC) and 7,309 (FC) patients. A higher percentage of patients were adherent to SPC vs FC (56.8% vs 44.5%, p&amp;lt;0.001). A lower percentage of non-adherent patients was found for the SPC vs FC (12.6% vs 27.4%, p&amp;lt;0.001). Among very-high, high and other CV risk patients, respectively, a 30%, 28% and 21% increase in the number of adherent patients was found for SPC vs FC [65.4% vs 50.4%, p&amp;lt;0.001 (very-high); 54.7% vs 42.7%, p&amp;lt;0.001 (high); 43.5% vs 35.9%, p&amp;lt;0.001 (other CV risk)] (Fig. 1). The proportion of very-high-CV risk patients reaching LDL-C ≤55mg/dl in the first year of follow-up was higher in SPC vs FC (35.4% vs 23.8%, p&amp;lt;0.001) (Fig.2). Similarly, among high-risk patients, 46.9% and 23.1% (p&amp;lt;0.001) of SPC and FC, respectively, reached ≤70 mg/dl LDL-C and among other CV-risk patients, 71.6% and 49.5% (p&amp;lt;0.001) of SPC and FC, respectively, reached ≤116 mg/dl LDL-C levels during first year of follow-up. Conclusions This real-world analysis in patients with hypercholesterolemia showed that treatment with ROS/EZE SPC vs FC could be associated with better medication adherence and lower LDL-C levels, whatever the CV risk category.

Abstract P366: Enrollment in Medicare Managed Care Plan is Associated With Higher Adherence to Anti-Hypertensive Drugs

Introduction: Adherence to anti-hypertensive drugs, which is sub-optimal despite public health and policy efforts, is essential in controlling high blood pressure. Medicare Advantage plans are gaining popularity, partly due to their managed care designs that held promise to improve chronic disease management. Hypothesis: We assessed the hypothesis that hypertensive patients with a managed care plan have higher adherence to antihypertensive drugs than those with a non-managed care plan. Methods: We analyzed medication adherence – measured using proportion of days covered (PDC) over 12 months for antihypertensive drugs – among 174,172 patients with a hypertension diagnosis from the medical and pharmacy claims and benefits data in the 2017-2019 IBM MarketScan Research Database. We fitted separate generalized linear regression models among monotherapy (use of one class of antihypertensive drugs) and polytherapy (combined use of at least two classes of antihypertensive drugs) users and computed postestimation margins with the best-fitted model to compare medication adherence by plan type: 1) Managed Care exclusive provider organization and health management organization (EPO/HMO) plan, 2) Managed Care point-of-service plan, 3) Managed Care preferred provider organization plan, 4) non-Managed Care comprehensive plan, 5) non-Managed Care consumer driven health plan / high deductible health plan. Other patient characteristics included in the analyses were age, age-squared, sex, comorbidities, census region, and their interaction terms. Results: The average PDC among Medicare patients on monotherapy was 0.53 and among those on polytherapy was 0.74. Patients with a managed-care EPO/HMO plan had the highest PDC (0.53, 95% confidence interval [CI]: 0.52, 0.54 among monotherapy users and 0.73, 95% CI: 0.72, 0.74 among polytherapy users, respectively) and those with a non-managed care comprehensive plan had the lowest PDC (0.42, 95% CI: 0.41, 0.43 among monotherapy users and 0.62, 95% CI: 0.61, 0.63 among polytherapy users, respectively). By census region, patients living in the North Central region with a managed care EPO/HMO plan had the highest average PDC (0.71, 95% CI: 0.70, 0.72 among monotherapy users and 0.85, 95% CI: 0.84, 0.86 among polytherapy users, respectively). Other factors such as age, sex, and number of chronic conditions were significantly associated with PDC. Conclusions: In conclusion, with an increase in the proportion of older adults enrolled in Medicare Advantage insurance, managed care models may play a more important role in influencing adherence to essential drugs such as anti-hypertensive drugs among Medicare beneficiaries. Future research should investigate factors that promote adherence to medications across different managed care plan designs.

