Higher Likelihood Of Adherence Research Articles

The role of pre-existing knowledge and knowledge acquisition in internet-based cognitive-behavioural therapy for eating disorders

Knowledge is a relevant concept in internet-based cognitive-behaviour therapy (I-CBT), yet little research has sought to understand the role of knowledge in I-CBT for eating disorders. This study addressed this gap. Data were analysed from 293 participants enrolled in a RCT of I-CBT for eating disorder symptoms. A test assessing knowledge of CBT principles and eating disorders was administered before and after I-CBT. Participants had high knowledge to begin with, correctly answering 72% of items. A significant increase in knowledge scores and knowledge confidence was observed after ICBT. While no relationship between the degree of knowledge gain and the degree of symptom improvement emerged, an increase in confidence in one's knowledge was associated with greater symptom improvement. Higher baseline knowledge levels predicted lower likelihood of drop-out and a higher likelihood of adherence, but were unrelated to symptom-level improvement. Findings suggest that while new knowledge can be acquired through I-CBT, the degree of knowledge gain alone is not sufficient to explain improvement in symptoms. Pre-existing knowledge levels may be an important prognostic indicator of patient progress and compliance to I-CBT. Ensuring that patients can correctly apply the key I-CBT skills may be more important than knowledge gain.

Continuous medication monitoring: A clinical model to predict adherence to medications among chronic kidney disease patients.

An adherence model is required to optimise medication management among chronic kidney disease (CKD) patients, as current assessment methods overestimate the true adherence of CKD patients with complex regimens. An approach to assess adherence to individual medications is required to assist pharmacists in addressing non-adherence. To develop an adherence prediction model for CKD patients. This multi-centre, cross-sectional study was conducted in 10 tertiary hospitals in Malaysia using simple random sampling of CKD patients with ≥1 medication (sample size=1012). A questionnaire-based collection of patient characteristics, adherence (defined as ≥80% consumption of each medication for the past one month), and knowledge of each medication (dose, frequency, indication, and administration) was performed. Continuous data were converted to categorical data, based on the median values, and then stratified and analysed. An adherence prediction model was developed through multiple logistic regression in the development group (n=677) and validated on the remaining one-third of the sample (n=335). Beta-coefficient values were then used to determine adherence scores (ranging from 0 to 7) based on the predictors identified, with lower scores indicating poorer medication adherence. Most of the 1012 patients had poor medication adherence (n=715, 70.6%) and half had good medication knowledge (n=506, 50%). Multiple logistic regression analysis determined 4 significant predictors of adherence: ≤7 medications (constructed score=2, p<0.001), ≤3 co-morbidities (constructed score=1, p=0.015), absence of complementary/alternative medicine use (constructed score=1, p=0.003), and knowledge score ≥80% (constructed score=3, p<0.001). A higher total constructed score from the prediction model indicated a higher likelihood of adherence (odds ratio [OR]: 2.41; 95% confidence interval [CI]: 2.112-2.744; p<0.001). The area under the receiver operating characteristic (ROC) curve of the developed model (n=677) had good accuracy (ROC: 0.867, 95% CI: 0.840-0.896; p<0.001). The validated model (n=335) also had good accuracy (ROC: 0.812, 95% CI: 0.765-0.859; p<0.001). There was no significant difference between the development and validation groups (p=0.11, Z-value:1.62, standard error: 0.034). The score constructed from the medication adherence prediction model for CKD patients had good accuracy and could be useful for identifying patients with a higher risk of non-adherence, to ensure optimised adherence management.

Antidepressant adherence and its predictors in immigrants with depression: A population-based study.

Immigrants in Korea are relatively vulnerable in terms of medication self-management and have low levels of medication adherence. We aimed to evaluate antidepressant adherence and its patterns in immigrants and to identify predictors of nonadherence.In this matched cohort study using the National Health Insurance claims database, immigrants who were newly prescribed antidepressants were identified (n = 2,398). The immigrants were matched with native-born Koreans in a 1:1 ratio. Antidepressant adherence was measured by the medication possession ratio at monthly intervals. Logistic regression was performed to compare antidepressant nonadherence between immigrants and native-born Koreans, and to identify factors affecting immigrants’ nonadherence.The average medication possession ratio of immigrants was 27.1%, which was lower than that of native-born Koreans (30.9%) (P = .038). Immigrants had a lower likelihood of adherence than native-born Koreans (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.3–0.92). Older age, visiting a psychiatrist for the first diagnosis of depression (OR 2.24, 95% CI 1.60–3.13), achieving appropriateness of care (OR 3.54, 95% CI 2.51–4.98), and having a usual source of care (OR 1.69, 95% CI 1.25–2.27) were associated with a higher likelihood of adherence in immigrants.This study showed that antidepressant adherence of immigrants was lower than that of native-born Koreans. However, it appears that visiting a psychiatrist, achieving appropriateness of care, and having a usual source of care might increase antidepressant adherence among immigrants. Further research that focuses on cultural and/or linguistic factors affecting immigrants’ adherence and healthcare utilization is suggested as a way to increase adherence.

