Medication Adherence Problems Research Articles

Pharmacist's Impact on Medication Adherence and Drug-Related Problems in Patients with Epilepsy.

Drug-related problems (DRPs) and non-adherence are important barriers to ensuring optimal antiseizure drug treatment. The aim of this study was to improve medication adherence, detect and manage DRPs, and decrease the number of seizures with pharmacist-led education in patients with epilepsy. A prospective and interventional study was conducted in collaboration with the Department of Neurology, the rational drug usage unit of a hospital pharmacy in a university hospital. The impact of pharmacist-led education on medication adherence and interventions in the management of DRPs was assessed in patients with epilepsy who were admitted to the outpatient clinic. A total of 39 patients with epilepsy were evaluated in terms of medication adherence, DRPs, and seizure control over a 2-month follow-up period and patient satisfaction with pharmacy services at the end of the study. A total of 59 DRPs were detected, and 71.2% of them were accepted and implemented both by physicians and/or patients. Pharmacist interventions solved 62.7% of DRPs. The number of patients with high-level medication adherence significantly increased from 17 to 28 after pharmacist-led education (p < 0.001). The number of seizures decreased in 19 patients (48.7%) during the 2-month period. Patient satisfaction was high in all patients. It is shown that the contribution of pharmacists in treating patients with epilepsy is beneficial in improving medication adherence, detection and management of DRPs, and decreasing the number of seizures.

The Effect of Comprehensive Tele-Education in Patients with Diabetes Mellitus: A Randomized Controlled Trial

Aim: This study aimed to investigate the effectiveness of remote education given via telehealth to individuals diagnosed with Type 2&#x0D; diabetes on exercise goals, physical activity, nutrition, medication habits and diabetes problems.&#x0D; Material and Methods: A randomized controlled trial was conducted with a total of 30 patients with diabetes mellitus (15 tele-education,&#x0D; 15 routine education). Individuals were educated about general information about diabetes, nutrition therapy, exercise, physical activity,&#x0D; drug therapy, and acute/chronic complications. Participants were evaluated with the Mini Nutritional Assessment, International Physical&#x0D; Activity Questionnaire, Goal Orientation in Exercise Measurement, Modified Morisky Medication Adherence Scale and Problem Areas&#x0D; in Diabetes Scale.&#x0D; Results: In terms of MNA scores, only the decrease in the score of routine rehabilitation was significant (p=0.041). The MNA score did&#x0D; not differ between the tele-education and routine rehabilitation groups (p&gt;0.05). Finally, the education program did not affect the other&#x0D; scores (p&gt;0.05).&#x0D; Conclusion: The study results showed that tele-education can only positively affect nutrition. However, both tele-education and routine&#x0D; training provided similar and ineffective results. Future studies could focus on remote education programs delivered through different&#x0D; educational methods.

Effect of a Medication Adherence Mobile Phone App on Medically Underserved Patients with Chronic Illness: Preliminary Efficacy Study.

Medication adherence is vital in the treatment of patients with chronic illness who require long-term medication therapies to maintain optimal health. Medication adherence, a complex and widespread problem, has been difficult to solve. Additionally, lower-income, medically underserved communities have been found to have higher rates of inadequate adherence to oral medications. Even so, this population has been underrepresented in studies using mobile medication adherence app interventions. Federally qualified health centers provide care for medically underserved populations, defined as communities and populations where there is a demonstrable unmet need for health services. These centers have been reporting an increase in a more complex chronic disease population. Including medically underserved individuals in mobile health studies provides opportunities to support this disproportionately affected group, work toward reducing health disparities in access to health care, and understand barriers to mobile health uptake. The aim of this preliminary efficacy study was to evaluate the effects and feasibility of a commercially available medication adherence app, Medisafe, in a medically underserved adult population with various chronic illnesses seeking care in a federally qualified health center. Participants in this single-arm pre-post intervention preliminary efficacy study (N=10) completed a baseline survey, used the app for 2 weeks, and completed an end-of-study survey. The primary outcome measures were medication adherence and medication self-efficacy. Feedback on the use of the app was also gathered. A statistically significant median increase of 8 points on the self-efficacy for adherence to medications scale was observed (P=.03, Cohen d=0.69). Though not significant, the adherence to refills and medications scale demonstrated a median change of 2.5 points in the direction of increased medication adherence (P=.21, Cohen d=0.41). Feedback about the app was positive. Use of the Medisafe app is a viable option to improve medication self-efficacy and medication adherence in medically underserved patients in an outpatient setting with a variety of chronic illnesses.

