Medication Adherence Monitoring Research Articles

Monitoring medication adherence using smart digital technology in patients with pulmonary tuberculosis

Pulmonary tuberculosis cases can arise due to various factors, including treatment fatigue resulting from prolonged therapy, insufficient patient knowledge about the condition, geographical distance between patients’ residences and healthcare facilities, a lack of reminders from healthcare workers regarding medication adherence, and the perception that treatment provided at community health centers may be inadequate. This study aimed to investigate the effectiveness of digital smart applications in enhancing medication adherence among pulmonary tuberculosis patients. Utilizing a trial survey approach, the research focused on patients seeking treatment at the Surabaya Community Health Center. Smart digital applications were employed to monitor medication adherence, with patients inputting their data via cell phones. The study recorded data over one month and found that while some patients struggled to operationalize the smart digital application, many were able to utilize it effectively. Overall, the findings suggest that smart digital applications can be valuable tools for monitoring medication adherence among pulmonary tuberculosis patients, particularly for older adults.

Remote Blood Pressure Monitoring With Social Support for Patients With Hypertension

Hypertension management has traditionally been based on office visits. Integrating remote monitoring into routine clinical practices and leveraging social support might improve blood pressure (BP) control. To evaluate the effectiveness of a bidirectional text monitoring program focused on BP control and medication adherence with and without social support in adults with hypertension. This randomized clinical trial included adults aged 18 to 75 treated at an academic family medicine practice in Philadelphia in 2018 and 2019. Patients had been seen at least twice in the prior 24 months and had at least 2 elevated BP measurements (>150/90 mm Hg or >140/90 mm Hg for patients aged 18-59 years or with diabetes or chronic kidney disease) during visits. All participants had a cell phone with text messaging, offered at least 1 support partner, and were taking maintenance medications to treat hypertension. Patients were randomized 2:2:1 to remote monitoring of BP and medication adherence (RM), remote monitoring of BP and medication adherence with feedback provided to a social support partner (SS), or usual care (UC). Data were analyzed on an intention-to-treat basis between October 14, 2019, and May 30, 2020, and were revisited from May 23 through June 2, 2023. The RM and SS groups received an automatic home BP monitor, 3 weekly texts requesting BP measurements, 1 weekly text inquiring about medication adherence, and a weekly text with feedback. In the SS arm, support partners received a weekly progress report. The UC group received UC through their primary care practice. Clinicians caring for the patients in the intervention groups received nudges via electronic health records to adjust medications when 3 of 10 reported BP measurements were elevated. Patients were followed up for 4 months. The primary outcome was systolic BP at 4 months measured during the final follow-up visit. Secondary outcomes included achievement of normotension and diastolic BP. In all, 246 patients (mean [SD] age, 50.9 [11.4] years; 175 females [71.1%]; 223 Black individuals [90.7%] and 13 White individuals [5.3%]) were included in the intention-to-treat analysis: 100 patients in the RM arm, 97 in the SS arm, and 49 in the UC arm. Compared with the UC arm, there was no significant difference in systolic or diastolic BP at the 4-month follow-up visit in the RM arm (systolic BP adjusted mean difference, -5.25 [95% CI, -10.65 to 0.15] mm Hg; diastolic BP adjusted mean difference, -1.94 [95% CI, -5.14 to 1.27] mm Hg) or the SS arm (systolic BP adjusted mean difference, -0.91 [95% CI, -6.37 to 4.55] mm Hg; diastolic BP adjusted mean difference, -0.63 [95% CI, -3.77 to 2.51] mm Hg). Of the 206 patients with a final BP measurement at 4 months, BP was controlled in 49% (41 of 84) of patients in the RM arm, 31% (27 of 87) of patients in the SS arm, and 40% (14 of 35) of patients in the UC arm; these rates did not differ significantly between the intervention arms and the UC group. In this randomized clinical trial, neither remote BP monitoring nor remote BP monitoring with social support improved BP control compared with UC in adults with hypertension. Additional efforts are needed to examine whether interventions directed at helping patients remember to take their BP medications can lead to improved BP control. ClinicalTrials.gov Identifier: NCT03416283.