PS-BPC07-5: A REAL-WORLD ANALYSIS OF PHARMACO-UTILIZATION AND OUTCOMES OF PATIENTS ON PERINDOPRIL/AMLODIPINE/INDAPAMIDE FREE VS SINGLE-PILL COMBINATION IN ITALY

Objective: To evaluate and compare medication adherence, cardiovascular (CV) events and mortality incidence among 2 cohorts of patients treated with Perindopril/Amlodipine/Indapamide (PER/AML/IND) as a free or single-pill combination in a real-world setting in Italy. Design and method: Data were extracted from administrative databases of Italian Healthcare Entities. Adult patients treated with PER/AML/IND as single-pill or free combination (during the period 2010–2020) were included and categorized into 2 cohorts. The index date (ID) corresponded to the first prescription of a single-pill combination (single-pill cohort) or the first prescription of the 3 drugs simultaneously (within 30 days) (free cohort). Patients were characterized in the year prior to ID and followed up from ID to the end of data availability. Patients who died during the first 12-month period were excluded. Propensity score matching (PSM) was applied to minimize selection bias and to reduce potential imbalances between the two cohorts. Adherence was calculated as the proportion of days covered (PDC: PDC &lt; 40% non-adherence; PDC = 40–79% partial adherence; PDC&gt; = 80% adherence). Incidence of mortality and CV events was analyzed after the first year of follow-up and reported as event rate per 1,000-person/year. Results: The analysis included 37,365 patients (54.3% male) in the single-pill cohort and 6,105 (50.8% male) in the free cohort. The post-PSM cohorts were balanced for their characteristics and comprised 6,105 (free-cohort) and 12,105 (single-pill-cohort) patients. The adherence to medication (PDC &gt; = 80%) was better in the single-pill cohort compared to the free cohort (59.9% vs 26.9% adherent patients, p &lt; 0.001). Accordingly, there were more non-adherent patients in the free (54.0%) than in the single-pill (20.8%) cohort (p &lt; 0.001), while similar values were observed for partial adherence (19%, both cohorts). The mortality rate was higher in the free-cohort versus single-pill-cohort patients (33.7 vs 29.9 per 1,000-person/year, p &lt; 0.05). The same effect was reported for incidence of death and CV events as a composite endpoint: 139.0 (free-cohort) versus 105.8 (single-pill-cohort) per 1,000-person/year (p &lt; 0.001). Conclusions: This real-world analysis among hypertensive patients showed that the treatment with PER/AML/IND as a single-pill, as opposed to free combination, could be associated with better medication adherence in the single-pill cohort at one year and with a lower incidence of cardiovascular events and mortality.

Differences in medication adherence between preemptive and post-dialysis young kidney transplant recipients.

The mechanisms underlying the superior graft survival associated with preemptive kidney transplantation, compared with transplantation following a period of dialysis, are unknown. We aimed to compare medication adherence between preemptively transplanted young kidney transplant recipients and those who received a transplant after an interval of dialysis. This was a secondary analysis of the Teen Adherence in Kidney transplant Effectiveness of Intervention Trial (TAKE-IT), in which adherence was assessed with electronic monitoring over 15months among 11-24-year-old transplant recipients. Adherence scores were calculated for each day as 0%, 50%, or 100% (intake of none, half, or all prescribed doses). We used ordinal logistic regression, with generalized estimating equations to account for repeated measures within each participant, to estimate the association between preemptive transplantation and adherence. The model was adjusted for sex, age at transplant, time since transplant, primary kidney disease, race, donor source, medication insurer, household income, and adherence intervention. There were 43 preemptive transplant recipients and 103 who had been treated with dialysis. The median adherence score was 85.1% (IQR 81.3-88.9) for those preemptively transplanted, and 80.0% (IQR 76.7-83.4) for those transplanted after dialysis. Preemptively transplanted recipients had significantly higher odds of adherence than those dialyzed before transplantation (adjusted OR 1.76 95% CI 1.21-2.55; p = 0.003). Preemptively transplanted patients showed significantly better adherence than those treated with dialysis before transplantation. This suggests that the superior outcomes observed among preemptive kidney transplant recipients may reflect selection of patients more likely to adhere to therapy. A higher resolution version of the Graphical abstract is available as Supplementary information.

