Drug Adherence In Patients Research Articles

Smartphone application for improving self-awareness of adherence to edoxaban treatment: a randomised controlled trial (ADHERE-APP)

Abstract Background Adherence to oral anticoagulants is essential for stroke prevention in patients with atrial fibrillation (AF). This study aims to test the feasibility and effectiveness of the smartphone app-based intervention to improve drug adherence in patients with AF. Methods This prospective, randomised, open-label, multicentre trial (ADHERE-APP) enrolled a total of 502 patients at 9 university hospitals in South Korea from November 2021 to January 2023. Patients with AF aged ≥19 years requiring oral anticoagulation,and were treated with edoxaban were enrolled. Patients were randomized in a 1:1 ratio to the conventional treatment group and the app conditional feedback group. Patients in the app conditional feedback group used a smartphone application that pushed alarms for taking medication and measuring blood pressure (BP) and heart rate (HR) at specific times of the day. In addition to medication alarms, the habit of measuring one’s BP and HR could improve drug adherence by increasing self-awareness of the disease. The automatic BP machine was connected to the smartphone via Bluetooth and the measured BP and HR were automatically updated on the smartphone app. The primary endpoint was adherence to edoxaban as measured by pill count at 12 and 24 weeks. In addition, we evaluated the differential effect of the smartphone application by age on the primary endpoint. Results Among the 502 patients, the mean age was 66.0±10.0 years and 67.7% were male. Of the 372 patients who completed 12-weeks trial, edoxaban adherence at 12 weeks was high in both arms, with no difference in the primary outcome (96.5% [92.5%-100.0%] vs. 98.0% [93.2%-99.5%], P = 0.488). or in secondary outcomes, including the proportion of patients achieving adherence ≥ 80% or 95%. In patients aged >65 years, adherence to edoxaban was higher in the app conditional feedback group than in the conventional treatment group (95.8% [93.0%-99.5%] vs. 98.0% [95.8%-99.5%], P = 0.049). Conclusions Overall adherence to edoxaban was much higher than expected in patients with AF. There was no difference in edoxaban adherence between the app conditional feedback group and the conventional treatment group, however, in older patients, app feedback increased medication adherence.

Video-Based Directly Observed Therapy (ViDOT) as a strategic tool to improve medication adherence in epilepsy: A narrative review.

The prevalence of epilepsy is highest in the Central Africa subregion most especially in rural settlements. This is further compounded by a high prevalence of treatment gap, from poor drug adherence, and poor road network. One approach to overcoming this burden is to leverage Video-based Directly Observed Therapy (ViDOT) use for stable patients living with epilepsy, harnessing the advancement in mHealth technologies, and widespread adoption of smartphones. ViDOT is a form of telemedicine that is a smartphone-based, treatment approach for monitoring and evaluating remote patients. We performed a narrative review of the existing literature using electronic databases from PubMed and Google Scholar to identify relevant publications related to ViDOT and chronic diseases, in particular epilepsy. The selected articles were assessed for relevance, and key findings were synthesized to provide an overview of the role of ViDOT in addressing the challenges of drug adherence in epilepsy. The review shows that poor drug adherence is a major risk for poor outcomes in patients living with epilepsy. ViDOT has the potential to significantly contribute to improved drug adherence in patients living with epilepsy. Other benefits of ViDOT include the elimination of prolonged waiting times, improvement in access to specialized care, eradication of self-induced stigma and discrimination, diminishing neurologists' workload, and cost-effectiveness. Challenges include poor network coverage and unstable internet service. Giving a brief psychoeducation about epilepsy, anti-epileptic drug (AED) side effects, and the importance of sticking with the recommended drug use can improve AED adherence and epilepsy outcomes. Information dissemination through ViDOT to people with epilepsy and their caregivers at large is important to promote a healthy life.

제 2형 당뇨병 환자의 약물 순응도 영향요인

Diabetes continues to increase due to changes in lifestyle habits such as obesity, irregular diet, and decreased physical activity along with the aging population. Moreover, diabetes is difficult to cure and has a high incidence of complications and mortality, so it is very important to increase the drug adherence to maintain normal blood sugar. therefore, this study is a cross-sectional and descriptive survay conducted to identify factor affecting drug adherence in patients with type 2 diabetes.
 This study used the Korea Medical Panel data (β-version 1.0) in 2018, and among them, 1,069 people who were taking drugs after diagnosis of type 2 diabetes. The dependent variable of the study was the presence or absence of drug adherence, and the independent variable included demographic, physical and social characteristics and drug use characteristics. Data analysis was performed using Chi-Square and Logistic Regression using SPSS/wWin 22.0. The study result that 95.3% of patients with type 2 diabetes had a 1.97 (95% CI=1.06~3.67) times higher drug adherence factors than those without spouses of demographic factors. As for the physical and social characteristics factors, the group without decision-making disabilities had a drug adherence ratio of 2.25 (95% CI=1.16~4.24) for those with decision-making disabilities. Finally, compared to the group that did not occur in the drug side effects of drug use characteristics, the group satisfied with the drug was 4.44 times higher (95% CI=2.34-8.45) and the drug adherence ratio of the moderate/ unsatisfied subjects was 17.70 (95% CI=5.72-54.76). In conclusion, in order to increase drug adherence in type 2 diabetes patients, it is necessary to increase drug satisfaction through active intervention by health and medical staff through immediate monitoring of drug side effects, as well as education and intervention.

