Measure Treatment Adherence Research Articles

Factors Related to Adherence to Therapy in Patients Using Oral Anticoagulants in Outpatient Follow-Up

Introduction: Factors related to therapy adherence can influence the complexity of care for patients using anticoagulants. Objective: To identify the factors related to patient adherence to oral anticoagulant treatment in outpatient follow-up. Materials and Methods: This is a descriptive, cross-sectional study with a quantitative approach, conducted at the oral anticoagulation outpatient clinic of a cardiology reference hospital in northern and northeastern Brazil. A questionnaire with sociodemographic and clinical variables and an instrument measuring treatment adherence were employed. The data was analyzed using the Statistical Package for the Social Sciences and the Chi-squared and Fisher’s exact statistical tests. All the statistical tests applied a significance level of 5 %. Results: 202 patients were screened, 66.3 % of whom were classified as adherent. Patients with a clinical referral for valve replacement, a treatment time longer than five years, and an international normalized ratio (INR) value outside the therapeutic target showed greater adherence to treatment. In addition, having a sedentary lifestyle and the use of antiarrhythmic medication were significantly associated with adherence. Variables such as sex, income, occupation, level of education, and the presence of complications were not significantly associated with treatment adherence. Conclusion: This study’s findings highlight that adherence to treatment with anticoagulants hinges more on clinical factors and health behavior than on sociodemographic characteristics. Although traditionally studied, these are not necessarily reliable predictors of adherence. The essential factor seems to be more closely related to health education and medical and family support, which emphasizes the need for individualized support for these patients, with a focus on awareness and regular clinical follow-up.

Factors Affecting Adherence to Medications among Type2 Diabetic Patients Attending Primary Health Care Center in Cairo

Abstract Background Poor adherence to medications is a major public health problem. Non-adherence results in disease progression, reduced functional abilities, a lower quality of life, waste of medication and increase use of medical resources such as nursing homes, hospital visits and hospital admissions. Objective To measure the prevalence and factors affecting adherence to medications among T2DM patients attending primary health care center of Saraya El Quobba. To measure the agreement between MTA (Measure Treatment Adherence) and ARMS (Adherence to Refills and Medications Scale) questionnaires as a tool of measurement treatment adherence. Methods A Cross sectional study was carried out in family medicine center of Saraya El Qubba in Cairo on 130 participants who had been diagnosed T2DM at least3 months before. Patients with T1DM, Patients with known history of psychiatric illness or cognitive impairment, Patients with communication problems such as aphasia, severe hearing or visual impairment were excluded. Selection of participants was done through Systematic Random Sampling. Data about adherence was collected using structured questionnaires MTA (Measurement Treatment Adherence) and ARMS (Adherence to Refills and Medications Scale) questionnaires. Results 62.6% of our sample were females, 38.9% belonged to age group of 60-70 years, 71.8% were married, 29% had intermediate education, 61.8% were unemployed. The level of adherence among patients attending primary health centre of Saraya El Quobba was 65.6%. Many factors were found to affect medication adherence as regular monitoring of blood glucose level (76.7%), regular follow up visit (75.9%), presence of family support (20.6), monthly income (84.2%) and educational level. There was a statistically significant strong negative correlation between the 2 measurements scores (r=-0.8644, p < 0.001). Conclusion The level of adherence was high among the participants in the current study. Many factors were found to affect medication adherence as regular monitoring of blood glucose level, regular follow up visit, presence of family support, monthly income, both high and low educational level. Agreement between to questionnaires was found.

A Self-led Self-management Intervention Supporting Teens with IBD (ASSIST-IBD): protocol for a feasibility study of a novel digital treatment adherence intervention

IntroductionTreatment non-adherence is common in young people with inflammatory bowel disease (IBD), yet support is lacking. A self-led self-management intervention supporting teens with IBD (ASSIST-IBD) is a new theory-based digital...