Effects of medication adherence on disease activity in chronic obstructive pulmonary disease: a systematic review and meta-analysis

ABSTRACT The disease activity of Chronic obstructive pulmonary disease (COPD) patients is often measured, which can could be related to medication adherence. Yet, there is no systematic inventory of studies comparing adherents and non-adherent patients in terms of disease activity. The systematic review and meta-analysis aimed to reveal the effect of medication adherence on disease activity in patients with COPD. For the present meta-analysis, studies comparing medication adherence in adherents and non-adherent patients were screened and included. Results were expressed as mean difference (MD) and 95% CI. A total of eleven identified studies matched the inclusion criteria, reporting on a total of 6,346 COPD patients in the analysis. The number of exacerbations in COPD patients over a year was significantly lower in non-adherent patients than in adherent subjects (MD = 0.69, 95% CI [0.36,1.01], P < 0.0001). Similarly, a significant difference was observed between medication-adherent and non-adherent groups in FEV1 (MD = −166.47, 95% CI [−255.03, −77.92], P= 0.0002). Interestingly, the results of the meta-analysis showed no significant difference between medication-adherent and non-adherent patients in SGRQ (MD = −0.85, 95% CI [−4.98, 3.27], P= 0.68), CAT (MD = −0.83, 95% CI [−1.78, 0.13], P= 0.09), and FEV1% (MD = −3.33, 95% CI [−6.83, 0.17], P= 0.06).The studies performed suggested that clinical medical staff should pay attention to the medication behavior of COPD patients and effectively improve the medication adherence of patients.

213.9: Differences in Medication Adherence Between Preemptive and Post-dialysis Young Kidney Transplant Recipients

Introduction: The mechanisms underlying the superior graft survival associated with pre-emptive kidney transplantation, compared with transplantation following a period of dialysis, are unknown. Selection for pre-emptive transplantation of a group biased to better treatment adherence is possible. We aimed to compare medication adherence between pre-emptively transplanted young kidney transplant recipients and those who received a transplant after an interval of dialysis. Methods: This was a secondary analysis of the Teen Adherence in Kidney transplant Effectiveness of Intervention Trial (TAKE-IT), in which adherence was assessed with electronic monitors over a 15-month period among 11–24 year-old kidney transplant recipients. Adherence scores of 0%, 50%, or 100% were calculated for each day, depending on whether the patient took none, half, or all prescribed doses. We used ordinal logistic regression to estimate the association between pre-emptive transplantation and adherence, with generalized estimating equations to account for repeated measures within each participant. The model was adjusted for sex, age at transplant, time since transplant, primary kidney disease, race, donor source, medication insurer, household income, and adherence intervention (time-varying). Results: There were 43 pre-emptive transplant recipients (median age 15.8 [IQR 13.7-17.6]; 60.5% male) and 103 who has been treated with dialysis (median age 15.7 [IQR 13.3-17.4]; 60.2% male). The mean adherence score was 85.1% (IQR 81.3-88.9) for those pre-emptively transplanted, and 80.0% (IQR 76.7-83.4) for those transplanted after dialysis. Table 1 shows the results adjusted logistic regression model. Preemptively transplanted recipients had significantly higher odds of adherence than those dialyzed before transplantation (OR 1.76 95%CI 1.21-2.55; p=0.003). Conclusions: Pre-emptively transplanted patients showed significantly better adherence than those treated with dialysis before transplantation. This suggests that the superior outcomes observed among preemptive kidney transplant recipients likely reflect selection of patients more likely to adhere to therapy.