#347 Long-term effectiveness of a village doctor-led multifaceted strategy on blood pressure control: a cluster randomized trial

Abstract Background and Aims We tested the effectiveness of a village doctor-led multifaceted strategy on blood pressure (BP) control over 36 months among patients with hypertension in rural China. Village doctors are community health workers who provide basic primary health care in rural China. Method 326 villages were randomly assigned to the village doctor-led intervention or usual care. Individuals aged ≥40 years with an untreated mean BP ≥140/90 mmHg (≥130/80 mmHg in individuals with clinical cardiovascular disease) or treated BP ≥130/80 mmHg were recruited. The trained village doctors initiated and titrated antihypertensive medications according to a simple stepped-care protocol with supervision from primary care physicians. They also delivered discounted and free medications to patients and conducted health coaching on lifestyle change, medication adherence, and home BP monitoring. Intention to treat analysis was conducted. Results At baseline, mean age (62.8 vs. 63.2 years), percentage of women (60.9% vs. 61.6%), mean systolic BP (157.0 vs. 155.5 mmHg), and diastolic BP (88.1 vs. 87.3 mmHg) were comparable between intervention and control groups. At 36 months, 72.5% patients in the intervention group and 11.7% patients in the control group had a BP of less than 130/80 mmHg, with a group difference of 60.8% (95% CI 59.4 to 62.2%; p<0.0001). Mean systolic BP decreased by –30.8 mmHg (95% CI –31.7 to –29.9) from baseline to 36 months in the intervention group and by –7.6 mmHg (–8.5 to –6.8) in the control group, with a group difference of –23.1 mmHg (95% CI –24.4 to –21.9 mmHg; p<0.0001). Mean diastolic BP decreased by –14.8 mmHg (–15.3 to –14.3) from baseline to 36 months in the intervention group and by –4.9 mmHg (–5.3 to –4.4) in the control group, with a group difference of –9.9 mmHg (–10.6 to –9.3 mmHg; p<0.0001). No treatment-related serious adverse events were reported in either group. Conclusion In rural China, the village doctor-led multifaceted strategy significantly reduced BP over 36 months in patients with hypertension. This proven-effective and sustainable implementation strategy could be scaled up throughout rural China and in other low- and middle-income countries for hypertension control.

Transitioning from pediatric to adult-oriented healthcare in rheumatology: the pediatric side of the coin.

The transition of adolescents and young adults (AYAs) from pediatric to adult-oriented healthcare may be affected by many factors, including the personal and cultural settings. We aimed to analyze the transition readiness and the factors affecting the transition success in rheumatology. Patients older than 12 years were included in this prospective study. All filled out the Transition Readiness Assessment Questionnaire (TRAQ) 5.0. AYAs were phone-interviewed after their transfer to adult-oriented healthcare. Drug adherence was evaluated with 4-item Morisky Medication Adherence Scale (MMAS-4). AYAs rated their transitional care experience with visual analogue scale (VAS 0-10; 0, the worst; 10, the best). A total of 504 TRAQs were filled out by 406 patients (F/M = 1.5). The total TRAQ score was positively correlated with age and higher in the forms filled out by girls than boys (4.2 vs 4.0, respectively; p= 0.005). The transition was successful for 78 (83.9%) out of 93 patients transferred to adult-oriented healthcare. The VAS for the transition process was lower and the post-transfer MMAS-4 score was worse (8 vs 9, p= 0.030 and 3 vs 4, p= 0.020; respectively) in patients whose transition was not successful when compared with the successfully-transitioned ones. The best-performing TRAQ cut-off value was >4.0 for predicting transfer readiness in rheumatology. A TRAQ score of > 4 could be used while deciding about the transfer readiness of AYAs in rheumatology. Improving the AYAs' experience of the transition process and closely monitoring medication adherence during transition are essential for a successful transition.

Performance of Medication Tasks: Relationship Among Patient-Reported Outcomes, Performance-Based Assessments, and Objective Assessments.

