Improve Medication Adherence In Patients Research Articles

Telepharmacy intervention: Can it impact medication adherence among patients with chronic disease?

Background: Medication adherence among patients with chronic diseases remains challenging for healthcare professionals. The large number and types of drugs that must be taken in the long term and the lack of knowledge related to drugs and diseases are factors that affect patient compliance. Telepharmacy is expected to improve patient medication adherence by providing easy access to consult with pharmacists. Objective: To assess the effect of telepharmacy on chronic patient medication adherence. Methods: This study had a cross-sectional study design, and the study population was Lifepack application users. The data was collected through an online questionnaire distributed through the Lifepack platform. The adherence was evaluated using the Morisky Medication Adherence Scale, and the association of telepharmacy and patient medication adherence was examined using the chi-square independence test with significance at p < 0.05. Results: In a study comprising of 94 respondents, a proportional ratio of respondents who used and did not use telepharmacy services was observed (45.75% and  54.25%, respectively). Analysis using the chi-square statistic (χ²) demonstrated a significant association between telepharmacy and patient adherence (χ² = 64.745, df = 1, p < 0.001). Furthermore, the odds ratio (OR) revealed a substantial difference in adherence, with an OR of 122.67 (95% CI [27.58, 545.66]). Conclusion: Telepharmacy has a significant impact on medication adherence in chronic patients.

Effects of Face-to-Face Nursing Support on Optimal Adherence to Oral Titratable PAH Therapies

Background Therapies currently available to pulmonary arterial hypertension (PAH) patients do not reverse the disease; however, they improve pulmonary hemodynamics, offer symptomatic relief, and lengthen the time to clinical worsening. These therapies do not come without their challenges, which include side effects and compliance with challenging titration regimens. Health care providers, particularly nurses, play a significant role in improving patient medication adherence. In-home nurse visits offer disease state education, set medication expectations, and provide support tools for patients when experiencing adverse events that may lead to therapy discontinuation. The purpose of this study is to determine the impact that in-home, face-to-face nursing visits have on optimal adherence to oral PAH therapies. Methods We identified patients who received an oral PAH drug (riociguat, selexipag, or treprostinil) supported by a nursing program (study group) and patients who received an oral PAH drug (bosentan, ambrisentan, or macitentan) not supported by a nursing program (control group) using CVS Health pharmacy data from January 1, 2018, to June 30, 2019. A logistic regression model examined demographic and medication factors associated with adherence. Results From January 2018 to June 2019, we identified 107 patients in the study group and 213 patients in the control group. After 6 months, patients in the study group reported 0.6 more fill counts (5.1 vs 4.5; P = .002) and an 11% higher medication possession ratio (MPR) than those in the control group (86.4% vs 75.0%; P = .001). After adjusting for patient characteristics, control patients tended to be more likely to drop therapy in the first 6 months after the index fill (hazard ratio = 1.52; P = .064). After 6 months, the study group reported higher rates of therapy persistence than the control group (72.0% vs 60.6%; P < .05). Conclusions Patients receiving oral PAH therapies (riociguat, selexipag, or treprostinil) supported through a visiting nurse program had significantly higher rates of optimal adherence as demonstrated by a statistically significant improvement in the MPR and a higher prescription fill count than a control group. Ultimately, a multidisciplinary approach supporting the patient and providing patient education, proper motivation, and face-to-face nursing may support improved patient outcomes.

"Phardiacare" Program for Improved Medication Adherence and Clinical Outcomes of Type 2 Diabetes Mellitus Patients in Community Health Centers.

