Differences In Medication Adherence Research Articles

Latent Profile Analysis of Medication Beliefs in Patients with Type 2 Diabetes in the Hospital-Home Transition and Comparison with Medication Adherence.

The treatment of Type 2 Diabetes Mellitus (T2DM) is a protracted and arduous process. Medication, being a universally crucial therapeutic measure, underscores the significance of medication adherence in managing the disease effectively. Medication beliefs have emerged as a significant predictor of adherence, attracting considerable scholarly attention in recent years. However, there remains a paucity of research utilizing individual-centered approaches to explore medication beliefs among the T2DM population during the hospital-home transition, leaving the relationship between these beliefs and medication adherence unclear. To investigate latent categories of medication beliefs among patients with T2DM during the transition from hospital to home, and to analyze variations in medication adherence across these categories of patients. Between August 2022 and September 2023, this study selected 304 patients with a pre-discharge diagnosis of T2DM as study subjects from a tertiary hospital in Dongguan City. The patients' profiles were assessed comprehensively via the Sociodemographic and Clinical Characteristics Questionnaire, alongside the Chinese version of Beliefs about Medicines Questionnaire-Specific and Morisky Medication Adherence Scale-8. The present study conducted latent profile analysis using Mplus 7.4 software and analyzed the influencing factors of different medication belief categories and their differences in medication adherence using SPSS 26.0 software. The medication beliefs of 304 patients were rated at 3.36±5.24 points, while medication adherence scored 6.23±1.56 points. The medication beliefs were classified into four categories: moderate necessity - low to moderate concern group (40.13%), high necessity - low concern group (9.54%), moderate necessity - moderate to high concern group (19.08%), and moderate necessity - high concern group (31.25%). Age, monthly per capita household income, and place of residence emerged as influential factors for the four categories. Moreover, the disparity in medication adherence among these categories demonstrated statistical significance (P < 0.001). The medication beliefs of patients were classified into four distinct categories, and variations in medication adherence were evident across these categories. The high necessity - low concern group demonstrated the highest medication adherence scores, while the moderate necessity - high concern group exhibited the lowest scores. Healthcare providers are advised to tailor personalized medication belief enhancement programs based on patients' homogeneous beliefs, addressing specific issues encountered by each category. This approach aims to ensure optimal medication adherence across diverse medical and social environments, effectively improving patient prognosis and enhancing quality of life.

A229 DRUG PERSISTENCE WITH THERAPY OF ADALIMUMAB BIOSIMILAR, IDACIO, IN INFLAMMATORY BOWEL DISEASES

Abstract Background For post marketed medicine, drug persistence could be used as an indication for effectiveness and safety in routine clinical care over time. Non-adherence and non-persistence to treatment are associated with disease flares and may lead to disease progression among patients with inflammatory bowel diseases (IBD) in real-life. Aims The aim of this analysis was to explore drug persistence with an adalimumab biosimilar, Idacio, in IBD patients using the data collected by Fresenius Kabi patient support program (KabiCare) in Canada. Methods Patients with IBD enrolled in KabiCare and received at least one dose of adalimumab biosimilar, Idacio, were followed up from February 2021 to September 2023 in Canada. Medication initiation date and stop date, disease types (Crohn’s disease [CD], and ulcerative colitis [UC]) and patient treatment (categorized by naïve to biologic,or switched from other biologics) were recorded in the database. The stop date was the date when KabiCare was informed that medication was discontinued. The patients continuing medication were censored at the maximal follow-up date of analysis, September 12, 2022. Log-rank tests were used for KM (Kaplan-Meier) plot comparison to examine if there were differences in medication adherence between CD and UC, and between naïve group vs. switch group by disease. Results The study sample consisted of 1049 patients: 830 (79.1%) had CD, and 338 (32.2%) were in naïve group. KabiCare followed patients with CD for a median time of 512 days (interquartile range: 285-673 days; maximum: 895 days), and followed patients with UC for a median time of 492 days (interquartile range: 183-672 days; maximum: 925 days). At 800 days after starting the medicine, the drug persistence probability was similar for patients with CD and UC (At day-800: 76.6% vs. 67.6%, p=0.07). Among patients with CD, the drug persistence probability was higher in the switch group compared to naïve group (At day-800: 78.9% vs. 71.7%, p=0.0028). Among patients with UC, the drug persistence probably was similar in the switch group compared to naïve group (At day-800: 78.4% vs. 62.3%, p=0.34). Conclusions The drug persistence of adalimumab biosimilar, Idacio, was over 76% in patients with CD and over 67% in patients with UC 800 day after therapy initiation. Compared to patients in the naïve group, patients in the switch group were more likely to stay on adalimumab therapy. Funding Agencies None

Correlation between Usual Source of Care and Medication Adherence in Patients with Hypertension.

