Complex Regimens Research Articles

Medication Adherence Among Adults With Comorbid Chronic Conditions Initiating Oral Anticancer Agent Therapy for Multiple Myeloma.

Increased use of oral anticancer agents (OAAs) has empowered adults with multiple myeloma (MM) to manage their oncolytic therapy, but such a shift may result in issues with medication use, particularly among patients being concurrently treated for pre-existing, multiple chronic conditions. This retrospective cohort study used 2013-2018 commercial and Medicare claims data to assess medication use in adults with MM. To be included, adults (18 years and older) must have been diagnosed with and had 2+ claims for an OAA, had continuous enrollment for 12 months before and after OAA initiation, and have been previously diagnosed with and had prescription fills for 2+ select chronic conditions. The proportion of days covered metric assessed medication adherence and was compared for 12 months before and after the OAA initiation by Wilcoxon signed-rank tests, McNemar's tests, and difference-in-differences models. The mean OAA adherence in the first year of therapy was 58.3% (standard deviation: 24.5) and 65.1% (standard deviation: 27.01) for commercial and Medicare patients, respectively. Adherence and the proportion adherent (proportion of days covered ≥ 80%) to comorbid therapies generally declined in the first year after OAA initiation. Changes in medication use were particularly noticeable among those on antihypertensive therapy: adjusted analyses uncovered a 2.5% (Medicare) and 5.2% (commercial) difference in adherence to these medications between those initially adherent and nonadherent to OAA therapy (both P < .05). Initiating OAA therapy in adults with MM may complicate an already complex treatment regimen, resulting in poor overall medication adherence in patients with multiple comorbid conditions.

Management Practice and Drug Related Problems and Its Contributing Factors Among Cervical Cancer Patients at Oncologic Center in Ethiopia: A Hospital-Based Retrospective Study.

IntroductionIn cervical cancer therapy, there is a high prevalence of drug-related problems (DRPs) due to the high toxicity and complexity of most antineoplastic regimens. However, there is a paucity of data about DRPs among patients with cervical cancer in Ethiopia. Hence, the present study was aimed at investigating management practices and DRPs among patients diagnosed with cervical cancer.MethodsA registry-based retrospective cohort study was employed among cervical cancer patients at the oncology center of Felege Hiwot Comprehensive Specialized Hospital (FHCSH). All patients with a histologically confirmed diagnosis of cervical cancer from January 2016 to December 2020 were included. Relevant information was recorded by reviewing medical records. The possibility of DRPs was evaluated by comparing with standard guidelines. Logistic regression analysis was employed.ResultsA total of 184 cervical cancer patients were included, with a mean age of 50.2±10.7 years. A total of 216 DRPs were identified from 93 cervical cancer patients, translating to a prevalence of 50.5% and a mean of 2.32±1.11 DRPs per patient. ADR (27.3%), DDI (25%), and the need for additional drug therapy (22.2%) were the most prevalent DRPs. DRPs were associated with the presence of co-morbidity (AOR = 4.23, 95% CI = 1.78–10.05, p = 0.001), complications (AOR = 2.99, 95% CI = 1.28–6.99, p = 0.011), being treated with ≥5 medications (AOR = 5.1, 95% CI = 2.38–10.95, p < 0.001), being stage II (AOR = 0.14, 95% CI = 0.02–0.90, p = 0.038), and stage III (AOR = 0.04, 95% CI = 0.01–0.32, p = 0.003).ConclusionCisplatin-based chemotherapy was the frequently used therapeutic option. Co-morbidity and complication status, number of medication and stage of cancer were significantly associated with DRPs. The study highlights the need of clinical pharmacy services to optimize drug therapy and reduce DRPs.

Harnessing new mHealth technologies to Strengthen the Management of Multidrug-Resistant Tuberculosis in Vietnam (V-SMART trial): a protocol for a randomised controlled trial

IntroductionMultidrug-resistant tuberculosis (MDR-TB) remains a major public health problem globally. Long, complex treatment regimens coupled with frequent adverse events have resulted in poor treatment adherence and patient outcomes. Smartphone-based mobile...