A Review on digital medicine and its implications in drug development process

A field known as "digital medicine" is focused with using technology as aid for assessment and involvement in the interest of better public health. Digital medical solutions are built on top-notch technology and software that supports the practice of medicine broadly, including treatment, rehabilitation, illness prevention, and health promotion for individuals and across groups. Digital medical products can be used independently or in conjunction with pharmaceuticals, biologics, devices, and other products to enhance patient care and health outcomes. With the use of smart, easily accessible tools, digital medicine equips patients and healthcare professionals to treat a variety of illnesses with high-quality, safe, and efficient measures and data-driven therapies. The discipline of digital medicine includes both considerable professional knowledge and responsibilities linked to the usage of these digital tools. The application of these technologies in digital medicine is supported by the development of evidence. Technology is causing changes in medicine. Wearable and sensors are becoming more compact and affordable, and algorithms are becoming strong enough to forecast medical outcomes. Nevertheless, despite quick advancements, the healthcare sector lags behind other sectors in effectively utilizing new technology. The cross-disciplinary approach necessary to develop such tools, needing knowledge from many experts across many professions, is a significant barrier to entry. The participation in digital medicine programs is optional, complies with all legal requirements and standards, and protects patient data in line with relevant state and federal privacy legislation, just like other data created and maintained in electronic medical records. Aside from helping doctors more correctly titrate dosages and assess how well a treatment works, experts say digital medicine programs hold promise as a solution to the problem of medication adherence.

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.

Predictors of medication adherence in a large 1-year prospective cohort of individuals with schizophrenia: insights from the multicentric FACE-SZ dataset

Schizophrenia is characterized by the most salient medication adherence problems among severe mental disorders, but limited prospective data are available to predict and improve adherence in this population. This investigation aims to identify predictors of medication adherence over a 1-year period in a large national cohort using clustering analysis. Outpatients were recruited from ten Schizophrenia Expert Centers and were evaluated with a day-long standardized battery including clinician and patient-rated medication adherence measures. A two-step cluster analysis and multivariate logistic regression were conducted to identify medication adherence profiles based on the Medication Adherence rating Scale (MARS) and baseline predictors. A total of 485 participants were included in the study and medication adherence was significantly improved at the 1-year follow-up. Higher depressive scores, lower insight, history of suicide attempt, younger age and alcohol use disorder were all associated with poorer adherence at 1 year. Among the 203 patients with initially poor adherence, 86 (42%) switched to good adherence at the 1-year follow-up, whereas 117 patients (58%) remained poorly adherent. Targeting younger patients with low insight, history of suicide, alcohol use disorder and depressive disorders should be prioritized through literacy and educational therapy programs. Adherence is a construct that can vary considerably from year to year in schizophrenia, and therefore may be amenable to interventions for its improvement. However, caution is also warranted as nearly one in five patients with initially good adherence experienced worsened adherence 1 year later.