Comparison of real-world treatment patterns among patients with psoriasis prescribed ixekizumab or secukinumab

Real-world data on treatment patterns associated with use of interleukin-17A inhibitors in psoriasis are lacking. To compare treatment patterns between ixekizumab or secukinumab users in clinical practice. A retrospective cohort study included patients with psoriasis aged ≥18years treated with ixekizumab or secukinumab between March 1, 2016, and May 31, 2018 in IBM MarketScan (IBM Corp, Armonk, NY) databases. Inverse probability of treatment weighting and multivariable models were used to address cohort imbalances and estimate the risks of nonpersistence (60-day gap), discontinuation (≥90-day gap), switching, and the odds of adherence. The study monitored 645 ixekizumab users for 13.7months and 1152 secukinumab users for 16.3months. Ixekizumab users showed higher persistence rate (54.8% vs 45.1%, P<.001) and lower discontinuation rate (37.8% vs 47.5%, P<.001) than secukinumab. After multivariable adjustment, ixekizumab users had lower risks of nonpersistence (hazard ratio, 0.82; 95% confidence interval, 0.71-0.95) and discontinuation (hazard ratio, 0.82; 95% confidence interval, 0.70-0.96), and higher odds of high adherence to treatment measured by a medication possession ratio ≥80% (hazard ratio, 1.31; 95% confidence interval, 1.07-1.60). The risk of switching was similar between cohorts. Disease severity and clinical outcomes were unavailable. Ixekizumab users demonstrated longer drug persistence, lower discontinuation rate and risk of discontinuation, higher likelihood of adherence, and similar risk of switching compared with secukinumab users in clinical practices.

Assessment of factors related to smokers' adherence to a short-term support group for smoking cessation: a longitudinal study in a developing country.

The aim of this study was to determine which individual characteristics of smokers are associated with their adherence to a support group for smoking cessation. Smokers from Porto Alegre, Brazil, were invited to participate in a support group for smoking cessation consisting of four weekly sessions. Demographic data, smoking history, presence of tobacco-related diseases, severity of nicotine dependence, stage of motivation, and symptoms of anxiety and depression were evaluated at baseline. Adherence was defined as attendance at group sessions and was measured at the second and fourth sessions of the program. The study recruited 167 smokers who attended the first meeting and met criteria for admission to the study. One hundred and two of the participants returned to the second session and only 55 of those who attended the first meeting completed the four-week program. For immediate adherence (second session), adult smokers over the age of 35 were more likely to adhere to the treatment (p = 0.004), whereas smoking higher numbers of cigarettes per day was associated with lower adherence to attendance at group meetings (p = 0.031). For final adherence (fourth session), only minimal level symptoms of anxiety were associated with a higher likelihood of adherence (p = 0.02). Older smokers, those who smoked fewer cigarettes per day, and those with lower levels of anxiety exhibited higher rates of adherence to a smoking cessation support group.

An evaluation of adherence in patients with multiple sclerosis newly initiating treatment with a self-injectable or an oral disease-modifying drug.