Maintaining a usual source of care (USC), which is crucial for primary healthcare, encompasses initial contact, comprehensive services, coordinated care, and ongoing support. However, limited research exists on the relationship between USC and medication adherence in patients with hypertension. This study aimed to investigate the association between USC and medication adherence among patients with hypertension. Data from the 2nd Korea Health Panel Survey 2020 were analyzed. The final sample consisted of 3,318 participants aged 19 years or older diagnosed with hypertension. USC was categorized into three groups: no USC, place only (without a regular doctor), and regular doctor. Medication adherence was assessed using detailed items (dose, frequency, time, no stop) and a 4-point Likert scale. A logistic regression analysis was conducted with control for relevant variables. Compared to the no USC group, the regular doctor group had significantly higher odds ratios (ORs) for overall perfect/high medication adherence rates: 1.70 (95% confidence interval [CI], 1.42-2.03) and 1.59 (95% CI, 1.14-2.20). Similar results were observed for each adherence item, including prefect dose (OR, 2.14; 95% CI, 1.73- 2.63), frequency (OR, 1.87; 95% CI, 1.53-2.28), time (OR, 1.72; 95% CI, 1.43-2.07), and no stop (OR, 1.56; 95% CI, 1.09-2.23)/high frequency (OR, 2.47; 95% CI, 1.21-5.01), time (OR, 2.30; 95% CI, 1.19-4.44). However, the place only group showed no significant differences in medication adherence except for perfect adherence to dose (OR, 1.35; 95% CI, 1.06-1.71). These findings provide evidence supporting the need for healthcare policies that encourage having a regular doctor in South Korea, which has a healthcare system with limited primary care.

Exploratory analysis of medication adherence and social determinants of health among older adults with diabetes

BackgroundDiabetes is the fifth leading cause of death in the United States (US), affecting approximately 27%, or 15.9 million adults 65 years of age and older. Diabetes is the most expensive chronic condition in the US and accounts for the second largest avoidable healthcare cost. Adherence to long-term medication treatment plans is crucial among patients with diabetes because it decreases risk of developing comorbid conditions and improves quality of life. Greater exposure to adverse social determinants of health (SDOH) over an individual's lifespan can result in worse health outcomes. Hence, it is important to obtain a better understanding of how social determinants of health (SDOH) influence patients' behaviors and affect medication adherence among older adults with diabetes. ObjectivesIdentify and prioritize SDOH associated with medication adherence among a nationally representative sample of older adults with diabetes. Secondary objectives were to characterize SDOH, estimate medication adherence, and explain implications for health disparity populations among older adults in the US who have been diagnosed with diabetes. MethodsThis study used a cross-sectional secondary data analysis to examine the National Health and Nutrition Examination Survey database, identifying associations between SDOH and medication adherence among older adults with diabetes in the US. ResultsA total of 1807 respondents' data were included in the analyses. Nearly three-quarters (73.9%) of patients were considered adherent to their oral diabetes medications. Multivariable analysis revealed significant differences in medication adherence based on disability status (p = 0.016), household balanced meals (p = 0.033), and interview language (p = 0.008). ConclusionsResults revealed those with a disability, those who could not afford a balanced meal, and/or those who spoke English were associated with a higher likelihood of being nonadherent to their diabetes medications in comparison to individuals not in these groups. These findings can assist in developing SDOH-centered medication adherence strategies for pharmacists to implement with older patients with diabetes.