Psychometric assessment of the Adherence to Asthma Medication Questionnaire in asthma patients in China: a validation study

Background Patients’ medication adherence plays a critical role in the treatment and rehabilitation of disease. However, few tools are currently available that can be used to identify the reasons for their nonadherence with their medication regimens. It is possible to evaluate both the level of medication adherence of a patient as well as the reasons for it using the Adherence to Asthma Medication Questionnaire (AAMQ). The purpose of this study was to adapt the AAMQ for use in Chinese patients and a variety of asthma patients. Methods A total of 242 asthma patients were recruited from Jinzhou in China. The Adherence to Asthma Medication Questionnaire was translated and back-translated using the Brislin translation model. Test-retest reliability, internal consistency, and stability all play a large role in determining the reliability of a scale. Confirmatory factor analysis was used to examine the scale’s construct validity, and expert consultation was used to verify the scale’s content validity. Statistics were deemed significant at p < 0.05. Results The Cronbach’s α value of the Chinese version of the AAMQ was 0.866, and the coefficient values for the three domains ranged between 0.702 and 0.798. The split-half reliability and stability values were 0.794 and 0.772, respectively. The content validity index of the scale (S-CVI) was 0.923, and the content validity index of the level of scale entry was 0.857–1.000. According to the confirmatory factor analysis, the chi-square degreed of freedom were 1.484, and the model fitting indices were all within normal limits. Conclusions The AAMQ had good reliability and validity for asthmatic patients. The results of the scale’s assessment can be used as a criterion for medication adherence among asthmatic patients and to understand the causes. This study provides a reference for solving the problem of medication adherence among asthma patients and implementing targeted nursing measures. Patient or public contribution Gratitude is extended to all individuals collaborating in completing the survey and to the author.

Pengaruh Edukasi Emo-Demo Terhadap Kepatuhan Minum Obat Pasien Hipertensi Pada Peserta Prolanis

The problem of medication adherence in individuals with hypertension remains a challenge, even in developing countries. The purpose of this study was to determine the effect of Emo demo education on adherence to taking medication in hypertensive patients enrolled in the Prolanis program at Puskesmas Sumbersari Lumajang. This study was conducted at Sumbersari Health Center in March 2023. This study used a quasi-experimental research design with a one group pre-post test design. The purposive sampling technique was chosen to select a sample of 50 respondents. This study used the MMAS-8-4 (Morisky Medication Adherence Scale) questionnaire as a measuring tool for medication adherence. Statistical tests using the Wilcoxon Signed Rank test. Before the emo-demo, most of the 22 (44%) respondents were at a low level of compliance. After emo-demo education, most of the respondents were in moderate compliance 33 (66%) and high compliance 14 (28%). The results of bivariate analysis show that Emo demo education has a significant effect on drug compliance in hypertensive patients participating in Prolanis, with a p-value of 0.000 which is smaller than the predetermined level of significance of 0.05. The provision of Emo Demo in health education with a focus on the target group is expected to be facilitated by the puskesmas. Effective medication adherence among hypertensive patients can improve control of blood pressure and prevent complications of the disease.

Exploration of the psychometric properties of the novel General Medication Adherence Scale (GMAS) for chronic illness patients

Objective Many related scales have been developed and applied to measure patients’ medication adherence, but the research on the psychometric characteristics of the scale still requires further studies. This study aims to provide further validation of the GMAS scale by using Rasch analysis and to make targeted recommendations for scale improvement. Methods This is a cross-sectional study using secondary data. 312 Chinese adult patients were recruited from two tertiary hospitals and one community health service center in Tianjin to complete a questionnaire containing the GMAS, from January to June 2020. Participants included to have at least one chronic condition and also have been on medication for more than 3 months, but excluded patients with major life-threatening illnesses (e.g. heart failure, cancer), cognitive impairments preventing clear expression and significant communication difficulties. Rasch analysis was used to explore the psychometric properties of the GMAS scale. Key indicators including unidimensionality, validity and reliability, differential item functioning and degree of fit with Rasch model are validated. Results After fitting the Rasch model for the first time, 56 samples poorly fitting the model were deleted. The remaining 256 samples were used for Rasch analysis. The results show that GMAS can fit the Rasch model well, which proves that the scale has favourable psychometric characteristics. But some items had differential item functioning in whether patients have comorbidities. Conclusion The GMAS was found to be useful as a screening tool for patients’ medication adherence problems reported, except some issues to be addressed for further improvement of the scale.

