Medication Calendar Research Articles

Absence of July effect on trauma outcomes at the start of the academic medical calendar

Purpose The “July effect” refers to the phenomenon of a higher complication incidence and lower survival rate for patients treated at academic institutions during the beginning of the academic medical calendar. To date, no multi-center study has examined the presence of a “July effect” in a large cohort of trauma patients. We sought to determine if there is a by-month effect on survival and length of stay (LOS) for trauma patients in large academic centers. Methods We performed a multicenter, retrospective cohort study between 2010 and 2020 from five high-volume academic trauma centers in the United States. We included all adult motor vehicle collision (MVC) traumas evaluated at all centers in the study population (age >16 years, mechanism of injury classified as “motor vehicle collision”). Data included date and time of injury, injury severity score (ISS), LOS, and mortality. Each injury was classified as minor (ISS 1–8), moderate (9–15), severe (16–24), and very severe (>25). The mortality and LOS for each range over the entire epoch was calculated by month for each ISS classification. Results We analyzed 39,668 MVC traumas (mean age 41.83, range 39.9–43.3 among sites, 58.9% male and range 56.1–60.4%, 67.4% white range 42.3–84.7%). Survival for the “very severe” traumas ranged from 86.7–90.3%. Across the five sites, there was no significant change in survival (either increased or decreased mortality) or LOS for MVC patients in July or August for any injury classification level. Both age and ISS had a significant effect on survival (OR 0.02 for ISS >25, 0.22 for patients >65 years-old, both p < 0.05). Conclusions In five high-volume centers, there was no significant effect of the July transition on survival or LOS of MVC trauma patients.

The Influence of Using Medication Calendar on Driving Compliance In Patients with Diabetes Mellitus in Meninting Village

Medication calendar or commonly known as functional calendar is a media that specifically designed to improve adherence to taking medication by adding several special features such as patient names, drug names, and hours of taking medication. The purpose of this study was to determine the effect of using the medication calendar in increasing medication adherence in diabetes mellitus patients. This research used a pre-experimental research design with one group pretest and posttest design approach. The sampling technique used was simple random sampling. The sample was 30 respondents. Compliance in taking medication was obtained using the MMAS-8 questionnaire. The data of patients’ medication adherence before and after using medication calendar, was analyzed using the Wilcoxon Signed Rank Test. The results showed that there was a difference in the medication adherence level before and after the medication calendar intervention with a value of p = 0.000 < α = 0.05. The use of medication calendar is proven to be able to influence the medication adherence in diabetes mellitus patients. This tool can be an alternative way to increase medication adherence, as part of an important pillar in the management of Diabetes Mellitus.

Pharmacist Effect on Discharge Follow-Up Education in Pediatric Oncology Outpatient Clinics: A Quality Improvement Study.

We aimed to describe the effect of education provided by a clinical pharmacy specialist at a patient's follow-up appointment after discharge, and to assess caregiver satisfaction. A single-center, quality improvement study was conducted. A standardized data collection tool was created to characterize interventions made by clinical pharmacy specialists during an outpatient clinic appointment scheduled shortly after discharge. Pediatric patients with cancer who met the following criteria were included: 1) initial diagnosis without receiving chemotherapy, 2) first course of chemotherapy after initial diagnosis or relapsed disease, and 3) post-hematopoietic stem cell transplantation or cellular therapy. A survey was provided to families after the follow-up discharge appointment to assess the caregiver's satisfaction of the new process. From January to May 2021, a total of 78 first-time discharge appointments were completed. The most common reason for follow-up was discharge after first course of chemotherapy (77%). The average duration of each appointment was 20 minutes (range, 5-65). The clinical pharmacy specialist made an intervention during 85% of appointments. The most common intervention made during the visit was reinforcement of medications (31%). Thirteen surveys were completed by caregivers; 100% of the caregivers reported the follow-up appointment was helpful. Additionally, they reported the most useful resource provided at discharge was the medication calendar (85%). Investing clinical pharmacy specialist time with patients and caregiver after discharge appears to have a meaningful effect on patient care. Caregivers report this process is helpful in better understanding their child's medications.

