Electronic Drug Monitoring Research Articles

The Combined Relationship of Prescription Drug Monitoring Program Enactment and Medical Cannabis Laws with Chronic Pain-Related Healthcare Visits.

U.S. state electronic prescription drug monitoring programs (PDMPs) are associated with reduced opioid dispensing among people with chronic pain and may impact use of other chronic pain treatments. In states with medical cannabis laws (MCLs), patients can use cannabis for chronic pain management, reducing their need for chronic-pain related treatment visits and moderating effects of PDMP laws. Given high rates of chronic pain among Medicaid enrollees, we examined associations between PDMP enactment in the presence or absence of MCL on chronic pain-related outpatient and emergency department (ED) visits. We created annual cohorts of Medicaid enrollees with chronic pain diagnoses using national Medicaid claims data from 2002-2013 and 2016. Negative binomial hurdle models produced adjusted odds ratios (aOR) for the likelihood of any chronic pain-related outpatient or ED visit and incident rate ratios (IRR) for the rate of visits among patients with ≥ 1 visit. Medicaid enrollees aged 18-64years with chronic pain (N = 4,878,462). A 3-level state-year variable with the following categories: 1) no PDMP, 2) PDMP enactment in the absence of MCL, or 3) PDMP enactment in the presence of MCL. Healthcare codes for chronic pain-related outpatient and ED visits each year. The sample was primarily female (67.2%), non-Hispanic White (51.2%), and ages 40-55years (37.2%). Compared to no-PDMP states, PDMP enactment in the absence of MCL was not associated with chronic pain-related outpatient visits but PDMP enactment in the presence of MCL was associated with lower odds of chronic pain-related outpatient visits (aOR = 0.81, 95% CI:0.71-0.92). PDMP enactment was not associated with ED visits, irrespective of MCL. During a period of PDMP and MCL expansion, our findings suggest treatment shifts for persons with chronic pain away from outpatient settings, potentially related to increased use of cannabis for chronic pain management.

#3028 Predictive validity of the Basel Assessment of Adherence to Immunosuppressive Medication Scale (BAASIS©) after renal transplantation

Abstract Background and Aims Adherence towards immunosuppressive medication is crucial for allograft survival after renal transplantation. However, its assessment in daily clinical practice remains challenging. The BAASIS© questionnaire, is a validated self-report instrument to detect non-adherence. However, its predictive validity for clinical relevant consequences of non-adherence needs to be established. Method The prospective AdTorque-trial (DRKS00026674) includes a consecutive cohort of 226 adult kidney graft recipients transplanted at the Medical University of Vienna between 01/2018 and 12/2019. Medication adherence was monitored up to two years by a multi-component assessment including the BAASIS©, electronic drug monitoring, pharmacy refill records, tacrolimus trough level, records by medical personal, individual evaluation by a transplant psychologist and concurrent immune monitoring by the quantification of Torque Teno virus load. The BAASIS© was applied at three-month intervals during the first year and at 24 months during routine follow-up visits. The adherence phases implementation and persistence were assessed by three items (i.e. taking, timing and dose-reduction) and one item of the BAASIS©. Non-adherence was defined by YES on any of these items. The primary clinical outcome was the occurrence of biopsy-proven allograft rejection during a maximum clinical follow-up of up to 4 years after transplantation. Herein we present the preliminary analysis of the multimodal monitoring focusing on the BAASIS© questionnaire. Results Of all 226 recipients (33% female, median age 57 years), 153 completed the adherence monitoring for 2 years, resulting in a total of 973 BAASIS© assessments. Non-adherence was reported at least once by 124 (55%) recipients and 67 recipients (30%) revealed non-adherence multiple times. The proportion of non-adherent recipients increased from 11% to 31% within the first three months and was between 27% to 32% at subsequent visits from month 6 to 24 post-transplant. Issues in the punctual timing of dose taking was the most frequent cause for non-adherence. During the clinical follow-up of 44 months (median, IQR 12-48), non-adherent recipients had a significantly higher rate of biopsy-proven rejection than adherent recipients (25%, n = 30 vs. 7%, n = 7; p < 0.001). A time-dependent cox regression model showed that non-adherence assessed by the BAASIS© predicted an increased risk for allograft rejection (HR 2.87, 95% CI 1.47-5.6). Conclusion Medication non-adherence was substantially reported already in early phases post-transplant and was associated with an increased risk for allograft rejection. Our analysis demonstrated the predictive validity of the BAASIS©, a self-report instrument which can easily be integrated in daily transplant practice. Regular adherence assessments might identify patients at risk for poor clinical outcome due to medication non-adherence and provide rationale for intervention.