Occupational therapy practitioners use standardized assessments to guide their clinical decision-making, but it is unclear how well performance on standardized assessments translates to performance at home. To understand the concurrent and predictive validity of patient-reported outcomes and performance-based assessments for monitoring performance at home within the context of medication management and adherence. Exploratory study. Participants completed standardized assessments in a lab or at home, which were followed by home-based electronic monitoring of medication adherence. Sixty community-dwelling adults with hypertension or stroke who independently took antihypertensive medications. Participants completed the Hill-Bone Medication Adherence Scale, the Hill-Bone Medication Adherence Reasons Scale, the Performance Assessment of Self-Care Skills Medication Management subtask, and the Executive Function Performance Test-Enhanced Medication Management subtest. Then, they used an electronic pill cap to monitor medication adherence at home for 1 month. Patient-reported outcomes and performance-based assessments in the context of medication management and adherence demonstrated poor concurrent and predictive validity to medication adherence at home. There is a gap between what people think they will do, what they can do on a standardized assessment, and what they actually do at home. Future research is needed to strengthen concurrent and predictive validity to clinically meaningful outcomes. Plain-Language Summary: Occupational therapy practitioners should use caution when using standardized assessments to try to predict client performance at home. They should also continue to use a battery of assessments, clinical reasoning, and client preferences to guide their decision-making for monitoring performance at home within the context of medication management and adherence.

Understand the FDA-cleared fentanyl testing: A clinical evaluation of the SEFRIA fentanyl immunoassay

BackgroundScreening for fentanyl has been adopted by many clinical laboratories to detect illicit drug use and monitor medication adherence. However, compared to other urine drug testing, fentanyl screening assays are relatively new and therefore their clinical performances are largely unknown. This study extensively evaluated the clinical performance, positive cutoff, and interference profile of SEFRIA fentanyl immunoassay in real patient settings. MethodsThe FDA-cleared cutoff of 1.0 was verified with 21 urine samples with low or undetectable levels of fentanyl. After assay implementation, all screened-positive samples were confirmed by liquid chromatography-tandem mass spectrometry. A new cutoff was derived from the numeric values of the false positive (FP) screening results. The FP rates before and after implementing the new cutoff were compared. Interferences were identified by an untargeted drug analysis and confirmed by spiking experiments. ResultsA total of 3951 screening results were reviewed in the first two months of the assay utilization, 410 were screened-positive, and 157 (38 %) were FP. After a new cutoff of 1.3 was implemented, the FP rate was reduced to 17 % based on 11119 screening results. Trazodone, labetalol, and haloperidol were identified as major interferents, accounting for 56 % of the FP results using the cutoff of 1.3. ConclusionBy applying the new cutoff and including an interference comment to positive screening results, the FP rate was reduced from initial 38 % to 7.5 % (17 % times 56 %).

Expert Insight Into the Use of eHealth Interventions to Aid Medication Adherence During COVID-19.

The COVID-19 pandemic has transformed the way healthcare is delivered by the increased utilisation of eHealth tools to deliver remote patient consultations. These eHealth tools served various functions during COVID-19 including monitoring and surveillance of patients. Therefore, assessment of digital health interventions for monitoring medication adherence is crucial to maximise the potential benefits of eHealth. The aim of this study is to understand the perspectives of experts in medication adherence around eHealth interventions used to aid adherence during COVID-19. The study was exploratory and utilized a mixed-method approach. Data was gathered from a survey distributed by the International society for Medication Adherence, and from arranging subsequent structured interviews. Purposive sampling was used to collect data from individuals who were rich in knowledge about the field of medication adherence. Template analysis was used to analyse the collected data. Twenty-one participants responded to the survey and 6 completed the interviews. Results showed that eHealth tools reduced barriers to medication adherence by improving health literacy of patients. The main strengths of eHealth technology used in COVID-19 highlighted by participants were convenience and user empowerment. Moreover, weaknesses and barriers included lack of cooperation between technology providers, lack of awareness of doctors about eHealth and patient's digital health literacy. The increased utility of eHealth tools during COVID-19 highlighted their vital role in aiding medication adherence of patients. These technologies have both decreased and increased barriers to medication adherence through numerous ways. Future directions should focus on gaining the perspectives of patients on the use of eHealth interventions and its role in aiding medication adherence.