Интерактивный медицинский календарь как жанр интернет-коммуникации на занятиях по русскому языку как иностранному

This paper describes the linguo-didactic prospects of using the method of interactive medical calendar to develop an artificial language environment for students who study Russian as a foreign language. It features classifications of medical calendars, their receptive properties, and experience of using them as a linguo-didactic genre in teaching Russian. The authors designed an interactive medical calendar that develops a professional medical jargon in non-Russian speakers at medical institutes. The method proved to be an efficient multimedia tool that unites the realities of medicine and language learning in a new context. It promotes learning by doing and out-of-class practice. The calendar allows non-Russian speakers to use professional terms and activates theoretical knowledge while developing digital skills. It also improves the skill of cross-cultural contacts, encourages informal communication, individualizes the learning process, and increases motivation in mastering both the medical profession and the Russian language. The method of medical calendar is a simple genre that facilitates the academic process of learning Russian as a foreign language by adding new activities and information.

Safety and Feasibility of Outpatient High-Dose Cytarabine Consolidation in AML Patients

INTRODUCTION: High dose cytarabine (HiDAC) for acute myeloid leukemia (AML) consolidation has historically been given as an inpatient (IP) regimen. Reasons for IP administration may include regimen scheduling/logistics, hydration requirements, patient assessments, and adverse effect management. However, the landscape of oncology treatment is moving towards chemotherapy administered in an outpatient (OP) setting. This may be directed by hospital census, reimbursement challenges, or patient satisfaction. At The Ohio State University, IP-HiDAC was identified as one regimen to transition to the OP setting. We present a detailed description of the process and our institutional experience by which patients receive OP-HiDAC through clinic and ambulatory home infusion. METHODS: To develop a safe process for patients to receive OP-HiDAC, we created a guideline authored by pharmacists, physicians, and a clinical nurse specialist. Exclusion criteria for OP-HiDAC includes serum creatinine >1.5 mg/dL, enrollment on a clinical trial requiring IP administration, and lack of social support. To facilitate standardization, an order-set was developed for all required supportive care prescriptions. Providers are required to have a visit with OP-HiDAC candidates the week prior to chemotherapy initiation to educate and organize the logistics of OP treatment. For OP-HiDAC, cytarabine is given over 2 hours every 10 hours on days (D) 1, 3, and 5 every 28-day cycle. The morning dose is given in the OP clinic and the evening dose is administered at home through an ambulatory infusion pump. Pharmacists and nurses are required to provide education prior to or during the first infusion appointment, including reviews of the home pump disconnect process and medication calendars. Caregivers can choose to disconnect the chemotherapy at home after the evening infusion, or patients can return to the clinic on D2, 4, and 6 for pump disconnect. Caregivers are required to complete a signature, speech, and gait log 1 hour prior to each evening dose. Patients are able to choose whether to self-inject growth factor on D7 (filgrastim, peg-filgrastim, or biosimilars) or return for clinic administration, with insurance approval. RESULTS: A retrospective chart review characterized our experience and healthcare resource utilization (HRU) of HiDAC from June 1, 2020 (OP-HiDAC go-live) through July 2022, see Table 1. During the first month, only 1 patient was treated outpatient each week, with the remainder of patients receiving IP-HiDAC. This process allowed for workflow evaluation from staff, patients, and caregivers. Since making OP-HiDAC the preferred regimen, 41 patients received OP-HIDAC and 37 received IP-HiDAC. Common reasons for IP-HIDAC included lack of caregiver, infection/bleeding concern, and lack of transportation. In the OP-HiDAC and IP-HiDAC groups, the majority of patients were ≤60 years old, 93% and 84%, respectively, and received full dose 3000 mg/m2/dose, 90% and 81%, respectively. In the IP-HiDAC group, 16 patients (43%) had an unplanned hospital admission(s) during treatment, compared to 18 patients (44%) in the OP-HiDAC group. Common reasons for unplanned admissions in both groups were comparable and included febrile neutropenia, sepsis, thrombocytopenia with bleeding (including hematuria and epistaxis), pain, syncope, and dyspnea. One OP-HIDAC patient had suspected neurotoxicity and after a brief admission for monitoring, continued therapy OP without recurrence of symptoms. Another OP-HiDAC patient had a pump malfunction on C2D1 in which the evening dose did not infuse. The caregiver correctly notified triage and was given further instructions, preventing a hospital admission. The median total number of hospital days for unplanned admissions with OP-HiDAC and IP-HiDAC were 3 and 4, respectively, suggesting that OP-HiDAC patients did not require longer hospitalizations for toxicity or complications. CONCLUSIONS: OP-HiDAC through clinic and ambulatory pump home infusion is an exciting alternative to IP-HiDAC, saving inpatient resource utilization by avoiding planned chemotherapy admissions. OP-HiDAC requires significant education for both healthcare teams and patients/caregivers to be successful and ultimately can provide opportunity for increased patient satisfaction with less time spent in a hospital or clinic setting. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Improving Medication Adherence in Cardiovascular Disease Prevention: What's New?