A Coeditors' Note

AbstractThe January‐February 2024 issue of the Hastings Center Report includes two sets of pieces concerning brain health. One is a special report on ethical challenges that emerge at various points in the care of people facing dementia. The other set launches the journal's Neuroscience and Society series. An At Law essay provides a framework for challenging discriminatory practices related to the use of algorithms generated by electronic prescription drug monitoring programs in health care. The issue also contains policy recommendations for the use of companion digital humans to address social isolation and loneliness, guidance for the rollout of vaccine delivery technologies, and a call for ethical investigation of data infrastructure.

Assessing the impact of an electronic therapeutic drug monitoring record in the management of vancomycin through pharmacist intervention: a single‐centre study

AbstractBackgroundA gap in vancomycin therapeutic drug monitoring (TDM) electronic documentation, management, and related clinical pharmacist activities was identified by our clinical pharmacy team. In response, an electronic TDM (eTDM) template was planned, designed, and implemented by the pharmacy department team in collaboration with the electronic medical records team (EMR) and documentation committee.AimTo assess the impact of an electronic therapeutic drug monitoring (eTDM) template to measure the impact of adherence to vancomycin guidelines. Guideline adherence indicators include the number of vancomycin levels within the therapeutic range and the number of appropriate concentrations taken.MethodAn interventional, single‐centre study of vancomycin therapy in adult patients was performed from 2019–2021. Data were extracted from the electronic medical records and TDM paper‐based forms completed by clinical pharmacists. The number of concentrations within the therapeutic range and the number of appropriately taken levels were analysed by the chi‐square test. This study received an exemption from the Peninsula Health Human Research Ethics Commitee (QA/60523/PH‐2019/197291).ResultsThere was a total of 198 concentrations collected in the ‘before’ period and 125 concentrations collected in the ‘after’ period. The number of concentrations in therapeutic range increased from 34.8% to 43.2% (p = 0.132), not statistically significant. The number of concentrations taken appropriately increased from 33.8% to 55.2% (p < 0.001). The proportion of patients with pharmacist involvement increased from 43.0% to 57.0% (p = 0.868).ConclusionThe study shows that implementation of an electronic vancomycin monitoring template improved the proportion of appropriate levels taken and is the preferred method of documentation by clinical pharmacists. Future projects may benefit from analysing the cost associated with unnecessary vancomycin serum levels ordered or inclusion of pharmacists in the TDM of other narrow therapeutic medications.

Forgiveness of Dolutegravir-Based Triple Therapy Compared With Older Antiretroviral Regimens: A Prospective Multicenter Cohort of Adherence Patterns and HIV-RNA Replication

BackgroundFor many people with HIV (PWH), taking antiretroviral therapy (ARV) every day is difficult.MethodsAverage adherence (Av-Adh) and log-transformed treatment interruption (TI) to ARV were prospectively measured over 6 months using electronic drug monitoring (EDM) in several cohorts of PWH. Multivariate linear regression models including baseline confounders explored the influence of EDM-defined adherence (R2) on 6-month log10 HIV-RNA. Multivariate logistic regression models were used to compare the risk of HIV-RNA detection (VR) within subgroups stratified by lower (≤95%) and higher (>95%) Av-Adh.ResultsThree hundred ninety-nine PWH were analyzed with different ARVs: dolutegravir (n = 102), raltegravir (n = 90), boosted PI (bPI; n = 107), and NNRTI (n = 100). In the dolutegravir group, the influence of adherence pattern measures on R2 for HIV-RNA levels was marginal (+2%). Av-Adh, TI, and Av-Adh × TI increased the R2 for HIV-RNA levels by 54% and 40% in the raltegravir and bPI treatment groups, respectively. TI increased the R2 for HIV-RNA levels by 36% in the NNRTI treatment group. Compared with the dolutegravir-based regimen, the risk of VR was significantly increased for raltegravir (adjusted odds ratio [aOR], 45.6; 95% CI, 4.5–462.1; P = .001), NNRTIs (aOR, 24.8; 95% CI, 2.7–228.4; P = .005), and bPIs (aOR, 28.3; 95% CI, 3.4–239.4; P = .002) in PWH with Av-Adh ≤95%. Among PWH with >95% Av-Adh, there were no significant differences in the risk of VR among the different ARVs.ConclusionsThese findings support the concept that dolutegravir in combination with 2 other active ARVs achieves greater virological suppression than older ARVs, including raltegravir, NNRTI, and bPI, among PWH with lower adherence.