Understanding mother-to-child transmission of HIV among mothers engaged in HIV care in Kenya: a case report

BackgroundMother-to-child transmission of HIV, which may occur in utero, during birth, or through breastmilk, is now largely preventable with the advancement of HIV testing and treatment for women and their infants. Globally, great progress has been recorded over the years, with a 58% decline in new infections in children from 2010 to 2022. Currently, Kenya is among the countries with the highest rates of mother-to-child transmission of HIV despite consistent efforts to promote prevention of mother to child transmission strategies.MethodsThis case report presents the experiences of a woman, engaged in HIV care in Kenya, whose baby contracted HIV. The data used to describe this case come from surveys, provider notes, health records, observational notes, notes from phone call consultations, and one in-depth interview. All data sources were carefully reviewed, compared and complied to describe the timeline of events and context of the participant’s experience.ResultsWe found multiple factors which may have contributed to this case of mother-to-child transmission of HIV. Antenatal care was initiated late in pregnancy (during the third trimester), and as a result, HIV diagnosis and treatment also occurred late in pregnancy. In addition, a lack of coordination between the clinic providing antenatal care and HIV treatment, and the hospital providing labor and delivery services led to breastfeeding initiation prior to the administration of infant HIV prophylaxis medications. Finally, poor maternal adherence to HIV medications went undetected and unaddressed until it was revealed by routine viral load monitoring three months after initiating HIV treatment (more than two months postpartum).ConclusionsOur case report shows the continued need for more intensive and integrated care for mothers living with HIV and their infants including support for pregnant women newly diagnosed with HIV, coordination of perinatal and HIV care, provisions for routine monitoring of HIV medication adherence, intensive follow-up care including point of care testing for HIV exposed infants and in person breastfeeding support. Our case report contributes an important perspective especially in light of the current UNAIDS Global AIDS Strategy which recently inspired the Global Alliance to end AIDS in Children.

Advancing affordable IoT solutions in smart homes to enhance independence and autonomy of the elderly

There is a growing trend among elderly people to live alone and this trend is expected to increase in the future. Social isolation and limited support can have a negative impact on the physical and mental well-being of older adults. The increasing life expectancy and expanding geriatric population necessitate the development of innovative solutions to support their health, independence, and autonomy. This article addresses the key challenges and issues confronting the elderly and analyzes various IoT technologies and solutions proposed to enhance their lives. Smart home technologies improve the quality of life and enable older adults to live independently in their own homes while their adult children are at work. This article presents a smart home model for the elderly in Kazakhstan, based on their needs, concerns, and financial capabilities. The proposed prototype will be developed using an accessible, open-source intelligent system that includes health monitoring, medication adherence monitoring, alerting family members in case of falls or deteriorating health indicators, and video surveillance. Another advantage of this system is the automation of processes such as automatic lighting control, voice command functionality, home security, and climate control. Preliminary testing of the hardware model shows promising results, with plans for continuous improvement and evaluation as it is deployed. Key criteria for its implementation include affordability, accessibility, and feasibility. Based on Kazakhstan’s unique socio-cultural and economic context, this paper proposes a sophisticated smart home model tailored to the specific needs and financial capabilities of elderly Kazakhs.

Monitoring buprenorphine in patients on medication-assisted treatment.

Buprenorphine is used for medication-assisted treatment of opioid dependence. Monitoring of medication adherence involves testing of urine or oral fluid for the drug or its metabolite. Quantitative results using liquid chromatography tandem mass spectrometer testing defined the excretion pattern of the drug and its metabolites. Frequency distribution curves of buprenorphine and norbuprenorphine describe the expected drug concentrations of patients on this medication. Urine and oral fluid drug testing can be used to monitor adherence in this population.