The use of herbal medicines in patients with type-2 diabetes mellitus in Indonesia

In Indonesia, the use of herbal medicine as an alternative medicine is increasing. Herbal remedies are used as complementary medicine and self-medication. Diabetes mellitus requires treatment over the long term. This may contribute to the medication adherence problem. Consequently, many patients seek alternative treatments, such as herbal medications. The purpose of this study was to determine the use and type of herbal medicines among diabetic patients in Indonesia. A cross-sectional study with 190 respondents selected at random from multiple cities in Indonesia. A questionnaire was used to determine the most frequently used herbal medicine, the demographic profile of the patients, the health services, and the level of patient satisfaction with the use of herbal medicines. The participants were predominantly female (62.7%), housewives (39.5%), aged between 40 and 65 (84.5%), high school graduates (74.7%), and had low to moderate incomes (74.7%). The use of herbal medicine was 22%, and the combination of herbal medicine and prescription medication was 6%. Bitter leaves (10%), mangosteen peel (8.9%), insulin leaves (7.9%), mahkota dewa herbs (6.3%), and bitter melon are used as herbal or traditional medicines (4.7%). In terms of satisfaction, 28.7%, 40.9%, and 14.4% of respondents were quite satisfied, satisfied, and very satisfied with the use of herbal medicines, respectively. Herbal remedies are commonly used in alternative diabetes treatments. Bitter leaves are the most frequently used herb, with over half of respondents expressing satisfaction with the benefits of herbal medicine.

The impact of the COVID-19 pandemic on medical conditions and medication adherence in people with chronic diseases

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has drastically disrupted primary health care and pharmacy services, posing a challenge in people with chronic diseases who receive routine care. Currently, there exists limited literature on the indirect impact of the pandemic on chronic disease management, particularly related to accessibility to medications and health care resources. ObjectivesTo determine the prevalence of medical- and medication-related problems reported by people with chronic diseases during the pandemic. The secondary objective was to identify the barriers and contributing factors related to these medical- and medication-related problems. MethodsThe anonymous and voluntary, Web-based survey was filled out by interested adult respondents with chronic disease(s) across Michigan between September 1, 2020, and January 1, 2021. The primary outcome included self-reported medical- and medication-related problems during the pandemic. Secondary outcomes included potential risk factors for medical- and medication-related problems. Descriptive statistics was used to describe respondents’ demographics, chronic disease characteristics, medication adherence, medical- and medication-related problems, and COVID-19–related factors. The multivariable Firth logistic regression was used to analyze correlations between potential risk factors associated with medical- and medication-related problems. ResultsA total of 1103 respondents completed the survey and were included in the analysis. Approximately, 51% of respondents reported a medication-related problem with 19.6% reported problems obtaining medication(s) and 31.7% reported forgetting or not taking their medication(s). The top reason for problems obtaining medication(s) was doctor’s office being closed for in-person visit(s). In addition, of all responses, more than half reported worsening symptoms of their chronic disease(s) during the pandemic especially with psychiatric disorders (79.5%) and inflammatory bowel disease (60%). Respondents with a significantly higher risk of medication-related problems included those who were younger, were female, and had psychiatric disorder(s), diabetes, arthritis, or lupus, and respondents with a significantly higher risk of medical-related problems included those with multiple chronic diseases, psychiatric disorder(s), and heart failure. ConclusionUnderstanding the consequences of the pandemic, such as medical- and medication-related problems, in this population is critical to improving health care accessibility and resources through potential outpatient pharmacy services during this and future pandemics.

