Medication Adherence Monitoring Research Articles

Recommendations for Use of Video Directly Observed Therapy During Tuberculosis Treatment - United States, 2023.

U.S. clinical practice guidelines recommend directly observed therapy (DOT) as the standard of care for tuberculosis (TB) treatment (1). DOT, during which a health care worker observes a patient ingesting the TB medications, has typically been conducted in person. Video DOT (vDOT) uses video-enabled devices to facilitate remote interactions between patients and health care workers to promote medication adherence and clinical monitoring. Published systematic reviews, a published meta-analysis, and a literature search through 2022 demonstrate that vDOT is associated with a higher proportion of medication doses being observed and similar proportions of cases with treatment completion and microbiologic resolution when compared with in-person DOT (2-5). Based on this evidence, CDC has updated the recommendation for DOT during TB treatment to include vDOT as an equivalent alternative to in-person DOT. vDOT can assist health department TB programs meet the U.S. standard of care for patients undergoing TB treatment, while using resources efficiently.

A glycemic diet improves the understanding of glycemic control in diabetes patients during their follow-up.

A glycemic diet improves the understanding of glycemic control in diabetes patients during their follow-up.

Application of Artificial Intelligence to the Monitoring of Medication Adherence for Tuberculosis Treatment in Africa: Algorithm Development and Validation.

Artificial intelligence (AI) applications based on advanced deep learning methods in image recognition tasks can increase efficiency in the monitoring of medication adherence through automation. AI has sparsely been evaluated for the monitoring of medication adherence in clinical settings. However, AI has the potential to transform the way health care is delivered even in limited-resource settings such as Africa. We aimed to pilot the development of a deep learning model for simple binary classification and confirmation of proper medication adherence to enhance efficiency in the use of video monitoring of patients in tuberculosis treatment. We used a secondary data set of 861 video images of medication intake that were collected from consenting adult patients with tuberculosis in an institutional review board-approved study evaluating video-observed therapy in Uganda. The video images were processed through a series of steps to prepare them for use in a training model. First, we annotated videos using a specific protocol to eliminate those with poor quality. After the initial annotation step, 497 videos had sufficient quality for training the models. Among them, 405 were positive samples, whereas 92 were negative samples. With some preprocessing techniques, we obtained 160 frames with a size of 224 × 224 in each video. We used a deep learning framework that leveraged 4 convolutional neural networks models to extract visual features from the video frames and automatically perform binary classification of adherence or nonadherence. We evaluated the diagnostic properties of the different models using sensitivity, specificity, F1-score, and precision. The area under the curve (AUC) was used to assess the discriminative performance and the speed per video review as a metric for model efficiency. We conducted a 5-fold internal cross-validation to determine the diagnostic and discriminative performance of the models. We did not conduct external validation due to a lack of publicly available data sets with specific medication intake video frames. Diagnostic properties and discriminative performance from internal cross-validation were moderate to high in the binary classification tasks with 4 selected automated deep learning models. The sensitivity ranged from 92.8 to 95.8%, specificity from 43.5 to 55.4%, F1-score from 0.91 to 0.92, precision from 88% to 90.1%, and AUC from 0.78 to 0.85. The 3D ResNet model had the highest precision, AUC, and speed. All 4 deep learning models showed comparable diagnostic properties and discriminative performance. The findings serve as a reasonable proof of concept to support the potential application of AI in the binary classification of video frames to predict medication adherence.

Patients with Complex or Long-term Health Needs in Cardiology

During the whole illness trajectory, nurses play a vital role in managing the care of patients with cardiovascular long-term and complex illnesses. The application of Self-care of chronic illness -theory improves patients´ self-management and give the knowledge and skills with which patients can formulate their individual goals and feel self-confidence despite the condition. The aim of this review is to describe the reflections concerning advanced nursing care of patients with cardiovascular complex or long-term conditions. А theoretical review, conducted in a dialectical process between evidence-based literature, a theoretical framework and professional reflection. Nurses assess patient's level of risk for cardiovascular disease, contribute to primary and secondary illness prevention through patient education based on a nursing theory, observe symptom clusters and their effects to the patient´s functional capacity and quality of life with relevant PREMs and PROMs, conduct and interpret clinical measurements, monitor medication and treatment adherence, and develop as well as review the person-centered nursing care plan accordingly.

