Differences In Adherence Rates Research Articles

Three-year follow-up of a novel orthopedic ward fracture liaison services (OWFLS) model.

We established an orthopedic ward fracture liaison services (OWFLS) model and evaluated its role in improving detection rates of bone metabolic markers, treatment rates, and long-term treatability. This observational retrospective cohort study included 120 patients aged >50 years hospitalized for primary osteoporotic fracture from January 2018 to January 2019 (group A: not included in OWFLS). Group B (included in OWFLS) comprised 120 patients from February 2019 to February 2020. We compared rates of bone metabolic index testing, treatment, and adherence; symptomatic improvement; and recurrent fracture between groups. Rates of bone metabolism index testing (50% vs. 0%) and medication use (94.2% vs. 64.2%) were significantly higher after OWFLS implementation. There was no significant difference in adherence rates at 3 months between groups (97.3% vs. 93.5%). Adherence rates at 1 and 3 years were better in group B than A (73.5% vs. 51.9%; 57.5% vs. 26%, respectively). Recurrence of bone pain at 1 and 3 years was significantly lower in group B than A (20.4% vs. 46.8%; 45.1% vs. 76.6%, respectively). OWFLS improved the detection rate of bone metabolism indicators, treatment rate, and patient adherence and reduced recurrence of bone pain. OWFLS may be suitable for settings lacking human resources.

Exploring Real-World Adherence and Cost Implications of Continuous Glucose Monitoring in Patients with Diabetes: Impact of Device Sourcing.

Insurance benefit design influences whether individuals with diabetes who require a continuous glucose monitor (CGM) to provide real-time feedback on their blood glucose levels can obtain the CGM device from either a pharmacy or a durable medical equipment supplier. The impact of the acquisition channel on device adherence and healthcare costs has not been systematically evaluated. Retrospective claims analysis compared the adherence rates for patients new to CGM therapy and the costs of care for individuals who obtained CGM devices from a pharmacy versus acquisition through a durable medical equipment supplier. Utilizing the Mariner Commercial Claims Database, individuals aged >18 years with documented diabetes and an initial CGM claim during the first quarter of 2021 (2021Q1, index date) were identified. Patients had to maintain uninterrupted enrollment for a duration of 15 months but file no CGM claim during the six months preceding the index date. Direct matching was employed to establish comparable Pharmacy and Durable Medical Equipment cohorts. Outcomes included quarterly adherence, reinitiation, and costs for the period from 2021Q1 to the third quarter of 2022 (2022Q3). Between-cohort differences in adherence rates and reinitiation rates were analyzed using z-tests, and cost differences were analyzed using t-tests. Direct matching was employed to establish comparable Pharmacy and Durable Medical Equipment cohorts. A total of 2, 356 patients were identified, with 1,178 in the Pharmacy Cohort and 1,178 in the Durable Medical Equipment cohorts Cohort. Although adherence declined over time in both cohorts, the Durable Medical Equipment Cohort exhibited significantly superior adherence compared to the Pharmacy Cohort at 6 months (Pharmacy 52%; Durable Medical Equipment 65%; P<0.05), 9 months (Pharmacy 49%; Durable Medical Equipment cohorts 61%; P<0.05), and 12 months (Pharmacy 48%; Durable Medical Equipment 59%; P<0.05). Mean annual total medical costs for adherent patients in the Pharmacy Cohort were 53% higher than the Durable Medical Equipment Cohort (Pharmacy $10,635; Durable Medical Equipment $6,967; P<0.01). In non-adherent patients, the Durable Medical Equipment Cohort exhibited a significantly higher rate of therapy reinitiation during the period compared to the Pharmacy Cohort (Pharmacy 10%; Durable Medical Equipment 22%; P<0.05). The results from this real-world claims analysis demonstrate that, in a matched set, individuals who received their CGM through a durable medical equipment supplier were more adherent to their device. For individuals who experienced a lapse in therapy, those whose supplies were provided through the durable medical equipment channel were more likely to resume use after an interruption than those who received their supplies from a pharmacy. In the matched cohort analysis, those who received their CGM equipment through a durable medical equipment supplier demonstrated a lower total cost of care.

Adherence to antihypertensives in the United States: A comparative meta-analysis of 23 million patients.