The role of pharmacists in middle-income countries such as Indonesia is still not optimal. In this study, we developed a program called "Phardiacare", a specific pharmacist-led program for Type 2 diabetes mellitus (T2DM) patients. The objective of this study is to assess the effectiveness of the application of the "Phardiacare" program in improving medication adherence and clinical outcomes in T2DM patients. The study was quasi-experimental, with a pretest-posttest design, and was conducted prospectively from July to October 2019 at the Matraman and Jatinegara District Health Center, Jakarta, Indonesia. The study comprised 33 T2DM patients in an intervention group (IG) who received the "Phardiacare" program and 33 patients in a control group (CG). Assessment was performed of HbA1c, FBG, LDL, HDL, total cholesterol, triglycerides, and blood pressure. HbA1c after intervention in the IG was lower than that of the CG (p <0.05). Intra-group mean differences showed improvement in the clinical parameters of FBG, triglycerides, and diastolic blood pressure in the IG (p <0.05), but not in the CG. Other clinical parameters did not show significant improvement. The results of the multivariate analysis showed that the "Phardiacare" program had a 16 times greater effect in reducing levels of HbA1c in the IG [95% CI 3.995:67.113, p <0.001] compared to the CG, even after controlling for confounding variables. The "Phardiacare" program was effective in improving patient medication adherence by decreasing HbA1c and FBG, but it did not have a significant effect on LDL, HDL, total cholesterol, and systolic blood pressure. Therefore, the implementation of Phardiacare program in the management of chronic diseases, especially T2DM, should be considered.

Use of Motivational Interviewing in Older Patients with Multiple Chronic Conditions and Their Informal Caregivers: A Scoping Review.

The use of motivational interviewing is relatively new in multiple chronic conditions (MCCs). A scoping review was conducted according to JBI methodology to identify, map and synthesize existing evidence on the use of motivational interviewing to support self-care behavior changes in older patients with MCCs and to support their informal caregivers in promoting patient self-care changes. Seven databases were searched, from database inception to July 2022, for studies that used motivational interviewing in interventions for older patients with MCCs and their informal caregivers. We identified 12 studies, reported in 15 articles, using qualitative, quantitative, or mixed-method designs, conducted between 2012 and 2022, describing the use of motivational interviewing for patients with MCCs. We could not locate any study regarding its application for informal caregivers. The scoping review showed that the use of motivational interviewing is still limited in MCCs. It was used mainly to improve patient medication adherence. The studies provided scant information about how the method was applied. Future studies should provide more information about the application of motivational interviewing and should address self-care behavior changes relevant to patients and healthcare providers. Informal caregivers should also be targeted in motivational interviewing interventions, as they are essential for the care of older patients with MCCs.

Therapeutic potential of microneedles based delivery systems for the management of atopic dermatitis

Atopic Dermatitis (AD) is a diverse skin condition with a range of shapes, localization, and progression of the disease. Even though its pathophysiology is multifaceted and not entirely comprehended, it appears to be the consequence of a mix of environmental and genetic variables that cause skin barrier disruption, dermal and systemic immunological imbalance, a significant hereditary influence, and skin microbiome dysbiosis. AD is now a major global health concern owing to its rising incidence over the past few decades. For topical distribution of numerous medications, nano-based formulations have been widely investigated during the past decade. Nanoparticles have been used for transdermal applications but their distribution over stratum corneum(SC), the primary skin barrier, is still difficult. Recent advancements in microneedle array (MN) technology, particularly the use of nanoparticles (NPs) that transport both lipophilic and hydrophilic medicinal drugs, have shown promise in the administration of a variety of formulations. Microneedles (MNs) are the devices that physically penetrate the stratum corneum to effectively traverse the epidermal barrier producing minor invasion and improving patient medication adherence. These are the microscale methods to significantly widen range of medications available for transdermal administration. The current work focuses on the developments associated with the use of microneedles and nanoparticles for efficient penetration of numerous drugs. The review also focuses on the significance of microneedles in treating atopic dermatitis, and various microneedles under preclinical and clinical studies have been summarised along with regulatory challenges and toxicity issues.

Assessment of medication adherence after enrollment in a health system funded medication assistance program for patients with diabetes