The impact of community pharmacists on older adults in Turkey

ObjectiveThis study aimed to evaluate the impact of theory-based, structured, standardized pharmaceutical care services led by community pharmacists (CPs) on patient-related outcomes in older Turkish adults. Practice descriptionThis prospective, quasi-experimental pilot study was conducted at the national level at community pharmacies in Turkey. After virtual training of CPs, pharmaceutical care services including medicine bag check-up, medication review, patient medicine card, patient education, and counseling services (including motivational interviewing) were delivered to promote medication adherence in older adults. Practice innovationTheory-based, structured, standardized pharmaceutical care services addressing medication adherence problems in older Turkish adults with noncommunicable diseases. Evaluation MethodsDescriptive data (including demographic and clinical data, medication-related problems by using the DOCUMENT classification, potential inappropriate prescribing by using the Ghent Older People’s Prescriptions Community Pharmacy Screening- (GheOP3S) tool, and pharmacy service satisfaction) were presented. Pre- and post-evaluation were compared by using the Wilcoxon test (for continuous variables) and McNemar’s or McNemar-Bowker chi-square test (for categorical variables). ResultsOne hundred and thirty-eight medication-related problems were identified among 52 older adults. The medication adherence rate was significantly increased from 51.9% to 75%, and the mean of total quality of life (QoL) score rose significantly from 51.7 to 53.4 (P < 0.05). There was a statistically significant change in the median of necessity-concern differential (baseline: 7 [2.2–10.0] vs. final: 8.0 [5–11]; P < 0.05). At baseline, all patients had at least 1 potential inappropriate prescribing according to the GheOP3S tool, and the rate was 73.1% at the final assessment. ConclusionCommunity pharmacist-led pharmaceutical care services significantly improved patient-related outcomes (such as medication adherence, beliefs about medication, and QoL) in older adults with noncommunicable diseases. No statistically significant change was detected in their lifestyle behaviors (such as physical activity and diet program) or health awareness.

A non-randomised pilot study of the Solutions for Medication Adherence Problems (S-MAP) intervention in community pharmacies to support older adults adhere to multiple medications

BackgroundOlder patients prescribed multiple medications commonly experience difficulties with adherence. High-quality evidence on interventions targeting older patients is lacking. Theory is rarely used to tailor adherence solutions. This study aimed to pilot test a novel intervention, developed using the Theoretical Domains Framework, which guides community pharmacists in identifying adherence barriers and delivering tailored solutions (behaviour change techniques). Key study procedures (e.g. recruitment, data collection) for a future randomised controlled trial (cRCT) were also assessed.MethodsUsing purposive sampling, this non-randomised pilot study aimed to recruit 12 community pharmacies (six in Northern Ireland; six in London, England). Pharmacists were trained to deliver the intervention to non-adherent older patients (maximum 10 per pharmacy; target n = 60-120) aged ≥ 65 years (reduced to 50 years due to recruitment challenges) and prescribed ≥ 4 regular medicines. The intervention, guided by an iPad web-application, was delivered over 3-4 face-to-face or telephone sessions, tailored to specific barriers to adherence. We assessed the feasibility of collecting adherence data (primary outcome: self-report and dispensing records), health-related quality of life (HRQOL) and unplanned hospitalisations (secondary outcomes) at baseline and 6-months. The final decision on progressing to a cRCT, using pre-defined ‘stop-amend-go’ criteria, is presented.ResultsFifteen pharmacists from 12 pharmacies were recruited and trained. One pharmacy subsequently dropped out. Sixty patients were recruited (meeting the ‘Amend’ progression criteria), with 56 receiving the intervention. Adherence barriers were identified for 55 patients (98%) and a wide range of behaviour change solutions delivered (median: 5 per patient). Self-report and dispensing adherence data were available for 37 (61.7%) and 44 (73.3%) patients, respectively. HRQOL data were available for 35 (58.3%) patients. GP-reported and self-reported hospitalisations data were available for 47 (78.3%) and 23 (38.3%) patients, respectively. All progression concepts were met (nine ‘Go’ and three ‘Amend’ criteria).ConclusionThis study demonstrates the feasibility of key study procedures (e.g. pharmacy recruitment) and delivery of a tailored adherence intervention in community pharmacies. However, modifications are required to enhance issues identified with patient recruitment, retention and missing data. A future definitive cRCT will explore the effectiveness of the intervention.Trial registrationISRCTN, ISRCTN73831533, Registered 12 January 2018.

