Medication Refill Research Articles

Description of patient questions received by clinical pharmacists in the Nudge Study.

The Nudge Study is a patient level-randomized trial testing different text message medication refill reminders sent to patients assigned to 4 arms: (1) usual care, (2) generic text, (3) optimized text, and (4) optimized text plus chatbot. This report describes the frequency and types of patient questions sent to clinical pharmacists (CPs) following text reminders. Patients were enrolled from Denver Health and Hospital Authority (DHHA) and Veterans Affairs Eastern Colorado Health Care System (VA ECHCS) from October 1, 2019, through May 30, 2021. Included patients responded to at least 1 text or interactive voice response (IVR) message. Patients were dichotomized as those who posed at least 1 question to a CP and those who posed no questions. Of the 6,325 patients enrolled in an intervention arm, 3,323 (52.5%) responded to at least 1 text or IVR message, and among those responding, 305 (9.2%) responded with a pharmacist question. Patient factors associated with submitting a CP question included age (45-74 years), enrollment from DHHA, and receipt of the optimized text or optimized text plus chatbot message versus the generic text. Questions to CP were in the following categories: medication related (48.2%), refill logistics (38.4%), cost (9.2%), and other (17.7%). In a text messaging intervention focused on medication refills, there were few questions directed to the CP. Patients assigned to receive optimized texts were more likely to have questions. We hypothesize that this may suggest greater patient engagement regarding their condition, resulting in more questions.

Targeted Telephone-Based Outreach Reconnects Glaucoma Patients With Subspecialty Care.

A personalized telephone-based intervention is a cost-effective method to return overdue patients with open angle glaucoma (OAG) to subspecialty care. Patients who accepted care overwhelmingly preferred in-person appointments with their provider instead of hybrid visits with telehealth. To evaluate the effectiveness of a telephone-based outreach strategy to reconnect OAG patients with subspeciality care. Established patients with OAG who were seen before March 1, 2021, but had not returned for care in the following year were contacted via a telephone-based intervention. Patients lost to follow-up (LTF) were offered the option of an in-person visit or a hybrid telehealth visit, which combined in-office testing of vision, intraocular pressure, and optic nerve imaging with a virtual consultation with their glaucoma specialist on a separate date. Of 2727 patients with OAG, 351 (13%) had not returned for recommended care. Outbound calls reached 176 of those patients (50%). Nearly half of all patients contacted readily accepted care, with 71 scheduling in-person appointments (93%) and 5 selecting hybrid visits (6.6%). Medication refills were requested by 17 of those 76 patients, representing nearly a third of the 56 patients who were treated with topical glaucoma medications. Assessment of the program 90 days later found that 40 patients had returned for care, 100 patients had transferred or declined further care, and 40 patients were identified as deceased, lowering the LTF rate to 6.4%, with 15 patients still scheduled for future visits. On the basis of an average call duration of 2.8±2.0 minutes, the added cost of returning a patient with OAG to care by the program was $28.11. Providing targeted outreach by telephone is an effective and cost-efficient strategy to reconnect OAG patients LTF with subspecialty care.

RETRACTED ARTICLE: Development of attributes and attribute levels for a discrete choice experiment on patients’ and providers’ choice for antiretroviral therapy service in Northwest Ethiopia

BackgroundDiscrete choice experiments (DCEs) are used to assess the strength of preferences and value of interventions. However, researchers using this approach have been criticized for not conducting or publishing rigorous studies to select the required attributes and levels. Proper specification of attributes and their levels determines the validity of DCE. Hence, our study aimed to identify and define attributes and levels for the design of a DCE to elicit patients’ and providers’ preferences for ART service in Northwest Ethiopia.MethodsFour stages were followed to derive the final list of attributes and levels: (1) a literature review to derive conceptual attributes; (2) key informant interviews of 17 providers and in-depth interviews of 15 adult stable patients to identify context-specific attributes and attribute levels; (3) ranking survey among 31 HIV/AIDS program implementers and rating survey among 35 adult stable patients and 42 health workers providing antiretroviral therapy (ART) service to indicate participants’ preference of attributes; and (4) an expert opinion to reduce the list of attributes and levels.ResultsFirst, a literature review identified 23 candidate attributes. Second, individual-level analysis of the qualitative transcripts confirmed 15 of these 23 attributes. Third, the ranking and rating surveys put the importance of the 23 ART service attributes in order of preference. Fourth, through discussions with eight experts, 17 attributes were discarded based on multiple criteria. The six retained attributes were: the location of ART refills, the frequency of receiving ART refills, the person providing ART refills, the participants/others seen at the same ART refill visit, medication refill pick-up/delivery times, and the total cost of the visit during antiretroviral (ARV) medication refill. Finally, levels were assigned to these 6 attributes based on data from the literature, transcripts, and knowledge of the Ethiopian context.ConclusionsThis detailed description illuminates the attribute development process and provides the reader with a basis for evaluating the rigor of this phase of DCE construction. This paper contributes empirical evidence to the limited methodological literature on attributes and levels of development for DCE, thereby providing further empirical guidance on ART service preference, specifically among patients of low- and middle-income countries.