BackgroundHigh costs for patients’ medications decrease medication access and adherence which contributes to poor clinical outcomes. Numerous medication assistance programs exist, but many patients needing assistance, particularly insured patients, do not receive assistance due to eligibility criteria. ObjectiveTo determine if there is an association between medication adherence to antihyperglycemic therapy and patient access to Nebraska Medicine Charity Care (NMCC). Practice descriptionNMCC covers up to 100% of medication out-of-pocket costs for patients in financial need who do not qualify for other programs. Practice innovationThere is no published information about a long-term health system-led financial medication assistance program being utilized to improve patient medication adherence and clinical outcomes. Evaluation methodsA retrospective cohort analysis was conducted to assess adherence in patients who initiated NMCC between July 1, 2018 and June 30, 2020, with a focus on diabetes for feasibility. Adherence was assessed using a modified medication possession ratio (mMPR) for 6 months after initiating NMCC based on health system dispensing data. Overall population adherence analyses were conducted in all available data, while pre-post analyses were conducted in those with antihyperglycemic medication fills during the prior 6 months. ResultsOf 2758 unique patients receiving NMCC support, 656 patients with diabetes medication use were included. Of these, 71% had prescription insurance and 28% had prescription fills in the baseline period. Mean (SD) adherence to noninsulin antihyperglycemic medications in the follow-up period was 0.80 (0.25) with 63% adherent per mMPR ≥0.80. In the prepost analysis, mMPR was significantly higher during the follow-up period at 0.83 (0.23) than during the preindex period at 0.34 (0.17), as was the proportion who were adherent (66% vs. 2%) (P < 0.001). ConclusionThis practice innovation observed an improvement in adherence and A1C outcomes in patients with diabetes who received medication financial assistance through a health system.

Adherence Assessment on Hypertension Therapy Using The Pill Count Method In Lubuk Kilangan Health Center, Indonesia

Adherence is a major problem in hypertension treatment. Patients' adherence can be evaluated through pill count by counting the remaining amount of the patient's medication at the beginning and the end, using a pillbox as a tool to improve patient medication adherence. The purpose of this study was to describe the differences in adherence between patients who used the pillbox and without the pillbox. The research method used is Pretest-Posttest Control Group Design. The sample of this study is Prolanis (Chronic Disease Management Program) patients in 2021 at the Lubuk Kilangan Health Center in Padang City. They meet the inclusion and exclusion criteria that have been set. Sampling was carried out by total sample and obtained 70 subjects divided into the treatment group and the control group. The research technique used a Home Medication Review (HMR). The results of the study using the Mann-Whitney Test statistical test on adherence (p = 0.007) showed a value (p&lt;0.05). It can be concluded that there are differences in adherence before and after the intervention. This result indicates that adherence is higher in patients who use the pillbox than those without the pillbox.

A non-randomized, controlled, interventional study to investigate the effects of community pharmacists’ cognitive behavioral therapy–based interventions on medication adherence and relevant indicators in patients with depression

BackgroundThe prevalence of depression is increasing in Japan. Pharmacists play an important role in helping patients use medicines effectively. Several studies had investigated the impact of community pharmacists on patient adherence to antidepressant therapy, and their results indicated that further study was warranted.MethodsThis study was conducted from June 2019 to May 2020 using a cluster non-randomized, open-label, parallel-group design. Four community pharmacy stores in Osaka and Hyogo Prefectures, Japan, participated in the study, and enrolled patients with unipolar depression. In the intervention group (IG), patients received cognitive behavioral therapy (CBT)-based medication support, and their medication adherence and adverse drug reactions were monitored by telephone. In the control group (CG), the pharmacists engaged in routine interactions with the study participants. Before participating in this study, the intervention-group pharmacists attended a 5-hour training session on CBT-based medication support. The primary outcome of this study was medication adherence, assessed using the Drug Attitude Inventory (DAI)-10. Secondary outcomes included the changes from baseline at 6 months in the following variables: the Patient Health Questionnaire (PHQ)-9 total score, the EQ-5D-5 L (Euro-QOL 5 dimensions 5 levels) score, patient satisfaction, and the Pharmacists’ Confidence Scale about Medication Consultation for Depressive Patients (PCMCD) score.ResultsFour pharmacies (two in IG and two in CG) completed the intervention period. Results were obtained from 19 patients in the IG and 12 patients in the CG. In the IG, the mean DAI-10 score increased from 4.941 at baseline to 6.105, the mean PHQ-9 score decreased from 9.263 to 8.625, and the mean patient satisfaction score increased from 39.947 to 42.211. In the CG, the mean DAI-10 score decreased from 6.333 to 4.167, the mean PHQ-9 score increased from 9.333 to 12.923, and the mean patient satisfaction score decreased from 38.929 to 38.167.ConclusionCBT-based medication support provided by community pharmacists may improve patient medication adherence to antidepressant therapy and symptoms. Such support can be expected to facilitate better treatment of depressed patients and may also allow the duration of treatment to be shortened.Trial registrationUMIN000037954, Date of first registration: 17/06/2019.