SELF-MONITORING OF BLOOD PRESSURE AND FEEDBACK USING APP IN TREATMENT OF UNCONTROLLED HYPERTENSION: SMART APP STUDY

Objective: Self-monitoring of blood pressure (SMBP) is a reliable method used to assess blood pressure (BP) accurately. However, patients do not often know how to respond to the measured BP value. We developed a mobile application-based feedback for tailored recommendations and aimed to evaluate whether this feedback is superior to SMBP alone in terms of BP reduction and drug compliance improvement in patients with hypertension. Design and method: Self-Monitoring of and Feed-back using APP in TReatment of UnconTrolled Blood Pressure (SMART-BP) is a prospective, randomized, open-label, multicenter trial to evaluate the efficacy of SMBP-App compared with SMBP alone. In the SMBP alone group, the patients performed home BP measurement and receive the standard care, whereas in the SMBP-App group, the patients received additional recommendations from the application using feedback algorithm in response to the obtained BP value. The primary endpoints were mean home BP and adherence of antihypertensive medication. Follow-up visits were scheduled at 12 and 24 weeks after randomization. Results: Among total 173 patients (88 for SBMP-app and 85 for SMBP alone) with full-analysis set, 53% were men, and the mean age was 59.8 years. Baseline characteristics including BP were not significantly different between two groups. At 6 months, mean reduction in home systolic BP was significantly higher in SMBP-App group than SBMP alone group (-20.0±13.5 vs. -14.9±12.9, = 0.012). Also, SMBP-app group showed higher drug adherence value and proportion of adherence over 95% than in SMBP alone group (95.2% vs. 90.4%, P = 0.004; 72/88 vs. 46/85, P = 0.010). Reduction in home systolic BP at 3 months and office systolic BP at 3 months were also higher in SBMP-App, similar with primary end point. Conclusions: SMBP-App is superior to SMBP alone in terms of blood pressure reduction and improved drug adherence in patients with hypertension.

Treatment adherence of outpatients with chronic myeloid leukemia at National institute of Hematology & Blood transfusion

Objective: To describe the treatment adherence of outpatients with chronic myeloid leukemia at national institute of hematology & blood transfusion. Subjects and Methods: A cross-sectional descriptive study was conducted on 170 outpatients at National Institute of Hematology and Blood Transfusion from January 2022 to June 2022. Results: 98.8% of patients came to the clinic for examination on time. The percentage of patients with drug adherence accounted for 68.8%. There were still many patients who did not comply because they forgot to take the medicine, stopped taking it on their own, and found it difficult to take the medicine. 42.35% of patients had limited knowledge about the disease. Adherence to the diet was relatively good. However, the salt and fat reduction diet was still not well implemented. The exercise regime was still limited, the percentage of people who do exercise occasionally and do not exercise accounted for 50.6%. Conclusion: The rate of patient adherence to treatment was still not high. Interventions are needed to enhance the drug adherence of patients.

Abstract 12551: Self-Monitoring of Blood Pressure and Feedback Using App in Treatment of Uncontrolled Hypertension: SMART-BP Study