Exploring the Relationship Between Medication Adherence and Diabetes Disparities among Hispanic Patients in a Large Health System

BackgroundSub-optimal HbA1c control is a driver of disparities in diabetes outcomes among Hispanic patients. Differences in medication adherence may underlie racial/ethnic differences in HbA1c level.ObjectiveTo examine the relationship between medication adherence and disparities in HbA1c level among Hispanic patients, relative to other racial/ethnic groups, obtaining care in the University of California Health System (UC Health).DesignThis study used clinical, administrative, and prescription dispensing data (January–December 2021) derived from the electronic health records of 5 Academic Medical Centers in UC Health, and linear regression models (LRMs) to conduct a cross-sectional analysis of the association between medication adherence, race/ethnicity, and HbA1c level. Adjusted LRMs were run with and without the measure of medication adherence to assess this relationship.ParticipantsPatients with a UC Health primary care physician (PCP), with ≥ 1 PCP visit within the last 3 years, ages 18–75, reporting Asian, Hispanic, or White race/ethnicity, and who had ≥ 2 encounters with an ICD diagnosis of diabetes or had a prescription for a diabetes medication within the last 2 years, as of 12/31/21 (N = 27, 542; Asian = 6253, Hispanic = 7216, White = 14,073).Main MeasuresOur measure of medication adherence was the proportion of days covered (PDC) for diabetes medications in 2021. Our outcome was the most recent HbA1c value.Key ResultsIn the LRM excluding the PDC, Hispanic ethnicity was positively associated with HbA1c level (β = 0.31, p = < 0.001). In the LRM model including PDC, PDC was negatively associated with HbA1c level (β = − 0.18, p = < 0.001). However, the positive relationship between Hispanic ethnicity and HbA1c level did not change (β = 0.31, p = < 0.001).ConclusionsThe findings of this study suggest that the relationship between Hispanic ethnicity, HbA1c level, and factors outside of medication adherence should be explored among primary care patients receiving care in Academic Medical Centers.

Gender-Related Factors in Medication Adherence for Metabolic and Cardiovascular Health.

This review explores the impact of gender on medication adherence in the context of metabolic and cardiovascular diseases. Optimal adherence to medication is crucial for achieving treatment goals and preventing adverse outcomes in chronic diseases. The review examines specific conditions such as type 2 diabetes, hypercholesterolemia, arterial hypertension, cardiovascular diseases, and heart failure. In type 2 diabetes, female sex, younger age, new drug prescription, non-white ethnicity, low education level, and low income were identified as predictors of non-adherence. Depressive disorders were also found to influence adherence. In hypercholesterolemia, women exhibited poorer adherence to statin therapy compared to men, with statin-related side effects and patient perception being significant factors. Adherence to anti-hypertensive therapy showed conflicting results, with studies reporting both higher and lower adherence in women. Limited evidence suggests that women may have poorer adherence after acute myocardial infarction and stroke. Regarding heart failure, adherence studies have shown inconsistent findings. The reasons for gender differences in medication adherence are multifactorial and include sociodemographic, disease-related, treatment-related, and psychological factors. This review emphasizes the need for further research to better understand these differences and develop gender-customized interventions that can improve medication adherence and reduce the burden of metabolic and cardiovascular diseases.

Home Blood Pressure Telemonitoring Technology for Patients With Asymptomatic Elevated Blood Pressure Discharged From the Emergency Department: Pilot Study.