Diabetes distress and peripheral neuropathy are associated with medication non-adherence in individuals with type 2 diabetes in primary care.

Psychosocial factors like diabetes distress and social support, as well as the presence of complications, affect an individual's self-management ability; however, their role in adherence behaviours is not yet clear. We examined the role of psychosocial factors and complications in non-adherence behaviours in individuals with diabetes in primary care. Baseline survey with nine-month follow up through medical records of patients with type 2 diabetes attending primary care. Medication adherence and diabetes distress were assessed using Morisky Green Levine Medication Adherence Scale and Problem Areas in Diabetes, respectively. Appointment adherence was assessed through medical records. Of the 448 participants studied, 59.8% had medication non-adherence and 21.7% were non-adherent to scheduled appointments. PAID score (odds ratio (OR) 1.01, 95% confidence interval 1.00-1.03, p = 0.013), peripheral neuropathy (OR 1.99, 95%CI 1.18-3.37, p = 0.01), home glucose monitoring (OR 0.46, 95%CI 0.30-0.69, p < 0.001), HbA1c (OR 1.34, 95%CI 1.13-1.61, p = 0.001), and age (OR 0.96, 95%CI 0.93-0.98, p = 0.001) were associated with medication non-adherence. Indian ethnicity (OR 2.93, 95%CI 1.59-5.39, p = 0.001), secondary or higher education (OR 1.94, 95%CI 1.14-3.27, p = 0.014), and HbA1c (OR 1.38, 95%CI 1.18-1.63, p < 0.001) were associated with appointment non-adherence. Non-adherence behaviours were prevalent and significantly associated with higher HbA1c. Medication non-adherence was more likely in younger individuals, those with higher diabetes distress or peripheral neuropathy. Appointment non-adherence was more likely in individuals of Indian ethnicity or those with higher education. Greater support for these groups may help improve adherence behaviours and outcomes.

Questionnaires and scores for assessing medication adherence — advantages and disadvantages of the diagnostic method in research and actual clinical practice

The problem of medication adherence is still relevant, and the search for a reliable method for its diagnosis continues. One of the most convenient and promising ways to assess medication adherence, both in research and actual clinical practice, is the use of various questionnaires and scores. Currently, several dozen different questionnaires and scores are presented in Russia and other countries. All of them are indirect methods of adherence assessment and are characterized by subjectivity. The article presents data on the most famous and widely used foreign adherence scales (the 4- and 8-item Morisky Medication Adherence Scale (MMAS-4 and MMAS-8), Hill-Bone, SEAMS, BMQ, MARS, etc.) and several questionnaires proposed by Russian authors (the National Society of Evidence-based Pharmacotherapy Adherence Scale, the Quantitative Adherence Questionnaire and the National Questionnaire of Treatment Compliance). The main characteristics of the described scales, their advantages, disadvantages and prospects for use in studies and clinical practice are considered. There are following conclusions: 1) none of the current questionnaires is devoid of subjectivity; 2) almost all questionnaires overestimate medication adherence, do not fully diagnose nonadherence, and often determine only specific type of adherence; 3) even validated questionnaires, which used in patients with different diseases in various countries, can have different values of sensitivity, specificity and reliability — from excellent to very poor; 4) in this regard, the results should be skeptically and cautiously interpreted; 5) in actual clinical practice, preference should be given to concise scales that include no more than 10 questions, with a simple scoring system, preferably validated with using well-known criteria from large clinical trials; 6) to improve the diagnosis accuracy, usage of several available methods for assessing medication adherence is recommended.

A systematic overview of systematic reviews evaluating medication adherence interventions.