Introduction: Self-monitoring of blood pressure (SMBP) is a reliable method used to assess blood pressure (BP) accurately. However, patients do not often know how to respond to the measured BP value. We developed a mobile application-based feedback for tailored recommendations and aimed to evaluate whether this feedback is superior to SMBP alone in terms of BP reduction and drug compliance improvement in patients with hypertension. Methods: Self-Monitoring of and Feed-back using APP in TReatment of UnconTrolled Blood Pressure (SMART-BP) is a prospective, randomized, open-label, multicenter trial to evaluate the efficacy of SMBP-App compared with SMBP alone. In the SMBP alone group, the patients performed home BP measurement and receive the standard care, whereas in the SMBP-App group, the patients received additional recommendations from the application using feedback algorithm in response to the obtained BP value. The primary endpoints were mean home BP and adherence of antihypertensive medication. Follow-up visits were scheduled at 12 and 24 weeks after randomization. Results: Among total 173 patients (88 for SBMP-App and 85 for SMBP alone) with full-analysis set, 53% were men, and mean age was 59.8 years. Baseline characteristics including BP were not significantly different between the two groups. At 24 weeks, mean reduction in home systolic BP was significantly higher in SMBP-App group than SBMP alone group (-22.4±13.5 vs. -17.2±13.3, P=0.019). Also, SMBP-App group showed higher drug adherence value and proportion of ≥95% adherence than in SMBP alone group (100% [97.2%-100.0%] vs. 97.6% [94.0%-100.0%], P=0.025; 86.1% vs. 68.0%, P=0.013). Reduction in home systolic BP at 12 weeks and office systolic BP at 12 or 24 weeks were also higher in SBMP-App, similar with primary end point. Conclusions: SMBP-App is superior to SMBP alone in terms of blood pressure reduction and improved drug adherence in patients with hypertension.

Nonadherence by Serum Drug Analyses in Resistant Hypertension: 7-Year Follow-Up of Patients Considered Adherent by Directly Observed Therapy.

Background Measurement of serum concentrations of drugs is a novelty found useful in detecting poor drug adherence in patients taking ≥2 antihypertensive agents. Regarding patients with treatment-resistant hypertension, we previously based our assessment on directly observed therapy. The present study aimed to investigate whether serum drug measurements in patients with resistant hypertension offer additional information regarding drug adherence, beyond that of initial assessment with directly observed therapy. Methods and Results Nineteen patients assumed to have true treatment-resistant hypertension and adherence to antihypertensive drugs based on directly observed therapy were investigated repeatedly through 7 years. Serum concentrations of antihypertensive drugs were measured by ultra-high-performance liquid chromatography-tandem mass spectrometry from blood samples taken at baseline, 6-month, 3-year, and 7-year visits. Cytochrome P450 polymorphisms, self-reported adherence and beliefs about medicine were performed as supplement investigations. Seven patients (37%) were redefined as nonadherent based on their serum concentrations during follow-up. All patients reported high adherence to medications. Nonadherent patients expressed lower necessity and higher concerns regarding intake of antihypertensive medication (P=0.003). Cytochrome P450 polymorphisms affecting metabolism of antihypertensive drugs were found in 16 patients (84%), 21% were poor metabolizers, and none were ultra-rapid metabolizers. Six of 7 patients redefined as nonadherent had cytochrome P450 polymorphisms, however, not explaining the low serum drug concentrations measured in these patients. Conclusions Our data suggest that repeated measurements of serum concentrations of antihypertensive drugs revealed nonadherence in one-third of patients previously evaluated as adherent and treatment resistant by directly observed therapy, thereby improving the accuracy of adherence evaluation. Registration URL: https://www.clinicaltrials.gov; unique identifier: NCT01673516.

MO121: The Relationship between Perceived Stress with Anxiety, Depression, Sleep Quality, Insomnia and Drug Adherence in Patients with Systemic Lupus Erythematosus during the COVID-19 Pandemic