HSD18 Patient Experience of Using Telehealth Services during COVID-19 in Dubai Health Authority: A Retrospective Cross-Sectional Electronic Survey

To examine patients’ telehealth usability during COVID-19 in Dubai. A cross-sectional retrospective study adopted Telehealth Usability Questionnaire (TUQ). A total of 64,173 participants who used telehealth services during 2020 – 2021 were recruited from the electronic medical record to participate in electronic survey from October to December 2022. The survey was administered through DHA text messaging system. The survey examined participants’ characteristics and the six domains of TUQ with a Likert scale. Frequency, percentage, and weighted mean score percentages were used as descriptive statistics to analyze this data. A total of 1,535 participants completed the survey. The overall TUQ showed the mean age of users was 43.37 years (±11.67 SD). More than half of the users were females (65.21%), the majority were married (74.46%), of a UAE nationality (83.58%), had higher education (56.68%), and were currently working (57.13%). Consultations and COVID-19-related concerns (45.14%), medication refills (19.80%), and laboratory tests (18.24%) were the main reasons for telehealth visits. Weighted means of TUQ six domains were usefulness (87.11%), ease of use and learnability (86.98%), interface quality (85.73%), interaction quality (86.44%), reliability (79.48%), and satisfaction and future use (86.44%). Our study revealed high levels of usability and willingness to use telehealth services as an alternative modality to in-person consultations among the participants of the survey. Our results support the implementation of telehealth services in DHA; however, further studies are required to understand the applicability of telehealth after COVID-19 and how to further improve satisfaction.

Implementation of the appointment-based model in community pharmacies: An analysis of refills and adherence

BackgroundTraditionally, much of community pharmacy practice relies on patients to request their own medication refills. These refills are often not aligned, which has been shown to decrease adherence and workflow efficiencies. The appointment-based model (ABM) is designed to proactively synchronize refills and schedule patient-pharmacist appointments. ObjectivesTo describe the characteristics of patients enrolled in the ABM; and to compare the number of distinct refill dates, number of refills, and adherence for antihypertensives, oral antihyperglycemics, and statins 6-months and 12-months pre-post ABM implementation. MethodsIn September 2017, the ABM was implemented across independent community pharmacies within a pharmacy banner in Ontario, Canada. In December 2018, a convenience sample of three pharmacies was extracted. Demographic and clinical characteristics were collected on program enrollment (index) date for individual patients and their medication fill histories were used to investigate adherence measures including distinct number of refill dates, number of refills, and proportion of days covered. Descriptive statistics were analyzed using StataCorp. ResultsAnalysis of 131 patients (48.9% male; mean age 70.8 years ± 10.5 SD) filled on average 5.1 ± 2.7 medications with 73 (55.7%) experiencing polypharmacy. Patients had a significant reduction in mean number of refill dates (6.8 ± 3.8 SD six-months pre-enrollment, 4.9 ± 3.1 SD six-months post-enrollment, p < 0.0001). Adherence to chronic medications remained high (PDC ≥95%). ConclusionThe ABM was implemented for a cohort of established users, already highly adherent to their chronic medications. Results demonstrate reduced filling complexity and fewer refill dates while also sustaining the high baseline adherence across all chronic medications studied. Future studies should investigate patient perspectives and potential clinical benefits of the ABM.