Quality of Life and Medication Therapy Adherence in Primary Healthcare: focus on common mental disorders

Introduction. Medication therapy adherence is a challenge in the clinical practice of health providers. Objective. To identify predictors of nonadherence to medication therapy and quality of life (QoL) in medication users. Method. A cross-sectional analytical study was conducted at five primary health care (PHC) units in Brazil. Standardized tools included the Self-Reporting Questionnaire, Measurement of Treatment Adherence, and World Health Organization Quality-of-Life-Bref, in addition to a sociodemographic and treatment-related questionnaire. Results. Participants with common mental disorders (CMDs) who used psychotropic medication were more likely to be nonadherent to medication treatment. Sociodemographic variables, presence of a CMD, and psychotropic medication use were key predictors of lower QoL in patients treated at PHC. Discussion and conclusion. The findings of this study could inform interventions designed to improve medication therapy adherence and train public health care professionals to enhance health care.

Psychometrics properties of type 2 diabetes treatment adherence questionnaire (DTAQ): a study based on Pender’s health promotion model

BackgroundManagement of type 2 diabetes (T2D) as a chronic disease requires treatment adherence such as controlling the blood glucose level and adopting a healthy lifestyle. The present study aimed to develop and psychometrically evaluate a questionnaire based on the Pender’s Health Promotion Model (HPM) to measure treatment adherence and the associated factors among T2D patients.MethodsThe present study was conducted in qualitative and the quantitative phases between March 2022 and March 2023. The participants were T2D patients visiting Shahid Mohammadi hospital Diabetes Clinic in Bandar Abbas in the south of Iran. The first draft of items was extracted from the qualitative phase. The present study used interviews with T2D patients, item construction, validity and reliability evaluation of the instrument, and the relevant statistical analyses. It emphasized the significance of content, face, and construct validity, along with reliability testing using Cronbach’s alpha and test-retest method. Data were analyzed using SPSS software, V16 and AMOS, V23.ResultsA 97-item questionnaire was developed through the qualitative phase and, after content validity, it was reduced to 86 items. Five items were removed in face validation, and after the test-retest method, 79 items were retained. The confirmatory factors analysis confirmed a 65-item model with appropriate fitness of data. Cronbach’s alpha coefficient showed an acceptable reliability of the diabetes treatment adherence questionnaire (α = 0.92).ConclusionThe questionnaire developed based on the HPM model provides a standard and comprehensive measurement of the degree of adherence to treatment and the associated factors among Iranian T2D patients. This is especially valuable in the Iranian healthcare context, where effective management of chronic diseases such as diabetes is of a top priority. Questionnaires can help identify barriers and facilitators of treatment adherence to inform systematic and goal-oriented interventions. The proposed questionnaire had good psychometric properties, and can be used as a valid and practical instrument to measure the factors related to treatment adherence behaviors.

The Effect of Depression on Disease Activity and Treatment Response in Patients with Inflammatory Arthritis: Results from a Narrative Literature Review.

Inflammatory arthritis refers to a group of diseases that have a common presentation of joint pain, stiffness, and inflammation. Meanwhile, major depressive disorder is a mental health disorder characterized by anhedonia and low mood. Inflammatory arthritis patients have high rates of major depressive disorder, estimated at being up to 38.8%. Depression leads to a significant reduction in patient's health-related quality of life, treatment adherence, and many other measures of health, both subjective and clinical. This literature review explores the effect that depression has on treatment response for the drugs used in inflammatory arthritis. A systematic search using PubMed was conducted identifying articles which were each reviewed for relevance and eligibility. Depression was negatively associated with treatment response to all classes of drugs used to manage inflammatory arthritis, with an increased disease activity and/or number of swollen/tender joints, as well as a reduced rate of remission being recorded for patients with depression compared to those without. However, this effect on treatment response was less clear when conventional synthetic Disease Modifying Anti-rheumatic Drugs were studied, possibly because their anti-inflammatory effects have wide impacts on the whole immune system, whereas biologic Disease Modifying Anti-rheumatic Drugs have very specific targets. Inflammatory arthritis patients have a significantly lowered response to most drugs when they have depression. Screening and treating depression may attenuate this association. It is recommended that further research focuses on screening for and treating depression in inflammatory arthritis patients.

Memory Support System in French: a Pilot Study.