PCR26 Medication Utilization Patterns of Novel Hormonal Therapies for the Management of Metastatic Castration-Resistant Prostate Cancer

Adherence to oral novel hormonal therapies (NHTs) impacts clinical and economic outcomes, but little is known regarding real-world adherence in the US. The objectives were to compare medication adherence between abiraterone acetate (ABI) and enzalutamide (ENZ) users and to determine patient demographic and clinical characteristics associated with adherence.

How did the COVID-19 lockdown impact patients with dual diagnoses?

PurposeIndividuals with dual diagnoses might experience significant clinical and social vulnerabilities during the pandemic and lockdown. This study aims to compare medication adherence, substance use, clinical stability and overall functioning before and during lockdown periods.Design/methodology/approachThis was a cross-sectional survey among patients registered in dual diagnosis clinic of an addiction psychiatry center in Northern India between March 2019 and February 2020. This study approached 250 patients for telephonic interviews. This study assessed adherence to medications with the brief adherence rating scale (BARS). Global functioning was measured by global assessment of functioning. Clinical interviews assessed substance use and the clinical status of psychiatric disorders.FindingsOne hundred fifty patients were recruited. The mean age of the sample was 35.8 years. The sample had a slight preponderance of alcohol dependence. Depressive disorder was the largest category of psychiatric diagnosis. Compared to prelockdown period, during the lockdown, there were an increased number of days of nonadherence (X2 17.61, p < 0.05), proportion of patients underdosing (X2 8.96, p = 0.003) and lower BARS scores (t = 10.52, df = 144, p < 0.0001). More patients were abstinent from substances during the lockdown (X2 49.02, p < 0.0001). Clinical stability of psychiatric disorders did not differ during the two-time points, but overall functioning decreased during the lockdown (t = 2.118, p = 0.036). This study observed a small positive correlation (r = 0.2, p = 0.02) between functioning and adherence levels.Originality/valueLockdown was associated with poor medication adherence, change in substance use patterns and functional impairment. In the future, treatment programs and policies must take preemptive steps to minimize the effects of restrictions.

Impact of Telehealth on Medication Adherence in Chronic Gastrointestinal Diseases.

BackgroundWith the COVID-19 pandemic, the demand and availability of telehealth in outpatient care has had exponential growth. Although use of telehealth has been studied and validated for various medical specialties, relatively few studies have looked at its role in gastroenterology.AimTo assess effectiveness of telehealth medicine in gastroenterology by comparing medication adherence rate for patients seen with telehealth and traditional in-person appointment for various gastrointestinal conditions.MethodsRetrospective chart review of patients seen in outpatient gastroenterology clinic was performed to identify patients who were given prescription to fill either through telehealth or in-person appointment. By using provincial pharmacy database, we determined the prescription fill rate.ResultsA total of 206 patients were identified who were provided new prescriptions or prescription renewal at their gastroenterology clinic visit. One hundred and three patients were seen through in-person visit during pre-pandemic period, and 103 patients were seen through telehealth appointment during COVID-19 pandemic. The mean age of patients was 49.2 years (55% female). On average, patients had 4.7 previous visits with their gastroenterologists before their visit. IBD management was the most common reason for visits (37.9% and 46.6% in telehealth and in-person groups, respectively). Prescription fill rate for patients seen through telehealth was 92.2% compared to 81.6% for the in-person group (OR: 2.69, 95% CI: 1.12–6.45; P = 0.023).ConclusionsMedication adherence rate for telehealth visits was higher than for in-patient visits. These findings suggest that telehealth can be an effective method of care delivery, especially for patients with chronic gastrointestinal conditions like IBD.

Self-Reported Medication Adherence Among Patients with Ulcerative Colitis in Japan and the United Kingdom: A Secondary Analysis for Cross-Cultural Comparison.