Hypertension affects 1 in 5 Canadians and is the leading cause of morbidity and mortality globally. Hypertension control is declining due to multiple factors including lack of access to primary care. Consequently, patients with hypertension frequently visit the emergency department (ED) due to high blood pressure (BP). Telehealth for Emergency-Community Continuity of Care Connectivity via Home-Telemonitoring Blood Pressure is a pilot project that implements and evaluates a comprehensive home blood pressure telemonitoring (HBPT) and physician case management protocol designed as a postdischarge management strategy to support patients with asymptomatic elevated BP as they transition from the ED to home. Our objective was to conduct a feasibility study of an HBPT program for patients with asymptomatic elevated BP discharged from the ED. Patients discharged from an urban, tertiary care hospital ED with asymptomatic elevated BP were recruited in Vancouver, British Columbia, Canada, and provided with HBPT technology for 3 months of monitoring post discharge and referred to specialist hypertension clinics. Participants monitored their BP twice in the morning and evenings and tele-transmitted readings via Bluetooth Sensor each day using an app. A monitoring clinician received these data and monitored the patient's condition daily and adjusted antihypertensive medications. Feasibility outcomes included eligibility, recruitment, adherence to monitoring, and retention rates. Secondary outcomes included proportion of those who were defined as having hypertension post-ED visits, changes in mean BP, overall BP control, medication adherence, changes to antihypertensive medications, quality of life, and end user experience at 3 months. A total of 46 multiethnic patients (mean age 63, SD 17 years, 69%, n=32 women) found to have severe hypertension (mean 191, SD 23/mean 100, SD 14 mm Hg) in the ED were recruited, initiated on HBPT with hypertension specialist physician referral and followed up for 3 months. Eligibility and recruitment rates were 40% (56/139) and 88% (49/56), respectively. The proportion of participants that completed ≥80% of home BP measurements at 1 and 3 months were 67% (31/46) and 41% (19/46), respectively. The proportion of individuals who achieved home systolic BP and diastolic BP control at 3 months was 71.4% (30/42) and 85.7% (36/42) respectively. Mean home systolic and diastolic BP improved by -13/-5 mm Hg after initiation of HBPT to the end of the study. Patients were prescribed 1 additional antihypertensive medication. No differences in medication adherence from enrollment to 3 months were noted. Most patients (76%, 25/33) were highly satisfied with the HBPT program and 76% (25/33) found digital health tools easy to use. HBPT intervention is a feasible postdischarge management strategy and can be beneficial in supporting patients with asymptomatic elevated BP from the ED. A randomized trial is underway to evaluate the efficacy of this intervention on BP control.

P728 Real world evidence for adalimumab biosimilar, MSB 11022, therapy in inflammatory bowel diseases: Adherence analysis

Abstract Background Adherence to medication is crucial for maintaining remission in patients with inflammatory bowel diseases (IBD). Patient-support program (PSP) plays a significant role in education for patients on medication adherence. The objective of this project was to analyze the data collected by Fresenius Kabi PSP (KabiCare) in IBD patients population on their adherence to an adalimumab biosimilar, MSB 11022, in real world practice in Canada. Methods Patients with IBD enrolled in KabiCare and received at least one dose of adalimumab biosimilar, MSB 11022, were follow-up from Feb 2021 to Nov 2022 in Canada. Medication initiation date and stop date, disease types (Crohn’s disease [CD], and ulcerative colitis [UC]) and patient treatment (categorized by naïve to biologic, or switched from other biologics) were recorded in the database. The stop date was the date when KabiCare was informed that medication was discontinued. The patients continuing medication were censored at the maximal follow-up date of analysis, November 9, 2022. Log-rank tests were used for KM (Kaplan-Meier) plot comparison to examine if there were differences in medication adherence between CD and UC, and between naïve group vs. switch group by disease. Results The study sample consisted of 836 patients, 670 (80.0%) of whom had CD, and 266 (31.8%) were in naïve group. KabiCare followed patients for a median time of 291 days (interquartile range: 190-392 days; maximum: 622 days). At 600 days after starting the medicine, the adherence probability was similar for patients with CD and UC (At day-600: 83.4% vs. 82.2%, P=0.26); however, the adherence probability was higher in the switch group compared to naïve group (At day-600: 87.9% vs. 73.5%, P=0.0001). Among patients with CD, the adherence probability was higher with switch group compared to naïve group (At day-600: 88.8% vs. 71.7%, P=0.0001). Among patients with UC, the adherence probably was similar between switch group compared to naïve group (At day-600: 90.5% vs. 76.5%, P=0.11). Conclusion The adherence probability of adalimumab biosimilar, MSB 11022, was over 80% 600-day after initiating therapy, regardless of the type of IBD disease. Compared to patients in naïve group, patients in switch group were more likely to stay on adalimumab therapy. As far as we know, this is the first report of using adalimumab biosimilar, MSB 11022, in real world clinical practice of IBD.