Mild cognitive impairment (MCI) confers a higher risk of developing dementia. While largely preserved, instrumental activities of daily living (IADLs) may be affected to varying degrees by MCI. The Memory Support System (MSS) is a curriculum and calendar/note-taking system that has proven effective in sustaining independence in IADLs for individuals with MCI and in protecting mood among care partners. Until recently, the MSS has only been utilized among English- and Spanish-speaking samples. This study investigated the use of a translated and culturally adapted MSS in four French-speaking, community-dwelling participants with MCI and their support partners. Measures of treatment adherence, daily function, self-efficacy for memory, quality of life, mood, anxiety, and caregiver burden were assessed at baseline, treatment end, and eight-week follow-up. By treatment end and follow-up, participants with MCI showed improvement in adherence to the MSS calendar, IADLs, everyday abilities requiring memory and planning, self-efficacy, depression and anxiety symptoms, and quality of life. Care partners showed improvement in quality of life and depressive symptoms, while their caregiver burden and anxiety symptoms generally remained unchanged. Findings suggest that, with appropriate training, Francophones with MCI can and will use the MSS, and that MSS training may contribute to daily functioning and aspects of participant and care partner well-being.

#69 Validation of the Visayan Translation of the End Stage Renal Disease—Adherence Questionnaire (VESRD-AQ)

Abstract Background and aims End-stage renal disease (ESRD) is one of the chronic diseases that rely heavily on patient's adherence to treatment. Measuring the factors related to adherence have been done but are difficult to compare due to non-uniformity of the tools used. The 46-item End-Stage Renal Disease—Adherence Questionnaire (ESRD-AQ) by Kim, et.al (2010) is a validated tool used to measure treatment adherence to the whole of ESRD management: hemodialysis, medications, fluid restrictions, and diet prescription. About 2000 ESRD patients have been registered in the Central Visayas, Philippines in 2022. The availability of a standardized and validated tool in the Visayan native language will help in assessing adherence and its related factors which can lead to interventions that could improve outcomes in ESRD patients. This study was done to translate the End-stage renal disease (ESRD-AQ) into the Visayan dialect (Visayan ESRD-AQ) and test its validity. Method The ESRD-AQ underwent forward translation into a Visayan version. This translation was evaluated for content validity using the Content Validity Index (CVI) rated by 5 experts, and face validity with a group of 5 ESRD patients. Blind backward translation was done and compared to the original ESRD-AQ. Construct validity was tested via a Known-Group Analysis. Test-retest reliability was done using the Intraclass Correlation Coefficient (ICC) to establish the questionnaire's stability overtime. Results The Visayan ESRD-AQ had adequate Content Validity Index of 1.0 which shows that each item on the questionnaire was relevant to its aim. Construct validity showed that the known adherers had higher scores than the known non-adherers. This means that the questionnaire was able to differentiate between the two groups. The responses of two patients were evaluated through the Intraclass Correlation Coefficient (ICC) and had the scores of 0.52 and 0.69, meaning that the questionnaire can be reliably used over time. Conclusion The Visayan ESRD-AQ is a valid and reliable tool for measuring adherence behaviors in a sample of Visayan-speaking dialysis patients as supported by the results of the Content Validity Index and known-group analysis. The can also be used reliably over time as it showed moderate test- retest reliability score. The validated VESRD-AQ may be valuable to researchers in studies of advanced chronic kidney disease. It could be used for studying adherence behaviors of ESRD patients across the Visayan region of the Philippines and the factors that contribute to adherence or non-adherence. Results of these studies can be used to improve services in dialysis units and can even be a tool in policy making with regards to hemodialysis in the Philippines. Further translations into other dialects or languages can also be done to be able to reach a broader population.

Preliminary Assessment of an Ambulatory Device Dedicated to Upper Airway Muscle Training in Patients With Sleep Apnea: Proof-of-Concept Study