Improving Medication Adherence in Cardiovascular Disease Prevention: What's New?

Pilot study to assess a pharmacist- and medication navigator-led intervention of oral anticancer medication (OAM) adherence.

58 Background: While advances in OAM make treatment more convenient for patients, OAM must be taken and handled correctly. Studies show gaps in patients’ knowledge of taking/handling OAM, suboptimal adherence, and worse outcomes. A prior study at our institution showed low patient understanding of OAM taking (30%) and handling (15%). Other pharmacist (RPh)- or nurse-led interventions have included patient education, short-term follow-up, and reminder tools. No studies have examined multisession interventions co-led by an RPh and medication navigator (MN). This ongoing pilot study assesses the feasibility of such an intervention, its impact on patients’ understanding and adherence, and patient acceptability. Methods: Patients at our institution met with an RPh and MN for an education and teach-back session at OAM initiation (T1). Patients were given a Drug Information Sheet and Medication Calendar as educational tools. Patients were then invited to enroll in a multisession intervention, including an RPh-led re-education at the first refill (T3) and MN-led boosters (T2, T4). At each session, teach-back responses were recorded and participants completed study measures and evaluations. Preliminary results on T1 and T2 are presented. Results: To date, 37 (95%) patients enrolled at T1 and 33 completed the MN-led booster a week later (T2). At T1 and T2, 85% of participants demonstrated sufficient understanding of OAM taking and handling. However, despite high levels of self-reported adherence, 48% lacked knowledge about when or where to get a refill. At T1 (32%) and T2 (60%), of patients raised issues that were not previously shared with their clinical team. Patients were highly satisfied with the intervention and found the education session, booster, and educational tools useful. Conclusions: While data collection is ongoing, preliminary results suggest this intervention is feasible, enhances patient understanding and adherence to their medications, and is acceptable to patients undergoing OAM treatment. Integration of RPh and MN into oncology teams can enhance care delivery and provide timely assistance for OAM-related issues, providing insight into future models of care.

Is There a July Effect in Orthognathic Surgery?

July denotes the start of the academic medical calendar, bringing with it the excitement of trainees being promoted to the next postgraduate level. Whether it is the newly minted intern, senior resident, fellow, or young attending, this time of the year presents a steep learning curve as the individuals adjust to new roles and responsibilities. This transition period, otherwise identified as Quarter 3, has led some authors to hypothesize the presence of a “July Effect” during which patient morbidity and mortality may be increased because of provider inexperience and/or inefficiency (1, 2). Many recent studies, however, failed to substantiate the theory. The purpose of this study was to determine the existence of the July effect in orthognathic surgery using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), which reports 30-day follow-up data for procedures in all surgical fields.

Oral chemotherapy follow up on a Brazilian private health care unit.