The effect of number of pills and dosing frequency on antiretroviral drug adherence: An assessment using two adherence monitoring measures

Background: Strict adherence requirement to antiretroviral drugs remains a key determinant of successful treatment outcome. Drug regimen complexity has been identified as a factor that discourages adherence to antiretroviral therapy. Several measures are available to assess drug adherence each with its strengths and weaknesses. Only few of these measures are cost effective and can be used in resource limited settings. Objective: To determine the effect of number of pills, dosing frequency, and concomitant drugs on adherence to antiretroviral drug therapy. Method: This is a cross-sectional study utilizing a semi-structured questionnaire. Adherence to antiretroviral therapy was measured using self-report and prescription refill. The total number of pills and the dosing frequency were calculated and its association with poor adherence tested via a logistics regression model. Results: Majority of the respondents were females (69.5%), aged 31-40 years (42.2%), married (68.5%), had greater than one pill in their drug regimen (84%), were on twice daily regimen (56.4%) and on other non-ARV drugs (59.9%). An assessment of the adherence levels showed that 140(37.4%) and 161(43%) of the interviewed patients had poor adherence level of ≤ 95% as measured via self-report and pharmacy pick up respectively. At multivariate analysis taking other non-ARV drugs and taking 2 or more ARV pills were predictors of poor adherence to antiretroviral drugs (OR=9, 4.8-16.69) and (OR=0.19, 0.08-0.5) respectively. Conclusion: The number of times drugs are taken in a day did not affect adherence in this study however, increased number of pills and addition of other concomitant medications to an antiretroviral regimen discouraged adherence.

Improving individualized prescription in patients with multimorbidity through medication review

BackgroundOlder patients tend to have multimorbidity, represented by multiple chronic diseases or geriatric conditions, which leads to a growing number of prescribed medications. As a result, pharmacological prescription has become a major concern because of the increased difficulties to ensure appropriate prescription in older adults. The study’s main objectives were to characterize a cohort of older adults with multimorbidity, carry out a medication review and compare the pharmacological data before and after the medication review globally and according to the frailty index.MethodsThis was a quasi-experimental (uncontrolled pre-post) study with a cohort of patients ≥ 65 years old with multimorbidity. Data were collected from June 2019 to October 2020. Variables assessed included demographic, clinical, and pharmacological data, degree of frailty (Frail-VIG index), medication regimen complexity index, anticholinergic and or sedative burden index, and monthly drug expenditure. Finally, a medication review was carried out by an interdisciplinary team (primary care team and a consultant team with a geriatrician and a clinical pharmacist) by applying the Patient-Centered Prescription model to align the treatment with care goals.ResultsFour hundred twenty-eight patients were recruited [66.6% women; mean age 85.5 (SD 7.67)]. The mean frail index was 0.39 (SD 0.13), corresponding with moderate frailty. Up to 90% of patients presented at least one inappropriate prescription, and the mean of inappropriate prescriptions per patient was 3.14 (SD 2.27). At the three-month follow-up [mortality of 17.7% (n = 76)], the mean chronic medications per patient decreased by 17.96%, varying from 8.13 (SD 3.87) to 6.67 (SD 3.72) (p < 0.001). The medication regimen complexity index decreased by 19.03%, from 31.0 (SD 16.2) to 25.1 (SD 15.1), and the drug burden index mean decreased by 8.40%, from 1.19 (SD 0.82) to 1.09 (SD 0.82) (p < 0.001). A decrease in polypharmacy, medication regimen complexity index, and drug burden index was more frequent among frail patients, especially those with severe frailty (p < 0.001).ConclusionsAn individualized medication review in frail older patients, applying the Patient-Centered Prescription model, decreases pharmacological parameters related to adverse drug effects, such as polypharmacy, therapeutical complexity, and anticholinergic and, or sedative burden. The benefits are for patients with frailty.

A Multifaceted Intervention to Improve Medication Adherence in Kidney Transplant Recipients: An Exploratory Analysis of the Fidelity of the TAKE IT Trial.