ObjectiveAs the multiple sclerosis (MS) disease-modifying drug (DMD) treatment options have expanded to include oral therapies, it is important to understand whether route of administration is associated with DMD adherence. The objective of this study was to compare adherence to DMDs in patients with MS newly initiating treatment with a self-injectable versus an oral DMD.MethodsThis retrospective database study used IMS Health Real World Data Adjudicated Claims – US data between July 1, 2010 and June 30, 2014. Adherence was measured by medication possession ratio (MPR), calculated as the total number of treated days divided by the total number of days from the first treated day until the end of 12-month follow-up. A binary measure representing adherence (MPR ≥0.8) versus nonadherence (MPR <0.8) to therapy was used. Logistic regression evaluated the likelihood of adherence to index DMD type (self-injectable vs oral). Covariates included patient baseline characteristics (ie, age, sex, comorbidities) and index DMD type.ResultsThe analysis included 7,207 self-injectable and 1,175 oral DMD-treated patients with MS. In unadjusted analyses, the proportion of patients adherent to therapy (MPR ≥0.8) did not differ significantly between the self-injectable (54.1%) and the oral DMD cohorts (53.0%; P=0.5075). After controlling for covariates, index DMD type was not a significant predictor of adherence (odds ratio [OR] 1.062; 95% confidence interval [CI]: 0.937–1.202; P=0.3473). Higher likelihood of adherence was associated with male sex (OR 1.20; 95% CI: 1.085–1.335; P=0.0005) and age groups older than 18–34 years (ORs 1.220–1.331; P<0.01). Depression was associated with a lower likelihood of adherence (OR 0.618; 95% CI: 0.511–0.747; P<0.0001).ConclusionMale sex and age older than 18–34 years were significantly associated with a higher likelihood of adherence, while depression was associated with a lower likelihood of adherence. Index DMD type, stratified by the route of administration (self-injectable vs oral DMD), was not a significant predictor of DMD adherence.

National Evaluation of Hospital Performance on the New Commission on Cancer Melanoma Quality Measures.

To increase adherence to cancer management guidelines, the Commission on Cancer (CoC) developed and approved five melanoma quality measures in 2015. Our objectives were to evaluate formally the national performance of these melanoma measures and to examine patient, tumor, and hospital characteristics associated with adherence. From the National Cancer Data Base (2012), patients with invasive, nonmetastatic melanoma were identified. Inclusion and exclusion criteria were based on the CoC definition for each measure. Patient-level and hospital-level adherence rates were calculated for the five measures. A hospital was deemed "compliant" if it met the CoC standard, which requires 80% of patients to receive the measure-specific recommended care. Patient, tumor, and hospital characteristics potentially associated with higher likelihood of adherence at the patient-level were estimated using hierarchical random-effects logistic regression models. A total of 31,598 patients from 1343 hospitals were examined. Patient-level adherence rates varied from 31.6% (Measure 5: ≥10 axillary lymph nodes removed/examined) to 72.6% (Measure 1: sentinel lymph node biopsy (SLNB) appropriateness measure). Hospital-level adherence rates, ranged from 19.3% of hospitals (N=538 hospitals for Measure 5) to 44.8% of hospitals (N=1090 hospitals for Measure 3: completion lymph node dissection after positive SLNB). No hospital-level factors (e.g., teaching status) were consistently associated with better adherence. National adherence rates to the five new CoC melanoma quality metrics are low, and most hospitals would not meet the CoC requirement of 80% adherence. Feedback for performance of these measures to hospitals, decisions support tools, and educational initiatives are needed to improve guideline adherence.

Medication Adherence and Treatment Satisfaction Among Renal Transplant Recipients

BACKGROUND Evidence suggests that patients who are more satisfied with their treatment show better adherence with the prescribed therapy. Although there is valuable data about medication adherence among renal transplant recipients (RTRs), there is a limited literature about their treatment satisfaction and its relation to adherence. The aim of the present study was to investigate factors that can predict medication adherence and to explore the relationship between treatment satisfaction and medication adherence in renal transplant recipients. MATERIAL AND METHODS Adult RTRs were included in the study using convenient sampling. The participants were asked to complete the 8-item Morisky Medication Adherence Scale (MMAS-8) and Treatment Satisfaction Scale TSQM 1.4 in addition to several socio-demographic and treatment-related data. The results were statistically analyzed using univariate and multivariate logistic regression modelling in a stepwise procedure. RESULTS A total of 151 RTRs were included in the study, of which 52 were classified as adherent (34%). Univariate analysis showed that, in comparison with non-adherent RTRs, the adherent group demonstrated significantly higher satisfaction scores in the domains of convenience (96.6±8.7 vs. 85.3±19.3), side effects (95.9±14.1 vs. 82.6±24.1), and global satisfaction (93.4±9.8 vs. 86.7±16.7), while they had marginally higher satisfaction scores in the effectiveness domain (90.4±11.6 vs. 86.5±14.5). Results from multiple logistic regression showed that higher likelihood of adherence was significantly associated with increased satisfaction score in the convenience domain [AOR=1.76, 95% CI=(1.21, 2.55); p=0.003] and marginally related to increased satisfaction scores in the side effects domain [AOR=1.31, 95% CI=(0.99, 1.74); p=0.061]. Male RTRs were significantly more likely to be adherent than female RTRs [AOR=2.23, 95% CI=(1.02, 4.84); p=0.043]. CONCLUSIONS Although the adherence rate among RTRs is relatively low, males and RTRs who reported higher treatment satisfaction (convenience and side effects domains) showed better medication adherence. It is recommended that interventional programs for the improvement of dialysis patient adherence should be developed, in addition to designing strategies to improve treatment convenience and knowledge of medication side effects.