PS-C08-4: TEC4HOMEBP: DEVELOPING A HOME BLOOD PRESSURE TELE-MONITORING PATHWAY TO SUPPORT PATIENTS DISCHARGED FROM THE EMERGENCY DEPARTMENT WITH ELEVATED BLOOD PRESSURE

Objectives: Elevated blood pressure (BP) in the emergency department (ED) is common, but clinical uncertainty exists on how best to manage asymptomatic hypertension. Telehealth for Emergency-Community Continuity of Care Connectivity via Home Blood Pressure Telemonitoring (TEC4Home BP) evaluates how home blood pressure telemonitoring (HBPTM) can support patients with elevated BP manage their health at home after visiting the ED. The aim of this study is to assess the effect of HBPTM on BP control among those discharged home from the ED with severely elevated BP. We also examined adherence to HBPTM, medical therapy and patient satisfaction. Methods: We conducted a prospective, single-centre, observational study and recruited 50 participants from Vancouver General Hospital (VGH), ED with hypertensive urgency, asymptomatic severely uncontrolled BP (&gt; 160/100 mm Hg averaged over 3 readings) or referred to the VGH Hypertension Clinic from the ED for high BP. All participants received a validated home BP monitor (A&amp;D UA-651BLE) and App (Sphygmo App, Calgary, AB) to automatically teletransmit 2 readings in the morning and evening daily for 3 months. Proportion of patients diagnosed with hypertension with controlled home BP defined as less than 135/85 mmHg, adherence to HBPTM, and medication therapy using the Hill Bone medication adherence scale, at 1and 3 months following discharge from the ED. Results: From May to December 2021, 50 participants (60 years old, 61% females, average baseline BP (SD) in ED 191 +/−26/ 99 +/−15 mm Hg) were recruited. Our recruitment and enrollment rate were 41% and 88%, respectively. At 1 and 3 months, average home BP (SD) was 136 +/−15/80 +/−11 and 128 +/−10 /77 +/−10 mm Hg. At 3 months, there was a 66% improvement in proportion of those who achieved target BP control. Adherence to HBPTM at 1 and 3 months was 84 and 54%, respectively. There were no differences in medication adherence at baseline and 3 months of study. Participants were highly satisfied with the HBPTM program and 79% would highly recommend the program. More detailed data analysis is currently underway and will be presented. Conclusions: HBPTM is a feasible, effective, and acceptable strategy to triage and monitor patients with significantly elevated BP when discharged from the ED. Future studies are need to advise the integration of HBPTM pathway a key clinical strategy to improve patient flow in the ED, reduce length of stay in the ED, and improve BP control in patients with hypertension.

Differences in medication adherence by sex and organ type among adolescent and young adult solid organ transplant recipients.

Identification of differences in medication adherence by sex or organ type may help in planning interventions to optimize outcomes. We compared immunosuppressive medication adherence between males and females, and between kidney, liver and heart transplant recipients. This multicenter study of prevalent kidney, liver and heart transplant recipients 14-25 years assessed adherence 3 times (0, 3, 6 months post-enrollment) with the BAASIS self-report tool. At each visit, participants were classified as adherent if they missed no doses in the prior 4 weeks and non-adherent otherwise. Adherence was also assessed using the coefficient of variation (CV) of tacrolimus trough levels; CV < 30% was classified as adherent. We used multivariable mixed effects logistic regression models adjusted for potential confounders to compare adherence by sex and by organ. Across all visits, males (n=150, median age 20.4 years, IQR 17.2-23.3) had lower odds of self-reported adherence than females (n=120, median age 19.8 years, IQR 17.1-22.7) (OR 0.41, 95% CI 0.21-0.80) but higher odds of adherence by tacrolimus CV (OR 2.50, 95% CI 1.30-4.82). No significant differences in adherence (by self-report or tacrolimus CV) were noted between the 184 kidney, 58 liver, and 28 heart recipients. Females show better self-reported adherence than males but greater variability in tacrolimus levels. Social desirability bias, more common in females than males, may contribute to better self-reported adherence among females. Higher tacrolimus variability among females may reflect biologic differences in tacrolimus metabolism between males and females rather than sex differences in adherence. There were no significant differences in adherence by organ type.