BackgroundInadequate adherence to prescribed immunosuppressive medication regimens among kidney transplant recipients is common, yet interventions are needed to support patients in sustaining adequate adherence to prescribed regimens and achieving optimal transplant outcomes.ObjectiveWe examined the preliminary fidelity of a transplant center-based, multifaceted adherence monitoring strategy known as TAKE IT.MethodsThe TAKE IT strategy includes: (1) routine, online, monthly patient self-report adherence assessments; (2) care alerts directed to nurses; (3) quarterly reports monitoring tacrolimus values and adherence trends; (4) support tools tailored to specific adherence concerns. A 2-arm, patient-randomized trial is underway at two large transplant centers (N=449). To evaluate the initial fidelity of TAKE IT, we investigated patient uptake of monthly adherence assessments during the course of a 3-month period, whether any disparities emerged, and the nature of any reported adherence concerns.ResultsAmong 202 patients randomized and exposed to TAKE IT for 3-months or more, 81% (164/202) completed an adherence assessment, 73% (148/202) completed at least two, and 57% (116/202) completed all monthly assessments. Overall, 50% (82/164) of kidney transplant recipients reported at least one adherence concern over the 3-month assessment period. The most common barriers were classified as regimen-related (eg, regimen complexity), cognitive (eg, forgetfulness), and medical (eg, side effects). Higher-income participants were more likely to complete all surveys compared to lower-income participants (P=.01).ConclusionsTAKE IT demonstrated 81% (164/202) completion of an adherence assessment, 73% (148/202) completion of at least two, and 57% (116/202) completion of all monthly assessments during this brief, initial observation period. Among those that did respond to the online assessments, the majority demonstrated sustained engagement. Additional monitoring modalities could also be offered to meet patient preferences to ensure all patients’ medication use can be properly monitored.Trial RegistrationClinicalTrials.gov NCT03104868; https://clinicaltrials.gov/ct2/show/NCT03104868

Teaching Family Caregivers to Assist Safely with Mobility: Methods for safe patient handling can and should be used in the home.

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. The articles in this new installment of the series explain principles for promoting safe mobility that nurses should reinforce with family caregivers. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage the caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.

Preventing Falls and Fall-Related Injuries at Home: Teaching family caregivers about home modification and what to do if a fall occurs.

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. The articles in this new installment of the series explain principles for promoting safe mobility that nurses should reinforce with family caregivers. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage the caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.

Prevalence and patient-rated relevance of complexity factors in medication regimens of community-dwelling patients with polypharmacy

PurposeTo describe the prevalence of complexity factors in the medication regimens of community-dwelling patients with more than five drugs and to evaluate the relevance of these factors for individual patients.MethodsData were derived from the HIOPP-6 trial, a controlled study conducted in 9 general practices which evaluated an electronic tool to detect and reduce complexity of drug treatment. The prevalence of complexity factors was based on the results of the automated analysis of 139 patients’ medication data. The relevance assessment was based on the patients’ rating of each factor in an interview (48 patients included for analysis).ResultsA median of 5 (range 0–21) complexity factors per medication regimen were detected and at least one factor was observed in 131 of 139 patients. Almost half of these patients found no complexity factor in their medication regimen relevant.ConclusionIn most medication regimens, complexity factors could be identified automatically, yet less than 15% of factors were indeed relevant for patients as judged by themselves. When assessing complexity of medication regimens, one should especially consider factors that are both particularly frequent and often challenging for patients, such as use of inhalers or tablet splitting.Trial registrationThe HIOPP-6 trial was registered retrospectively on May 17, 2021, in the German Clinical Trials register under DRKS-ID DRKS00025257.

National Trends in Antihypertensive Treatment Among Older Adults by Race and Presence of Comorbidity, 2008 to 2017.