Using Digital Health Technologies to Monitor Pain, Medication Adherence and Physical Activity in Young People with Juvenile Idiopathic Arthritis: A Feasibility Study

Juvenile idiopathic arthritis can be influenced by pain, medication adherence, and physical activity. A new digital health intervention, InteractiveClinics, aims to monitor these modifiable risk factors. Twelve children, aged 10 to 18 years, received daily notifications on a smartwatch to record their pain levels and take their medications, using a customised mobile app synchronised to a secure web-based platform. Daily physical activity levels were automatically recorded by wearing a smartwatch. Using a quantitative descriptive research design, feasibility and user adoption were evaluated. The web-based data revealed the following: Pain: mean app usage: 68% (SD 30, range: 28.6% to 100%); pain score: 2.9 out of 10 (SD 1.8, range: 0.3 to 6.2 out of 10). Medication adherence: mean app usage: 20.7% (SD, range: 0% to 71.4%), recording 39% (71/182) of the expected daily and 37.5% (3/8) of the weekly medications. Pro-re-nata (PRN) medication monitoring: 33.3% (4/12), one to six additional medications (mean 3.5, SD 2.4) for 2–6 days. Physical activity: watch wearing behaviour: 69.7% (439/630), recording low levels of moderate-to-vigorous physical activity (mean: 11.8, SD: 13.5 min, range: 0–47 min). To conclude, remote monitoring of real-time data is feasible. However, further research is needed to increase adoption rates among children.

Development and Effect of a Coordinated Community Health Worker Intervention Model for the Stroke Survivors in Kerala, South India

Introduction: Structured models for secondary prevention of stroke in community settings are scarce. We aimed to develop and evaluate a model for improving medication adherence and enhanced risk factor monitoring. Methods: We developed a multimodal coordinated community health worker (CHW) intervention (C-CHW-I) model for stroke survivors. Following training, all patients received a minimum of three CHW home visits, and once in 3-month telephone call and health education for 6 months by CHWs. Seven blocks from 16 blocks of the study area were randomised to additionally receive an SMS alert for 6 months to reinforce CHW involvement. The primary outcomes were medication adherence and risk factor monitoring, and the secondary outcome was risk factor control. Results: The mean age of the study population was 64 ± 12 years, 765 (85%) had ischaemic stroke. In the overall study cohort receiving the CHW intervention, mean medication adherence significantly improved from 3.56 (0.88) at baseline to 3.78 (0.61) at 6 months; p p p = 0.008); however, no difference persisted at 6 months. The proportion of smokers and alcohol users reduced in both groups with a trend to greater reduction in the intervention group (smokers: 5.9% vs. 2.8% [p = 0.446] and alcohol users: 1.6% vs. 1.4% [p = 0.474]). At 6 months, the SBP did not differ (SBP 132.1 (16.2) in the SMS group vs. 133.2 (15.8) mm Hg in the control group, p = 0.409). Conclusion: Our model improved medication adherence and risk factor monitoring of stroke survivors in community settings, and this can reduce stroke burden in the community.

Patient Perspectives on Lifestyle Changes Following a Diabetes Diagnosis

Diabetes mellitus poses significant health risks and managing it effectively involves substantial lifestyle changes. This study aimed to explore the personal experiences and perceptions of individuals diagnosed with diabetes in regard to the lifestyle changes they undertook following their diagnosis, with the objective of understanding the emotional, behavioral, and health impacts of these changes. A qualitative research design was employed, involving semi-structured interviews with 20 participants who had been diagnosed with diabetes within the past five years. Data collection aimed at achieving theoretical saturation and was analyzed using NVivo software through thematic analysis, focusing on identifying and understanding themes and patterns in participants' responses. The analysis revealed three main themes: Emotional Responses, Lifestyle Modifications, and Health Outcomes. Emotional Responses included initial reactions such as shock and denial, various coping mechanisms, and long-term emotional adjustments. Lifestyle Modifications encompassed dietary changes, increased physical activity, medication adherence, and health monitoring. Health Outcomes were reflected in improvements in physical and psychological well-being, better management of complications, enhanced quality of life, increased knowledge and awareness about diabetes, and varied perspectives on future health prospects. The findings underscore the complexity of diabetes management post-diagnosis and highlight the need for personalized support systems that address both the emotional and practical aspects of lifestyle changes. Effective management strategies should be holistic, incorporating emotional support, practical lifestyle adjustment guidance, and ongoing health monitoring.