Evaluation of Prescription Drug Monitoring Program Integration With Hospital Electronic Health Records by US County-Level Opioid Prescribing Rates

This cross-sectional study assesses the level of electronic health record (EHR) and prescription drug monitoring program integration in hospitals in US counties with vs without high opioid prescribing rates.

Effectiveness of electronic health care and drug monitoring program to prevent COVID-19 and adherence to therapeutic regimen in patients with ischemic heart disease - A pilot study

Background and Aim: One of the high risk groups due to the prevalence of COVID-19 are patients with chronic heart disease The aim of this study was to evaluate the effectiveness of the electronic health care and drug monitoring program to prevent COVID-19 and adherence to therapeutic regimen of patients with chronic heart disease (ischemic heart disease) Methods: This pilot study is a quasi-experimental study with control group 10 patients with ischemic heart disease were randomly assigned to two groups of 5 individuals (intervention and control) Data collected using demographic questionnaire and Beigi's treatment follow-up questionnaire (2012), researcher-made questionnaire for prevention of SARS-CoV-2 Data analyzed with SPSS-22 software Results: Patients in both groups were matched in age, sex, and BMI (P 0 05) The adherence to the medication regimen and adherence to diet and physical activity, and adherence to the preventive issues of Covid-19 during 10 training sessions, showed a significant increase in the intervention group (p 0 005) Conclusion: Electronic services and the use of e-visit in primary health care and adherence to home care regimen, using the mobile phones and the Internet, can enable accurate monitoring of patients' status and prevent patients at risk to avoid COVID-19 © 2020 Baqiyatallah University of Medical Sciences All rights reserved

Impact of a Maternal Prevention of Mother-to-child Transmission of HIV (PMTCT) Intervention on HIV-exposed Infants in Uganda.

Background:Uganda has successfully reduced pediatric HIV infections through prevention of mother-to-child transmission of HIV (PMTCT) programs, yet little is known about adherence to infant-specific components of interventions. We hypothesized that infants born to mothers receiving the WiseMama (WM) electronic drug monitoring (EDM)-based adherence intervention would have increased uptake of six-week post-natal nevirapine (NVP) infant prophylaxis and better adherence to six-week early infant diagnosis (EID) HIV testing.Methods:At two sites in Uganda, the Wise Infant Study (WIN) prospectively followed an infant cohort. Infants were born to women enrolled in an RCT testing the effect of real-time reminders delivered via EDM on maternal adherence to antiretroviral therapy. We assessed intrapartum and discharge receipt of NVP prophylaxis using pharmacy and infant HIV DNA testing laboratory data.Results:Of 121 women eligible for WIN, 97 (80%) consented and enrolled; 46 had been randomized to control and 51 to intervention. There were no differences in receipt of a six-week NVP supply (control 87%, intervention 82%, p = 0.53). Receipt of any NVP prophylaxis did not vary by delivery location (p = 0.35), and although 12% of infants were delivered at non-study health facilities, they were not less likely to receive NVP at discharge (p = 0.37). Among infants with a completed HIV test, there was no difference in mean time to first test (control 52 days (SD 18), intervention 51 days (SD 15), p = 0.86). Only one infant, in the control group, tested positive for HIV.Conclusion and Global Health Implications:We found no significant differences in adherence to infant PMTCT practices between intervention and control infants with relatively high rates of NVP receipt albeit with suboptimal adherence to six-week EID testing. Further work is needed to ensure improved access, uptake, and follow-up of HIV-exposed infants in the Option B+ era.

Evaluation of the Rational Analgesic use in elderly adults: A cross-sectional study.