(425) Counterincision for High Submuscular Penile Prosthesis Reservoir Placement

Abstract Introduction Inflatable penile prosthesis (IPP) reservoir placement into the high submuscular (HSM) space is safe and well tolerated. Recent studies have proposed that reservoirs placed via an abdominal counterincision (CI) may offer more precise positioning with herniation rates comparable to a transinguinal (TI) approach. Objective Our objective was to evaluate the CI-HSM technique with respect to operative time, pain control, and complications. Methods We retrospectively reviewed our patient database to identify all men who underwent IPP reservoir placement via the CI-HSM technique. From this database, a similarly sized and matched control group of TI-HSM patients was identified based on concomitant procedures, date of surgery, age, and medical history. Operative time, intraoperative and postoperative complications, morphine milligram equivalents (MME) prescribed, and postoperative patient phone calls were also compared between TI-HSM and CI-HSM patients. Statistical analysis was performed using Student’s T-test and Fisher’s Exact test for continuous and discrete variables, respectively. Results Among 580 IPP cases identified, CI-HSM technique was used in 44 (7.6%). Of these, thirty-five (80%) were primary implants, nine (20.4%) were remove/replace revisions, and seven (15.9%) were combined with other ancillary procedures (i.e. artificial urinary sphincter, urethral slings, or penile plications). The TI-HSM technique was used in 536 patients (92.4%); of these, 44 matched controls were identified for comparison to the CI-HSM cohort. Thirty-four (77%) of these patients underwent primary implants while ten (23%) were revision cases. Cases employing the CI-HSM technique had a longer mean operative time (90 minutes) compared to those using the TI-HSM technique (75 minutes) (Table). A similar number of CI-HSM patients (3/44, 6.8%) were treated for infection versus TI-HSM patients (1/44, 2.2%). Reservoir herniation was not observed in the CI-HSM cohort, however one (2.2%) patient in the TI-HSM matched control cohort required revision secondary to herniation. No differences were identified between TI-HSM and CI-HSM patients with regards to outpatient medications, narcotic medication refills, or postoperative phone calls. Conclusions IPP reservoir placement via CI-HSM technique is safe and well tolerated. Operative times were similar as compared to reservoirs placed via TI-HSM technique. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast.

Systematic review of the impact of medication synchronization on healthcare utilization, economic, clinical, and humanistic outcomes

AbstractMedication synchronization (med‐sync) or appointment‐based medication synchronization (ABMS) programs allow patients to have their chronic medication refills aligned to one pickup day. For patients on multiple chronic medications, it provides a more manageable way of picking up those medications. The objective of the study was to systematically characterize literature describing economic and healthcare utilization, clinical, and humanistic outcomes for patients enrolled in med‐sync. A literature search was conducted on PubMed, International Pharmaceutical Abstracts (Ovid), CINAHL (EBSCO), EMBASE (Elsevier), and Cochrane Library. Studies were included if they were conducted at a pharmacy in the United States, between January 2008 and October 2022, and evaluated the impact of med‐sync on at least one of the four outcomes of interest (utilization, economic, clinical, and humanistic). The title and abstracts were screened, followed by a full‐text review and final data extraction by two researchers. A data extraction template and Cochrane risk of bias tool were used for data collection and quality assessments, respectively. The search resulted in 1617 studies and finally, 27 studies were included in the systematic review. All studies included patients enrolled in either ABMS, med‐sync, or in conjunction with other pharmacy services. Across all studies evaluating medication adherence, proportion of days covered (PDC) increased. All studies that administered patient surveys showed a majority of patients were satisfied with their med‐sync program. One study showed a reduction in healthcare utilization and costs, while another study indicated no change. Med‐sync programs have shown clinical outcomes, specifically to improve adherence in patients taking chronic medications. In terms of humanistic outcomes, patient surveys have shown high rates of satisfaction with med‐sync programs. Additional studies are needed to determine if med‐sync can lead to improvements in healthcare utilization and cost outcomes.

Self-reported adherence and reasons for nonadherence among patients with low proportion of days covered for antihypertension medications.