The Effect of Medication Adherence and Asthma Control in Asthma Patients at a Public Health Center in Padang, Indonesia

Asthma is characterized by reversible swelling or narrowing of the airways. Low adherence can negatively affect the effectiveness of therapy, increasing asthma morbidity and mortality. The long-term goal of asthma treatment is to achieve and maintain controlled asthma, but this goal is still challenging for most patients. This study examines the relationship between medication adherence and asthma control in patients. This study is observational, with a cross-sectional approach conducted on 40 asthma patients who received treatment at a Public Health Center. Patient medication adherence was measured by Medication Possession Ratio (MPR) method, and the level of control was measured by the Asthma Control Test (ACT) questionnaire. The results showed that most patients based on sociodemographic characteristics were female (80.0%), elderly group ≥60 years (45.0%), high school education (55.0%), and housewives (45.0%). The category of medication adherence was divided into 47.5% adherent patients and 52.5% non-adherent patients. The level of patient control was divided into fully controlled (2.50%), partly controlled (35.0%), and uncontrolled (62.5%). There was a significant relationship between adherence and asthma control (r=0.508; p&lt;0.05). Therefore, improving patient medication adherence can potentially improve asthma control levels.

A nationwide exploratory survey assessing perception, practice, and barriers toward pharmaceutical care provision among hospital pharmacists in Nepal

Pharmaceutical care (PC) services reduce medication errors, improve the use of medicines, and optimize the cost of treatment. It can detect medication-related problems and improve patient medication adherence. However, PC services are not commonly provided in hospital pharmacies in Nepal. Therefore, the present study was done to determine the situation of PC in hospital pharmacies and explore the perception, practice, and barriers (and their determinants) encountered by hospital pharmacists while providing PC. A descriptive online cross-sectional study was conducted from 25th March to 25th October 2021 among pharmacists with a bachelor’s degree and above working in hospital pharmacies using non-probability quota sampling. The questionnaire in English addressed perception and practice regarding PC, and barriers encountered and were validated by experts and pre-tested among 23 pharmacists. Descriptive statistics were used to describe the data. Kendall’s correlation was used to explore the correlations among various perception and practice constructs. The scores were also compared among subgroups of respondents using the Mann–Whitney test for subgroups with two categories and Kruskal–Wallis test for greater than two categories. A total of 144 pharmacists participated in the study. Majority of the participants were male, between 22 and 31 years of age, and had work experience between 10 and 20 years. Over 50% had received no training in PC. The perception scores were higher among those with more work experience and the practice scores among those who had received PC training. Participants agreed that there were significant barriers to providing PC, including lack of support from other professionals, lack of demand from patients, absence of guidelines, inadequate training, lack of skills in communication, lack of compensation, problems with access to the patient medical record, lack of remuneration, and problems with accessing objective medicine information sources. A correlation was noted between certain perceptions and practice-related constructs. Hospital pharmacists who participated had a positive perception and practice providing PC. However, PC was not commonly practised in hospital pharmacies. Significant barriers were identified in providing PC. Further studies, especially in the eastern and western provinces, are required. Similar studies may be considered in community pharmacies.

Anticipated stigma and associated factors among chronic illness patients in Amhara Region Referral Hospitals, Ethiopia: A multicenter cross-sectional study.

Anticipated stigma related to chronic illness patients undermines diagnosis, treatment, and successful health outcomes. The study aimed to assess the magnitude and factors associated with anticipated stigma among patients with chronic illness attending follow-up clinics in Amhara Region Referral Hospitals, Ethiopia. A cross-sectional institution-based study was conducted in Amhara Region Referral Hospitals from 01 March to 15 April 2021. A simple random sampling technique was used to select the three Referral Hospitals in the region and study subjects. Data were collected using a pre-tested interview-based questionnaire. Data were entered and cleaned with Epi-Info version 6 and exported for analysis STATA version 14. Multiple linear regression was used to show the association between anticipated stigma and potential factors. Associations were measured using ß coefficients and were considered statistically significant if the p-value > 0.05. A total of 779 patients were included for analysis with a response rate of 97%. Their mean (Standard deviation) of anticipated stigma was estimated at 1.86 and 0.5, respectively. After running an assumption test for multiple linear regression; educational status, cigarette smoking, psychological distress, medication adherence, alcohol consumption, and social part of the quality of life were statically significantly associated with anticipated stigma. The result showed a high level of anticipated stigma reported among the participants. Emphasizing improving their social part of the quality of life, avoiding risky behaviors like alcohol consumption and cigarette smoking, access to health education for chronically ill patients, integrating mental health in all types of chronic disease, and developing strategies and protocols which will help to improve patient medication adherence to their prescribed medication will be crucial. This can provide a foundation for government andnon-governmental organizations, and researchers implementing evidence-based interventions and strategies on chronic care to address factors related to anticipated stigma.