BACKGROUND AND AIMSSleep disorders, depression and anxiety are commonly reported in patients with systemic lupus erythematosus (SLE). Public health emergencies such as pandemics can also increase these psychosocial distresses. Early diagnosis and treatment of these disorders will substantially affect patients' quality of life and medication adherence. The aim of this study was to evaluate both medication non-adherence and the incidence of perceived stress, anxiety, depression, sleep quality and insomnia during the COVID pandemic in patients with SLE.METHODThis was a cross-sectional, descriptive survey study. A total of 211 participants, including 160 SLE patients aged 18 years and older and 51 healthy volunteers who were similar in age and gender, were included. A questionnaire of socio-demographics and COVID-19 status, Medication Compliance Reporting Scale (MARS-5), Perceived Stress Scale (PSS), Hospital Anxiety and Depression Scale (HAD-A and HAD-D), Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) scales was assessed. The participants were interviewed face to face, and the answers were recorded by the researcher.RESULTSThe mean age of the patients was 41.85 ± 12.97 years and 142 (88.7%) of the patients were female. There was no significant difference between the patient and control groups in terms of the history of COVID-19 infection, symptoms and hospitalization. Fifty-nine (36.9%) patients had high perceived stress, 16 (10.0%) had anxiety, 45 (28.1%) had depression, 77 (48.1%) had poor sleep quality and 62 (38.8%) patients had insomnia. PSS (23.64 ± 7.86 versus 19.73 ± 4.80, P = .001), HAD-D (5.60 ± 3.40 versus 4.08 ± 2.21, P = .003), PSQI (6.31 ± 3.62 versus 4.43 ± 2.20, P = .001) and ISI (6.81 ± 4.98 versus 4.53 ± 2.83, P = .002) scores were significantly higher in the patient group than controls. Patients with PSS score ≥ 25 were categorized as patients with a high PSS score. Presence of anxiety, depression, poor sleep quality and insomnia were significantly higher in patients with a high PSS score. Medication non-adherence was detected in 79 (49.4%) of the patients. Interestingly, there was no difference in MARS-5 scores between high and low PSS groups. Comparison of baseline characteristics and clinical data of the patients according to PSS score is shown in Table 1. The high PSS score was positively correlated with HAD-A, HAD-D, PSQI and ISI scores. Regression analysis revealed that high perceived stress is an independent predictor of depression [Exp(β) 95% CI: 1.488 (1.245–1.779), P < .001], and anxiety [Exp(β) 95% CI: 1.235 (1.026–1.487), P = .026].CONCLUSIONSLE patients demonstrated increased levels of perceived stress, depression, poor sleep quality and insomnia compared to the healthy population during the COVID-19 pandemic. SLE patients with high perceived stress had more depression, anxiety, poor sleep quality and insomnia than those without. It needs to be determined whether these findings will have an impact on patient outcomes during long-term follow-up.Table 1.Comparison of baseline characteristics and clinical data of SLE patients according to Perceived Stress Scale (PSS) scoreVariableHigh PSS(n:59)Low PSS(n:101) P valueAge, years41.14 ± 12.4543.07 ± 13.83.379Female gender, n (%)52 (88.1%)90 (89.1%)1.000Smoking, n (%)6 (10.2%)14 (13.9%).623Alcohol, n (%)0 (0.0%)2 (2.0%).532Marital status, married, n (%)54 (91.5%)81 (80.2%).071History of Covid-19, n (%)16 (27.1%)15 (14.9%).065Hospitalization, n (%)5 (8.5%)2 (2.0%).102HAD-D score8.32 ± 3.054.01 ± 2.45<.001HAD-A score8.27 ± 2.525.31 ± 2.48<.001PSQI score8.27 ± 3.825.17 ± 2.96<.001ISI score9.88 ± 4.935.01 ± 4.06<.001MARS-5 score22.80 ± 2.4222.90 ± 2.11.772Presence of depression, n (%)37 (62.7%)8 (7.9%)<.001Presence of anxiety, n (%)12 (20.3%)4 (4.0%).001Poor sleep quality, n (%)45 (76.3%)32 (31.7%)<.001Insomnia, n (%)41 (69.5%)21 (20.8%)<.001

Rationale design and efficacy of a smartphone application for improving self-awareness of adherence to edoxaban treatment: study protocol for a randomised controlled trial (adhere app)

IntroductionHigh adherence to oral anticoagulants is essential for stroke prevention in patients with atrial fibrillation (AF). We developed a smartphone application (app) that pushes alarms for taking medication and measuring...

Lipid-lowering drug adherence and combination therapy effects on gastrointestinal cancer in patients with dyslipidemia without diabetes: a retrospective cohort study in South Korea

BackgroundIn aging populations, the number of people with high cholesterol levels is increasing. Appropriate management of high cholesterol levels with drugs such as statins may prevent secondary diseases. Despite many studies on the effects of statins on various types of cancer, the effectiveness of lipid-lowering therapy in preventing cancer remains controversial. This study aimed to evaluate its long-term effect on developing gastrointestinal (GI) cancer in patients with dyslipidemia.MethodsThis study used the National Health Insurance Sampling (NHIS) cohort data (2002–2015), which included patients with dyslipidemia without diabetes, and measured patients’ adherence to lipid-lowering therapy using the medication possession ratio. We used the Cox proportional hazard ratio (HR) to identify the association between the continuity of lipid-lowering therapy and the risk of GI cancer. We also evaluated the association between a combination of lipid-lowering drugs and a reduced risk of GI cancer.ResultsA total of 49,351 patients were diagnosed with dyslipidemia, of which 579 were diagnosed with GI cancer. Patients with higher adherence to lipid-lowering therapy had a significantly reduced risk of GI cancer compared to patients without drugs, and high adherence was associated with a reduced incidence of all types of GI cancer. Specifically, the combination of statins and ezetimibe or fibrates appears to reduce GI cancer risk effectively. Overall, the continuity of lipid-lowering therapy had a protective effect on GI cancer in middle-aged and elderly patients with dyslipidemia compared to non-users.ConclusionsOur findings suggest that the continuity of lipid-lowering therapy is vital in patients with dyslipidemia. In addition, for individuals vulnerable to GI cancer, combination therapy may be associated with more effective protection against GI cancer. Healthcare providers need patient education and monitoring to improve drug adherence in patients with dyslipidemia.