To systematically summarize evidence from multiple systematic reviews (SRs) examining interventions addressing medication nonadherence and to discern differences in effectiveness by intervention, patient, and study characteristics. MEDLINE, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects were searched for papers published from January 2004 to February 2017. English-language SRs examining benefits of medication adherence interventions were eligible. Inclusion was limited to adult patients prescribed medication for 1 of the following disease conditions: diabetes and prediabetes, heart conditions, hypertension and prehypertension, stroke, and cognitive impairment. Non-disease-specific SRs that considered medication adherence interventions for older adults, adults with chronic illness, and adults with known medication adherence problems were also included. Two researchers independently screened titles, abstracts, and full-text articles. They then extracted key variables from eligible SRs, reconciling discrepancies via discussion. A MeaSurement Tool to Assess systematic Reviews (AMSTAR) was used to assess SRs; those with scores below 8 were excluded. Conclusions regarding intervention effectiveness were extracted. Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methodology was applied to assess evidence quality. Of 390 SRs, 25 met the inclusion criteria and assessed adherence as a primary outcome. Intervention types most consistently found to be effective were dose simplification, patient education, electronic reminders to patients, and reduced patient cost sharing or incentives. Of 50 conclusions drawn by the SRs, the underlying evidence was low or very low quality for 45 SRs. Despite an abundance of primary studies and despite only examining high-quality SRs, the vast majority of primary studies supporting SR authors' conclusions were of low or very low quality. Nonetheless, health system leaders seeking to improve medication adherence should prioritize interventions that have been studied and found to be effective at improving patient adherence, including dose simplification, education, reminders, and financial incentives.

Pilot Testing Of A Brief Pre-Consultation Screener For Improving The Identification And Discussion Of Medication Adherence In Routine Consultations.

ObjectiveOne of the challenges in being able to identify and manage medication adherence problems in routine practice is that patients are often reluctant to “admit to” non-adherence, particularly when asked in a direct way. The study reported in this paper has been designed as part of an attempt to address this problem by examining the value of a new brief medicines use screener in helping patients to identify and discuss adherence issues in a clinical setting.Methods145 Patients with type 2 diabetes completed the new screener (MMWFU) together with an adherence self-report scale (MMAS4) and medication beliefs questionnaire (BMQ). Correlations between the scales were assessed together with an assessment of the sensitivity and specificity of the new screener.Results126 (88%) of the sample identified at least one medicines-related issue on the MMWFU, which showed strong correlations with the MMAS4 and BMQ Concerns scales, as well as good sensitivity and specificity against the MMAS4.ConclusionThe results indicate that the new screener can serve as a fairly sensitive indicator of non-adherence and its determinants. Future studies will be needed to establish how well it performs in other clinical settings.

A COMPARATIVE STUDY ON EFFICACY OF COLLAGEN PEPTIDE ACECLOFENAC AND PARACETAMOL VERSUS ACECLOFENAC AND PARACETAMOL ALONE FOR THE TREATMENT OF KNEE OSTEOARTHRITIS.

Background: The existing treatment for Osteoarthrits (OA) is symptomatic by NSAIDS are effective for reducing pain associated with OA, they do not reverse the disease. This makes way for the emergence of nutraceuticals like collagen peptide which are chondroprotective in nature.&#x0D; Objectives: To assess the prevalence of knee OA, efficacy of combination of collagen peptide, aceclofenac and paracetamol against aceclofenac and paracetamol alone in the treatment of osteoarthritis, the medication adherence and drug related problems in OA.&#x0D; Methods: A prospective observational study was carried out in the outpatients of Department of Orthopaedics, BMCH &amp; RC and Ambarish’s Clinic, Chitradurga. A total of 154 patients suffering from OA were identified. 60 subjects of Grade I knee OA were selected for the study from 112 cases of knee OA. The subjects were divided in two groups; Group A comprised of 30 subjects who were treated with collagen peptide, aceclofenac and paracetamol (Acetaminophen) for a period of two months, with a follow up of one month and the therapy was assessed by Visual Analogue Scale(VAS). Whereas Group B of 30 subjects who were treated with aceclofenac and paracetamol for two months with a follow up of one month and assessed by VAS.&#x0D; Results: The prevalence of knee osteoarthritis was found to be 72.72%.Among them Grade I was 77.67%. From this 60 patients were selected for further study of which 90% were females and 10% males. At the end Group A showed better results than Group B. Acetaminophen and Aceclofenac related gastrointestinal disturbances were found in both the groups. Majority of the patients also had good medication adherences.&#x0D; Conclusion: The study identifies and supports the use of collagen peptide to provide symptomatic relief and can be used as adjunct therapy for OA management.&#x0D; Keywords: Knee osteoarthritis, nutraceuticals, collagen peptide, Visual Analogue Scale.