Medication Adherence Assessment and Cost Analysis of COPD Treatment Under Out-Patient Clinic in Vietnam.

Chronic obstructive pulmonary disease (COPD) out-patient clinic is for stable patients but it requires patient's adherence to medicine and medical checkups. Our study aimed to assess COPD out-patient clinics management efficacy with respect to medication adherence and treatment costs at 3 out-patient clinics. Data were collected through 514 patient interviews and from medical records for statistical analysis. The most common comorbidity was hypertension (28.8%), and 52.9% of patients had experienced exacerbations in the past year requiring 75.7% of them to be hospitalized. According to the Morisky scale, 78.8% had high adherence and 82.9% were using inhaled corticosteroids regimens. The mean cost per year among different cohorts varied, with the out-patient cohort at $305.93, the acute exacerbations of COPD non-hospital cohort at $247.39, the standard admission cohort at $1275.3, and the emergency department cohort at $2132.5. Patients with low medication adherence had significantly lower annual costs ($238.25 vs $325.04, P = .001). In Vietnam, economic constraints have made Inhaled corticosteroids/ Long-acting β-2 agonists the main mode of treatment. However, the exclusion of Long-acting β-2 agonists/Long-acting anti-muscarinic antagonists drugs from health insurance coverage poses a challenge to Global Initiative for Chronic Obstructive Lung Disease-based prescription practices and increases the importance of monitoring medication adherence, particularly in patients with higher COPD Assessment Test scores.

A Novel Remote Patient and Medication Monitoring Solution to Improve Adherence and Persistence With Inflammatory Bowel Disease Therapy (ASSIST Study): Protocol for a Randomized Controlled Trial

Inflammatory bowel diseases (IBDs) are chronic inflammatory conditions of the gastrointestinal tract. Although adherence to IBD therapies is associated with improved clinical outcomes, overall adherence is poor. Consequently, there is a critical need to develop interventions that monitor adherence in real time and identify reasons for nonadherence to support clinical teams in initiating effective interventions. Recently, electronic- and web-based platforms have been developed to monitor adherence and guide interventions. A novel remote therapy monitoring (RTM) technology, the Tappt digital health system, has been developed to monitor real-time medication adherence patterns through smart label technologies, capture patient-reported outcomes and barriers to care, and process patient data through algorithms that trigger personalized digital and human touch points between clinical visits. Such a digital health solution enables care teams to proactively identify and mitigate nonadherence and worsening clinical outcomes. We propose a 12-month multicenter randomized controlled trial to assess the effectiveness of the Tappt digital health system on adherence, clinical outcomes, and health care use among patients diagnosed with IBD starting a new oral or subcutaneous therapy. The digital health system intervention will provide automatic measurement of medication adherence via smart labels for pill bottles or injectors as well as a monitoring platform for providers. The system will prompt patients to complete a two-item assessment of symptoms monthly using the PRO-2 scales for UC and Crohn disease, from which increased symptoms will be alerted to providers. Participants will be randomized 2:1 to the intervention group or the control group, which will receive standard of care. All participants are required to complete questionnaires at baseline as well as at 12, 26, and 52 weeks. Assuming an adherence rate of 0.65 and 0.9 among control and intervention participants, respectively, we will need to enroll 123 participants: 82 (66.7%) in the intervention group and 41 (33.3%) controls. We will compare adherence as measured by the medication possession ratio, defined as the number of days of supply of medication obtained during the observation period out of the total number of days in the observation period, in participants using the RTM versus those receiving standard of care. We will also compare clinical outcomes and health care use in participants using the RTM versus those receiving standard of care. We anticipate starting recruitment in December 2022. Effective medication adherence monitoring and intervention programs need to be cost-efficient, pose little or no burden to the patient, record reliable data in real time, and provide actionable insights to the health care team. We anticipate the Tappt digital health system to improve the medication possession ratio, clinical outcomes, and health care use compared with standard of care. ClinicalTrials.gov NCT05316584; https://clinicaltrials.gov/ct2/show/NCT05316584. PRR1-10.2196/40382.