PurposeNon-adherence to medication was reported by 28% of Japanese patients with ulcerative colitis, but in the United Kingdom, patients with inflammatory bowel disease have lower medication adherence, which increases clinical relapse risk. The objective of this study was to compare medication adherence among patients with ulcerative colitis in Japan with previously reported results and patients in the United Kingdom.Patients and MethodsThis cross-cultural comparison study investigated medication adherence among 100 ulcerative colitis patients in the United Kingdom and 432 ulcerative colitis patients in Japan. Adherence was assessed using The Morisky Medication Adherence Scale-8 questionnaire. Patient clinical features were collected from medical records and the questionnaire. Distribution of responses for each item, questionnaire total score, difference in ratio for each item between Japanese and UK patients, and difference in percentage of low/medium/high adherence between Japanese and UK patients were compared.ResultsThe proportion of low/medium or high adherence was significantly different between countries (42.6% and 7.4% [Japan] vs 24.0% and 76.0% [United Kingdom]; p<0.01). Significantly more Japanese patients reported taking medication correctly the day before the questionnaire compared with UK patients.ConclusionUK patients were more likely to not take medication when they felt their symptoms were under control compared with Japanese patients. UK patients perceived it was more difficult to remember to take the medication than Japanese patients. This study highlights culturally sensitive medication-taking behaviors in Japanese and UK patients with ulcerative colitis.

Evaluation of persistence and healthcare utilization in patients treated with anti-seizure medications as add-on therapy: A nationwide cohort study in South Korea

ObjectiveTo compare medication adherence and healthcare utilization among patients who were treated with anti-seizure medications (ASMs) as first add-on to monotherapy for epilepsy using the national health insurance claims data. MethodsA retrospective observational cohort study was conducted using the Korean National Health Insurance claims data. Patients who received ASM as first add-on to monotherapy during January 2017 to February 2018 were included. The selected patients were followed up for 12 months to evaluate persistence, adherence, and healthcare resource utilization. ResultsIn total, 4277 patients who received ASM as first add-on to monotherapy for epilepsy were enrolled. The mean treatment duration of add-on ASM was 296.6 ± 108.6 days during the 1-year follow-up period and 64.3% of the total population were persistent on the add-on ASM at 365 days from the index date. The mean medication possession ratio (MPR) was 90.3 ± 23.7 and the proportion of adherent patients with ≥80% MPR was 79.3%. Lamotrigine (LTG), levetiracetam (LEV), oxcarbazepine (OXC), and perampanel (PER) groups showed significantly higher persistence and adherence than carbamazepine (CBZ), topiramate (TPM), and valproate (VAL) groups during the 1-year follow-up period. Significant differences in length of stays, total hospitalization cost, outpatient visit cost, and emergency cost were shown between ASM groups and LTG, LEV, OXC, and PER showed relatively low utilization and cost. ConclusionsBetter adherence was observed in LTG, LEV, OXC, and PER groups than in CBZ, TPM, and VAL groups. Healthcare utilization and related costs showed significant difference between ASM groups.

Deferasirox Adherence and Persistence Among Texas Medicaid Patients Taking Dispersible Tablets and Film-Coated Tablets