Adherence to antihypertensives is crucial for control of blood pressure. This study analyzed factors and interventions that could affect adherence to antihypertensives in the US. PubMed, Scopus, Web of Science, and Embase were searched on January 21, 2022 and December 25, 2023 for studies on the adherence to antihypertensives in the US. Nineteen studies and 23545747 patients were included in the analysis, which showed that adherence to antihypertensives was the highest among Whites (OR: 1.47, 95% CI 1.34-1.61 compared to African Americans). Employment status and sex were associated with insignificant differences in adherence rates. In contrast, marital status yielded a significant difference where unmarried patients demonstrated low adherence rates compared to married ones (OR: 0.8, 95% CI 0.67-0.95). On analysis of comorbidities, diabetic patients reported lower adherence to antihypertensives (OR: 0.95, 95% CI 0.92-0.97); furthermore, patients who did not have Alzheimer showed higher adherence rates. Different BMIs did not significantly affect the adherence rates. Patients without insurance reported significantly lower adherence rates than insured patients (OR: 3.93, 95% CI 3.43-4.51). Polypill users had higher adherence rates compared with the free-dose combination (OR: 1.21, 95% CI 1.2-1.21), while telepharmacy did not prove to be as effective. Lower adherence rates were seen among African Americans, uninsured, or younger patients. Accordingly, interventions such as fixed-dose combinations should be targeted at susceptible groups. Obesity and overweight did not affect the adherence to antihypertensives.

Adherence to Voice Therapy Among Patients with Dysphonia: The Impact of Cultural Background

Voice therapy (VT), a cornerstone in dysphonia treatment, relies on patient adherence for efficacy. Despite its positive outcomes, adherence rates remain consistently low. This study investigates the impact of cultural background on adherence to VT. This is a retrospective cohort study that included all adult patients referred to our institution's Speech and Hearing unit, in 2018 for VT related to dysphonia. The study group included a distinct adult minority group (Bedouin Arabs) which was compared to a control group. Adherence rates, demographic factors, and therapy outcomes were analyzed. A total of 137 adult patients with dysphonia (20 in the study group and 117 in the control group) were included. There were no significant differences in adherence rates between the study and control groups (75% vs 74.3%, P=1), with an overall nonadherence rate of 74.4%. The median leg of time for VT was 239days, and the median number of visits was 3.0. Logistic regression analysis, adjusting for age and visits, indicated lower odds of dysphonia improvement in the study group (odds ratios [OR]: 0.12, P=0.05). However, visits showed a significant positive impact on improvement (OR: 2.58, P<0.001). While cultural background does not impact adherence rate, it is associated with different attendance patterns and lower voice outcomes following VT. Future efforts should concentrate on investigating aspects of adherence such as home exercises, accessibility of treatment, and the frequency of follow-up sessions to facilitate customized interventions for specific populations.

Disparities in Rates of Multitarget Stool DNA Test Completion for Colorectal Cancer Screening.

The aim was to assess patient adherence to multitarget stool DNA testing as well as factors associated with adherence. In the United States, disparities in colorectal cancer screening exist along racial and socioeconomic lines. While some studies suggest that stool-based screening tests may help reduce the screening gap, the data for multitarget stool DNA testing is unclear. We conducted a single-center retrospective cohort study on multitarget stool DNA testing ordered between April 2020 and July 2021. We calculated the proportion of patients who completed testing and used multivariate logistic regression to identify covariates associated with test adherence. Among 797 patients ordered for multitarget stool DNA testing, 481 patients (60.4%) completed testing. Adherence rates by patient subgroups ranged from 35.8% to 78.1%. Higher test adherence was found in Asian patients (odds ratio 2.65, 95% CI 1.36-5.18) and those who previously completed colorectal cancer screening (OR 1.45, 95% CI 1.01-2.09), while Black patients (OR 0.58, 95% CI 0.39-0.87), patients with resident primary care physicians (OR 0.34, 95% CI 0.21-0.56), and patients contacted through an outreach program (OR 0.47, 95% CI 0.25-0.87) had lower adherence. A significant proportion of patients ordered for multitarget stool DNA testing did not complete testing. Differences in adherence rates among patient subgroups may be reflective of underlying disparities in health care access.

Comparing Adherence to the Experience Sampling Method Among Patients With Schizophrenia Spectrum Disorder and Unaffected Individuals: Observational Study From the Multicentric DiAPAson Project.