In 2014, hypertension guidelines for older adults endorsed increased use of fixed-dose combinations, prioritized thiazide diuretics and calcium channel blockers (CCBs) for Black patients, and no longer recommend beta-blockers as first-line therapy. To evaluate older adults' antihypertensive use following guideline changes. Time series analysis. Twenty percent national sample of Medicare Part D beneficiaries aged 66 years and older with hypertension. Eighth Joint National Committee (JNC8) guidelines MAIN MEASURES: Quarterly trends in prevalent and initial antihypertensive use were examined before (2008 to 2013) and after (2014 to 2017) JNC8. Analyses were conducted among all beneficiaries with hypertension, beneficiaries without chronic conditions that might influence antihypertensive selection (hypertension-only cohort), and among Black patients, given race-based guideline recommendations. The number of beneficiaries with hypertension increased from 1,978,494 in 2008 to 2,809,680 in 2017, the proportions using antihypertensives increased from 80.3 to 81.2%, and the proportion using multiple classes and fixed-dose combinations declined (60.8 to 58.1% and 20.7 to 15.1%, respectively, all P<.01). Prior to JNC8, the use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and CCBs was increasing. Use of CCBs as initial therapy increased more rapidly following JNC8 (relative change in quarterly trend 0.15% [95% CI, 0.13-0.18%), especially among Black beneficiaries (relative change 0.44% [95% CI, 0.21-0.68%]). Contrary to guidelines, the use of thiazides and combinations as initial therapy consistently decreased in the hypertension-only cohort (13.8 to 8.3% and 25.1 to 15.7% respectively). By 2017, 65.9% of Black patients in the hypertension-only cohort were initiated on recommended first-line or combination therapy compared to 80.3% of non-Black patients. Many older adults, particularly Black patients, continue to be initiated on antihypertensive classes not recommended as first-line, indicating opportunities to improve the effectiveness and equity of hypertension care and potentially reduce antihypertensive regimen complexity.

Identifying opportunities for pediatric medication therapy management in children with medical complexity

BackgroundDespite potential benefits of medication therapy management (MTM) for complex pediatric patients, implementation of pediatric MTM services is rare. ObjectivesTo describe how a standardized pediatric MTM model identifies potential interventions and their impact on medication regimen complexity index (MRCI) scores in children with medical complexity (CMC) and polypharmacy. MethodsThis retrospective proof-of-concept study included pediatric patients receiving primary care in a large outpatient primary care medical home for CMC within a tertiary freestanding children’s hospital from August 2020 to July 2021. Medication profiles of established patients aged 0-18 years with at least 5 active medications at the time of the index visit were assessed for medication-related concerns, potential interventions, and potential impact of proposed interventions on MRCI scores. ResultsAmong 100 patients, an average of 3.4 ± 2.6 medication-related concerns was identified using the pediatric MTM model. Common medication-related concerns (>25% of patients) included inappropriate or unnecessary therapy, suboptimal therapy, undertreated symptom, adverse effect, clinically impactful drug-drug interaction, or duplication of therapy. A total of 97% had opportunities for 5.0 ± 2.9 potential interventions. Most common proposed interventions included drug discontinuation trial (69%), patient or caregiver education (55%), dosage form modification (51%), dose modification (49%), and frequency modification (46%). The mean baseline MRCI score was 32.6 (95% CI 29.3–35.8) among all patients. MRCI scores decreased by a mean of 4.9 (95% CI 3.8–5.9) after application of the theoretical interventions (P < 0.001). Mean potential score reduction was not significantly affected by patient age or number of complex chronic conditions. Potential impact of the proposed interventions on MRCI score was significantly greater in patients with higher baseline medication counts (P < 0.001). ConclusionMost CMC would likely benefit from a pharmacist-guided pediatric MTM service. A standardized review of active medication regimens identified multiple medication-related concerns and potential interventions for nearly all patients. Proposed medication interventions would significantly reduce medication regimen complexity as measured by MRCI. Further prospective evaluation of a pharmacist-guided pediatric MTM service is warranted.