e18311 Background: Oral antineoplastic therapy is a growing reality, and ensures greater comfort and better quality of life for patients. However, this modality of treatment requires greater attention of the professionals to avoid dispensing errors and to guarantee adherence to the treatment. The goal of this study is to present a method to follow up cancer patients to reduce percentage of problems related to medication and improve oral antineoplastic adherence. Methods: The study was conducted at a private oncology clinic in Rio de Janeiro during the year 2018. In the first dispensation, patients received verbal and written pharmaceutical advice on posology, proper storage, safe handling requirements and strategies to avoid adverse side effects and food and drugs interactions. There were also given nutrition, sexuality, rights and duties guidelines. To improve adherence and to avoid forgetfulness or duplicity of dosing, patients received a medication calendar. Pharmacist made dispensing, managed adverse side effects and assessed adherence of patient using a model based on Morisky Medication Adherence Scale. Patients that answered "yes" to any questions were considered non-adherents. All information was registered in medical record. Non-compliances were considered: wrong medicine, incorrect dose and delays of any administrative reason. Results: In 2018, on average 1487 dispensings were made and 1053 patients’ adherence behavior were measured. 94.37% were considered adherent. Monthly percentage of non-compliance was 1.5% of dispensings. Conclusions: The present study demonstrates that with education and pharmaceutical follow-up since the first dispensation, it is possible to guarantee a safer and more effective treatment for patients using oral cancer medication. It is imperative to maintain the objective of developing better techniques for dispensing, guiding and guaranteeing high adherence.

From solar terms to medical terms (Part II): Some implications for traditional Chinese Medicine

In the traditional Chinese Medicine (TCM), the timing of performing the treatment during the year is always an important factor for maximizing its effectiveness. Based on over half a century of observational and reanalysis data, a modified calendric system, named the Twenty-four Medical Terms (24-MTs), has been established for mainland China following a systematic calibration and geographical adjustment of the classic Twenty-four Solar Terms (24-STs). In view of “adapting the human body to the changing universe”, a core philosophy of the TCM, this improved medical calendar is expected to make a significant contribution to the development of precise Chinese Medicine in the big data era. Specifically, two maps of localized timings for the so-called Triple- Fu (TF) and Triple- Jiu (TF) defined using a joint heat index of air temperature and relative humidity are created as an alternative to the two nationwide unified timings representing the warmest and coldest periods of the year. These location-specific medical calendars, with a maximum regional time shift of one week for TJ and a systematic advancing of 3.6–28.2 days for TF in mainland China, are thought to be clinically useful for carrying out precise TCM such as “treating winter deceases in summer”. In addition, similar maps of localized timings for peak spring and peak autumn defined as the days of fastest warming and cooling around the years are generated for mainland China, so as to provide a helpful guidance for practicing season (ST/MT) related and geographically dependent precise health care in the context of “born in spring, grow in summer, harvest in autumn, and preserve in winter”, which is a key ideology in the TCM.

Engagement in a statewide oral oncolytic collaborative and practice impact.

89 Background: The rapid shift to oral oncolytic therapy presents challenges to oncology practitioners. The purpose of this study is to describe how participation in a statewide oral oncolytic improvement collaborative where best practices and resources were shared can readily impact quality of care as measured by national standards. Methods: The Michigan Oncology Quality Consortium (MOQC) hosted a series of learning collaborative sessions focused on topics and deployment of resources specific to oral oncolytic management and quality improvement. Participating practices performed pre/post self-assessments in Oct. 2013 and Apr. 2015 (n = 3). Concordance with national ASCO QOPI and ONS standards was compared, including documentation (5 measures), patient education (7 measures), and follow-up/monitoring (4 measures). A response scale of always, sometimes, and never was used. Specifically, practices were surveyed to assess which evidence-based MOQC resources were implemented: patient intake template, drug-specific self-management guides, start date mailer, medication calendar, primary care physician communication template, Edmonton Symptom Assessment Scale (ESAS), and patient adherence questionnaires. Results: Practice A showed improvement in documentation, patient education, and monitoring. This practice used the initial oral chemotherapy template, ESAS, patient education templates, and patient calendar (Table). Practice B implemented 6 resources and demonstrated improvements in 15 metrics. Practice C implemented 4 resources, namely patient-focused resources, to improve all patient education and monitoring metrics. Conclusions: Use of the collaborative model and supplying oncology teams with scientific evidence, standard workflows, and resources improves concordance with national standards of care. Large-scale deployment of this model program may provide a clinically efficient and effective mechanism to enhance widespread change. [Table: see text]