Popular Diabetes Mobile Applications for Medication Intake Monitoring

To solve the problem of monitoring and supporting the drug adherence of patients with diabetes using diabetes mobile applications, expanding and developing the mobile apps market, and increasing their competitiveness, it is necessary to conduct market research of consumer preferences and competitive advantages of diabetes apps. This paper aims to analyze popular diabetes mobile applications in Russia and the possibilities of their use to monitor and support the drug adherence of patients with type 1 and 2 diabetes mellitus. Materials and methods. The object of the study was 25 diabetes apps. The survey involved 985 mobile application users from 32 regions of Russia. All respondents were divided into two target segments. The first segment (S1) included 572 patients with type 1 diabetes mellitus, while the second target segment (S2) consisted of 413 patients with type 2 diabetes mellitus. Field research was carried out by the method of oral survey (12.6%) and web survey (87.4%) using a structured questionnaire. Positioning was carried out using a qualitative method with a two-dimensional map of perception. Competitiveness was assessed by 28 experts using the quantitative method of individual scores with the calculation of integral indicators. Results and discussion. It was found that only about 50% of respondents in the target segment S2 and more than 70% in segment S1 had a high degree of drug adherence. The main barriers to the use of diabetes mobile applications were the insufficient formation of the support system for drug administration regimens (76.6%, S1 and 84.3%, S2) and technical difficulties (51.6%, S1 and 48.7%, S2). A comparative analysis of the results of positioning and assessment of competitiveness showed that some diabetes apps had a higher competitive advantage with an emphasis on supporting drug adherence compared to consumer preferences for their use. A strategic mechanism has been proposed to increase the importance of mobile applications to support drug administration, dosing, and control regimens in patients with diabetes mellitus to satisfy consumer preferences better. Conclusion. The results obtained provide a basis for the development of a set of measures for the further development of the basic segment of the diabetes mobile applications market for monitoring and supporting drug adherence and increasing the competitive advantages of mobile applications, which will contribute to the effective treatment and prevention of diabetes mellitus in Russia and globally.

Measurement of Adherence Level of Pulmonary Tuberculosis Drugs use in Patients in the Primary Health Centers in Karawang Regency, West Java, Indonesia, using MMAS Instrument

Aims: This study aims to determine the level of drug adherence in patients with pulmonary tuberculosis at the Cilamaya Kulon Primary Health Center area, Karawang Regency, West Java, Indonesia.&#x0D; Study Design: The measurement of adherence level was carried out using the MMAS (Morisky Medication Adherence Scale) instrument.&#x0D; Place and Duration of Study: This study was conducted at Cilamaya Kulon Primary Health Center area, specifically in Bayur Lor and Pasirukem Primary Health Centers, Karawang Regency, West Java, Indonesia, from July to September 2021.&#x0D; Methodology: A cross-sectional design with a purposive sampling data collection method was used. Furthermore, the subjects were pulmonary TB patients from the Bayur Lor and Pasirukem Primary Health Centers, Karawang Regency. The instrument used was the MMAS questionnaire sheet, and data analysis was performed using SPSS (version 22.0) and continued with statistical tests using the chi-square test.&#x0D; Results: The results showed there was no significant relationship (p&gt;0.05) between age, gender, educational status, employment status, income level, smoking status, duration of treatment, drugs side effects, medication supervision, and patient motivation for drugs adherence in the Cilamaya Kulon Primary Health Center area. Furthermore, the level of medication adherence of pulmonary TB patients at this Primary Health Center area was high with a value of 84.13%.&#x0D; Conclusion: Adherence to medication in pulmonary TB patients was not influenced by age, gender, educational status, employment status, income level, smoking status, duration of treatment, drug side effects, medication supervision, and patient motivation. Therefore, the adherence level is included in the high category.

Impact of Socio–Economic, Health and Patient Related Factors on Medication Adherence in Patients with Hypertension and Type II Diabetes