Heart Failure Patients' Perceptions Of Preparation For Self-care

Six and a half million Americans diagnosed with heart failure (HF) face dauntingly complex treatment regimens when transitioning from hospital to home care. Most are not prepared to perform their self-care. Advanced practice nurse (APN) interventions such as home visits as well as interventions that target perceived preparation for self-care have indicated improved health and costs outcomes. However, little is known about targeting perceived preparations for self-care with a low-cost APN intervention. Purpose: This randomized controlled trial compared health outcomes, and healthcare charges between two groups of adults hospitalized with an HF diagnosis. Methods: A control (<i>n</i> = 78) group received routine postdischarge care. An intervention group (<i>n</i> =76) received routine post discharge care plus follow-up telephone calls by APNs on posthospital discharge days 1, 7, 14, 21, 28, 42 and 56. Both groups were followed for the first 8 weeks posthospital discharge to examine health outcomes (i.e., perceived preparation for self-care, social support, problem-solving orientation), healthcare charges (i.e., emergency department visits, rehospitalizations) and charges for the APN follow-up (intervention group only). Findings: At 8-weeks, comparing the intervention to the usual care group, the intervention group had significant differences in: perceived preparation for self-care mean scores (<i>M_I</i> =67.37, <i>SD</i> = 16.6 <i>vs. M_C</i> = 25.36, <i>SD</i> = 19, <i>t</i>(138) = -13.831, <i>p</i>=.000); hospital readmission rate (M_I = 16.9% <i>vs.</i> M_c = 33.4%, <i>χ2</i> = 4.59, <i>p</i> < .05); and mean healthcare charges (<i>M_I</i> = $3,124, <i>SD</i> = $6,413 <i>vs. M_C</i> = $6,897, <i>SD</i> = $11,268), <i>t</i>(142) = 2.45, <i>p</i> = .02) Conclusion: Targeting a low-cost APN telephone follow-up intervention at subjective perceptions resulted in significantly higher levels of perceived preparation for self-care, lower rehospitalization rates and lower healthcare charges in the intervention group compared to the control group that did not receive APN interventions. These findings highlight the ability of APNs to apply low-cost, easy to apply follow-up interventions to vulnerable populations especially during times of major budget cuts that affect healthcare services.

Assessment of Type II Diabetes Patients' Caregivers' Burnout Level: A Cross-Sectional Study in Taif, Saudi Arabia.

BackgroundDiabetes mellitus type II (T2D) is a chronic condition that requires significant change in the family behavior and is associated with psychosocial conflicts for both patients and their family environment. The aim of this study is to assess burnout among relatives caring for patients with T2D.MethodsThis cross-sectional study with random sampling was conducted on 501 caregivers of patients with T2D between April and September 2021 at Prince Mansour armed forces hospital in Taif city, Saudi Arabia. Data collection tool was a modified version of the caregiver stress self-assessment questionnaire. Data analysis was then carried out using t-test and chi-square test (SPSS v20).ResultsThe mean patient age was 64.4+12.0 years, female predominant with longstanding T2D. Metformin was the most prescribed T2D medication. The caregivers’ mean age was 34.9+12.4 years, male predominant, and around 45% of them report low level of education and income; 63.9% of the caregivers report little to no stress. Compared with caregivers with mild/moderate stress and moderate/severe stress, caregivers with little to no stress were more likely to be younger in age (P <0.001), male (P = 0.464), single (P = 0.035), patient’s offspring (P = 0.490), caring for T2D patients with younger age (P = 0.058) and shorter T2D duration (P = 0.074), patients who were less likely to use a wheelchair (P = 0.008), patients who were less likely to be prescribed a complex insulin regimen and with better glycemic control parameters (both P >0.05), and patients with higher HDL level (P = 0.037).ConclusionThere were no correlations between the caregivers’ levels of stress and the T2D patients’ HbA1c levels. There was a significant positive correlation between a caregiver’s stress score and the caregiver’s age. Future studies are needed to assess other caregivers’ parameters and their relation to metabolic control of T2D patients.

Comparing and validating medication complexity from insurance claims against electronic health records.