Impact of a mobile integrated healthcare and community paramedicine program on improving medication adherence in patients with heart failure and chronic obstructive pulmonary disease after hospital discharge: A pilot study

BackgroundThe mobile integrated health-community paramedicine (MIH-CP) program affiliated with the University of Maryland Medical Center focuses on improving patient transitions from hospital to home by addressing both medical and social determinants of health. Until recently, only self-contained health systems could integrate inpatient and outpatient medication data. Without some means to track patients in transition, there is a significant risk of medication-related problems and errors. ObjectiveTo evaluate the impact of the MIH-CP program on medication adherence among patients with congestive heart failure (CHF) and/or chronic obstructive pulmonary disease (COPD). MethodsThis is a pilot observational study designed to compare adherence to drug regimens prescribed at hospital discharge (measured by the proportion of days covered [PDC]) between patients enrolled in the MIH-CP program and a propensity-matched control group. Propensity scores were calculated using 11 demographic, diagnostic, third-party payer, and patient care-associated variables. Discharge medication details were obtained from electronic medical records. PDC for each of the medications were calculated from pharmacy claims data. ResultsEighty-three patients were included in the study; forty-three patients were placed in the intervention group and 40 were propensity-matched controls. After adjusting for age, sex, and third-party payer, findings indicated that medication adherence was higher among patients enrolled in the MIH-CP program compared with control during the first 30 days post-discharge, specifically among patients diagnosed with CHF (8% difference in PDC, 95% confidence interval [CI], ‐0.12-0.28%) and COPD (14% difference, 95% CI, ‐0.15-0.43%), although neither result achieved statistical significance. The differences in medication adherence between patients who were enrolled and those who were not enrolled in the MIH-CP program diminished after 30 days post-discharge. ConclusionThis pilot study demonstrated a trend toward improved medication adherence among patients enrolled in the MIH-CP program. Future research involving a larger patient cohort will be required to confirm these preliminary findings.

Association Between Copayment and Adherence to Medications for Pulmonary Arterial Hypertension.

Background Pharmacologic treatment for pulmonary arterial hypertension (PAH) improves exercise capacity, functional class, and hemodynamic indexes. However, monthly prescription costs often exceed $4000. We examined associations between (1) medication copayment and (2) annual household income with adherence to pulmonary vasodilator therapy among individuals with PAH. Methods and Results We used administrative claims data from an insured population in the United States to identify individuals diagnosed with PAH between 2015 and 2020. All individuals had ≥1 medication claim for endothelin receptor antagonists, phosphodiesterase type-5 inhibitors, prostanoids or prostacyclin receptor agonists, or the soluble guanylate cyclase stimulator riociguat. We defined copayments as low, medium, or high, as determined by their distributions for each medication class. Annual household income was categorized as <$40 000, $40 000 to $74 999, and ≥$75 000. The primary outcome was medication adherence, defined by proportion of days covered ≥80%. We studied 4025 adults (aged 65.9±13.3 years; 71.2% women). Compared with those with annual household income ≥$75 000, individuals in the <$40 000 and $40 000 to $74 999 categories had no significant differences in medication adherence. Compared with those with low copayments, individuals with high copayments had decreased adherence to prostanoids (odds ratio [OR], 0.36 [95% CI, 0.20-0.65]; P<0.001) and combination therapy with endothelin receptor antagonist and phosphodiesterase type-5 inhibitor (OR, 0.61 [95% CI, 0.38-0.97]; P=0.03). Conclusions We identified associations between copayment and adherence to prostanoids and combination therapy among individuals with PAH. Copayment may be a structural barrier to medication adherence and merits inclusion in studies examining access to pharmacotherapy among individuals with PAH.

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.

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.

Primary Localized Gastrointestinal Stromal Tumors: Medication Adherence and Prognosis According to Gender.

ObjectiveGender is associated with medication adherence for imatinib, but whether it is related to the prognosis of primary localized gastrointestinal stromal tumors (GISTs) is unclear. The goal of this study was to clarify the relationship between gender and prognosis in GIST patients, with differences in medication adherence considered.MethodsThe data of 320 GIST patients were retrospectively collected from the First Affiliated Hospital of Chongqing Medical University. Survival analysis was performed using the Kaplan–Meier method (Log rank test) and the risk factors of recurrence were determined using Cox multivariate analysis. Medication adherence-stratified analyses were performed to control for confounding factors.ResultsKaplan–Meier analysis revealed that among patients who received postoperative adjuvant imatinib therapy, men had a higher recurrence rate than women (P<0.01). Pearson’s chi-square test revealed better medication adherence in women than in men (P<0.01). Cox regression analysis revealed that gender was not an independent risk factor for recurrence-free survival (RFS; P=0.25), but medication adherence was (P<0.01). Among GIST patients with a medication possession ratio (MPR) of less than 90%, 62.86% of male patients took imatinib irregularly or not at all due to limited understanding of the disease, whereas 55.74% of female patients’ took imatinib irregularly because they could not tolerate adverse drug reactions.ConclusionAdherence was poorer in male than in female patients, which might explain the worse prognoses of the former among patients who received adjuvant treatment with imatinib. The gender difference in the degree of adherence should be considered in postoperative pharmacotherapy for patients with primary localized GISTs.