Objectives:To assess inappropriate analgesic use (IAU) by comparison of STOPP/START Version-2 and Beers 2019 criteria.Methods:This is a cross-sectional study of 331 elderly patients admitted to family medicine clinics at a tertiary hospital between February and July 2018. Data were collected from face-to-face surveys, including informed patient consent and electronic drug monitoring databases.Results:The presence of IAU by STOPP version2 was higher than the Beers criteria (19.6%, 14.5%, respectively; P<0.04; Z= –2.5) with a moderate agreement (Kappa= 0.458). The number of drugs and pain score were predictors of IAU. The most commonly caused IAU was diclofenac, although naproxen was the most used analgesic. Almost 39% of diclofenac use, 18.5% of naproxen use, and 33% of etodolac use were IAU. Most commonly, IAU reasons were; (i) NSAID use in hearth failure (Beers) (ii) NSAID use with an antiplatelet agent(s) without PPI (STOPP).Conclusions:The difference between criteria in terms of IAU was significant in favor of STOPP V2.

Measuring the multiple domains of medication nonadherence: findings from a Delphi survey of adherence experts.

Consensus on a gold-standard measure of patient medication nonadherence has been elusive, in part because medication nonadherence involves multiple, distinct behaviors across three phases (initiation, implementation, and persistence). To assess these behaviors, multiple measurement approaches may be needed. The purpose of this study was to identify expert-recommended approaches to measuring nonadherence behaviors. Thirty medication nonadherence experts were e-mailed two consecutive surveys. In both, respondents rated their agreement with definitions of nonadherence behaviors and measurement approaches. In the second survey, respondents rated the suitability of each measurement approach for assessing each behavior and identified the optimal measurement approach for each behavior. Consensus was achieved for eight patient medication nonadherence behaviors: not filling initial prescription and not taking first dose (noninitiation); refilling prescription late, missing doses, taking extra doses, taking doses at wrong time, and improperly administering medication (incorrect implementation); and discontinuing medication early (nonpersistence). Consensus was achieved for seven measurement approaches: self-report, prescription fill data, pill count, drug levels, electronic drug monitoring (EDM), smart technology, and direct observation. Self-report questionnaires were most commonly rated "at least somewhat suitable" for measuring behaviors. EDM was rated as optimal for measuring missing doses, taking extra doses, and taking doses at the wrong time. Prescription fill data were rated as optimal for not filling initial prescription, refilling late, and discontinuing. Direct observation was rated as optimal for measuring improper administration. Suitable and optimal measurement approaches varied across nonadherence behaviors. Researchers should select the measurement approach best suited to assessing the behavior(s) targeted in their research.

Antiretroviral Concentration in Hair as a Measure for Antiretroviral Medication Adherence: A Systematic Review of Global Literature.

This review aims to validate hair antiretroviral concentration (HAC) as a measure for antiretroviral medication adherence. This review included 31 studies that analyzed a total of 11 ARV drugs in four different drug classes. The associations between HAC and non-pharmacokinetic measures were generally lower than the association between HAC and other pharmacokinetic measures: the correlation coefficients (r) ranged from - 0.20 to 0.38 for self-report or pill counts and 0.20 to 0.85 for electronic drug monitoring; HAC and other pharmacokinetic measures were positively correlated with the correlation coefficients (r) ranging from 0.20 to 0.72, 0.34 to 0.86, 0.50 to 0.85 for antiretroviral concentration in plasma, peripheral blood mononuclear cells, and dried blood spots, respectively. HAC was one of the strongest independent predictors of virologic responses. HAC of tenofovir was significantly associated with renal toxicity in large sample studies. This review suggests that HAC is a valid biomarker of antiretroviral medication adherence.

Factors Associated With Sex-Related Pre-exposure Prophylaxis Adherence Among Men Who Have Sex With Men in New York City in HPTN 067.