Exploration of a community pharmacy delivered mobile health intervention to support medication taking for patients with multiple long-term conditions

Abstract Introduction Up to half of people with long-term conditions (LTCs) do not take their medicines as prescribed. Mobile health interventions, such as text messaging, have been shown to have positive impact on medication adherence.1 However, interventions for patients with multiple LTCs are lacking, and there are limited examples of their delivery from community pharmacy settings. We have developed a new intervention which combines a pharmacist consultation and automated two-way text messaging to support medicines taking. This has been developed using peer-reviewed literature and focus groups with patients and healthcare professionals (GPs, pharmacists, nurses). The intervention is tailored to the individual using a questionnaire and delivers content for up to eight LTCs. Aim To explore the acceptability of our new intervention with patients. Methods The new intervention was delivered to patients in a simulated environment, including a consultation with a pharmacist and two weeks of text messaging. Diary-interviews were used to gather feedback from eight patients, recruited through a public, patient and carer involvement group based at a university. Patients kept a diary during the period of text messaging and follow-up semi-structured interviews were conducted. Interviews were audio recorded and transcribed verbatim for analysis. Transcripts were coded for aspects of the intervention that the patients liked and ideas on how the intervention could be changed, including the impact of delivering the intervention from community pharmacies. Ethical approval for this study was granted by the University of Sunderland Research Ethics Committee. Results The intervention had good acceptability with patients. Patients were happy to interact with the text messaging content, including providing information about symptoms of their long-term condition and result of home monitoring. Patients liked that the intervention was linked to a pharmacist consultation, where there were opportunities to identify medication issues which text messaging could not solve. Delivering the intervention from a community pharmacy setting was felt to promote stronger engagement with the text messaging component, including the opportunity to build rapport with the pharmacist who would be overseeing the intervention. The mechanism to monitor medication adherence using two-way text messaging was suggested to be made more streamlined, and patients also wanted more examples of text message responses included in the patient information leaflet for the intervention. Discussion/Conclusion We found that our intervention to support medication taking from community pharmacies has initial acceptability with patients. Whilst others have trialled similar technologies from community pharmacies2 our intervention focussed solely on medication taking, and this seemed to result in positive attitudes towards its delivery from community pharmacies. The consultation was found to be an important component alongside the text messaging, how combining digital and non-digital components work together to support medication adherence was a gap highlighted in our previous review of similar interventions.3 Our intervention now requires changes based on the feedback gathered in this study and further testing in a larger and more diverse group.

Improved medication adherence with smart applications and medication dispensers - a literature review

Introduction: Medication adherence has a crucial part in ensuring treatment effectiveness. With polypharmacy, medication regimen may be complicated to follow. Smart devices and applications may be useful for geriatric patients, especially in case of cognitive dysfunction. The aim of this narrative literature review is to briefly evaluate the main principles of the use of medication dispensers and smart applications to support medication adherence. Methods: Literature review of peer-reviewed studies in adults (i.e. 18 years or older) and of the period 2012-2021 were selected to collect information about smart medication dispensers and smart applications to monitor medication adherence. The PubMed and Scopus databases were used for review. Results: Digital solutions were found useful for elderly patients, who have multiple medications in their treatment schemes. Younger patients could benefit more from mobile apps, as these tend to be easy to use and operate. Conclusions: Different digital solutions can successfully be used in different age groups to enhance medication adherence. Target group must be set beforehand the development. Further improvements are needed to use the full potential of data produced by devices for monitoring and supporting patients´ medication use.

Electronic Smart Blister Packages to Monitor and Support Medication Adherence: A Usability Study.