Background Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a prevalent condition affecting a substantial portion of the global population, with its prevalence increasing over the past 2 decades. OSAHS is characterized by recurrent upper airway (UA) closure during sleep, leading to significant impacts on quality of life and heightened cardiovascular and metabolic morbidity. Despite continuous positive airway pressure (CPAP) being the gold standard treatment, patient adherence remains suboptimal due to various factors, such as discomfort, side effects, and treatment unacceptability. Objective Considering the challenges associated with CPAP adherence, an alternative approach targeting the UA muscles through myofunctional therapy was explored. This noninvasive intervention involves exercises of the lips, tongue, or both to improve oropharyngeal functions and mitigate the severity of OSAHS. With the goal of developing a portable device for home-based myofunctional therapy with continuous monitoring of exercise performance and adherence, the primary outcome of this study was the degree of completion and adherence to a 4-week training session. Methods This proof-of-concept study focused on a portable device that was designed to facilitate tongue and lip myofunctional therapy and enable precise monitoring of exercise performance and adherence. A clinical study was conducted to assess the effectiveness of this program in improving sleep-disordered breathing. Participants were instructed to perform tongue protrusion, lip pressure, and controlled breathing as part of various tasks 6 times a week for 4 weeks, with each session lasting approximately 35 minutes. Results Ten participants were enrolled in the study (n=8 male; mean age 48, SD 22 years; mean BMI 29.3, SD 3.5 kg/m2; mean apnea-hypopnea index [AHI] 20.7, SD 17.8/hour). Among the 8 participants who completed the 4-week program, the overall compliance rate was 91% (175/192 sessions). For the tongue exercise, the success rate increased from 66% (211/320 exercises; SD 18%) on the first day to 85% (272/320 exercises; SD 17%) on the last day (P=.05). AHI did not change significantly after completion of training but a noteworthy correlation between successful lip exercise improvement and AHI reduction in the supine position was observed (Rs=–0.76; P=.03). These findings demonstrate the potential of the device for accurately monitoring participants’ performance in lip and tongue pressure exercises during myofunctional therapy. The diversity of the training program (it mixed exercises mixed training games), its ability to provide direct feedback for each exercise to the participants, and the easy measurement of treatment adherence are major strengths of our training program. Conclusions The study’s portable device for home-based myofunctional therapy shows promise as a noninvasive alternative for reducing the severity of OSAHS, with a notable correlation between successful lip exercise improvement and AHI reduction, warranting further development and investigation.

Obstructive Sleep Apnea: a risk for uncontrolled and more severe asthma in adults that we should keep an eye on.

Background. Asthma control can be influenced by several factors, including obstructive sleep apnea (OSA). The literature reports variable prevalence and magnitude of OSA impact on asthma outcomes. The aim of our study is to analyze the frequency of high-risk for OSA in asthma patients and its impact on disease severity and control. Methods. We conducted a cross-sectional study at an Allergy Department with adult asthma patients recruited while undergoing routine lung function tests. Data on sex, age, body mass index, allergen sensitization, smoking habits, risk of OSA (using the Berlin questionnaire), rhinitis control (through CARAT), asthma severity (based on GINA 2023), asthma control (using the ACT), adherence to asthma treatment (through Treatment Adherence Measure) and pulmonary function test results were collected. Results. We included 216 patients, predominantly women (70.4%), with a median (P25-P75) age of 29.0 (21.0-45.0) years, of whom 28.2% were on GINA treatment levels 4-5. In 75.5% of cases asthma was controlled. High-risk for OSA was identified in 21.8% of patients. Asthma patients with high-risk for OSA were more likely to have uncontrolled [(47.8%; n = 22) vs (15.8%; n = 26); p less than 0.001] and more severe disease [(44.7%; n = 21) vs (23.7%; n = 40), p = 0.006]. In multivariable analysis, high-risk for OSA (OR 2.81 [95%CI 1.1.28-6.17], p = 0.010), sex (women) (OR 5.21 [95% CI 1.70-15.96], p = 0.004), uncontrolled rhinitis (OR 3.65 [95%CI 1.38-9.64], p = 0.009) and GINA asthma treatment steps 4-5 (OR 2.46 [95%CI 1.15-5.26], p = 0.020) were associated with uncontrolled asthma. Conclusions. It is crucial to actively investigate OSA, especially in patients with uncontrolled and more severe forms of asthma.