HPTN 067 assessed the feasibility of daily and non-daily dosing of open-label emtricitabine/tenofovir disoproxil fumarate (FTC/TDF)-based pre-exposure prophylaxis (PrEP). Factors associated with sex-related PrEP adherence were assessed among men who have sex with men (MSM) randomized to one of 3 PrEP dosing arms in HPTN 067 in New York City. Sex-related PrEP adherence was defined per protocol as at least 1 PrEP tablet taken within 4 days pre-sex and at least 1 additional PrEP tablet taken within 24 hours post-sex, assessed via electronic drug monitoring and weekly interviews. Demographic data and behavioral measures were evaluated for association with sex-related PrEP adherence. Logistic regression for clustered data was used to estimate the unadjusted and adjusted odds ratios. Of 176 randomized MSM participants, 59% were Black, 10% White, 25% Hispanic, and 6% other; median age was 31 years. In the multivariable analyses, higher sex-related PrEP adherence was significantly associated with daily dosing arm, older age, employment, and higher PrEP adherence behavioral skills. Lower sex-related PrEP adherence was significantly associated with identifying as Black or Hispanic (compared with White), opiate use, and reporting "I forgot" as an adherence barrier. This analysis identified populations of MSM who might benefit from additional support to optimize PrEP adherence, including those who are younger, unemployed, or opiate users. MSM with lower PrEP behavioral skills may benefit from targeted interventions. Further study is needed to assess racial and ethnic disparities in PrEP adherence, which may reflect broader social and economic inequalities not captured in this study.

A competitive lateral flow assay for the detection of tenofovir

Proper management of an HIV infection requires that a patient be at least 80–95% adherent to a prescribed drug regimen to avoid poor health outcomes and the development of drug-resistant HIV strains. Clinicians generally monitor adherence habits indirectly through patient self-reporting, pill counting, and electronic drug monitoring. While direct measurement of patient samples like urine for monitoring drug levels is possible, it requires specialized equipment and training that is not readily available in resource-limited settings where the need is greatest. In this work we report the development of an antibody that binds to tenofovir (TFV), a key small molecule drug for both the treatment and prevention of HIV, and a competitive lateral flow assay that uses that antibody to monitor urine samples for the presence of the drug. TFV was conjugated to an immunogenic protein and injected into rabbits to raise polyclonal antibodies sensitive to the drug. The antibodies were verified for TFV-sensitivity by immunoprecipitation and HPLC. A gold nanoparticle-based competitive assay was developed to detect the presence of TFV in urine samples with a sensitivity of 1 μg mL−1. This TFV assay could be deployed as a point-of-care device for adherence monitoring in resource-limited settings as a low-cost, accurate, and speedy alternative to current methods to better inform changes in treatment.

Daily and Nondaily Oral Preexposure Prophylaxis in Men and Transgender Women Who Have Sex With Men: The Human Immunodeficiency Virus Prevention Trials Network 067/ADAPT Study.

Nondaily dosing of oral preexposure prophylaxis (PrEP) may provide equivalent coverage of sex events compared with daily dosing. At-risk men and transgender women who have sex with men were randomly assigned to 1 of 3 dosing regimens: 1 tablet daily, 1 tablet twice weekly with a postsex dose (time-driven), or 1 tablet before and after sex (event-driven), and were followed for coverage of sex events with pre- and postsex dosing measured by weekly self-report, drug concentrations, and electronic drug monitoring. From July 2012 to May 2014, 357 participants were randomized. In Bangkok, the coverage of sex events was 85% for the daily arm compared with 84% for the time-driven arm (P = .79) and 74% for the event-driven arm (P = .02). In Harlem, coverage was 66%, 47% (P = .01), and 52% (P = .01) for these groups. In Bangkok, PrEP medication concentrations in blood were consistent with use of ≥2 tablets per week in >95% of visits when sex was reported in the prior week, while in Harlem, such medication concentrations occurred in 48.5% in the daily arm, 30.9% in the time-driven arm, and 16.7% in the event-driven arm (P < .0001). Creatinine elevations were more common in the daily arm (P = .050), although they were not dose limiting. Daily dosing recommendations increased coverage and protective drug concentrations in the Harlem cohort, while daily and nondaily regimens led to comparably favorable outcomes in Bangkok, where participants had higher levels of education and employment. NCT01327651.