Pharmacotherapy for the Prevention of Depression and Behavioral Side Effects in Hematopoietic Stem Cell Transplantation Patients

Depression and decreased quality of life (QoL) develop in approximately 30% of nondepressed hematopoietic stem cell transplantation (HSCT) recipients early after transplantation. To potentially prevent this complication, we conducted a prospective randomized trial to assess whether prophylaxis of nondepressed HSCT patients with the antidepressant sertraline (SER) in addition to supportive psychotherapy starting at admission for transplantation decreases the risk of depression and improves QoL. The primary objective of the study was to evaluate whether there was an added benefit of SER versus placebo along with routine supportive psychotherapy on the development of depression in patients receiving HSCT. A secondary objective was to analyze the impact on patient-reported QoL and survival. The study was conducted at a single-site academic medical center. We randomized 123 nondepressed HSCT recipients (1:1) in a phase III double-blind study to receive SER starting at a dose of 50 mg/day, with possible dose escalations to 200 mg per day, or placebo beginning on admission for HSCT and continuing for 12 weeks. Supportive psychotherapy was provided for both groups. Depression (Beck Depression Inventory II [BDI-II]) and QoL (Functional Assessment of Cancer Therapy-Bone Marrow Transplantation [FACT-BMT]) were assessed prior to HSCT and then weekly to week 12 post-HSCT. A multivariable linear mixed-effects model was used to estimate the mean change in BDI-II scores as a function of elapsed time since baseline, treatment assignment, and their interaction. The same process was used to assess treatment effects on all QoL scores from the FACT-BMT assessment. A Kaplan-Meier curve was used to estimate the probability of survival for each group following initiation of treatment. A follow-up Cox proportional hazards model was used to estimate the mortality rate in the 2 groups. Our results do not indicate a benefit of SER in either a diminished risk of depression or improved QoL or survival outcomes. Based on our findings, we can only recommend early evaluation of HSCT recipients for depression, with antidepressant use reserved for patients with evidence of clinical depression, unless additional randomized trials can confirm the effects of early antidepressant therapy on mood and QoL in this vulnerable group. Future research in this area would be improved by systematic monitoring of medication adherence, identification of the optimal dose of SER (or other antidepressant), and inclusion of psychotherapy outcomes when relevant, the absence of which are limitations of this study.

Adherence Behaviors and Related Factors Among Elderly Hypertensive Patients in China: Evidence from the China Health and Retirement Longitudinal Study.

Non-adherence or partial adherence is the main reason for poor therapeutic effect of hypertension. This paper aims to assess adherence behaviors and related factors among elderly hypertensive patients in China. Participants aged ≥60 years, with hypertension, and with complete data in 2018 interviews of the China Health and Retirement Longitudinal Study (CHARLS) were included. The adherence behaviors included medication, blood pressure monitoring and the combined adherence behaviors. Referring to the social-ecological theory, correlates of adherence behaviors were divided into three layers, namely demographic characteristics, health behaviors, living environment and retirement. Univariate and multivariable logistic regression models were performed to identify factors of adherence behaviors. The prevalence of medication adherence (76.58%) was higher than that of blood pressure monitoring adherence (20.08%), and the full adherence rate was 18.53%. Self-rated health status, smoking status, living area, and health education status were detected to be associated with medication adherence and blood pressure monitoring adherence (all p < 0.05). Gender, sleep duration, health examination, and physical exercise were also detected to be associated with blood pressure monitoring adherence (all p < 0.05). Self-rated health status and health education status were detected to be associated with partially and fully adherence, while age, living area, and life satisfaction were detected to be associated with partially adherence, smoking status, sleep duration, health examination, and pension reliance were detected to be associated with fully adherence (all p < 0.05). Our study reveals the poor adherence behaviors of elderly hypertensive patients in China. This is most evident among those who were male, 60-69 years old, living in rural areas, self-reported being healthier, those without health examination and health education. Targeting these vulnerable populations, we suggest to strengthen health education, increase the publicity of basic public health services and enhance the self-management ability of hypertensive patients.