The Experience Sampling Method (ESM) is a valid method of remotely recording activities and mood, but the predictors of adherence to ESM in patients with Schizophrenia Spectrum Disorder (SSD) are not known. Studies on adherence are significant as they highlight the strengths and weaknesses of ESM-based study designs and allow the development of recommendations and practical guidelines for implementing future studies or treatment plans. The aim of this study was to compare the adherence to ESM in patients with SSD and unaffected control individuals, investigate their patterns, and report the predictors of adherence. In total, 131 patients with SSD (74 in residential facilities and 57 outpatients) and 115 unaffected control individuals were recruited at 10 different centers in Italy as part of the DiAPAson project. Demographic information, symptom severity, disability level, and level of function were recorded for the clinical sample. Participants were evaluated for daily time use and mood through a smartphone-based ESM 8 times a day for 7 consecutive days. Adherence was measured by the response rate to ESM notifications. Results were analyzed using the chi-square test, ANOVA, Kruskal-Wallis test, and Friedman test, and a logistic regression model. The overall adherence rate in this study was 50% for residents, 59% for outpatients, and 78% for unaffected control individuals. Indeed, patients with SSD had a lower rate of adherence to ESM than the unaffected control group (P≤.001), independent of time slot, day of monitoring, or day of the week. No differences in adherence rates between weekdays and weekends were found among the 3 groups. The adherence rate was the lowest in the late evening time slot (8 PM to 12 AM) and days 6-7 of the study for both patients with SSD and unaffected control individuals. The adherence rate among patients with SSD was not predicted by sociodemographic characteristics, cognitive function, or other clinical features. A higher adherence rate (ie, ≥70%) among patients with SSD was predicted by higher collaboration skills (odds ratio [OR] 2.952; P=.046) and self-esteem (OR 3.394; P=.03), and lower positive symptom severity (OR 0.835; P=.04). Adherence to ESM prompts for both patients with SSD and unaffected control individuals decreased during late evening and after 6 days of monitoring. Higher self-esteem and collaboration skills predicted higher adherence to ESM among patients with SSD, while higher positive symptom scores predicted lower adherence rates. This study provides important information to guide protocols for future studies using ESM. Future clinical or research studies should set ESM monitoring to waking hours, limit the number of days of monitoring, select patients with more collaborative skills and avoid those with marked positive symptoms, provide intensive training sessions, and improve participants' self-confidence with technologies. RR2-10.1186/s12888-020-02588-y.

Utility of Big Data to Explore Medication Adherence in Māori and Non-Māori Community-Dwelling Older Adults with Heart Failure in Aotearoa New Zealand: A Cross-sectional Study.

Medication adherence improves morbidity and mortality-related outcomes in heart failure, and knowledge of patterns of medication adherence supports patient and clinician decision-making. Routinely collected national data facilitate the exploration of medication adherence and associated factors in older adults with heart failure, including the association between ethnicity and adherence. There are known inequities in access to medicines between Māori (Indigenous People of Aotearoa New Zealand) and non-Māori, yet ethnic variation in medicines adherence in community-dwelling older adults with heart failure has not been explored. Here we identify medication adherence rates for community-dwelling older adults diagnosed with heart failure and differences in adherence rates between Māori and non-Māori. Cross-sectional analysis of interRAI (comprehensive standardised assessment) data in a continuously recruited national cohort from 2012 to 2019. Overall, 13,743 assessments (Māori N=1526) for older community-dwelling adults with heart failure diagnoses were included. The mean age of participants was 74.5years [standard deviation (SD) 9.1years] for Māori and 82.3 years (SD 7.8years) non-Māori. In the Māori cohort, 21.8% did not adhere fully to their medication regimen, whereas in the non-Māori cohort, this figure was 12.8%. After adjusting for confounders, the Māori cohort were more likely to be medication non-adherent than non-Māori [prevalence ratio 1.53, 95% confidence interval (CI) 1.36-1.73]. There was a significant disparity between Māori and non-Māori concerning medication adherence. Given the international use of the interRAI-HC assessment tool, these results have significant transferability to other countries and allow the identification of underserved ethnic groups for which culturally appropriate interventions can be targeted.

261-OR: Autonomous Artificial Intelligence (AI) Testing for Diabetic Eye Disease (DED) Closes Care Gap and Improves Health Equity on a Systems Level