Users' Interpretation of Pictograms and Pictures for Conveying Instructions and Warnings on Pharmaceutical Labels.

Pharmaceutical pictograms are figures that provide a visual representation of medication instructions and warnings. Pictograms were created in order to lower the continuously rising problem of poor medication adherence due to patients misunderstanding what is being instructed on medication labels. Research on pictograms show that their use could increase patients' comprehension of medication instructions, but the comprehension rates are still low. Researchers have argued that in order to improve the effectiveness of pictograms, they must be more concrete, simple, meaningful, and familiar. Pictures have these properties. Thus, the goal of this study was to examine if the use of pictures (i.e., real images) provide a better representation of what is being instructed to users on medication labels than pictograms. We hypothesized that real images would lead to a better understanding of the instructions and warnings for taking medication, and in turn, users would have higher comprehension levels. Participants completed an online survey evaluating the meaning of either pictograms or pictures. Both quantitative and qualitative data analyses were conducted on free responses to the questions and on users' ratings of the "goodness" of the stimuli. The results showed that participants were moderately accurate (74%) in their interpretation of pictograms, and the use of pictures did not improve their comprehension.

Abstract 079: Long-Lasting RNAi Therapeutics Targeting Angiotensinogen Induces a Robust and Durable Antihypertensive Effect

All angiotensin stems from angiotensinogen (AGT). A single dose of small interfering ribonucleic acids (siRNA) targeting AGT may provide long-lasting blood pressure reductions, as it would abolish angiotensin generation. Here we assessed efficacy of AGT siRNA in spontaneously hypertensive rats (SHRs). SHRs were treated for 4 weeks with vehicle, siRNA (10 mg/kg; s.c. every 2 weeks), valsartan (31 mg/kg/day; oral), captopril (100 mg/kg/day; oral), valsartan+siRNA, or captopril+valsartan (all groups n=8). Mean arterial pressure (MAP) was measured via radiotelemetry. Baseline MAP was 137±2 mmHg. ΔMAP was largest after valsartan+siRNA (-67±3 mmHg; P&lt;0.01 vs. captopril+valsartan), followed by captopril+valsartan, captopril, siRNA and valsartan (-55±4, -24±2, -14±1, and -9±2 mmHg, respectively). Valsartan+siRNA reduced cardiac hypertrophy the most (P&lt;0.05 vs. captopril+valsartan). After 4 weeks, siRNA lowered AGT by 98.6%, which increased to 99.9% in combination with valsartan. All treatments increased renin, the highest rise occurring after valsartan+siRNA. Yet, only valsartan+siRNA lowered angiotensin II. No treatment altered aldosterone. Plasma K + tended to increase in all groups, significance being reached only in the valsartan+siRNA group. Both types of dual blockade attenuated normal growth from the second week of treatment onwards. In conclusion, due to renin upregulation, circulating angiotensin II remained intact even with only 1.4% of AGT left, relative to pretreatment. Consequently, AGT siRNA caused a similar antihypertensive effect as valsartan and captopril. Importantly, when combining siRNA+valsartan, angiotensin II collapsed, and blood pressure decreased synergistically. Given the potential for low dosing frequency suggested by this study, this novel treatment may address medication adherence problems in patients with resistant hypertension and further development is warranted.