Health Literacy Based Communication by Illinois Pharmacists

Objectives: Health literacy has received attention as an important issue for pharmacists to consider when interacting with patients. Yet, there is little information about methods pharmacists use to communicate with patients and their extent of use of health literacy based interventions during patient interactions. The purpose of this study was to examine methods of communication and types of health literacy based interventions that practicing pharmacists use in Illinois.
 Methods: A survey instrument addressing the study purpose was designed along with other items that were part of a larger study. Eleven items in the survey referred to pharmacist-patient communication. The instrument was pilot tested before administering to a random sample of 1457 pharmacists from the Illinois Pharmacists Association. Data were primarily collected via a mailed survey using Dillman’s five step total design method (TDM). Two reminder letters were mailed at two week intervals to non-respondents.
 Results: Usable responses were obtained from 701 respondents (48.1% response rate). Using simple words (96%) and asking patients open-ended questions to determine comprehension (85%) were the most frequent methods that pharmacists used to communicate with patients. Only 18% of respondents always asked patients to repeat medication instructions to confirm understanding. The various recommended types of health literacy interventions were “always” performed by only 8 to 33% of the respondents. More than 50% of respondents indicated that they rarely or never had access to an interpreter (51%), or employed bilingual pharmacists (59%). Only 11% of pharmacists said that they rarely/never pay attention to nonverbal cues that may suggest low health literacy.
 Conclusions: Pharmacists infrequently use action oriented health literacy interventions such as using visual aids, having interpreter access, medication calendars, etc. Additional training on health literacy, its scope, and related interventions coupled with system redesign and compensation for time spent counseling are essential to encourage health literacy tailored communication with patients.
 
 Type: Original Research

Avoiding risky business: supporting optimal home medication administration for children with cancer.

Correct administration of medication at home to a child undergoing cancer treatment is critical to both curing the disease and minimizing adverse effects of treatment. The most common childhood cancer, acute lymphoblastic leukemia, relies on home administration of mercaptopurine, methotrexate, and corticosteroids for 2 or more years of treatment. Less than 95% adherence to nightly mercaptopurine administration during a 6-month period of observation was associated with a 2.5-fold increase in the risk of relapse compared with adherent patients. If this finding translates to other drugs and other diseases, strategies to maximize adherence will become a critical part of childhood cancer treatment. Walsh et al have already shown that medication errors in the home of children with cancer are common. If we consider the home setting carefully, we should not be surprised that there are challenges with both adherence and safety. Caregivers, usually parents, are expected to carry out a complex medication administration process in the home. These caregivers usually have far less education about medication and none of the tools to support performance provided for nurses giving medications in the hospital. Parents do not have medication administration records (updated each time a medication is added, changed, or discontinued) with prompts for each medication with a specific dose, route, and time of day or interval since last dose and records of doses given. We also ask parents to serve as pharmacists and ensure that only the correct medication products are available for administration. Parents of a child with cancer not only do not have such supports but also face additional challenges. A common approach to reduce medication error is to focus on the so-called five rights: the right patient, the right drug, the right dose, the right route, and the right time. Parents are highly likely to give the medication to the right patient since there is usually only one child with cancer in the home. Since the vast majority of home medications are given by the oral route, the odds are high that medications will be given by the right route. However, as shown in Table 1, there are many factors in the home that can decrease the probability of the right drug, the right dose, and the right time. Some of these issues are unique to pediatrics because they involve ability to swallow pills, potential poor cooperation with care, lack of availability of appropriate pill strengths for pediatric dosing, and issues related to parent as caregiver. One strategy to decrease error could be to focus on patient education about medication as in the 2014 Joint Commission National Patient Safety Goals, Stage 1 of the federal Meaningful Use criteria for electronic health records, and the American Society for Clinical Oncology/Oncology Nursing Society chemotherapy safety standards. Education alone, however, is likely insufficient to achieve reliable performance of a complex task such as medication administration in the home. In the article that accompanies this commentary, Walsh et al describe the development of a tool to support parents and other caregivers in the home to ensure that each child with cancer receives the right dose of the right drug at the right time via the right route. Walsh et al deserve kudos for this effort which includes a three-part product with a Web site for general information and decision-support tools, a communication guide to maximize understanding of information provided by caregivers, and a patientand cycle-specific medication calendar, available in a paper or electronic format. Critical to their work was the inclusion of the many parents who contributed to the design and testing of the final product. As the authors acknowledge, this is a preliminary effort whose impact has yet to be shown. Larger studies and studies at multiple centers are needed to determine if this specific strategy will decrease medication error in the home or if additional strategies will be needed. As the field of pediatric oncology moves forward, more work is needed to ensure parents of children with cancer have the exact supports needed for safe and reliable medication administration in the home in order to maximize cure and minimize harm.