Use of Tailored Short Messaging Services to Improve Medication Adherence in Patients with Metabolic Syndrome

The objective of this study aims to find the effectiveness of use of tailored SMS medication reminders to improve patient medication adherence. An observational study was carried out over a period of 6 months in discharged patients of a tertiary care referral hospital in Kerala. 347 patients were enrolled prospectively from various departments. The subjects were randomized into intervention and control group in 1:1 ratio. Medication adherence was assessed using indirect- subjective patient interviewing method during pre and post intervention phase. From the post-intervention interview it was found that the level of adherence has significantly improved in intervention group (71.4%) compared to the control group (25%). The outcomes of the study revealed that female population (N= 158) is more likely to have metabolic diseases and this might be due to menopause, obesity, lack of exercise, diet and other lifestyles. In this study hypertension was found to be predominant (65.1%) followed by type II diabetes mellitus (55.9%) and dyslipidemia (44.4%). This study demonstrated the effectiveness of use of tailored SMS medication reminders to improve mediation adherence in patients with metabolic syndrome. Text message reminders significantly improve medication adherence and seems to be feasible for clinical use

Emojis and Emoticons in Health Care and Dermatology Communication: Narrative Review.

Emoticons and emojis have become staple additions to modern-day communication. These graphical icons are now embedded in daily society through the various forms of popular social media and through users' personal electronic conversations. With ever-increasing use and inclusivity, exploration of the possible health care and dermatology applications of these tools is imperative. The goal of this narrative review was to provide and evaluate an up-to-date literature survey examining the utility of emoticons and emojis in medicine. Special attention was paid to their existing and potential uses in the field of dermatology, especially during the COVID-19 pandemic. A PubMed search of peer-reviewed publications was performed in mid-2021 to collect articles with emoticon or emoji keywords in combination with other health care-relevant or dermatology-relevant keywords. Screening of publications and described studies was performed by the authors with education and research experience in health care, dermatology, social media, and electronic communication trends. Selected articles were grouped based on common subjects for qualitative analysis and presentation for in-depth discussion. From this extensive search, researchers were able to identify a wide variety of publications detailing the use of emoticons and emojis in general health care, pediatric health care, public health, and dermatology. Key subject areas that emerged from the investigation included the ability of emoticons and emojis to improve communication within pediatric health care, enhance mood and psychological assessment or mental health screening in adults, develop interventions to improve patient medication adherence, complement novel means of public health and COVID-19 surveillance, and bolster dermatology-specific applications. This review illuminated the repurposing of emojis and emoticons for a myriad of advantageous functions in health care and public health, with applications studied in many populations and situations. Dermatology-specific uses were relatively sparse in the literature, highlighting potential opportunities for growth in future studies and practices. The importance of diversity and inclusivity has extended to emojis, with the recent introduction of skin color customization and new emojis better representing the comprehensive spectrum of users' experiences. A continuously evolving and technology-driven population creates a unique niche for emoticons and emojis to ease worldwide communication and understanding, transcending the barriers of age, language, and background. We encourage future studies and innovations to better understand and expand their utility.

Chronic kidney disease and its complete scenario, management of chronic kidney disease by clinical pharmacists - a prospective interventional study

Chronic kidney disease is a growing epidemic worldwide. Nearly two-thirds of CKD patients have diabetes mellitus, hypertension, and both comorbid conditions. Several disease management programs are developed and they implement with help of physicians, and highly trained clinical pharmacists to improve disease management and improve clinical outcomes. The goals of clinical pharmacist in the management of CKD patients by focusing on Four key areas: To obtain information about medication non-adherence, To assess the patient complications for dialysis, to assess the prevalence of chronic kidney disease patients, To evaluate the clinical pharmacist’s role in improving patient medication adherence, To identify the correlation between CKD and other comorbidities, To observe the drug interactions in prescribed drugs. Lack of patient knowledge on CKD disease conditions, and limited reimbursement, lack of primary care by physicians and health care professionals are all barriers that must be overcome with help of the clinical pharmacist role in the management of CKD.