The Effect of Prescription Drug Monitoring Programs on Opioid Prescriptions and Heroin Crime Rates

In response to growing abuse of prescription opioid painkillers, 50 U.S. states have implemented electronic prescription drug monitoring programs (PDMPs) that record patients into a state-wide registry when a prescription opioid is received. This paper uses a difference-in-differences regression framework and interactive fixed effects factor models to identify the effect of PDMPs and two related programs on the types and strengths of opioid painkiller prescriptions filled and on rates of heroin crimes. The implementation of PDMP databases caused an 10% decrease in the amount of oxycodone shipments, with results from Medicaid prescription data pointing to larger decreases within high dosage pills. PDMPs have heterogeneous effects on heroin crime incidents across counties depending on the county's pre-policy level of prescription opioid milligrams per capita, with an 49-89% increase in heroin crime within the most opioid-dense counties, depending on model specification.

Development of an algorithm for analysing the electronic measurement of medication adherence in routine HIV care.

Background Medication adherence is crucial for successful treatment. Various methods exist for measuring adherence, including electronic drug monitoring, pharmacy refills, pill count, and interviews. These methods are not equivalent, and no method can be considered as the gold standard. A combination of methods is therefore recommended. Objective To develop an algorithm for the management of routinely collected adherence data and to compare persistence and implementation curves using post-algorithm data (reconciled data) versus raw electronic drug monitoring data. Setting A community pharmacy located within a university medical outpatient clinic in Lausanne, Switzerland. Methods The algorithm was developed to take advantage of the strengths of each available adherence measurement method, with electronic drug monitoring as a cornerstone to capture the dynamics of patient behaviour, pill count as a complementary objective method to detect any discrepancy between the number of openings measured by electronic monitoring and the number of pills ingested per opening, and annotated interviews to interpret the discrepancy. The algorithm was tested using data from patients taking lopinavir/r and having participated in an adherence-enhancing programme for more than 3months. Main outcome measure Adherence was calculated as the percentage of persistent patients (persistence) and the proportion of days with correct dosing over time (implementation) from inclusion to the end of the median follow-up period. Results A 10-step algorithm was established. Among 2041 analysed inter-visit periods, 496 (24%) were classified as inaccurate, among which 372 (75%) could be reconciled. The average implementation values were 85% (raw data) and 91% (reconciled data) (p<0.0001). At day 544, persistence values were 68% (raw) and 82% (reconciled) (p=0.11), and adherence values were 74% (raw) and 82% (reconciled) (p<0.0001). Conclusion Combining electronic drug monitoring, pill count and patient interviews is possible within the setting of a medication adherence clinic. Electronic drug monitoring underestimates medication adherence, affecting subsequent analysis of routinely collected adherence data. To ensure a set of reliable electronic drug monitoring data, structured and timely electronic drug monitoring management should be reinforced.

Real-Time Electronic Drug Monitoring for HIV-Positive Adolescents: Promising Acceptability and Feasibility in China

Objective: Little research to date has focused on measuring adherence among and tailoring adherence interventions to HIV-positive youth. To explore the potential of emerging mHealth technologies as adherence tools for youth, we assessed the acceptability and feasibility of a real-time web-linked electronic drug monitoring (EDM) device to support antiretroviral (ART) adherence among HIV-positive adolescents in China. Methods: Twenty patients ages 10-15 years who were on ART at the Guangxi Center for Disease Control ART clinic in Nanning, China used a wireless EDM device for medication for one month. We monitored adherence in real time, and explored the device’s acceptability among patients using a mixed-methods approach. Results: Using EDM data, median adherence was 93.9% (IQR 10.2) of prescribed doses taken and 90.2% (IQR 13.3) using the on-time measure. Only 20% (4/20) of patients met the strictest generally-accepted criterion for optimal adherence (≥ 95% using on-time measure) over the observation period. Self-reported median adherence for the month was 100% proportion taken. Although they expressed concerns about inconvenience and the device’s size and appearance in open-ended questions, all adolescent participants reported a positive overall experience with the device in closed-ended questions. Conclusion: Wireless EDM technology represents an acceptable and rigorous method of measuring ART adherence, and a potentially useful adherence support, for HIV-positive adolescents at a critical time in their lives, as well as for adolescents who take medications for other chronic health conditions. Future studies should focus on identifying ways of strengthening caregiver-adolescent relationships and developing tailored, age-appropriate intervention packages to support adherence.

Colorimetric Detection of Azidothymidine Using an Alkyne-Modified Dextran Substrate.