We aimed to examine the change in adherence to annual diabetic eye disease (DED) testing in an integrated healthcare system (Johns Hopkins Community Physicians 30+ community based primary care clinics) before and after deployment of autonomous artificial intelligence (AI). Adherence to annual DED testing is defined as completed evaluation by either a human ophthalmology provider, or autonomous AI within a given calendar year. During the COVID pandemic, autonomous AI (IDx-DR, Digital Diagnostics, Coralville, IA) was deployed at multiple clinics, so that by 2021, some clinics had autonomous AI (AI sites), while others did not (non-AI sites). Overall adherence in 2019 (pre-AI) and 2021 (with AI) were compared, and stratified by demographics, using chi-square or Fisher’s exact test. Changes from 2019 to 2021 in odds of adherence within each subgroup were assessed for significant differences by site type (AI vs. non-AI), using logistic regression with a site type-by-time interaction term. From 2019 to 2021, the overall adherence rate increased from 42.6% to 55.5% at AI sites (1949 patients), and increased from 38.0% to 41.0% at non-AI sites (5379 patients). The increase in overall adherence rate at AI sites was significantly greater than that at non-AI sites (p&amp;lt;0.001). Various patient subgroups (M, F, ≥65 yo, &amp;lt;65 yo, Black, White, Medicare/military/commercial insurance) at AI sites demonstrated a significantly greater (p&amp;lt;0.05) compliance rate increase when compared to the same subgroups at non-AI sites. For Black patients, there was no difference in adherence rate between AI sites and non-AI sites (38.5% vs. 37.1%, p=0.45) in 2019, but the difference became significant (p&amp;lt;0.001) in 2021 due to increased adherence at the AI sites (58.0%) vs. 38.8% at non-AI sites. Autonomous AI improved DED testing adherence in a large, diverse patient cohort and decreased disparity in Black patients, a historically-disadvantaged subgroup. Disclosure T.Liu: None. J.Huang: None. H.Lehmann: None. R.M.Wolf: Research Support; Dexcom, Inc., Boehringer Ingelheim Inc. R.Channa: None. M.D.Abràmoff: Board Member; Digital Diagnostics, Consultant; AbbVie Inc., NovaGo Therapeutics AG, Other Relationship; Digital Diagnostics, Stock/Shareholder; Digital Diagnostics. Funding Digital Diagnostics

Difference in persistence between tablets and capsules.

e18894 Background: More recently, pharmaceutical companies have developed capsule and tablet forms of their drugs to allow a choice on dosage form. As both capsules and tablets should be bioequivalent, adherence rates between members prescribed capsules and tablets should be the same. This study compares persistency between capsule and tablet forms of enzalutamide and palbociclib. Methods: This retrospective cohort study included adult Caremark members who received enzalutamide and palbociclib between 03/01/2021 and 03/01/2022 with continuous eligibility for six months prior and 12 months post-index into the study. Members were excluded if they had a &gt; 60-day gap in fill or switched from a capsule to a tablet or vice versa during the study period. Adherence was measured using the prescription-based proportion of days covered (PDC) and defined as the sum of days with medication on hand divided by the number of days between index fill and exhaust of last fill. Continuous variables were compared with the student’s t-test and Mann-U tests; categorical variables were compared with a chi-square test. Logistic regression was utilized to assess adherence differences in capsules vs. tablets; p-values &lt; 0.05 were significant. Results: 5,997 members were included in the enzalutamide cohort; there were no insurance type or region differences (all p &gt; 0.05) between members receiving capsules and tablets. There were no significant differences in mean PDC (mean (SD) 0.963 (0.080) vs. 0.964 (0.073); p = 0.521) or adherence rates (94.2% vs. 95.2%); p = 0.215) between members receiving capsules and tablets. After adjusting for the variables in the model, there was no difference in adherence rates between tablets and capsules. Members less than 65 years of age had significantly lower adherence rates (odds ratio (OR)) 0.5 (95% confidence interval (CI), 0.35-0.71) compared to those aged 65-74. 5,361 members were included in the palbociclib cohort; there were significant differences in age, gender, type of insurance and region (all p &lt; 0.05) between members receiving capsules and tablets. There were no significant differences in PDC (0.962 (0.072) vs. 0.960 (0.072); p = 0.534) or adherence rates (94.9% vs. 94.9%); p = 1.0) between members receiving capsules and tablets. Conclusions: In this study, capsule and tablet forms of enzalutamide and palbociclib had similar adherence rates when adjusting for confounders.