Pill Burden Influences the Association Between Time-Based Prospective Memory and Antiretroviral Therapy Adherence in Younger But Not Older HIV-Infected Adults

Prospective memory (PM) is associated with antiretroviral (ARV) adherence in HIV, but little is known about how pill burden and age might affect this association. One hundred seventeen older (≥50years) and 82 younger (<50years) HIV-infected adults were administered a measure of PM in the laboratory and subsequently were monitored for ARV adherence for 30days using the Medication Event Monitoring System. In the older group, better time-based PM performance was associated with higher likelihood of adherence, irrespective of pill burden. Within the younger sample, time-based PM was positively related to adherence only in participants with lower pill burdens. Younger HIV-infected individuals with higher pill burdens may overcome the normal effects of time-based PM on adherence through compensatory medication-taking strategies, whereas suboptimal use of these strategies by younger HIV-infected individuals with lower pill burdens may heighten their risk of ARV nonadherence secondary to deficits in time-based PM.

Abstract 62: Impact of Once-Daily vs. Twice-Daily Dosing Frequency on Adherence in Chronic Medications among Patients with Non-Valvular Atrial Fibrillation

Objective: Multiple daily dosing may be negatively associated with patient medication adherence, but the findings are inconclusive. This study aims at comparing adherence to chronic medications for once-daily (QD) vs. twice-daily (BID) dosing in patients with non-valvular atrial fibrillation (NVAF). Methods: We analyzed the PharMetrics Integrated Claims database from 2004 to 2009. Adult patients with continuous insurance coverage, newly initiated on a QD or BID diabetes or hypertension medication, and having at least 1 AF diagnosis (ICD-9 427.31) were included. Patients with observed valvular heart disease or valve replacement procedures during the 180 days before the index fill date were excluded. The observation period started on the index date until the earliest of switching to another drug class, health plan disenrollment, and end of data availability. Compliance was calculated in two ways: medication possession ratio (MPR) and proportion of days covered (PDC). Adherence was defined as a MPR or PDC ≥ 0.8. Multivariate logistic regressions were conducted to compare the probability of adherence, adjusting for baseline demographics, index medications, comorbidities, pills burden, and healthcare costs. Results: Total of 8,256 QD and 2,441 BID patients with NVAF initiating the target chronic medications were identified. For the QD and BID group respectively, means (SD) age were 57.3 (14.0) and 56.9 (13.8) years (p=NS); 34% and 33% were females (p=NS); means (SD) duration of exposure to therapy were 447 (400) and 406 (374) days (p&lt;.001). Based on MPR, 75% of QD patients compared to 70% of BID patients were adherent (p&lt;.001). For PDC at 3, 6, 12 and 18 months, the proportions of adherent patients for the QD and BID groups were 74% vs. 68%, 65% vs. 58%, 57% vs. 50%, and 51% vs. 44% (p&lt;.001 for all comparisons), respectively. The adjusted odds ratio (95% CI) of adherence for the QD relative to BID group was 1.22 (1.09 - 1.36) based on MPR and 1.23 (1.07 - 1.41) based on PDC at 12 months. Conclusions: This study demonstrates that NVAF patients treated with QD dosing regimens for chronic medications were associated with approximately a 22% higher likelihood of adherence than those on BID regimens, regardless of whether Medication Possession Ratio or Proportion of Days Covered was used to define compliance.