Background: Chronic iron overload is a significant complication associated with long-term blood transfusions required to treat patients with sickle cell disease, thalassemia, myelodysplastic syndromes, and other blood disorders. Without iron chelation therapy (ICT), which binds to and removes excess plasma iron, patients would experience iron accumulation in the body, leading to liver, heart, or other organ failure. Despite the seriousness of these complications, low adherence to ICT has been reported. Deferasirox (DFX) is a once-daily oral ICT with documented better adherence compared to parenteral deferoxamine. Before March 2015, DFX was available only as a dispersible tablet (DT) that must be mixed with liquid; however, in March 2015 the FDA approved a film-coated tablet (FCT) version of DFX. Improved adherence with DFX-FCT has been reported, but studies conducted in Medicaid populations are limited. This study investigated medication adherence and persistence between Texas Medicaid patients taking DFX-FCT and DFX-DT, and among patients who switched from DFX-DT to DFX-FCT.Objectives: (1) To compare medication adherence and persistence between Texas Medicaid patients taking DFX-DT and DFX-FCT; and (2) to evaluate adherence and persistence in patients who switched from DFX-DT to DFX-FCT.Methods: A retrospective analysis was conducted using 2014-2016 Texas Medicaid prescription claims data. For patients taking either DFX-DT or DFX-FCT, the index date was the date of the first DFX-DT or DFX-FCT claim between 4/1/2015 and 12/31/2015, and patients were followed for 12 months. For patients who switched from DFX-DT to DFX-FCT, the switch date was the date of the first DFX-FCT claim between 4/1/2015 and 12/31/2015. The study period was 12 months before and 12 months after the switch date. Included patients were 2-63 years of age at index/switch, and were continuously enrolled in Texas Medicaid.Adherence was measured using the medication possession ratio (MPR) and proportion of days covered (PDC). Persistence was defined as continued access to medication without a gap of >60 days. Mann-Whitney U/Wilcoxon Signed Rank and Chi-square/McNemar tests were used for continuous and categorical variables, respectively.Results: A total of 57 and 165 Texas Medicaid patients who met the study criteria were taking DFX-DT and DFX-FCT, respectively. MPR was not significantly different between patient groups; however, PDC was significantly greater for DFX-FCT patients (median = 0.66; mean +/- SD = 0.61 +/- 0.25) compared to DFX-DT patients (median = 0.49; mean +/- SD = 0.49 +/- 0.25; p=0.003). Nearly 30% of DFX-FCT patients were adherent (PDC >= 0.8), while 15.8% of DFX-DT patients were adherent (p=0.039). DFX-FCT patients had greater persistence over DFX-DT patients (p=0.021). Accordingly, a significantly greater proportion of DFX-FCT patients were persistent with their ICT compared to DFX-DT patients (47.3% vs. 28.1%; p=0.011).For 121 eligible patients who switched from DFX-DT to DFX-FCT, MPR was not significantly different between pre- and post-switch periods. However, median (mean +/- SD) PDC increased from 0.58 (0.55 +/- 0.24) when patients were taking DFX-DT to 0.66 (0.66 +/- 0.23) when they switched to DFX-FCT (p<0.001), and persistence significantly increased from 227.6 days to 263.3 days (p=0.008). When patients were taking DFX-DT during the pre-switch period, 24.0% and 35.5% were considered adherent and persistent, respectively; these proportions increased to 34.7% and 54.5%, respectively, when patients switched to DFX-FCT.Conclusions: In the Texas Medicaid population taking DFX, medication adherence and persistence is better with DFX-FCT compared to DFX-DT. To optimize patient health outcomes and use of resources, health care providers and decision-makers should be aware of adherence and persistence rates associated with ICT, and actively monitor and encourage ICT adherence among patients. DisclosuresRichards:Novartis: Research Funding. Lawson:Novartis: Research Funding. Said:Novartis: Employment. Sasane:Novartis: Employment.

Comparing medication adherence using a smartphone application and electronic monitoring among patients with acute coronary syndrome

AimThe purpose of this study was to determine the extent of agreement between adherence measures obtained using two technological interventions, electronic monitoring (EM) and a smartphone application (App). BackgroundClinicians, patients, and researchers depend on valid measurements of medication adherence to inform the delivery of preemptive care when needed. Technology is routinely used for monitoring medication adherence in both clinical practice and research, yet there is a dearth of research comparing novel App based approaches to traditional approaches used for assessing medication adherence. MethodsAdherence rates were captured on both the EM and the App for 3697 daily observations from 44 participants with acute coronary syndrome over 90 days immediately following discharge from acute care. For EM, adherence was measured using EM equipped pill bottles. For the App, adherence was measured by having participants upload daily photos to the App prior to taking their daily aspirin. Agreement was assessed using a Bland-Altman analysis. ResultsThe mean adherence rate was higher on the App, 92%, than the EM, 78% (p < 0.001). The mean difference in adherence rates between these methods was 14% (95% Confidence Interval: −23%, −5%). ConclusionsThese findings illustrate a lack of agreement between technological interventions used for measuring adherence in cardiovascular patient populations, with higher adherence rates observed with the App compared to EM. These findings are salient given the increased reliance on telehealth due to the ongoing COVID-19 pandemic.