Factors associated with medication non-adherence among patients with heart failure.

to identify the factors contributing to medication non-adherence among patients with heart failure. cross-sectional and analytical study using the Medida de Adesão ao Tratamento [Treatment Adherence Measure] scale to assess medication non-adherence. Independent variables were collected using the European Heart Failure Self-care Behavior Scale and an instrument developed by the authors based on a previous study. Statistical tests were implemented to analyze data with p≤0.05 statistical significance. the sample comprised 340 patients, with 9.4% considered non-adherent. The multiple analysis results showed that one unit increase in an individual's self-care score led to an 8% increase in the prevalence of non-adherence; patients with a family income above three times the minimum wage presented a prevalence of non-adherence equal to 3.5% of the prevalence of those with up to one times the minimum wage; individuals consuming alcohol or with depression presented 3.49 and 3.69 times higher prevalence of non-adherence, respectively, than individuals not presenting such history. medication non-adherence was associated with self-care, family income, depression, and alcohol consumption.

The role of affective temperaments in self-care and medication adherence among individuals with bipolar disorder: a moderation analysis.

Affective temperament, defined as the fundamental predisposition from which normal affective states originate or as the constitutional core of personality, play a crucial role in mood disorders, particularly bipolar disorders. Understanding the relationship between temperaments, treatment adherence, and self-care is crucial for effective management and improved clinical results. This study aims to (1) assess the correlation between affective temperaments and treatment adherence, (2) investigate the relationship between affective temperaments and self-care abilities, (3) identify predictors of treatment adherence, and (4) explore the moderating effect of self-care on the relationship between treatment adherence and depressive temperament in individuals with bipolar disorder. A cross-sectional study was conducted with 231 individuals diagnosed with bipolar disorder (BD) type I (N=160) and type II (N=71). The participants were evaluated using the following psychometric tools: Temperament Evaluation of Memphis, Pisa, and San Diego (TEMPS) to assess affective temperaments, Personal and Social Performance Scale (PSP) to evaluate social functioning and self-care abilities, and Morisky Medication Adherence Scale (MMAS) to measure treatment adherence. The study involved statistical analyses to examine correlations, identify predictors, and explore moderating effects. The findings revealed significant correlations between affective temperaments and both treatment adherence and self-care abilities. Specifically, hyperthymic temperament was positively associated with higher treatment adherence, whereas cyclothymic and depressive temperaments were linked to lower adherence. Self-care abilities were found to mediate the relationship between depressive temperament and treatment adherence, suggesting that improved self-care can enhance adherence in individuals with depressive temperament. Affective temperaments significantly influence treatment adherence and self-care abilities in individuals with bipolar disorder. The mediating role of self-care highlights the importance of developing targeted interventions to improve self-care practices, thereby enhancing treatment adherence and overall well-being. Personalized treatment strategies based on temperament assessments could lead to better clinical outcomes and quality of life for individuals with bipolar disorder.

PHYSIO+++: protocol for a pilot randomised controlled trial assessing the feasibility of physiotherapist-led non-invasive ventilation for patients with hypoxaemia following abdominal surgery

IntroductionFew clinical trials have investigated physiotherapy interventions to treat hypoxaemia following abdominal surgery. The objective of this study is to determine the feasibility and safety of conducting a clinical trial...

Fluoroquinolones for the Treatment of Tuberculosis: An Overview

According to the World Health Organization (WHO), tuberculosis (TB) remains one of the top 10 causes of death worldwide. Tuberculosis is a major global health threat. In 2022, an estimated 10 million people worldwide developed TB disease, and there were about 1.5 million TB-related deaths. TB primarily affects low- and middle-income countries, with the highest burden in Africa, Asia, and the Western Pacific regions. The WHO has launched the "End TB Strategy" with the aim of eliminating TB as a public health problem by 2035. Early diagnosis and prompt initiation of treatment are essential for effective TB control. WHO recommends a package of interventions known as "Directly Observed Treatment, Short-course" (DOTS) for TB control, which includes standardized diagnostic approaches, access to quality-assured drugs, and supportive treatment adherence measures. Tuberculosis (TB) remains a global health burden, necessitating the development of new therapeutic strategies. Fluoroquinolones (FQs) have emerged as promising agents in the treatment of TB due to their potent antimicrobial activity against Mycobacterium tuberculosis (Mtb) and their ability to penetrate intracellular compartments. This review aims to summarize the current knowledge on the use of FQs as antitubercular agents, highlighting their mechanisms of action, efficacy and limitations.