Pharmacist-led hypertension management in a minority patient population

BackgroundNearly half of adults in America have hypertension (HTN), and only approximately 1 in 4 adults has their blood pressure (BP) under control. High BP is more common in African Americans adults, and BP control is lower among minority adults. Pharmacist-led interventions for HTN have been shown to be effective in improving BP control and reducing the risk of cardiovascular events. ObjectiveThis study aimed to leverage electronic health record (EHR) data to improve BP control through pharmacist-led interventions. MethodsThis was a prospective, cohort study conducted at Atrium Health Concord Internal Medicine, a large suburban practice in Concord, North Carolina. Patients with uncontrolled HTN were identified using an EHR data tool. Patients were included if they were at least 18 years of age, had sustained uncontrolled HTN, and were of a minority race or ethnicity. The primary outcome was proportion of patients achieving a BP of < 140/90 mm Hg in the intervention group compared with a control group. Secondary outcomes included mean change in BP from baseline, number and type of visits, and number and type of interventions. ResultsA total of 110 patients were enrolled in this study, 55 patients in each cohort. The baseline characteristics were generally well balanced between the 2 groups. The mean age was 62 years, and most patients were female and African American. For the primary outcome, 70.9% of the patients in the intervention group achieved a BP of < 140/90 mm Hg compared with 32.7% of the patients in the control group (P < 0.001). The most common intervention was lifestyle modifications, followed by BP monitoring technique education and medication adherence interventions. ConclusionIn this study, pharmacist-led interventions resulted in clinically and statistically significant improvements in sustained uncontrolled HTN among minority populations.

Evaluation of Drug Utilization and Dose Intensity Pattern in Dyslipidemic Patients with Type 2 Diabetes Mellitus

AbstractDyslipidemia can increase the risk of cardiovascular disease in individuals with metabolic diseases. Patients may have to take multiple medications simultaneously, leading to polypharmacy. A retrospective study was conducted to evaluate drug utilization and dose intensity patterns in dyslipidemic patients with type 2 diabetes mellitus over an 8-month period at a tertiary care hospital. The study included the case sheets of patients diagnosed with dyslipidemia and type 2 diabetes. The required data for the study were collected from the patient's case sheets from the Medical Records Department (from June 2015 to May 2020). The data were documented using MS Excel 2013 and analyzed descriptively using SPSS software version 20. Among the 384 study population, 53% were males and 47% were females, with an age group of 45 to 59 years. Metformin and glimepiride were the most commonly prescribed oral hypoglycemic agents, while glibenclamide was the least prescribed. Atorvastatin was the most prescribed hypolipidemic agent. The combination of atorvastatin and fenofibrate was the most preferred combination therapy. The most frequently prescribed hypoglycemic and hypolipidemic agents were metformin and atorvastatin, respectively. Dyslipidemic patients with diabetes mellitus require the administration of multiple medications. It is crucial to monitor medication adherence and medication-related problems among these populations.

Development and user acceptability testing of healthy heart mobile application- a tool for cardiovascular risk modification among patients with type 2 diabetes mellitus.