Effectiveness of Community Pharmacy Diabetes and Hypertension Care Program: An Unexplored Opportunity for Community Pharmacists in Pakistan.

Background: The effective management of patients diagnosed with both Diabetes as well as Hypertension is linked with administration of efficacious pharmacological therapy as well as improvement in adherence through counseling and other strategies. Being a part of primary healthcare team, community pharmacists can effectively provide patient care for chronic disease management. The objective of the study was to evaluate the impact of pharmacist counseling on blood pressure and blood glucose control among patients having both hypertension and diabetes attending community pharmacies in Pakistan. Method: A randomized, controlled, single-blind, pre-post-intervention study design was used. The respondents included patients diagnosed with diabetes mellitus (Type I or II) and hypertension visiting community pharmacies to purchase their regular medicine. A simple random sampling technique using the lottery method was used to select community pharmacies in groups A (intervention, n = 4) and group B (control, n = 4). The total number of patients was 40 in each group, while estimating a dropout rate of 25%. The patients in the intervention group received special counseling. Blood pressure and blood glucose were checked after every 15 days for 6 months. Prevalidated tools such as the hypertension knowledge level scale, the diabetes knowledge questionnaire 24, and a brief medication questionnaire was used. Data were coded and analyzed using SPSS 21. Wilcoxon test (p < 0.05) was used to compare pre-post intervention knowledge regarding the disease, while the Mann-Whitney test (p < 0.05) was used to find differences in medication adherence among control and intervention groups. Results: A significant improvement in mean knowledge scores of patients with diabetes (16.02 ±2.93 vs. 19.97 ±2.66) and hypertension (15.60 ±3.33 vs. 18.35 ±2.31) in the intervention group receiving counseling for 6 months than control group (p < 0.05) was noted. Furthermore, the fasting blood glucose levels (8.25 ±1.45) and systolic BP (130.10 ±6.89) were significantly controlled after 6 months in the intervention group. Conclusion: The current study results concluded that community pharmacists’ counselling has a positive impact on blood glucose and blood pressure management among patients suffering with both diabetes and hypertension.

Feasibility of a Randomized Controlled Mixed Methods Trial to Address Health Literacy, Beliefs, Medication Adherence, and Self-Efficacy (ADHERE) in a Clinical Pharmacist-Led Clinic.

PurposeTo assess the feasibility and acceptability of a health literacy-psychosocial support intervention – ADHERE and explore changes in glycemic values and medication adherence.Patients and MethodsThirty-one participants with hemoglobin A1c (HbA1c) ≥ 8% were randomly allocated to control (usual care) or intervention groups (receiving usual care plus a 6-session pharmacist-led intervention focusing on the modifiable psychosocial factors that may influence medication adherence). Feasibility metrics evaluated recruitment, retention, and intervention adherence. Questionnaires were administered to collect psychosocial factors and self-reported medication adherence at baseline, the end of the intervention, 3 months, and 6 months post intervention. HbA1c values were extracted from electronic medical records. Repeated measures analysis of variance was used to compare differences in mean outcomes between the control and intervention groups. To assess intervention acceptability, eleven individuals participated in semi-structured interviews about their intervention experiences. Qualitative content analysis was used for analyzing the interviews.ResultsThirty participants completed the study. Overall, the findings support the feasibility of the intervention. There were significant differences in HbA1c values. Participants in the intervention group had lower A1C (8.3 ± 1.4) than in the control group (9.2 ± 1.3) at the time of 6-month follow-up (p = 0.003). In addition, the participants in the intervention group showed improved HbA1c at 6-month follow-up (8.3 ± 1.4), compared to baseline (9.4 ± 1.5, p = 0.011) and after 6-session intervention (8.9 ± 1.6, p = 0.046). However, there were no significant differences in medication adherence between groups over time. Qualitative themes suggest participants liked the intervention and perceived the additional support from the pharmacist as beneficial.ConclusionA pharmacist-led intervention to provide additional health literacy-psychosocial support may contribute to long-term improvements in HbA1c. Equipping pharmacists with patient-specific diabetes medication adherence information and building in additional follow-up support for patients may improve patient health outcomes.