Background: Adherence to therapies is a primary determinant for treatment success in chronic diseases. Despite increased awareness, poor adherence to treatments for chronic diseases still remains a global problem. Failure to adherence, seriously affects the patient and the health care system.&#x0D; Aim: The main purpose of this study was to evaluate the level of drug adherence in patients with hypertension and type II diabetes. A prospective cross sectional study was carried out in tertiary care hospitals of Khammam region, Telangana with a size of 2880 patients. A structured questionnaire has been designed using MMAS 8 scale to determine the compliance level and the socioeconomic status of the objects was analyzed by Kuppuswamy scale. &#x0D; Results: In our study, the following results were reported, age (P &lt;0.001), gender (P &lt;0.001, OR = 1.954), residence (P &lt;0.0001, OR = 3.102), level of education (P &lt;0.0001), profession (p &lt;0.0001), net monthly income (P &lt;0.001), socio economic class (P &lt;0.001), medication Costs (P &lt;0.001 OR = 0.2346), Health Literacy (P &lt;0.001, OR =0.2051), Social support (P &lt;0.001, OR =3.549, 95% CI=2.701 to 4.649). Frequency of Visits (P &lt;0.001, OR =0.09421), No of medications (P &lt;0.001, OR =0.2506), Complexity (P &lt;0.001, OR =0.1862), Self-Monitoring (P &lt;0.001, OR = 0.1011), felt worse (p&lt;0.0001,OR=0.1591).&#x0D; Conclusion: Our results showed that demographic variables, socio economic factors, health care factors had direct influence on medication adherence. Illiterates, lower-economy patients have not followed the recommendations of health care providers who insist on the need to increase drug adherence in primary care. Our findings call for the need to design new interventions on multidimensional factors likely to interfere with this study, such as patient knowledge and information to improve compliance.

Regional and income disparities in treatment and drug adherence of patients with dyslipidemia: a retrospective cohort study in South Korea, 2003\u20132015

BackgroundsHealth disparities represent a major public health problem that needs to be addressed, and a variety of factors, including geographical location and income, can contribute to these disparities. Although previous studies have suggested that health differs by region and income, evidence on the difference in treatment rate is relatively insufficient. To identify differences in prescription rates by region and income in patients with dyslipidemia.MethodsUsing data from the National Health Insurance Service senior cohort, we included older adults who were diagnosed with dyslipidemia in Korea from 2003 to 2015. Overall prescription rate was determined for patients with dyslipidemia. In addition, medication possession ratio and a defined daily dose were analyzed in patients who were prescribed statins. A generalized estimating equation Poisson model was used to assess differences in prescription rates.ResultsPatients living in rural areas (Chungcheong-do, Jeolla-do, and Gyeongsang-do) had a significantly higher prescription rate than those in metropolitan cities. Unlike the prescription rate, the drug adherence was significantly higher in Seoul, Gyeonggi-do, and Gangwon-do but lower in Jeolla-do and Gyeongsang-do than in metropolitan cities. Patients with low income had lower prescription rates than those with high income, but this difference was not statistically significant.ConclusionOur findings demonstrate differences in the treatment rates of patients with dyslipidemia by region and income. Appropriate interventions are needed in vulnerable regions and groups to increase the treatment rate for patients with dyslipidemia.

Effects of the Interactive Web-Based Video "Mon Coeur, Mon BASIC" on Drug Adherence of Patients With Myocardial Infarction: Randomized Controlled Trial.

BackgroundSecondary prevention strategies after acute coronary syndrome (ACS) presentation with the use of drug combinations are essential to reduce the recurrence of cardiovascular events. However, lack of drug adherence is known to be common in this population and to be related to treatment failure. To improve drug adherence, we developed the “Mon Coeur, Mon BASIC” video. This online video has been specifically designed to inform patients about their disease and their current medications. Interactivity has been used to increase patient attention, and the video can also be viewed on smartphones and tablets.ObjectiveThe objective of this study was to assess the long-term impact of an informative web-based video on drug adherence in patients admitted for an ACS.MethodsThis randomized study was conducted with consecutive patients admitted to University Hospital of Lausanne for ACS. We randomized patients to an intervention group, which had access to the web-based video and a short interview with the pharmacist, and a control group receiving usual care. The primary outcome was the difference in drug adherence, assessed with the Adherence to Refills and Medication Scale (ARMS; 9 multiple-choice questions, scores ranging from 12 for perfect adherence to 48 for lack of adherence), between groups at 1, 3, and 6 months. We assessed the difference in ARMS score between both groups with the Wilcoxon rank sum test. Secondary outcomes were differences in knowledge, readmissions, and emergency room visits between groups and patients’ satisfaction with the video.ResultsSixty patients were included at baseline. The median age of the participants was 59 years (IQR 49-69), and 85% (51/60) were male. At 1 month, 51 patients participated in the follow-up, 50 patients participated at 3 months, and 47 patients participated at 6 months. The mean ARMS scores at 1 and 6 months did not differ between the intervention and control groups (13.24 vs 13.15, 13.52 vs 13.68, respectively). At 3 months, this score was significantly lower in the intervention group than in the control group (12.54 vs 13.75; P=.03). We observed significant increases in knowledge from baseline to 1 and 3 months, but not to 6 months, in the intervention group. Readmissions and emergency room visits have been very rare, and the proportion was not different among groups. Patients in the intervention group were highly satisfied with the video.ConclusionsDespite a lower sample size than we expected to reach, we observed that the “Mon Coeur, Mon BASIC” web-based interactive video improved patients’ knowledge and seemed to have an impact on drug adherence. These results are encouraging, and the video will be offered to all patients admitted to our hospital with ACS.Trial RegistrationClinicalTrials.gov NCT03949608; https://clinicaltrials.gov/ct2/show/NCT03949608