Home medication support for childhood cancer: family-centered design and testing.

Errors in the use of medications at home by children with cancer are common, and interventions to support correct use are needed. We sought to (1) engage stakeholders in the design and development of an intervention to prevent errors in home medication use, and (2) evaluate the acceptability and usefulness of the intervention. We convened a multidisciplinary team of parents, clinicians, technology experts, and researchers to develop an intervention using a two-step user-centered design process. First, parents and oncologists provided input on the design. Second, a parent panel and two oncology nurses refined draft materials. In a feasibility study, we used questionnaires to assess usefulness and acceptability. Medication error rates were assessed via monthly telephone interviews with parents. We successfully partnered with parents, clinicians, and IT experts to develop Home Medication Support (HoMeS), a family-centered Web-based intervention. HoMeS includes a medication calendar with decision support, a communication tool, adverse effect information, a metric conversion chart, and other information. The 15 families in the feasibility study gave HoMeS high ratings for acceptability and usefulness. Half recorded information on the calendar to indicate to other caregivers that doses were given; 34% brought it to the clinic to communicate with their clinician about home medication use. There was no change in the rate of medication errors in this feasibility study. We created and tested a stakeholder-designed, Web-based intervention to support home chemotherapy use, which parents rated highly. This tool may prevent serious medication errors in a larger study.

TextTB: A Mixed Method Pilot Study Evaluating Acceptance, Feasibility, and Exploring Initial Efficacy of a Text Messaging Intervention to Support TB Treatment Adherence.

Objective. To assess a text messaging intervention to promote tuberculosis (TB) treatment adherence. Methods. A mixed-methods pilot study was conducted within a public pulmonary-specialized hospital in Argentina. Patients newly diagnosed with TB who were 18 or older, and had mobile phone access were recruited and randomized to usual care plus either medication calendar (n = 19) or text messaging intervention (n = 18) for the first two months of treatment. Primary outcomes were feasibility and acceptability; secondary outcomes explored initial efficacy. Results. Feasibility was evidenced by high access to mobile phones, familiarity with texting, most phones limited to basic features, a low rate of participant refusal, and many describing suboptimal TB understanding. Acceptability was evidenced by participants indicating feeling cared for, supported, responsible for their treatment, and many self-reporting adherence without a reminder. Participants in the texting group self-reported adherence on average 77% of the days whereas only 53% in calendar group returned diaries. Exploring initial efficacy, microscopy testing was low and treatment outcomes were similar in both groups. Conclusion. The texting intervention was well accepted and feasible with greater reporting of adherence using text messaging than the diary. Further evaluation of the texting intervention is warranted.

Persistence, adherence, and toxicity with oral CMF in older women with early-stage breast cancer (Adherence Companion Study 60104 for CALGB 49907)

Cyclophosphamide-methotrexate-5-fluorouracil (CMF) is often selected as adjuvant chemotherapy for older patients with early-stage breast cancer due to perceived superior tolerability. We sought to measure persistence with CMF, adherence to oral cyclophosphamide, and the association of these with toxic effects. CALGB 49907 was a randomized trial comparing standard chemotherapy (CMF or AC, provider/patient choice) with capecitabine in patients aged ≥65 with stage I-IIIB breast cancer. Those randomized to standard therapy and choosing CMF were prescribed oral cyclophosphamide 100 mg/m(2) for 14 consecutive days in six 28-day cycles. Persistence was defined as being prescribed six cycles of at least one of the three CMF drugs. Adherence was the number of cyclophosphamide doses that women reported they had taken divided by the number prescribed. Persistence and adherence were based on case report forms and medication calendars. Of 317 randomized to standard chemotherapy, 133 received CMF. Median age was 73 (range 65-88). Seventy-one percent submitted at least one medication calendar; 65% persisted with CMF. Non-persistence was associated with node negativity (P = 0.019), febrile neutropenia (P = 0.002), and fatigue (P = 0.044). Average adherence was 97% during prescribed cycles. Self-reported adherence to cyclophosphamide was high, but persistence was lower, which may be attributable to toxic effects.