Cardiovascular disease (CVD) remains the primary cause of mortality in individuals with type 2 diabetes mellitus. Digital health has quickly emerged as a technology with the ability to bridge the gap in cardiovascular disease self-management and revolutionize the way healthcare has traditionally been delivered. However, there is little data on the application of mobile technologies for cardiovascular risk reduction among diabetic patients. The current study has been constructed with this in mind. A framework for the development of a healthy heart mobile application for CVD risk stratification and risk management among Type 2 diabetes mellitus patients was finalized after consultation with diabetologists, nutritionists, and scientists. The mobile app has three user cases: Patient login, doctor login, and admin login. A questionnaire was designed and the feedback of patients and Physicians was taken regarding the design, presentation, content, and user-friendliness of the app based on responses obtained on the questionnaire. The Android version of the healthy heart mobile mobile app was developed for CVD risk stratification and risk management among type 2 diabetes mellitus patients. The dashboard of the mobile app displayed the CVD risk score and category (mild, moderate, high, or very high CVD risk; which was colored coded), health tracker to monitor medication adherence, lipid profile, diabetes control, CVD risk profile and compliance with the WHO recommendations regarding diet, physical activity and addictions, User acceptability and experience were tested for the developed healthy heart mobile app among patients and physicians. The majority of the respondents graded the design, presentation, content, and user-friendliness of the app as either excellent or good. The mobile app for self-management and CVD risk reduction among diabetic patients was successfully developed. The paper and mobile-based CVD risk calculation and stratification were found to be a match for all the participants. The app was updated based on suggestions from the pilot study and was well-accepted by both patients and physicians.

Abstract 16854: Successful Retention of Vulnerable Populations in New York City: The BETTER-BP Randomized Trial

Introduction: Clinical trial retention in safety-net practices is challenging. To better understand reasons for loss to follow-up, we analyzed data from an ongoing clinical trial in the NYC public hospital system. Methods: We analyzed the first 185 participants enrolled in the BETTER-BP study, an ongoing randomized trial of wireless antihypertensive medication adherence monitoring with a financial incentive lottery to promote medication taking behavior. BETTER-BP enrolls participants from two NYC public hospitals (Bellevue and Gouverneur) and follow-up lasts 12 months. We reported the rate of loss to follow-up at 12 months and assessed baseline characteristics (age, sex, race, ethnicity, insurance status, BMI, blood pressure, comorbidities, and substance use) of those lost vs. retained. ANOVA was used for continuous variables, and the Chi-squared test for categorical variables. Results: Median age was 55.0 (47.5, 62.5) years, 59% were female, 59% Hispanic, and 26% Non-Hispanic Black. Three quarters were Medicaid-insured or uninsured. There were 155 participants retained at 12 months (83.8% retention rate). Characteristics of those retained vs. lost to follow-up are shown in the Table. Participants who were lost to follow-up were more likely to report current alcohol use (43.3% vs. 36.8%, p &lt; 0.001) and illicit substance use (16.7% vs. 3.9%, p &lt; 0.001). Notably, missingness in alcohol use and illicit substance use was also higher among those lost to follow up. Other baseline characteristics were similar between the two groups. Conclusion: Overall retention was high (&gt;80%). Alcohol and illicit drug use were associated with loss to follow up and may serve as markers for future strategies to mitigate attrition.

Transplant recipient, care partner, and clinician perceptions of medication adherence monitoring technology: A mixed methods study

Medication nonadherence is a leading cause of graft loss. Adherence monitoring technologies—reminder texts, smart bottles, video-observed ingestion, and digestion-activated signaling pills—may support adherence. However, patient, care partner, and clinician perceptions of these tools are not well studied. We conducted qualitative individual semistructured interviews and focus groups among 97 participants at a single center: kidney and liver transplant recipients 2 weeks to 18 months posttransplant, their care partners, and transplant clinicians. We assessed adherence practices, reactions to monitoring technologies, and opportunities for care integration. One-size-fits-all approaches were deemed infeasible. Interviewees considered text messages the most acceptable approach; live video checks were the least acceptable and raised the most concerns for inconvenience and invasiveness. Digestion-activated signaling technology produced both excitement and apprehension. Patients and care partners generally aligned in perceptions of adherence monitoring integration into clinical care. Key themes were importance of routine, ease of use, leveraging technology for actionable medication changes, and aversion to surveillance. Transplant clinicians similarly considered text messages most acceptable and video checks least acceptable. Clinicians reported that early posttransplant use and real-time adherence tracking with patient feedback may facilitate successful implementation. The study provides initial insights that may inform future adherence technology implementation.