BACKGROUND: Patient effort to comply with complex medication instructions is known to be related to nonadherence and subsequent medical complications or health care costs. A widely used Medication Regimen Complexity Index (MRCI) has been used with electronic health records (EHRs) to identify patients who could benefit from pharmacist intervention. A similar claims-derived measure may be better suited for clinical decision support, since claims offer a more complete view of patient care and health utilization. OBJECTIVE: To define and validate a novel insurance claims-based medication complexity score (MCS) patterned after the widely used MRCI, derived from EHRs. METHODS: Insurance claims and EHR data were provided by HealthPartners (N = 54,988) (Bloomington, Minnesota) and The Johns Hopkins Health System (N = 28,589) (Baltimore, Maryland) for years 2013 and 2017, respectively. Yearly measures of medication complexity were developed for each patient and evaluated with one another using rank correlation within different clinical subgroupings. Indicators for the presence of individually complex prescriptions were also developed and assessed using exact agreement. Complexity measures were then correlated with select covariates to further validate the concordance between MCS and MRCI with respect to clinical metrics. These included demographic, comorbidity, and health care utilization markers. Prescribed medications in each system's EHR were coded using the previously validated MRCI weighting rules. Insurance claims for retail pharmacy medications were coded using our novel MCS, which closely followed MRCI scoring rules. RESULTS: EHR-based MRCI and claims-based MCS were significantly correlated with one another for most clinical subgroupings. Likewise, both measures were correlated with several covariates, including count of active medications and chronic conditions. The MCS was, in most cases, more associated with key health covariates than was MRCI, although both were consistently significant. We found that the highest correlation between MCS and MRCI is obtained with patients who have similar counts of pharmacy records between EHRs and claims (HealthPartners: P = 0.796; Johns Hopkins Health System: P = 0.779). CONCLUSIONS: The findings suggest good correspondence between MCS and MRCI and that claims data represent a useful resource for assessing medication complexity. Claims data also have major practical advantages, such as interoperability across health care systems, although they lack the detailed clinical context of EHRs. DISCLOSURES: The Johns Hopkins University holds the copyright to the Adjusted Clinical Groups (ACG) system and receives royalties from the global distribution of the ACG system. This revenue supports a portion of the authors' salary. No additional or external funding supported this work. The authors have no conflict of interest to disclose.

Medication Regimen Complexity and Medication Burden Among Patients With Type 2 Diabetes Mellitus: A Retrospective Analysis.

Introduction: Most type 2 diabetes mellitus (T2DM) patients with chronic conditions require multiple medications to achieve and maintain good glycemic control. Objective: This study assessed medication burden, regimen complexity, and adherence among T2DM patients and evaluate its association with glycemic control. Method: We analyzed data of 2,696 T2DM patients at public health clinics in Malaysia from January 2018 until May 2019. Medication burden was based on medication count, regimen complexity was measured using the validated Medication Regimen Complexity Index (MRCI) tool, and adherence was measured using proportion of days covered (PDC) formula. Logistic regression models were used to compute unadjusted and adjusted odds ratio (aOR) with 95% confidence interval (CI) for association between the medication parameters and glycemic control (HbA1c ≤ 7.0%) over a 90-day period. Results: The cohort mean age was 60.4 years old (±10.8) and 62.9% were female. Overall, the average medication count was 4.8 with MRCI score of 15.1. Mean adherence score (PDC) was 90%. High medication count and MRCI scores were associated with lower odds of achieving good glycemic control (aOR 0.88; 95% CI 0.82, 0.94 and aOR 0.89; 95% CI 0.87, 0.92, respectively) while inverse association was observed between adherence and HbA1c level (aOR 2.7, 95% CI 1.66, 5.19). Similar findings were observed for diabetes-specific measures. Conclusions: High medication count, high regimen complexity, and low medication adherence were associated with poor glycemic control over the 3-month follow-up period. These parameters could be used to identify patients with complex pharmacotherapy regimens so that targets for intervention can be taken to achieve optimum outcomes and ease of self-care.

Expert Panel Guidance and Narrative Review of Treatment Simplification of Complex Insulin Regimens to Improve Outcomes in Type2 Diabetes.

Given the progressive nature of type 2 diabetes (T2D), most individuals with the disease will ultimately undergo treatment intensification. This usually involves the stepwise addition of a new glucose-lowering agent or switching to a more complex insulin regimen. However, complex treatment regimens can result in an increased risk of hypoglycaemia and high treatment burden, which may impact negatively on both therapeutic adherence and overall quality of life. Individuals with good glycaemic control may also be overtreated with unnecessarily complex regimens. Treatment simplification aims to reduce individual treatment burden, without compromising therapeutic effectiveness or safety. Despite data showing that simplifying therapy can achieve good glycaemic control without negatively impacting on treatment efficacy or safety, it is not always implemented in clinical practice. Current clinical guidelines focus on treatment intensification, rather than simplification. Where simplification is recommended, clear guidance is lacking and mostly focused on treatment of the elderly. An expert, multidisciplinary panel evaluated the current treatment landscape with respect to guidance, published evidence, recommendations and approaches regarding simplification of complex insulin regimens. This article outlines the benefits of treatment simplification and provides practical recommendations on simplifying complex insulin treatment strategies in people with T2D using illustrative cases.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-022-01222-2.