PurposeAn electronic version of the Dosepak® (EDP) which records date and time of dosing events has been developed to monitor adherence to medication packaged in blisters. This study aimed to evaluate its usability and acceptance and to monitor dose-taking adherence for optimal implementation in future clinical trials and practice.MethodsHealthy volunteers aged over 18 years were asked to dispense placebo tablets twice daily from EDPs equipped with a re-usable electronic module for a total duration of four weeks. Afterwards, subjects were asked to complete an online questionnaire and partake in a short one-on-one interview. The usability of the EDP was assessed using the System Usability Scale (SUS), while dose-taking adherence was monitored by EDP records, pill counting, and self-report. The short interview explored user experiences in more detail.ResultsTwenty subjects with median [IQR] age 41.5 [32–49.8] years, 55% female, 45% healthcare professionals, and 20% chronic medication users completed the study and found the EDP easy to use, with a mean [SD] SUS score of 78.0 [11.2]. Median [IQR] dose-taking adherence was 89% [82–95%] based on EDP records, 96.5% [89–100%] based on pill counting, 92% [91–96%] based on self-report, and the levels differed significantly (p < 0.05). Four themes emerged from the interviews: user preference, experience, patient burden, and ideas for improvement. Most participants preferred smaller sized blisters. They found the EDP simple to use and did not see any patient burden for its use in trials or clinical practice. Some reported forgetfulness and suggested reminders built into the blister or sent to their mobile phones. Adequate information or instruction should also be provided for older people and polypharmacy patients.ConclusionEDP had good perceived usability, was well accepted, and differed significantly from other adherence measurement methods. This study provides input to further guide scale-up of the blister packages.

Medication Adherence among Patients with Chronic Diseases in Saudi Arabia.

Introduction: The management of chronic illnesses commonly includes a long-term pharmacological approach. Although these medications effectively control disease, their full benefits are often not realized because approximately 50% of patients do not take their medications as prescribed. Medication adherence has become a big concern to clinicians and healthcare systems in Saudi Arabia and worldwide because of growing evidence associating nonadherence with adverse outcomes and higher costs of care. Despite it being a well-recognized problem, few studies have investigated medication adherence in Saudi Arabia. Therefore, this study aims to gain a better perspective on medication adherence among patients with chronic diseases in Saudi Arabia. Method: A questionnaire-based cross-sectional study was conducted among patients with chronic diseases in the Makkah region, Saudi Arabia, from 1 May to 31 July 2021. Patients aged 18 years and above who were taking prescribed or over-the-counter medications were included. Descriptive statistics were used to describe the participants’ characteristics, and categorical variables were reported as frequencies and percentages. A Chi-square test was used to test the relations between variables. Results: In total, 239 participants were included in the study. Females represented 62% of the participants. In terms of the history of chronic diseases, 44% had hypertension, 40% had diabetes mellitus, 21% had heart diseases and 9% had asthma. Nearly half (49%) of participants did not follow up regularly with a primary healthcare center and 42% said that they had forgotten to take their medications in the past. However, most of the participants (78%) stated that they took their medicine as instructed by their doctor or pharmacist, and 61% took their medications on time. The majority of participants (85%) said that the pharmacist explained the method of using the medications and the instructions for use, while 30% thought that the medications they took were too much. In regard to the reasons for medication nonadherence, having no specific reasons for medication nonadherence was the most common cause for nonadherence in our study. The relationship between patients taking medications as instructed by a healthcare provider (the doctor or pharmacist) and the healthcare provider giving clear instructions to patients about medication use was significant (p < 0.001). Conclusions: Failure to adhere is a significant problem that not only affects the patient but also the healthcare system. Additional research is needed to monitor medication adherence and identify factors contributing to this problem to provide successful strategies to improve medication adherence in Saudi Arabia.