Monitoring the adherence of patients taking highly active antiretroviral therapy (HAART) is a key step in treating an HIV infection, especially in resource-limited settings in the developing world. For most regimens, when patients are not at least 95% adherent to their drug schedule, there is a loss of effectiveness in treatment resulting in increases in health care costs, increases in the rate of transmission, and reduction of positive patient outcomes. Currently, subjective methods such as pill counting, electronic drug monitoring, and patient self-reporting are the only ways clinicians can track adherence and intervene in cases of noncompliance. We address this issue by developing a dipstick-based point-of-care azide-alkyne click chemistry assay with colorimetric read-out that directly tests for the presence of one common HAART drug in patient urine. An alkyne-modified dextran was synthesized and characterized by NMR and then used to colorimetrically report the presence of azidothymidine, an azide-containing HAART drug, in urine samples. The assay is specific to azide-containing molecules that are not naturally present in the urine and is sensitive to physiologically relevant urine concentrations as low as 750 uM. This point-of-care device is a strong alternative in resource-limited settings over current direct measurement techniques that are expensive and require trained users such as HPLC.

Qualitative analysis of barriers and facilitators encountered by HIV patients in an ART adherence programme.

Medication adherence is a complex, dynamic and changing behaviour that is affected by a variety of factors, including the patient's beliefs and life circumstances. Studies have highlighted barriers to medication adherence (e.g., unmanaged side effects or a lack of social support), as well as facilitators of medication adherence (e.g., technical simplicity of treatment and psychological acceptance of the disease). Since August 2004, in Lausanne (Switzerland), physicians have referred patients who are either experiencing or are at risk of experiencing problems with their HIV antiretroviral treatment (ART) to a routine interdisciplinary ART adherence programme. This programme consists of multifactorial intervention including electronic drug monitoring (MEMS™). This study's objective was to identify the barriers and facilitators encountered by HIV patients with suboptimal medication adherence (≤90 % adherence over the study period). The community pharmacy of the Department of Ambulatory Care and Community Medicine in Lausanne (Switzerland). The study consisted of a retrospective, qualitative, thematic content analysis of pharmacists' notes that were taken during semi-structured interviews with patients and conducted as part of the ART adherence programme between August 2004 and May 2008. Barriers and facilitators encountered by HIV patients. Barriers to and facilitators of adherence were identified for the 17 included patients. These factors fell into three main categories: (1) cognitive, emotional and motivational; (2) environmental, organisational and social; and (3) treatment and disease. The pharmacists' notes revealed that diverse barriers and facilitators were discussed during medication adherence interviews. Indeed, the results showed that the 17 non-adherent patients encountered barriers and benefited from facilitators. Therefore, pharmacists should inquire about all factors, regardless of whether they have a negative or a positive impact on medication adherence, and should consider all dimensions of patient adherence. The simultaneous strengthening of facilitators and better management of barriers may allow healthcare providers to tailor care to a patient's specific needs and support each individual patient in improving his medication-related behaviour.

Prescription Drug Monitoring and Dispensing of Prescription Opioids

In the United States, per-capita opioid dispensing has increased concurrently with analgesic-related mortality and morbidity since the 1990s. To deter diversion and abuse of controlled substances, most states have implemented electronic prescription drug monitoring programs (PDMPs). We evaluated the impact of state PDMPs on opioid dispensing. We acquired data on opioids dispensed in a given quarter of the year for each state and the District of Columbia from 1999 to 2008 from the Automation of Reports and Consolidated Orders System and converted them to morphine milligram equivalents (MMEs). We used multivariable linear regression modeling with generalized estimating equations to assess the effect of state PDMPs on per-capita dispensing of MMEs. The annual MMEs dispensed per capita increased progressively until 2007 before stabilizing. Adjusting for temporal trends and demographic characteristics, implementation of state PDMPs was associated with a 3% decrease in MMEs dispensed per capita (p=0.68). The impact of PDMPs on MMEs dispensed per capita varied markedly by state, from a 66% decrease in Colorado to a 61% increase in Connecticut. Implementation of state PDMPs up to 2008 did not show a significant impact on per-capita opioids dispensed. To control the diversion and abuse of prescription drugs, state PDMPs may need to improve their usability, implement requirements for committee oversight of the PDMP, and increase data sharing with neighboring states.