ASSOCIATIONS BETWEEN THERAPEUTIC REGIMEN-RELATED FACTORS AND MEDICATION ADHERENCE IN PATIENTS ON ORAL ANTICANCER THERAPY

Objective: Good adherence is critical for successful cancer treatment. Complex medication regimens have been found among the various therapy-related factors causing non-adherence. Methods: In a cross-sectional questionnaire-based study of outpatients, we assessed 75 patients suffering from cancer. The objective of this study is to find associations between therapeutic regimen-related factors and medication adherence in patients on oral anticancer therapy. Results: There was an increase in medication adherence as the length of therapy increased. About 10.76% of the patients with treatment duration &lt;4 years showed low adherence. Low adherence was not observed with treatment duration of more than 4 years. About 6.55% of those taking up to four drugs had low adherence as compared to 14.28% taking more than 4 drugs. About 8.69% of patients taking drugs up to thrice a day showed low adherence as compared to 16.66% taking more than thrice a day. The negative associations between medication regimen complexity and adherence observed in this study were in the predicted direction but did not achieve statistical significance (p&gt;0.05). The effect size was small (d=0.28) Conclusion: Complex prescription regimens reduce adherence to oral anticancer treatments, however, there are several other factors to consider than regimen simplification to increase adherence.

Analysis of factors contributing to medication errors during self-management of medication in the rehabilitation ward: a case control study

BackgroundIn the rehabilitation ward, many elderly patients require continuous use of medication after a stroke or bone fracture, even after discharge. They are encouraged to self-manage their medications from the time of admission. Medication errors, such as a missed dose or incorrect administered medication can worsen conditions, resulting in recurrent strokes, fractures, or adverse effects. The study was aimed to identify risk factors, such as medication and prescription, contributing to errors in self-management of medication.MethodsThis study was conducted on patients who self-managed their medication in the rehabilitation ward of Higashinagoya National Hospital from April 2018 to March 2020. The patient background including age and sex were investigated. The medication factors examined include the number of medications and administrations per day, dosing frequency on indicated days, prescription and start date are the same, medications from multiple prescriptions, and one package or one tablet at each dosage. The group of medication error cases were defined as the medication error group and that of control cases as the no-medication error group. A logistic regression analysis was performed for factors related to medication errors.ResultsA total of 348 patients were included in the study, of which 154 patients made medication errors, with 374 total medication error cases. The median number of medications in the medication error group was six, and that in the no-medication error group was five. Statistically significant factors correlated with errors made during self-management of medication were the number of medications, number of administrations per day, dosing frequency on indicated days, and medication from multiple prescriptions.ConclusionsWhen a patient is self-managing their medications, errors are likely to occur due to a high number of medicines they are taking and the complexity of the dosage regimen. Therefore, to prevent medication errors, reviewing the prescribed medications and devise ways to simplify the dosage regimens is crucial.

EP140: A novel, double-blind placebo-controlled seamless phase 1/2/3 AAV9 gene therapy study for Wilson disease

Wilson disease is a rare disorder of copper metabolism caused by pathogenic variants in the ATP7B gene, which encodes a copper transporter, leading to toxic accumulation of copper in the liver, brain, and other organs. Wilson disease is progressive and can be fatal. Current standard of care includes copper chelators and zinc. However, these treatments have complex dose regimens and serious side effects. UX701 is an investigational AAV9 gene therapy designed to restore ATP7B function in the liver and is being developed for treatment of patients with Wilson disease.

Administration of Subcutaneous Injections: Nurses can help family caregivers enhance their knowledge, experience, and skill in managing injectable treatments.

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Foundation. Results of focus groups conducted as part of the AARP Foundation's No Longer Home Alone video project supported evidence that family caregivers aren't being given the information they need to manage the complex care regimens of their family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's medications. Each article explains the principles nurses should consider and reinforce with caregivers and is accompanied by a video for the caregiver to watch. The second video can be accessed at http://links.lww.com/AJN/A75.