0815 Utilization of Telemedicine visits in a Pediatric Sleep Center and the Effect on PAP Adherence Rates

Abstract Introduction Although positive airway pressure (PAP) is an effective treatment for OSA, adherence is often suboptimal. Consistent follow up is needed to address barriers to adherence; however, in-person clinic attendance in our center has been low and was further reduced during the COVID-19 pandemic. Suboptimal adherence may result in cessation of reimbursement by insurance, leaving OSA untreated. Untreated OSA in children can lead to behavior and learning problems, impaired growth and cardiovascular complications. Due to the decrease in show rates, in-home telemedicine visits were offered in lieu of in-person visits. Methods A retrospective chart review was performed for children with OSA seen in the pediatric sleep clinic from March 2020 and October 2022. Subjects were excluded from analysis if they did not transition to telemedicine. Telemedicine visits were conducted in the same manner as in-person visits. PAP usage after telemedicine was compared to in-person visits. Adherence was reported as percent of total usage and percent of usage greater than four hours (U&amp;gt;4h) per night. Results Three hundred nineteen charts were reviewed of whom the majority were male (69.9%). The median age (interquartile range) at PAP initiation was 12 years (7-15). Seventy eight subjects were included in the analysis. Mean U&amp;gt;4h and total usage decreased when subjects transitioned from in-person to telemedicine visits (4.18% ± 26.7, p=0.17 (3.08% ± 22.5, p=0.23), respectively. These differences were not significant. 36 subjects (46%) had &amp;lt; ± 5% change in total adherence, 23 (29%) had &amp;gt; 5% increase in total adherence, and 19 (24%) had &amp;gt; 5% decrease. When comparing change in U&amp;gt;4h, 29 (37%) subjects had &amp;lt; ± 5% change in adherence, 22 (28%) had &amp;gt; 5% decrease, and 27 (35%) had &amp;gt; 5% increase in adherence. Conclusion There were no statistically significant differences in adherence rates between telemedicine and in-person visits. Adherence improved in some children on transition from in-person to telemedicine visits. Utilization of in-home telemedicine visits may be a useful alternative for some children treated with PAP. Further studies are needed to determine which specific patient populations may benefit most from in-home telemedicine visits. Support (if any)

Well-Child Care Disparities in U.S. Military Health System.

To describe adherence rates for well-child visits among military children in the first 15 months of life and identify any disparities in adherence in a universally insured population. A retrospective cohort analysis was conducted using the Military Health System data repository which included children who were born between October 2013 and September 2016 and were eligible for TRICARE (the military health insurance program). Children were followed from zero to fifteen months of life to assess adherence with a national Health Effectiveness Data and Information Set (HEDIS) metric of 6 well visits during this period. Differences in adherence rates were evaluated across select demographic characteristics including sponsor rank, race, age, service branch, patient sex, geographic region, number of enrollment sites and provider type. Fitted logistic regression models were used to determine the probability of adherence with the HEDIS metric and identify disparities. The final cohort included 168,830 infants. Across all variables, the mean number of well visits was 6.7 with an overall adherence rate of 86%. Child beneficiaries of junior enlisted, Black, and Air Force military members had lower adherence with the HEDIS metric. Enrollment at a single site and having a pediatrician for a primary care manager was associated with higher rates of adherence. Sponsor rank, race, and service branch, along with provider type and number of enrollment sites were significantly associated with the probability of adherence. Further research should evaluate barriers to care that affect a universally insured population.

Adherence to Post-polypectomy Surveillance Guidelines at a Large District General Hospital.

Introduction In 2020, the British Society of Gastroenterologists(BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI), and Public Health England (PHE) published joint guidelines regardingpost-polypectomy surveillance. This study aimed to establish clinician adherence at the Royal Devon University Healthcare NHS Foundation Trust to the 2020 guidelines compared to the now-retired 2010 guidelines. Materials and Methods Data on 152 patients treated under the 2010 guidelines and 133 patients treated under the 2020 guidelines were collected retrospectively from the hospital's colonoscopy database. Data were analysed to determine whether patients who had a colonoscopy fulfilled BSG/ACPGBI/PHE guidelines for follow-up. Costs were estimated using the price of colonoscopy in the NHS National Schedule. Results Approximately 41.4% (63/152) of patients were adherent to the 2010 guidelines while 66.2% (88/133) of patients were adherent to the 2020 guidelines. The difference in adherence rate was 24.7% (95% confidence interval 13.5% - 35.9%, p<0.0001). Nearly 37% (35/95) of patients who would have been followed up under the 2010 guidelines did not receive any follow-up as a result of the 2020 guidelines. This represents a cost saving of £36,892.28 per year in our hospital. Approximately 47% (28/60) of patients treated under the 2020 guidelines had surveillance colonoscopy planned when the guidelines recommended no follow-up. If every clinician were fully adherent to the 2020 guidelines, then a further £29,513.82 per year would have been saved. Discussion and Conclusion Following the introduction of the 2020 guidelines, adherence to polyp surveillance guidelines increased in our hospital. However, nearly half of the colonoscopies were performed unnecessarily due to non-adherence. Furthermore, our results demonstrate that the 2020 guidelines have decreased the need for follow-up.