Factors related to barriers and medication adherence in patients with type 2 diabetes mellitus: a cross-sectional study.

Evidence has shown that 50% of patients, including type 2 diabetes mellitus (DM), are non-adherent to the prescribed antidiabetic medication regimen. Some barriers lead to nonadherence in people with DM type 2. The study aimed to identify factors related to adherence in patient with DM and to assess the correlation between barriers to adherence type 2 DM patients. The cross-sectional study was conducted in 63 primary healthcare centers in Surabaya, Indonesia. Patients with DM type 2 were recruited between April and September 2019 using convenient sampling technique. Ethics approval was obtained (80/EA/KEPK/2019). A total of 266 patients with type 2 DM participated in this study. Of the respondents, 201 (75.2%) were female. Unwanted drug effects, changes in medication regimens, and refilling the prescription when the drugs run out were most reported factors that affected adherence. Spearman correlations and linear regression tests were used to examine the relationship between barriers to medication adherence, and education with medication adherence. A significant difference was observed between the level of education and adherence (p = 0.031). The results showed an association between barriers to medication and adherence to medication (r = 0.304; p < 0.001) which was confirmed in regression analysis (R = 0.309, R square = 0.095, p <0.001). Barriers to adherence are common and affect adherence to therapy. It is essential to expand the roles of health care professionals in the community to include counseling, barrier-monitoring, education, and problem-solving to improve patient medication adherence.

Interventions to Improve Medication Adherence in Patients with Schizophrenia or Bipolar Disorders: A Systematic Review and Meta-Analysis.

Adherence to prescribed medication regimes improves outcomes for patients with severe mental illness such as schizophrenia or bipolar disorders. The aim of this systematic review and meta-analysis was to compare the effectiveness among interventions to improve medication adherence in patients with schizophrenia or bipolar disorders. Literature published in the last decade was searched for interventions studies to improve adherence in patients with schizophrenia or a bipolar disorder. Interventions were categorised on the basis of type, and the context and effectiveness of the interventions were described. Two review authors independently extracted and assessed data, following criteria outlined by the Cochrane Handbook for Systematic Reviews of Interventions. The GRADEPro (McMaster University, 2020, Ontario, Canada) was used for assessing the quality of the evidence. Twenty-three publications met the selection criteria. Different types of interventions aiming to improve adherence were tested: educational, behavioural, family-based, technological, or a combination of previous types. Meta-analysis could be performed for 10 interventions. When considered separately by subgroups on the basis of intervention type, no significant differences were found in adherence among interventions (p = 0.29; I2 = 19.9%). This review concluded that successful interventions used a combination of behavioural and educational approaches that seem easy to implement in daily practice.

Pharmacist Intervention to Improve Medication Adherence in Patients with Acute Coronary Syndrome: The PRIMA-ACS Study

Despite ample evidence of benefit, adherence to secondary prevention medication therapy after acute coronary syndrome (ACS) is often suboptimal. Hospital pharmacists are uniquely positioned to improve adherence by providing medication education at discharge. To determine whether a standardized counselling intervention at hospital discharge significantly improved patients' adherence to cardiovascular medications following ACS. This single-centre, prospective, nonrandomized comparative study enrolled patients with a primary diagnosis of ACS (January 2014 to July 2015). Patients who received standardized discharge counselling from a clinical pharmacist were compared with patients who did not receive counselling. At 30 days and 1 year after discharge, follow-up patient surveys were conducted and community pharmacy refill data were obtained. Adherence was assessed using pharmacy refill data and patient self-reporting for 5 targeted medications: acetylsalicylic acid, P2Y purinoceptor 12 (P2Y12) inhibitors, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, β-blockers, and statins. Thirty-day and 1-year medication utilization, cardiovascular readmission rates, and all-cause mortality were also assessed. Of the 259 patients enrolled, 88 (34.0%) received discharge counselling. Medication data were obtained for 253 patients (97.7%) at 30 days and 242 patients (93.4%) at 1 year. At 1 year after discharge, there were no statistically significant differences between patients who did and did not receive counselling in terms of rates of nonadherence (11.9% versus 18.4%, p = 0.19), cardiovascular readmission (17.6% versus 22.3%, p = 0.42), and all-cause mortality (3.4% versus 4.2%, p > 0.99). Overall medication nonadherence was 2.8% (7/253) at 30 days and 16.1% (39/242) at 1 year. Discharge medication counselling provided by hospital pharmacists after ACS was not associated with significantly better medication adherence at 1 year. Higher-quality evidence is needed to determine the most effective and practical interventions to ensure that patients adhere to their medication regimens and achieve positive outcomes after ACS.