Glaucoma Medication Adherence 1 Year after the Support, Educate, Empower Personalized Glaucoma Coaching Program

To assess the efficacy of the Support, Educate, Empower (SEE) glaucoma coaching program on medication adherence among poorly adherent patients with glaucoma for 12 months after cessation of the intervention. Uncontrolled intervention study with a pre-post design. The SEE cohort was recruited from the University of Michigan and included patients with glaucoma aged ≥ 40 years, taking ≥ 1 medication, who self-reported poor adherence. Electronic medication monitoring of those who completed the program continued for up to 1 year after the coaching intervention. Adherence was monitored electronically (AdhereTech) during the 7-month program and 12-month follow-up period. Adherence was the percentage of doses taken on time. Participants were censored for surgery, change in glaucoma medications, or adherence monitor disuse. The SEE program included automated medication reminders, 3 in-person motivational interviewing-based counseling sessions with a glaucoma coach, and 5 phone calls with the coach for between-session support. There was no contact between the study team and participants during the 12-month follow-up after program cessation. Baseline participant characteristics were summarized with descriptive statistics. Paired t tests and Wilcoxon signed rank tests were used to investigate significant changes in monthly adherence during follow-up. Change in electronically monitored medication adherence over the 12 months following the conclusion of the SEE program. Of 48 participants, 39 (81%) completed the SEE program and continued electronic medication monitoring for up to 1 year after program cessation. The mean age of the participants was 64 years (standard deviation [SD], 10); of the 39 participants, 56% were male, 49% were Black, and 44% were White. The mean length of follow-up was 284 days (SD, 110; range, 41-365 days). Censoring occurred in 18 (56%) participants. The mean adherence during the follow-up period was 67% (SD, 22%). This was significantly lower than the adherence during the SEE program (mean, 81%; SD, 18%; P < 0.0001) but significantly higher than the baseline preprogram adherence (mean, 60%; SD, 18%; P= 0.0393). The largest monthly losses occurred at months 1 (mean, 7%; P= 0.0001) and 4 (mean, 6%; P= 0.0077). Glaucoma medication adherence decreased significantly in the year after cessation of the SEE coaching program but remained significantly higher than baseline adherence. To maintain excellent long-term medication adherence, intermittent reinforcement sessions may be necessary.

Assessment of Real-World Escalation to Biologics in US Patients With Asthma

Previous studies indicate that suboptimal medication adherence may contribute to uncontrolled asthma. Global Initiative for Asthma (GINA) guidelines recommend treatment escalation to biologics for patients with uncontrolled asthma despite adherence to high-dose maintenance medication and who have eosinophilic/allergic biomarkers or require maintenance oral corticosteroids. This study aimed to describe the clinical status of patients with asthma escalated to biologic therapy. This retrospective claims database analysis enrolled US patients with asthma who were escalated to biologics between January 2016 and June 2020. Exacerbations, control status, GINA step, and maintenance medication adherence during the 12 months before biologic therapy initiation were analyzed. Asthma control was assessed using both the European Respiratory Society/American Thoracic Society (ERS/ATS) and Stempel criteria. Adherence was defined as the proportion of days covered (PDC) by maintenance medication claims. Of 1786 patients escalated to biologics, 506 were included for analysis. During the 12 months before escalation, 346 patients had confirmed exacerbations. Uncontrolled asthma status was estimated in 55% and 70% of patients (ERS/ATS and Stempel criteria, respectively). GINA step was inferred for 395 patients: 154 were at step 2, 11 at step 3, 104 at step 4, and 126 at step 5. Of 403 patients with maintenance medication claims, 63% had suboptimal maintenance medication adherence (PDC <80%). In this study, most patients initiating biologic therapy had mild-to-moderate asthma or suboptimal maintenance medication adherence, possibly indicating inappropriate escalation. Incorporating objective medication adherence monitoring into existing guidelines may reduce inappropriate escalation to biologics.