Assessment of a strategy combining ambulatory blood pressure, adherence monitoring and a standardised triple therapy in resistant hypertension

Purpose Poor adherence to drug therapy and inadequate drug regimens are two frequent factors responsible for the poor blood pressure (BP) control observed in patients with apparent resistant hypertension. We evaluated the efficacy of an antihypertensive management strategy combining a standardised therapy with three long acting drugs and electronic monitoring of drug adherence in patients with apparent resistant hypertension. Materials and Methods In this multicentric observational study, adult patients with residual hypertension on 24 h ambulatory BP monitoring (ABMP) despite the use of three or more antihypertensive drugs could be included. Olmesartan/amlodipine (40/10 mg, single pill fixed-dose combination) and chlorthalidone (25 mg) were prescribed for 3 months in two separated electronic pills boxes (EPB). The primary outcome was 24 h ambulatory systolic BP (SBP) control at 3 months, defined as mean SBP <130 mmHg. Results We enrolled 48 patients (36.0% women) of whom 35 had complete EPB data. After 3 months, 52.1% of patients had 24 h SBP <130 mmHg. 24 h SBP decreased by respectively −9.1 ± 15.5 mmHg, −22.8 ± 30.6 mmHg and −27.7 ± 16.6 mmHg from the tertile with the lowest adherence to the tertile with the highest adherence to the single pill combination (p = 0.024). A similar trend was observed with tertiles of adherence to chlorthalidone. Adherence superior to 90% was associated with 24 h systolic and diastolic blood pressure control in multiple logistic regression analysis (odds ratio = 14.1 (95% confidence interval 1.1–173.3, p = 0.039). Conclusions A simplified standardised antihypertensive therapy combined with electronic monitoring of adherence normalises SBP in about half of patients with apparent resistant hypertension. Such combined management strategy enables identifying patients who need complementary investigations and those who rather need a long-term support of their adherence.

Non-Adherence to Anti-Epileptic Drugs and Associated Factors among Epileptic Patients in Dessie Town Public Hospitals, Northeast Ethiopia.

Background and PurposePatients who are non-adherent to their medication are frequently hospitalized with prolonged lengths of stay and make repeated emergency department visits. They are also more likely to miss work or school due to the seizure effects. In Ethiopia, although there is little evidence concerning anti-epileptic drug adherence, some studies were conducted with some controversy with studies done in another country. This study was therefore conducted to assess non-adherence to antiepileptic drugs and associated factors among adult epileptic patients attending in Dessie town public hospitals, northeast Ethiopia.MethodsHospital-based cross-sectional study design was employed on 368 patients from January 16, 2018 to March 16, 2018. A systematic random sampling technique was employed to recruit study participants. The collected data were entered into EpiData 3.1 and exported to SPSS version 22.0 for analysis. All covariates that were significant at p-value <0.25 in the bivariate logistic regression analysis were considered for further multivariable logistic regression analysis level of statistical significance at p-value <0.05.ResultsAmong the respondents, 37.5% (95% confidence interval [CI], 32.1–42.9) of them were non-adhered to antiepileptic drugs. Patients who were unable to write and read (adjusted odds ratio [aOR], 22.30; 95% CI, 5.84–85.21), primary education level (aOR, 5.63; 95% CI, 1.90–16.69), being male (aOR, 2.37; 95% CI, 1.33–4.23), experience adverse effect (aOR, 13.68; 95% CI, 3.27–56.97), patients got medication by payment (aOR, 2.06; 95% CI, 1.04–4.11) were statistically associated with non-adherence.ConclusionsThis study revealed that over one-third of participants were non-adherent to antiepileptic drugs. Sex, educational level, adverse effect, and medication source were independent factors for non-adherence to antiepileptic drugs. Therefore, educations and instructions about the importance of recommended drug use can improve antiepileptic drug adherence in patients with epilepsy.

The Potential of mHealth as a Game Changer for the Management of Sickle Cell Disease in India.

Sickle cell disease (SCD) is a chronic genetic disease that requires lifelong therapy and monitoring. Low drug adherence and poor monitoring may lead to an increase in morbidities and low quality of life. In the era of digital technology, various mobile health (mHealth) apps are being tested for their potential in increasing drug adherence in patients with SCD. We herewith discuss the applicability and feasibility of these mHealth apps for the management of SCD in India.