P06-09 Data processing with the short questionnaire to assess health enhancing physical activity (SQUASH): an update

BackgroundThe Short Questionnaire to Assess Health Enhancing Physical Activity (SQUASH) is a widely used questionnaire, and used for monitoring prevalence rates of physical activity(PA) in the Netherlands. To provide a standardized protocol for data processing and analysis of the SQUASH, an analysis guide was published in 2004. However, since then, the compendium of Metabolic Equivalent (MET) values of PA has been updated, and new PA guidelines have been developed. The new PA guidelines differ from the old ones in terms of the appropriate amount of active time (150 minutes/week versus 5 days/week 30 minutes), decrease in cut-off point for moderate intensity (adults 18-54 years of age) and adding a bone- and muscle strengthening component. Therefore, the protocol for data processing and analysis of the SQUASH needs to be updated. In this study, results from the old and new protocol demonstrate the differences in adherence rates between the two sets of guidelines in the Netherlands for the adult population.MethodsData of a nationally representative sample of 6942 participants aged 18 years and older were used to calculate adherence to the old and the new PA guidelines by using the original and the updated protocol. In the new protocol, the MET-values of the activities including sports were adjusted according to the 2011 Compendium. Moderate intense activity was defined as ≥ 3.0 MET irrespective of age and the bone and muscle strengthening component was added.ResultsAdherence to the old Dutch PA guidelines is 48.1% among adults aged 18-54 years, and 74.4% among adults 55 years and older. For the new PA guidelines the adherence is 48.4% and 38.1% respectively. The large difference for adults 55 years and older is due to changes in the cut-off values for moderate-to-vigorous intensity PA and the addition of bone and muscle strengthening exercises.ConclusionsThe updated protocol for data processing and analysis of the SQUASH describes the steps to calculate the new PA guidelines in a structured way and gives researchers the opportunity to work with the data from the SQUASH in a uniform way. The SPSS syntax for data processing is available at: www.sportenbewegenincijfers.nl/methoden.

12 weeks high intensity interval training versus moderate intensity continuous training in chronic low back pain subjects: a randomised single-blinded feasibility study

BackgroundCurrently, very little is known about the effects of an endurance high intensity interval training (HIIT) in chronic low back pain patients. Therefore, the feasibility and safety of the HIIT must be assessed first before Currently, very little is known about the effects of an endurance high intensity interval training in chronic low back pain patients. Therefore, the feasibility and safety of the HIIT has to be assessed first before it can be integrated safely into research and daily practice it can be integrated safely into research and daily practice. This study aims to answers the question if high intensity interval training and moderate intensity continuous training (MICT) have comparable adherence and feasibility.MethodsParticipants (age from 29 to 69 years) with non-specific chronic low back pain were recruited in this randomised, single-blinded, allocation concealed, feasibility study. The participants trained 30 min on a cycle ergometer for 12 weeks. One group had HIIT and the other MICT.ResultsOf 45 screened subjects 30 participated. The adherence rate was 94% in the HIIT group (median 0.94, IQR 0.23) versus 96% in the MICT group (median 0.96, IQR 0.08), without between-group differences: estimated median of the difference of − 0,01 [95% CI, − 0.11 to 0.06; p = 0.76]. Similar results in enjoyability (median 3, IQR 1 vs median 2, IQR 1.8) and willingness to continue the training (median 3, IQR 1 vs median 3, IQR 0.4).Both groups improved in pain and disability, without between-group differences in pain [median of the difference, 0.5; 95% CI, − 1 to 2; p = 0.95] nor in disability [median of the difference, 1.78; 95% CI, − 6.44 to 9.56; p = 0.64].ConclusionThere were no differences in adherence rates. HIIT is as feasible as MICT in non-specific chronic low back pain and can be used in future larger trials to deepen the knowledge about HIIT in this specific population.Trial registrationClinicalTrials.gov, NCT04055545. Registered 13 August 2019.

PD05-01 ASSOCIATION BETWEEN ON-TREATMENT FOLLOW-UP TESTING AND MEDICATION ADHERENCE AMONG PATIENTS PRESCRIBED PREVENTIVE PHARMACOLOGIC THERAPY FOR URINARY STONE DISEASE