Physical stability of stealth nanobeacon using surface-enhanced Raman scattering for anti-counterfeiting and monitoring medication adherence: Deposition on various coating tablets

Microtaggant technologies can encode individual numbers on coating tablet to authenticate pharmaceutical products and, therefore, combat the global spread of falsified medicine. In this study, a novel microtaggant, stealth nanobeacon (NB), with surface-enhanced Raman scattering (SERS) activity was applied to various coating tablets and its physical stability was evaluated. The NBs were composed of a reporter molecule (AH, adenine hydrochloride) and prepared with different sizes of gold nanoparticles (AuNPs). The NBs were directly deposited on the surface of various model coatings (e.g., hydroxypropyl cellulose, hydroxypropyl methyl cellulose, Eudragit® RS30D, ethyl cellulose). To investigate physical stability of the NB on the coating tablets, SERS spectra of the NB after friability test and acceleration test (store at 75% RH, 40 °C) were evaluated using a portable Raman spectrometer. After the friability test, there was no significant decrease in the peak intensity of the SERS signal (PH) for authentication in all samples. In the acceleration test, the SERS signals of the samples were attenuated, but sufficient SERS signal intensity (PH > 70) was maintained in the seven types of coating for authentication. These results demonstrate that the microtaggant NB has the potential to be used for a wide range of coating tablets.

Electronically monitored medication adherence in idiopathic pulmonary fibrosis: prevalence, predictors and outcomes.

Medication adherence studies in idiopathic pulmonary fibrosis (IPF) are limited, use cross-sectional designs and report discontinuation rates.We prospectively investigated adherence to pirfenidone in IPF patients using electronic monitoring, which provides insights on whether and when the medication was taken on a day-by-day basis. We investigated the impact of nonadherence on lung function and selected predictors for nonadherence based on the COM-B behavioural model. The longitudinal statistical analyses included generalised estimation equations and linear mixed effects models.55 patients initiating pirfenidone were followed-up for 2 years after diagnosis (76.4% men, mean age 71.1 years (range 50–87 years), mean forced vital capacity (FVC) 88% predicted (sd 18.3), mean diffusing capacity of the lung for carbon monoxide (DLCO) 58.1% predicted (sd 14.7)). Our data showed an association (p=0.03) between the proportion of days with three pirfenidone intakes (i.e. dosing adherence) and FVC % predicted, whereby a high dosing adherence seemed necessary to maintain stable or improving FVC % predicted values. 58.2% of the participants were able to implement at least 90% correct dosing days, yet adherence significantly decreased over time. Too short dosing intervals had negative effects on lung function outcomes. Knowledge on IPF and self-reported adherence were significantly associated with electronically measured adherence.In conclusion, nonadherence is prevalent and might negatively affect lung function. Further research is needed on the impact of nonadherence on outcomes and its predictors, so that tailored interventions can be developed. Meanwhile, a self-report questionnaire could be used to identify adherence issues and teams should equip patients with knowledge about their treatment and how to take it.

DEVELOPMENT OF A MOBILE APPLICATION BASED SPECIFIC STRESS SCALE FOR GESTATIONAL DIABETES MELLITUS

Gestational diabetes mellitus (GDM) is the type of diabetes that occurs in women at the time of gestation or pregnancy. Prevalence of GDM is increasing worldwide. Yearly 21 million new cases are reported. A normal pregnancy itself is linked with unique physical and psychological challenges and which is documented by medical fraternity. But no mention is made on psychological complaints specific to pregnant women diagnosed to have diabetes. It is well documented that diabetes is linked with significant distress level because it demands many lifestyle changes and pregnancy itself is a challenging condition. It stands to reason that a diabetic pregnancy will be linked with significant stress. Maternal exposure to stress can adversely affect the health of both foetus and mother. Stress can also affect diabetic management by influencing diet compliance, medication adherence and blood glucose monitoring. Studies also stated that stress can cause hyperglycaemia by altering hormone balance in body. Therefore any action plan for GDM must include proper stress management to obtain a desired outcome. Customised scales are available to measure the stress related to diabetes and normal pregnancy. But there was no specific scale available to measure GDM related stress scale. This study was undertaken to develop a mobile application based specific stress scale for GDM. A new scale called Gestational Diabetes Stress Scale (GDSS) was developed and introduced through a mobile application. This is a 16 item scale. GDSS gives total score and four subscale scores. A mean item score greater than or equal to 3 indicates the need of clinical attention. The total score is used to measure the overall stress level in patient. And the four subscale scores are to identify the possible sources of stress, which means whether the stress is due to emotional burden and/or medication related and/or health care set up and/or due to any economic or social relationship related and thus it allows the health care professional to manage the stress accordingly, thereby the gap in measuring gestational diabetes mellitus related stress was bridged and through the mobile application all the needed patients and health care providers can use it.