Adherence to hemophilia patients with prophylaxis: Veritas-Pro and psychometric properties adapted to Turkish.

The Validated Hemophilia Regimen Treatment Adherence Scale-Prophylaxis (VERITAS-Pro) assesses adherence to prophylaxis treatment recommendations in hemophilia patients. This study aimed to adapt the VERITAS-Pro into Turkish and evaluate its reliability and validity. The research design used is a psychometric study. A convenience sample of 102 patients with hemophilia A or B was followed by the Aegean Adult Hemophilia and Thrombosis Center. The VERITAS-Pro was adapted to Turkish in six steps, including forward- and back-translation, committee review, and reliability and validity analysis. Based on the confirmatory factor analysis, modification indices suggested discrepancies amongst items, which were improved upon the removal of items 11 and 15. Findings from this alternative model are: χ2/df = 1.34; RMSEA = 0.05; SRMR = 0.09; and IFI = 0.92. The alternative model showed high adherence rates. Cronbach's alpha value for the Turkish version was found to be 0.83. The test-retest reliability of the Turkish scale ranged from 0.31 to 0.78. All items discriminated significantly between participants who were more adherent and those who were less adherent (t = 23.53; p<0.01). Translation of the VERITAS-Pro into local languages enables more accurate measurement of treatment adherence among people with hemophilia and facilitates cross-cultural comparison studies. According to the validity and reliability evidence obtained, the psychometric properties of the Turkish version of the VERITAS-Pro are suitable.

Exploration of smart adherence-monitoring methods in vitamin D-deficient patients: A pilot feasibility clinical study.

Treatment adherence is an underestimated determinant of treatment success. Poor treatment adherence can also affect the efficacy of clinical trials. A combination of multiple adherence-monitoring methods is required to ensure robustness. We investigated whether multiple adherence-monitoring methods, including a novel smartwatch-based monitoring method, would yield reliable and concordant results. In this open, randomized, decentralized clinical trial, vitamin D-deficient individuals were randomized to an App - only group (an electronic medication diary) or an App + Watch group (i.e., App and smartwatch-based monitoring) groups after a week run-in period. The participants received vitamin D supplements (1000 IU) for 12 weeks (two consecutive periods of 6 weeks) with two pill counts (at the sixth week) and biweekly blood samplings for serum 25(OH) vitamin D concentration. Adherence was assessed and compared between the methods. Sixteen participants were enrolled, of which 13 completed the study. Serum 25(OH) vitamin D levels comparably increased in both groups until the first 7 weeks but trended higher in the App + Watch group in the second period. The number of doses recorded by the pill count and App did not differ significantly between the run-in and Period 1 (p = 0.5534) but became significantly discrepant in Period 2 (p = 0.0225). In contrast, the concordance for smartwatch-based monitoring was consistent in either period (p = 0.5898 and p = 0.5839, respectively). We explored multiple adherence-monitoring methods in this pilot feasibility clinical study. Smartwatch-based adherence monitoring may be an objective and sensitive method for measuring treatment adherence.

Evaluation of Medication Adherence in Chronic Kidney Disease Patients with and without Hemodialysis

Abstract Background: Poor long-term adherence and persistence to pharmacological therapy is widely acknowledged as one of the primary clinical difficulties in the management of chronic diseases such as chronic kidney disease (CKD). The present study was aimed to measure treatment adherence using the Morisky Medication Adherence Scale (MMAS)-8 questionnaire in CKD patients with or without hemodialysis. Methodology: It was a cross-sectional study conducted in 120 clinically stable CKD patients with Stage 3 onward with or without hemodialysis. The sociodemographic and clinical characteristics of participants were collected in a predesigned format. Individual participants were scheduled for interviews and asked to complete inventory questionnaires. Medication adherence was assessed using a validated diagnostic tool MMAS-8 questionnaire. Results: Out of 120 individuals, the average number of medicines prescribed per prescription was 5.63 ± 2.22 and 4.65 ± 1.72 in the dialysis and nondialysis groups, respectively. Patients on dialysis had a higher pill burden than nondialysis patients, with more than three-fourths (78.3%) of them taking more than five medications every prescription. Low, moderate, and good adherence were reported in 61.7% (n = 37) versus 26.7% (n = 16), 33.3% (n = 20) versus 71.7% (n = 43), and 5% (n = 3) versus 1.6% (n = 1) of patients with and without dialysis, respectively, in MMAS-8. The most often reported nonadherence behaviors were forgetting to take medications, forgetting to pack medications while traveling, and feeling pressured to follow a treatment plan. There was an association between the dialysis and nondialysis groups in education level, employment, and pill load among patients with low adherence. Conclusion: Majority of the respondents (more than 90%) reported low-to-moderate adherence in both dialysis and nondialysis populations. Physicians and all other health-care professionals should work together to reduce the obstacles to good adherence by enhancing communication, reducing the burden of taking a lot of pills, and, if possible, by occasionally checking on patient adherence when there is suspicion of poor adherence.