You have accessJournal of UrologyCME1 May 2022PD05-01 ASSOCIATION BETWEEN ON-TREATMENT FOLLOW-UP TESTING AND MEDICATION ADHERENCE AMONG PATIENTS PRESCRIBED PREVENTIVE PHARMACOLOGIC THERAPY FOR URINARY STONE DISEASE Joseph Crivelli, Phyllis Yan, Ryan Hsi, Vahakn Shahinian, Brian Denton, and John Hollingsworth Joseph CrivelliJoseph Crivelli More articles by this author , Phyllis YanPhyllis Yan More articles by this author , Ryan HsiRyan Hsi More articles by this author , Vahakn ShahinianVahakn Shahinian More articles by this author , Brian DentonBrian Denton More articles by this author , and John HollingsworthJohn Hollingsworth More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002524.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Guidelines on medical management for urinary stone disease (USD) recommend that clinicians obtain a 24-hour urine specimen within six months of initiating preventive pharmacological therapy (PPT) to assess therapeutic response. We examined whether there are beneficial spillover effects associated with this testing, specifically increased PPT adherence. METHODS: Using claims data from working-age, commercially insured adults with USD (2008 to 2019), we identified those who were prescribed PPT (i.e., a thiazide diuretic, alkali citrate therapy, or allopurinol). Next, we sorted patients into three groups: 1) those who did not complete any 24-hour urine testing, 2) those who completed only a baseline 24-hour urine collection prior to initiating PPT, and 3) those who completed both baseline testing and on-treatment follow-up testing within six months of initiating PPT. We defined PPT adherence based on percentage days covered using pharmacy claims and assessed this over 0 to 180 days and 180 to 360 days following the initial prescription fill. Finally, we fit multivariable logistic regression models to evaluate the association between on-treatment follow-up testing and PPT adherence. RESULTS: Among a cohort of 5,072 patients receiving PPT for USD, 3,517 (69.3%) did not complete 24-hour urine testing, 1,214 (23.9%) completed a baseline collection only, and 341 (6.7%) completed both baseline and on-treatment follow-up testing. Adjusted adherence rates based on results from multivariable logistic regression are shown in the Figure. There were no significant differences in adherence rates between patients without any 24-hour urine testing and those who performed a baseline urine collection only; however, compared to patients without any 24-hour urine testing, rates of PPT adherence were significantly higher for those who completed both baseline and on-treatment follow-up testing (45.9% vs. 24.7% at 0 to 180 days [P<0.01] and 29.5% vs. 15.7% at 180 to 360 days [P<0.01]). CONCLUSIONS: On-treatment follow-up testing for patients with USD managed with PPT was associated with higher rates of medication adherence. Further research is needed to understand how the timing of on-treatment follow-up testing can be optimized to maximize PPT adherence. Source of Funding: NIH 5R01DK121709 (JH) © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e86 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph Crivelli More articles by this author Phyllis Yan More articles by this author Ryan Hsi More articles by this author Vahakn Shahinian More articles by this author Brian Denton More articles by this author John Hollingsworth More articles by this author Expand All Advertisement PDF DownloadLoading ...

Does the Method of Content Delivery Matter? Randomized Controlled Comparison of an Internet-Based Intervention for Eating Disorder Symptoms With and Without Interactive Functionality

Despite their potential as a scalable, cost-effective intervention format, self-guided Internet-based interventions for eating disorder (ED) symptoms continue to be associated with suboptimal rates of adherence and retention. Improving this may depend on the design of an Internet intervention and its method of content delivery, with interactive programs expected to be more engaging than static, text-based programs. However, causal evidence for the added benefits of interactive functionality is lacking. We conducted a randomized controlled comparison of an Internet-based intervention for ED symptoms with and without interactive functionality. Participants were randomized to a 4-week interactive (n = 148) or static (n = 145) version of an Internet-based, cognitive-behavioral program. The interactive version included diverse multimedia content delivery channels (video tutorials, graphics, written text), a smartphone app allowing users to complete the required homework exercises digitally (quizzes, symptom tracking, self-assessments), and progress monitoring features. The static version delivered identical intervention content but only via written text, and contained none of those interactive features. Dropout rates were high overall (58%), but were significantly—yet slightly—lower for the interactive (51%) compared to the static intervention (65%). There were no significant differences in adherence rates and symptom-level improvements between the two conditions. Adding basic interactive functionality to a digital intervention may help with study retention. However, present findings challenge prior speculations that interactive features are crucial for enhancing user engagement and symptom improvement.

Treatment adherence with diclofenac 3% gel among patients with multiple actinic keratoses: an integrated low-intensity intervention program versus standard-of-care.