Personalized Care in Opioid Use Disorder maintained on Buprenorphine

IntroductionEffectiveness of buprenorphine (BUP) is moderated by medication misuse diversion and non-adherence, and poor retention and high cost. Contingency Managment has added benefit to BUP with Take-home doses as the most preferred reward by Opioid Use Disorder patients.ObjectivesExamine the clinical effectiveness of a novel incentivised medication adherence and abstinence monitoring to enable contingent access to increasing BUP take-home doses.Explore associations with opioid use and retention. Contrast characteristics of polysubstance abusers (PSA) and response to BUP, with single opioid users.MethodsTwo-arm, pragmatic, 16-week outpatient RCT of BUP maintenance.Takehome doses were provided as stepped-approach upto 4-weeks contingent of abstinence (UDS) and adherence according to Therapeutic Drug Monitoring-TDM. Primary outcome and secondard outcomes were % negative UDS for opioids anx retention, respectively. -ResultsOpioid % negative UDS was 76.7% (SD 25.0%) in I-AAM versus 63.5% (SD 34.7%) in TAU (13.3%; 95% [CI] 3.2%–23.3%; Cohen’s d 0.44; 95% CI 0.10–0.87). In I-AAM, 40 participants (57.1%) were retained versus 33 (46.4%) in TAU [OR: 1.54; 95% CI 0.79–2.98). PSA (73.7%, n=104) and carisprodol use increases non-fatal overdose (OR) 3.83, 95% CI 1.25 to 11.71) and 5.31, 95% CI 1.92 to 14.65], respectively. Opioid and non-opioid UDS are positively associated. BUP elimination rate (BUP-EL.R) predicts 26.5% to 65% of negative opioid UDS [Beta - 89.95, 95% CIl -154.20 to -25.70, R2 0.22]. Family enagement increases retention by 3-fold.ConclusionsBUP + incentivised TDM for contingent access to increasing take-home doses increased abstinence. BUP-EL.R seems promising in BUP treatment precision and BUP is clinically valuable in polysubstance abusers.Engaging family enhances retention.DisclosureNo significant relationships.

Abstracts 8th PCNE working symposium ‘Navigating research on pharmaceutical care’. 11–12 February 2022, Lisbon, Portugal

Abstracts 8th PCNE working symposium ‘Navigating research on pharmaceutical care’. 11–12 February 2022, Lisbon, Portugal

Time Trend Analysis of Tuberculosis Treatment While Using Digital Adherence Technologies-An Individual Patient Data Meta-Analysis of Eleven Projects across Ten High Tuberculosis-Burden Countries.

Worldwide, non-adherence to tuberculosis (TB) treatment is problematic. Digital adherence technologies (DATs) offer a person-centered approach to support and monitor treatment. We explored adherence over time while using DATs. We conducted a meta-analysis on anonymized longitudinal adherence data for drug-susceptible (DS) TB (n = 4515) and drug-resistant (DR) TB (n = 473) populations from 11 DAT projects. Using Tobit regression, we assessed adherence for six months of treatment across sex, age, project enrolment phase, DAT-type, health care facility (HCF), and project. We found that DATs recorded high levels of adherence throughout treatment: 80% to 71% of DS-TB patients had ≥90% adherence in month 1 and 6, respectively, and 73% to 75% for DR-TB patients. Adherence increased between month 1 and 2 (DS-TB and DR-TB populations), then decreased (DS-TB). Males displayed lower adherence and steeper decreases than females (DS-TB). DS-TB patients aged 15–34 years compared to those >50 years displayed steeper decreases. Adherence was correlated within HCFs and differed between projects. TB treatment adherence decreased over time and differed between subgroups, suggesting that over time, some patients are at risk for non-adherence. The real-time monitoring of medication adherence using DATs provides opportunities for health care workers to identify patients who need greater levels of adherence support.