Do Community Free-Medication Service Policy Improve Patient Medication Adherence? A Cross-Sectional Study of Patients With Severe Mental Disorders in Beijing Community.

Background: Nowadays, mental health problems have become a major concern affecting economic and social development, with severe mental health disorders being the top priority. In 2013, Beijing began to implement the Community Free-Medication Service policy (CFMS). This article aims to evaluate the effect of the policy on medication adherence.Methods: In this study, multi-stage sampling was used to select representative patients as samples. Some of the baseline data were obtained by consulting the archives, and information about patient medication adherence measured by Brooks Medication Adherence Scale was obtained through face-to-face interviews. Logistic regression was used to examine the impact of the policy.Results: Policy participation had a significant positive impact on medication adherence (OR = 1.557). The effect of policy participation on medication adherence in the Medication-only mode and Subsidy-only mode were highly significant, but it was not significant in the Mixed mode.Conclusion: This study found that the CFMS in Beijing as an intervention is effective in improving the medication adherence of community patients. However, the impact of the policy is not consistent among service modes. Reinforcement magnitude and frequency should be considered when designing reinforcement interventions.

A Machine Learning Approach to Detecting Low Medication State with Wearable Technologies.

Medication adherence is a critical component and implicit assumption of the patient life cycle that is often violated, incurring financial and medical costs to both patients and the medical system at large. As obstacles to medication adherence are complex and varied, approaches to overcome them must themselves be multifaceted.This paper demonstrates one such approach using sensor data recorded by an Apple Watch to detect low counts of pill medication in standard prescription bottles. We use distributed computing on a cloud-based platform to efficiently process large volumes of high-frequency data and train a Gradient Boosted Tree machine learning model. Our final model yielded average cross-validated accuracy and F1 scores of 80.27% and 80.22%, respectively.We conclude this paper with two use cases in which wearable devices such as the Apple Watch can contribute to efforts to improve patient medication adherence.

The Role and Responsibility of Clinical Pharmacists in Rheumatology Clinic: An exploratory study in Hong Kong

In Hong Kong, arthritis is the third leading chronic disorder among the older people. It could create a huge amount of burden on the health care system if patients cannot achieve good diseases control and have recurrent flare up of diseases. To maintain stable control and minimize acute flare up, medication adherence is essential. Studies revealed that drug education has the highest evidence in improving medication adherence. Pharmacists who are expert in drugs can provide counseling to arthritis patients, improving their drug adherence and disease activities. As a result, research evaluating the effectiveness of pharmacist counseling service on improving arthritis patients’ medication adherence and disease activities in Hong Kong has been initiated in a specialist out-patient clinic of a local acute hospital.&#x0D; This research aims to improve patient medication adherence and enhance medication safety. A validated Compliance Questionnaire on Rheumatology (CQR-19) is used to measure the medication adherence. From the preliminary data, over 90% of the recruited subjects are non-adherence at baseline and thus, detailed drug counseling is necessary.&#x0D; During the first visit, pharmacists will provide a 20 minutes drug counseling service to the referred patients. This includes discussion on drug administration schedule, importance of drug adherence, side effects management and pain management. Besides, pharmacists also have different roles in other aspects such as drug information and procurement. Pharmacists would assist in providing evidence-based information and recommendations to physicians and nurses for drug-related enquiries. These attempts to improve therapeutic outcomes and minimize medication errors, enhance medication safety and reduce hospitalization. Design of the multidisciplinary care model and results of this study would provide a reference for the future development of clinical pharmacist service in rheumatology.