Diclofenac 3% gel is a widely used topical treatment with proven efficacy in reducing the burden of actinic keratosis (AK); however, clinical benefit might not fully translate in clinical practice as nonadherence is substantial for prolonged treatment regimens. We evaluated the efficacy of an integrated low-intensity intervention program versus standard-of-care on treatment adherence among patients with multiple AK receiving diclofenac in hyaluronic acid gel 3%. We designed an open label, randomized, parallel group, interventional, multicenter, longitudinal cohort study including patients with multiple, grade I/II AKs. Visits were scheduled for end of treatment (T4), follow-up 1 (T5) and follow-up 2 (T6) at 90, 180 and 365 days from baseline, respectively. Patients in the intervention group received additional visits at 30 and 60 days from baseline, a brief health education intervention, an enhanced patient-physician communication, a weekly SMS reminder to medication prescriptions. Patients were equally allocated between intervention (intervention group [IG], N.=86) and control group ([CG] N.=86); at baseline, both groups had similar socio-demographic and clinical characteristics. Change scores from baseline showed a slight increment in quality of life related to AK in both groups (CG: <inf>ΔT4-T1</inf>=-0.079; IG: <inf>ΔT4-T1</inf>=-0.006; P=0.39) and in quality of physician-patient interaction reported by IG (Δ<inf>T3-T2</inf>=0.18; P<0.0001). Adherence rate was not statistically different between IG and CG (28.4% vs. 40.7%; P=0.11). Patients reported similar satisfaction for effectiveness, convenience and side effects of treatment. Clinical conditions improved over time and results did not differ between groups; complete clearance rate at 1 year was 18% and 29% for CG and IG, respectively. Our findings showed no difference in adherence rate between the two groups, suggesting that enhanced follow-up interventions and health care education may not be sufficient drivers to promote adherence among this clinical population. Further studies are needed to explore barriers to adherence with treatments for AKs.

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.

Impact of Adherence to Ibrutinib on Clinical Outcomes in Real-World Patients With Chronic Lymphocytic Leukemia.

BackgroundChronic lymphocytic leukemia (CLL) is a B-cell neoplasm with clonal expansion of small lymphocytes. Ibrutinib, an irreversible inhibitor of Bruton tyrosine kinase (BTK), is a first-line treatment option, and recent data suggest that strict adherence is directly related to clinical outcomes.ObjectivesThe primary objective of this study was to quantify ibrutinib adherence rates in real-world patients with CLL on ibrutinib; secondary outcomes included progression-free survival and overall survival.MethodsThis retrospective study included subjects who were treated at a large academic medical center over approximately 5 years. Subjects were at least 18 years, diagnosed with CLL or small lymphocytic lymphoma, and treated with ibrutinib monotherapy for at least 6 months. Adherence was quantified using the medication possession ratio (MPR), which is the ratio of the sum of days’ supply of medication in a period over the number of days in that period, and was based on fill history from the medical center’s specialty pharmacy.ResultsFor the 32 subjects in this study, the mean ibrutinib adherence rate was 91.7% (range, 84.4%–100%). Only 3 subjects had disease progression, and 1 death was recorded while on therapy (all with MPR < 95%); therefore, analyses of clinical outcomes were unable to be assessed due to a low number of events. There were no statistically significant differences in rates of adherence based on baseline characteristics and adverse drug events.ConclusionIn patients with CLL treated with ibrutinib, mean adherence was 91.7%, which is lower than rates seen in clinical trials.

640 Can incentives improve self-glucose monitoring adherence in pregnancies complicated by diabetes? A randomized controlled trial

Self-glucose monitoring is critical for management of diabetes in pregnancy, and increased adherence to testing is associated with improved obstetrical outcomes. Incentives have been shown to improve adherence to diabetes self-management. We hypothesized that use of financial incentives in pregnancies complicated by diabetes would improve adherence to self-glucose monitoring. We conducted a single-center randomized controlled trial (RCT) of women with pre-gestational or gestational diabetes requiring insulin. Women < 29 weeks gestation were randomized in a 1:1:1 ratio to one of three payment groups: control, positive incentive and loss aversion. The control group received $25 upon enrollment. The positive incentive group received 10 cents/test, and the loss aversion group received $100 for > 95% adherence and “lost” payment for decreasing adherence. The primary outcome was % adherence to recommended self-glucose monitoring where adherence was reliably quantified using a cellular-enabled glucometer. Adherence, calculated as the # tests per day/# recommended tests per day X 100%, was averaged over the course of study. The study was powered to detect a 10% difference in adherence rates with a 2-sided alpha 0.05 and 80% power. Anticipating a 30% withdrawal rate, we recruited 130 participants. From 3/2016 to 7/2019, we enrolled 130 women and 13 withdrew. Baseline demographics were similar across the three groups. Overall, the loss aversion group displayed higher rates of overall adherence to self-glucose monitoring. Average adherence in the loss aversion, control and positive incentive groups were 69% (+/- 24), 57% (+/- 31) and 58% (+/- 28), respectively (p=0.009). The loss aversion group averaged $50 compared to $38 (positive incentive) and $25 (control). This RCT suggests that loss aversion incentives improve adherence to self-glucose monitoring among women whose pregnancies are complicated by diabetes. Further studies are needed to determine whether use of incentives can improve maternal and neonatal outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)