Abstract P5-10-12: Adherence, Persistence and Toxicity with Oral CMF in Older Women with Early Stage Breast Cancer in CALGB 49907 (Adherence Companion Study 60104)

Abstract Background: Cyclophosphamide-methotrexate-fluorouracil (CMF) is often selected as adjuvant chemotherapy for older patients with early stage breast cancer due to perceived better tolerability compared to other standard regimens such as doxorubicin-cyclophosphamide (AC). We sought to measure adherence and persistence with oral cyclophosphamide and the relationship with toxicity among women who were prescribed CMF in CALGB49907. Patients and Methods: CALGB49907 (NEJM 2009) was a randomized trial that compared standard chemotherapy (CMF or AC) versus capecitabine in patients age ≥65 with stage 1-3 breast cancer. Those randomized to standard chemotherapy were treated with either AC or CMF. For those given CMF, cyclophosphamide was prescribed at 100 mg/m2 daily for 14 consecutive days of each of six 28 day cycles. Persistence was defined as completing all six cycles. Adherence was measured using patient self-report medication calendars, and was calculated as the number of doses that women reported they had taken divided by the doses they were prescribed, taking into account toxicity-related dosing changes. Results: Of the 317 patients randomized to standard chemotherapy, 133 elected to receive CMF. CMF patients were older (p=0.009) and less likely to be Hispanic (P<0.001) than patients who received AC. Median age of CMF patients was 73 (range 65 to 88); only 86 patients (65%) persisted with CMF to completion of planned protocol therapy. In a multivariable logistic regression model, non-persistence was associated with the report of a non-hematologic adverse event (p <0.001), but not with a hematologic adverse event (p = 0.578). Febrile neutropenia occurred in 21% of the non-persistent patients, but only in 1 % of the persistent patients (P<0.001). Fatigue also occurred in 21% of the non-persistent patients, but only in 6% of the persistent patients (p=0.009). Other non-significant covariates included age, race, performance status at enrollment, type of surgery, nodal status, ER status, and PgR status. Ninety-four of 133 (71%) CMF-treated patients submitted medication calendars documenting their use of cyclophosphamide. The only characteristic that was found to differ between women who submitted medication calendars and those who did not was that the former were less likely to be ER-positive (p=0.010). Average adherence across all cycles with available data was 97%, and adherence did not vary by cycle (p=0.46). Five percent of participants reported taking fewer than 80% of expected doses and were deemed non-adherent. In a logistic regression model, there were no significant variables predicting non-adherence. Conclusions: In this substudy of a large clinical trial of older women with early stage breast cancer, self-reported adherence to oral cyclophosphamide as part of standard CMF chemotherapy was high. However, only 65% of older women were persistent with CMF, lower than the 92% observed among patients who elected to receive AC in the trial. Further research is needed to study how non-persistence impacts outcomes in this population and whether persistence can be increased by improving management of toxicities in older women. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-10-12.

Every Last Drop: Implementation of Medication Calendars to Improve Home Medication Adherence on an Inpatient Pediatric Observation Unit

Every Last Drop: Implementation of Medication Calendars to Improve Home Medication Adherence on an Inpatient Pediatric Observation Unit

Medication Adherence in New Zealand Older Adults: Effects of an External Cognitive Support

Pharmacotherapy is the most frequently used treatment modality among the older adult population. Consequently, medication adherence represents an important treatment consideration. The present study was conducted to assess the extent of medication adherence in the New Zealand sample, and evaluate the effectiveness of an external cognitive support in a sample of 50 community-dwelling older adults (M = 70.70, Mdn = 72.00, SD = 8.12). A randomised controlled trial to compare the usual medication practice with a medication calendar was conducted. The present sample had high levels of medication adherence, with high adherence measured on an adherence ratio 97% (range 82% to 109%), and low rate of medication errors (19 errors). There were no significant differences in medication adherence between intervention and control groups (ps > .05). However, consistent with prior research, there was some evidence to suggest that female participants were less compliant and made more errors than male participants. Further research on larger more representative older adult samples is warranted.

The use of a medication calendar improves compliance in veterans administration heart failure patients

The use of a medication calendar improves compliance in veterans administration heart failure patients