A serious game-based platform for measuring treatment adherence

A serious game-based platform for measuring treatment adherence

Point of care assay for blood aripiprazole concentrations: development, validation and utility.

The antipsychotic aripiprazole is often used in the treatment of first-episode psychosis. Measuring aripiprazole blood levels provides an objective measure of treatment adherence, but this currently involves taking a venous blood sample and sending to a laboratory for analysis. To detail the development, validation and utility of a new point of care (POC) test for finger-stick capillary blood concentrations of aripiprazole. Analytical performance (sensitivity, precision, recovery and linearity) of the assay were established using spiked whole blood and control samples of varying aripiprazole concentration. Assay validation was performed over a 14-month period starting in July 2021. Eligible patients were asked to provide a finger-stick capillary sample in addition to their usual venous blood sample. Capillary blood samples were tested by the MyCare™ Insite POC analyser, which provided measurement of aripiprazole concentration in 6 min, and the venous blood sample was tested by the standard laboratory method. A total of 101 patients agreed to measurements by the two methods. Venous blood aripiprazole concentrations as assessed by the laboratory method ranged from 17 to 909 ng/mL, and from 1 to 791 ng/mL using POC testing. The correlation coefficient between the two methods (r) was 0.96 and there was minimal bias (slope 0.91, intercept 4 ng/ml). The MyCare Insite POC analyser is sufficiently accurate and reliable for clinical use. The availability of this technology will improve the assessment of adherence to aripiprazole and the optimising of aripiprazole dosing.

Adherence, helpfulness and barriers to treatment in juvenile idiopathic arthritis – data from a German Inception cohort

ObjectivesTo develop and evaluate German versions of the Parent Adherence Report Questionnaire (PARQ) and Child Adherence Report Questionnaire (CARQ) and to evaluate adherence in patients with juvenile idiopathic arthritis (JIA).MethodsThe PARQ and CARQ were translated into German, cross-culturally adapted and administered to patients (age ≥ 8 years) and their parents enrolled in the Inception Cohort Study of newly diagnosed JIA patients (ICON).The psychometric issues were explored by analyzing their test–retest reliability and construct validity.ResultsFour hundred eighty-one parents and their children with JIA (n = 465) completed the PARQ and CARQ at the 4-year follow-up. Mean age and disease duration of patients were 10.1 ± 3.7 and 4.7 ± 0.8 years, respectively. The rate of missing values for PARQ/CARQ was generally satisfactory, test-retesting showed sufficient reliability. PARQ/CARQ mean child ability total scores (0–100, 100 = best) for medication were 73.1 ± 23.3/76.5 ± 24.2, for exercise: 85.6 ± 16.5/90.3 ± 15.0, for splints: 72.9 ± 24.2/82.9 ± 16.5. Construct validity was supported by PARQ and CARQ scores for medications, exercise and splints showing a fair to good correlation with the Global Adherence Assessment (GAA) and selected PedsQL scales. Adolescents showed poorer adherence than children. About one third of the parents and children reported medication errors. Perceived helpfulness was highest for medication, and adverse effects were reported the greatest barrier to treatment adherence.ConclusionsThe German versions of the PARQ and CARQ appear to have a good reliability and sufficient construct validity. These questionnaires are valuable tools for measuring treatment adherence, identifying potential barriers and evaluating helpfulness of treatments in patients with JIA.