Cardiovascular Outcomes According to Polypharmacy and Drug Adherence in Patients with Atrial Fibrillation on Long-Term Anticoagulation (from the RE-LY Trial)

Prevalence of atrial fibrillation (AF) increases with age, along with comorbidities and, thus, polypharmacy. Non-adherence is associated with polypharmacy. This study aimed to identify patients at risk for cardiovascular events according to their pharmacological treatment intensity and adherence. Patients (n = 18,113) with a mean age of 71.5 ± 8.7 years, at high cardiovascular risk were followed between December 2005 until December 2007 for a median time of 2 years. The association between polypharmacy and adherence and their impact on cardiovascular and bleeding events were explored. Adherence was defined as a study drug intake of ≥80%. Patients with more co-medications had a higher body mass index, higher prevalence of hypertension, coronary heart disease, heart failure, and diabetes mellitus (all p < 0.0001) compared to ≤4 or 5-8 co-medications, but no differences in history of stroke (p = 0.68) or transient ischemic attack (p = 0.065). Across all treatments, the adjusted hazard ratios (HRs) increased in patients with more co-medications (≥9 vs ≤4) for all-cause death (HR 1.30; 1.06-1.59), major bleeding (HR 1.65; 1.33-2.05), and all bleeding events (HR 1.44; 1.31-1.59). Yearly event rates were higher in non-adherent than adherent patients for stroke and systemic embolism (SSE) (3.14 vs 1.00), all-cause death (7.76 vs 2.66), major bleeding (6.21 vs 2.65), and all bleeding (28.71 vs 19.05; all p < 0.0001). After an event the patients were more likely to become non-adherent (adherence after SSE 30.3%, after major bleeding 33.4%, after all bleeding 66.7%; all p < 0.0001). The treatment effects were consistent to the overall group in the different polypharmacy groups. In conclusion, polypharmacy and non-adherence are risk indicators for increased adverse cardiovascular and bleeding events. Dabigatran is safe to use across the full spectrum of AF patients, independent of the number of co-medications and adherence. Patients with co-medications and comorbidities require special attention and encouragement to adhere to oral anticoagulation.

Role of community pharmacists in improving adherence and clinical outcomes after acute coronary syndromes (IM-ADHERENCE): six month-results

Abstract Background Acute coronary syndromes (ACS) are the leading cause of death from cardiovascular diseases (CVD) and are responsible for 8% of deaths in Italy. Available data evaluating patient long-term adherence show that about 20–30% of patients interrupts medical therapy within first six months from the index event. Although several strategies have been developed to improve adherence, there are few data evaluating the role of community pharmacist on patient adherence and its impact on clinical outcomes Purpose Our aim was to evaluate if involving community pharmacists could improve patients' adherence to medical prescriptions after ACS, reducing the rate of re-admissions due to CVD and related costs (IM-ADHERENCE study). We report the results of the first six months of the study. Methods Patients discharged for ACS from February to September 2018 in three main hospitals of our city area, in active therapy with at least one of the recommended drugs for secondary prevention (ASA, P2Y12, statin), were identified by a cardiologist to be included in the interventional arm. Patient's drug reconciliation was obtained by the hospital pharmacist before discharge. An adherence plan assessment was performed by the referral community pharmacist at 30 days, 3, 6, 9 and 12 months after discharge with 3 kinds of interventions: counseling, pill counts and self-administered questionnaire on adherence. The cardiologist also identified patients discharged within 6 months before the study beginning as historical control arm. The investigators collected the data from pill counts, questionnaire results on adherence (interventional arm) and administrative databases throughout 6 months from hospital discharge. Main outcome was the rate of adherent patients after 6 months, defined as a value of Proportion of Days Covered (PDC) &amp;gt;80% (chi square test; p&amp;lt;0.05). Secondary outcomes concerned re-admission rates due to CV events and related costs. Results A total of 128 patients were identified, 61 patients were enrolled in the interventional arm (age 68±12,3; 87% male; 15 drop-out included in the analysis). The interventional and control arms had the same sample size and were comparable. At 6 months, the interventional arm compared with control had a higher rate of adherent patients (51% vs 33%, p=0.046) and a lower rate of re-admission to hospital for CV events (46% vs 69%, p=0.01). A significant reduction in health costs was obtained as lower rate of hospitalizations (about € 207.501 in 6 months). Conclusions The intervention of community pharmacist in patient drug adherence after ACS reduced re-hospitalizations and health costs at 6 months from index event. This study was an opportunity to integrate hospital and community pharmacists with cardiologist work in treatment and outcome of ACS patients, achieving medication reconciliation and a higher drug adherence, with less re-hospitalizations. These data are waiting to be confirmed at 1-year analysis. Funding Acknowledgement Type of funding source: None