Differences in medication adherence by dosing schedule among patients with asthma

Differences in medication adherence by dosing schedule among patients with asthma

Tool to improve patient-provider interactions in adult primary care: Randomized controlled pilot study.

To assess whether an intervention to help patients prioritize goals for their visit would improve patient-provider communication and clinical outcomes. Randomized controlled pilot study. Primary care clinic. There were 120 adult hypertensive patients enrolled. Patients were randomized to receive either usual care or a previsit patient activation card developed through a series of focus groups that prompted patients to articulate their needs and set priorities for their clinic visit. Encounters were audiorecorded, transcribed, and assessed using duplicate ratings of patient activation and decision making. The primary outcome was change in medication adherence as measured by pill count at 4 and 12 weeks after the initial visit. Secondary outcomes evaluated patient-provider interaction quality (patient satisfaction, patient activation, shared decision making, patient trust, and physicians' perceived difficulty of the encounter), functional status, and blood pressure control. Of the 120 enrolled patients, 106 completed the baseline visit (mean age of 66 years, 53% women, 57% Black, 36% White). Participants had multiple comorbidities (median number of medications = 8). During the visit, there was greater patient activation in the intervention arm than in the control arm (4.4 vs 3.8, P = .047; ratings were based on a scale from 1 to 10). However, after the visit there were no differences in medication adherence (4 weeks: 45.8% vs 49.5%; 12 weeks: 49.4% vs 51.1%), blood pressure control (4 weeks: 133/78 mm Hg vs 131/77 mm Hg; 12 weeks: 129/77 mm Hg vs 129/76 mm Hg), or encounter satisfaction (78.6% vs 73.8% fully satisfied; P = .63). There were also no differences in shared decision making, patients' trust, or perceived difficulty of the encounter. A single previsit tool designed to prompt patients to set a prioritized agenda improved patient activation during the visit, but did not affect the quality of the interaction or postvisit patient-centred outcomes.

Adherence to Inflammatory Bowel Disease Medications in Southern New Zealand.

Inflammatory bowel diseases (IBDs) require continuous clinical management; poor medication adherence may result in worse disease outcomes and increased healthcare costs. This study investigated medication adherence and associated risk factors in IBD patients. Otago (New Zealand) IBD patients were mailed questionnaires on demographics, medication-taking behavior, and a validated Probabilistic Medication Adherence Scale (ProMAS). The response rate was 29.7% (n = 174/590). The study sample was mean (SD) 50.5 (16.9) years old, 57.9% female, 49.4% had Crohn's disease, and 43.9% ulcerative colitis, with median of 9.5 years (interquartile range: 5.0-22.0) of IBD duration. About 31.1% scored below medium adherence according to ProMAS. About 11.9%, 24.7%, and 23.1% reported failing to renew, purposely not taking, and stopping taking medications, respectively; 27.2% of those who reported having no issues taking medication scored below medium on the ProMAS. Older age was associated with higher ProMAS adherence score (Pearson's r = .25; P = .0014). There were no differences in medication adherence between the types of IBDs (P = .87), disease activity status (P = .70), or gender (P = .27). There was no correlation between the number of medications and level of adherence (Pearson's r = .09; P = .27). About 18.7%, 10.1%, and 5.0% of patients reported forgetting to take medications when traveling, when out of routine, and when busy, respectively. The most used strategies to remember medications included utilizing specific routines (40.1%) and keeping medications in specific locations (21.1%). A third of IBD patients had below medium medication adherence. There were discrepancies between self-reported and tool-assessed medication adherence scores with over one-third of patients underestimating/overestimating their adherence.