Impact of Proton Pump Inhibitor Dosing on PPI Utilization Patterns Among Patients with Gastroesophageal Reflux Disease

Purpose: To examine proton pump inhibitor (PPI) dosing frequency and its association with PPI therapy utilization among patients with gastroesophageal reflux disease (GERD). Methods: This retrospective administrative claims data analysis included patients with ≥1 pharmacy claim for a PPI from 1/1/2006-3/31/2007; the first claim date was the index date. Patients had GERD diagnoses (ICD-9-CM 530.1, 530.10-530.12, 530.3, 530.81, 530.85, 787.1) and continuous enrollment for 12 months pre- and post-index date. Index PPI dosing frequency (quantity dispensed/days supply) was measured during post-index period. Patients were assigned to frequency categories: once daily (QD) for frequency=1.0, twice daily (BID) for frequency=2.0, >BID for frequency>2.0. Adherence was measured with medication possession ratio (MPR) and defined as MPR≥0.80. PPI change was defined as ≥1 non-index PPI fill after index date. Descriptive analysis was conducted and significance was tested with t-test and chi-square. Results: The study included 174,619 patients with GERD. The mean age of the cohort was 51.1 (±12.7) years and 54.6% were female. Most (91.4%) were on QD regimen throughout the post-index period, 8.1% were on BID and 0.5% of the patients were on >BID and excluded from analysis. Among patients whose first (index) PPI fill was QD, 1.8% increased dosing frequency during post-index and 0.5% had both an increase and decrease in frequency; all others had no change in dosing frequency. Among patients whose index PPI fill was BID, 12.3% decreased frequency, 1.0% increased frequency, and 4.3% both increased and decreased frequency during post-index. More QD PPI users (25.8%) than BID PPI (18.1%) were adherent (p<0.0001). Mean (standard deviation) MPR among patients with QD PPI and BID PPI were 0.53 (0.35) and 0.47 (0.32), respectively (p<0.0001). PPI change occurred in 26.2% of QD patients and 28.3% of BID patients (p<0.0001). Among PPI changers, 91.1% of index QD users changed to a different PPI with QD dosing, 8.3% changed to a different PPI with BID dosing and 0.6% changed to different PPI with >BID dosing. Among PPI changes, 52.2% of index BID users changed to a different PPI with QD dosing, 44.6% changed to a different PPI with BID dosing and 3.2% changed to a different PPI with >BID dosing. Conclusion: Once-daily dosing of PPI was associated with higher likelihood of adherence. More than a quarter of GERD patients changed to a different PPI during the study period and a substantial proportion of BID PPI users continued on BID dosing on a different PPI. Sponsored by Takeda Pharmaceuticals North America, Inc., Deerfield, IL, USA. Disclosure: Ronnie Fass-Consultant: Takeda, Xenoport, Vecta, Eisai, Salix; Research Suuport: Takeda, Wyeth, AstraZeneca, Sucampo; Speakers Bureau: Eisai, Takeda Reema Mody, M Charisse DeLeon-Employee: Takeda Rachel Halpern, Laura Becker-Employee: i3 Innovus, a vendor to Takeda.

Patient trust-in-physician and race are predictors of adherence to medical management in inflammatory bowel disease

Adherence plays an important role in the therapeutic effectiveness of medical therapy in inflammatory bowel disease (IBD). We assessed whether trust-in-physician and Black race were predictors of adherence. We performed a cross-sectional study of Black (n = 120) and White (n = 115) IBD patients recruited from an outpatient IBD clinic. Self-reported adherence to taking medication and keeping appointments, trust-in-physician, and health-related quality of life were measured using the validated instruments, the modified Hill-Bone Compliance Scale (HBCS), the Trust-in-Physician Scale (TIPS), and the Short IBD Questionnaire (SIBDQ), respectively. Overall adherence was 65%. Higher adherence correlated with greater trust-in-physician (r = -0.30; P < 0.0001), increasing age (r = -0.19; P = 0.01), and worsening health-related quality of life (r = -0.18; P = 0.01). Adherence was also higher among White IBD patients compared to Blacks (HBSC: 15.6 versus 14.0, P < 0.0001). Trust-in-physician, race, and age remained predictors of adherence to medical management after adjustment for employment, income, health insurance, marital and socioeconomic status, and immunomodulator therapy. The adjusted odds ratio for adherence in Blacks compared to Whites was 0.29 (95% confidence interval: 0.13-0.64). Every half standard deviation increase in trust-in-physician and every incremental decade in age were associated with 36% and 47% higher likelihood of adherence, respectively. Trust-in-physician is a potentially modifiable predictor of adherence to IBD medical therapy. Black IBD patients exhibited lower adherence compared to their White counterparts. Understanding the mechanisms of these racial differences may lead to better optimization of therapeutic effectiveness.