A Theory of Planned Behavior informed factorial survey of New York community pharmacists to determine their intentions to monitor antihypertensive medication adherence among older adults

BackgroundOlder adults with uncontrolled hypertension can benefit from pharmacist-led interventions as they regularly access community pharmacies. However, several barriers to adherence interventions in a community pharmacy setting exist, and few studies have evaluated the feasibility of medication adherence monitoring within the community pharmacy workflow in the United States. ObjectivesTo undertake a factorial survey to determine medication adherence monitoring attitudes of pharmacists and the factors that facilitate or impede adherence counseling by pharmacists within a U.S. community pharmacy setting for antihypertensives in older adults. MethodsThe study was a Theory of Planned Behavior informed factorial survey of New York community pharmacists. The survey had (1) a factorial vignette, to determine how pharmacists make real-life decisions in response to complex situations; (2) questionnaires on medication monitoring attitudes, behavioral beliefs, normative beliefs, and perceived behavioral control regarding medication adherence monitoring, and (3) respondent and workplace characteristics. In response to vignettes, the adherence monitoring tasks were (1) examining patients dispensing records to assess adherence, (2) asking patients about their adherence behavior, and (3) exploring patient beliefs about their antihypertensives. ResultsFrom the 350 completed responses, more than the vignette characteristics, it was the pharmacist characteristics that explained the major variance in the 3 medication monitoring tasks. The respondents demonstrated modestly positive attitudes to medication monitoring, were less positive about their external perception of medication monitoring, and reported difficulty to perform the medication monitoring tasks. In factorial vignette analysis, these attitudes and beliefs significantly impacted adherence monitoring tasks as did situational factors such as time pressures, medication beliefs of patients, the relationship developed with patients, and staffing in the pharmacy, and respondent factors such as pharmacy type and location. ConclusionFuture community pharmacist-led adherence interventions should be designed to address pharmacist attitudes and beliefs and certain workplace characteristics to enable successful implementation.

Association Between High-Deductible Health Plans and Engagement in Routine Medical Care for Type 2 Diabetes in a Privately Insured Population: A Propensity Score-Matched Study.

High-deductible health plans (HDHPs) are increasingly more common but can be challenging for patients to navigate and may negatively affect care engagement for chronic conditions such as type 2 diabetes. We sought to understand how higher out-of-pocket costs affect participation in provider visits, medication adherence, and routine monitoring by patients with type 2 diabetes with an HDHP. In a retrospective cohort of 19,379 Kaiser Permanente Northern California patients with type 2 diabetes (age 18-64 years), 6,801 patients with an HDHP were compared with those with a no-deductible plan using propensity score matching. We evaluated the number of telephone and office visits with primary care, oral diabetic medication adherence, and rates of HbA1c testing, blood pressure monitoring, and retinopathy screening. Patients with an HDHP had fewer primary care office visits compared with patients with no deductible (4.25 vs. 4.85 visits per person; P < 0.001), less retinopathy screening (49.9% vs. 53.3%; P < 0.001), and fewer A1c and blood pressure measurements (46.7% vs. 51.4%; P < 0.001 and 93.2% vs. 94.4%; P = 0.004, respectively) compared with the control group. Medication adherence was not significantly different between patients with an HDHP and those with no deductible (57.4% vs. 58.6%; P = 0.234). HDHPs seem to be a barrier for patients with type 2 diabetes and reduce care participation in both visits with out-of-pocket costs and preventive care without out-of-pocket costs, possibly because of the increased complexity of cost sharing under an HDHP, potentially leading to decreased monitoring of important clinical measurements.