The Use of SMS Text Messaging to Improve the Hospital-to-Community Transition in Patients With Acute Coronary Syndrome (Txt2Prevent): Results From a Pilot Randomized Controlled Trial.

BackgroundAcute coronary syndrome (ACS) is a leading cause of hospital admission in North America. Many patients with ACS experience challenges after discharge that impact their clinical outcomes and psychosocial well-being. SMS text messaging has the potential to provide support to patients during this postdischarge period.ObjectiveThis study pilot tested a 60-day SMS text messaging intervention (Txt2Prevent) for patients with ACS. The primary objective was to compare self-management domains between usual care and usual care plus Txt2Prevent. The secondary objectives were to compare medication adherence, health-related quality of life, self-efficacy, and health care resource use between groups. The third objective was to assess the feasibility of the study protocol and the acceptability of the intervention.MethodsThis was a randomized controlled trial with blinding of outcome assessors. We recruited 76 patients with ACS from St. Paul’s Hospital in Vancouver, Canada, and randomized them to 1 of 2 groups within 7 days of discharge. The Txt2Prevent program included automated 1-way SMS text messages about follow-up care, self-management, and healthy living. Data were collected during the index admission and at 60 days after randomization. The primary outcome was measured with the Health Education Impact Questionnaire (heiQ). Other outcomes included the EQ-5D-5L, EQ-5D-5L Visual Analog Scale, a modified Sullivan Cardiac Self-Efficacy Scale, and Morisky Medication Adherence Scale scores, and self-reported health care resource use. Analyses of covariance were used to test the effect of group assignment on follow-up scores (controlling for baseline) and were considered exploratory in nature. Feasibility was assessed with descriptive characteristics of the study protocol. Acceptability was assessed with 2 survey questions and semistructured interviews.ResultsThere were no statistically significant differences between the groups for the heiQ domains (adjusted mean difference [Txt2Prevent minus usual care] for each domain—Health-directed activity: –0.13, 95% CI –0.39 to 0.13, P=.31; Positive and active engagement in life: 0.03, 95% CI –0.19 to 0.25, P=.76; Emotional distress: 0.04, 95% CI –0.22 to 0.29, P=.77; Self-monitoring and insight: –0.14, 95% CI –0.33 to 0.05, P=.15; Constructive attitudes and approaches: –0.10, 95% CI –0.36 to 0.17, P=.47; Skill technique and acquisition: 0.05, 95% CI –0.18 to 0.27, P=.69; Social integration and support: –0.12, 95% CI –0.34 to 0.10, P=.27; and Health services navigation: –0.05, 95% CI –0.29 to 0.19, P=.69). For the secondary outcomes, there were no statistically significant differences in adjusted analyses except in 1 self-efficacy domain (Total plus), where the Txt2Prevent group had lower scores (mean difference –0.36, 95% CI –0.66 to –0.50, P=.03). The study protocol was feasible, but recruitment took longer than expected. Over 90% (29/31 [94%]) of participants reported they were satisfied with the program.ConclusionsThe Txt2Prevent study was feasible to implement; however, although exploratory, there were no differences between the 2 groups in adjusted analyses except for 1 self-efficacy domain. As the intervention appeared acceptable, there is potential in using SMS text messages in this context. The design of the intervention may need to be reconsidered to have more impact on outcome measures.Trial RegistrationClinicalTrials.gov NCT02336919; https://clinicaltrials.gov/ct2/show/NCT02336919International Registered Report Identifier (IRRID)RR2-10.2196/resprot.6968