BACKGROUND: Incorporation of pharmacy fill data into the electronic health record has enabled calculations of medication adherence, as measured by proportion of days covered (PDC), to be displayed to clinicians. Although PDC values help identify patients who may be nonadherent to their medications, it does not provide information on the reasons for medication-taking behaviors. OBJECTIVE: To characterize self-reported adherence status to antihypertensive medications among patients with low refill medication adherence. Our secondary objective was to identify the most common reasons for nonadherence and examine the patient sociodemographic characteristics associated with these barriers. METHODS: Participants were adult patients seen in primary care clinics of a large, urban health system and on antihypertensive therapy with a PDC of less than 80% based on 6-month linked electronic health record-pharmacy fill data. We administered a validated medication adherence screener and a survey assessing reasons for antihypertensive medication nonadherence. We used descriptive statistics to characterize these data and logistic and Poisson regression models to assess the relationship between sociodemographic characteristics and adherence barriers. RESULTS: The survey was completed by 242 patients (57% female; 61.2% White; 79.8% not Latino/a or Hispanic). Of these patients, 45% reported missing doses of their medications in the last 7 days. In addition, 48% endorsed having at least 1 barrier to adherence and 38.4% endorsed 2 or more barriers. The most common barriers were being busy and having difficulty remembering to take medications. Compared with White participants, Black participants (incident rate ratio = 2.49; 95% CI = 1.93-3.22) and participants of other races (incident rate ratio = 2.16; 95% CI = 1.62-2.89) experienced a greater number of barriers. CONCLUSIONS: Nearly half of patients with low PDC reported nonadherence in the prior week, suggesting PDC can be used as a screening tool. Augmenting PDC with brief self-report tools can provide insights into the reasons for nonadherence. DISCLOSURES: Dr Kharmats, Ms Martinez, Dr Belli, Ms Zhao, Dr Mann, Dr Schoenthaler, and Dr Blecker received grants from the National Institute of Health/National Heart, Lung, Blood Institute. Dr Voils holds a license by Duke University for the DOSE-Nonadherence measure and is a consultant for New York University Grossman School of Medicine. This research was supported by the NIH (R01HL156355). Dr Kharmats received a postdoctoral training grant from the National Institutes of Health (5T32HL129953-04). Dr Voils was supported by a Research Career Scientist award from the Health Services Research & Development Service of the Department of Veterans Affairs (RCS 14-443). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the United States Government.

Development and implementation of a telephone triage curriculum for neurology residents (P3-2.005)

<h3>Objective:</h3> Build a curriculum to support and improve neurology resident’s telephone triage skills of a patient emergency response line. <h3>Background:</h3> Many neurology trainees answer patient questions over the telephone while on call with minimal training or experience. Other non-neurology residencies have published quality improvement studies on trainee specific training on telephone triage skills. Not all institutions have imbedded training for residents on telephone triage skills. <h3>Design/Methods:</h3> Two months of pages routed through the pager response line were collected at an academic institution. A list of neurological complaints was created based upon the text of the page. Residents completed a pre-intervention survey of confidence level for management telephone triage. Based upon aggregated data of common neurologic complaints, a 1-hour lecture was given and triage flowsheets were developed to train residents on appropriate over-the-phone management of common neurological complaints. A post-intervention self-evaluation survey is planned for one month after the flowsheets are distributed to the residents. <h3>Results:</h3> The most common neurological complaints from patients using the pager response line were breakthrough seizure, persistent or worsening headache, a new neurological symptom, or worsening functional decline (46% of pages). Other common indications for calls included concern for a medication side effect or request for medication refills (35% of pages). For the pre-intervention survey, the majority of the residents (80%) responded as “not at all confident” to “somewhat confident” in their response to “How confident are you with answering pager response line pages independently?”. <h3>Conclusions:</h3> Majority of residents were not confident in providing the telephone triage service for our departmental after-hours pager response line. This exemplifies the need for more specific neurological telephone triage training for residents providing this service. A curriculum has been developed and is currently being implemented based upon the most common neurological complaints found during our study period. Post training survey will be administered November 2022. <b>Disclosure:</b> Dr. Eckenstein has nothing to disclose. Dr. Wold has nothing to disclose.

Trends and Characteristics of Blood Pressure Prescription Fills Before and During the COVID-19 Pandemic in the United States.

The COVID-19 pandemic disrupted healthcare in the United States and raised concerns about certain antihypertensives, and may have impacted both prescribing practices and access to blood pressure (BP) medications. We assessed trends in BP prescription fills before and during the first year of the COVID-19 pandemic, using cross-sectional data for BP fills and tablets in the IQVIA (IMS Health) National Prescription Audit® database. Drugs filled via retail (92% coverage), mail-order (78% coverage), and long-term care (72% coverage) channels from January 2018 through December 2020 were included. Data were projected nationally and by state. Between 2.9 and 3.4 billion BP tablets were dispensed monthly until February 2020, increasing sharply to 3.8 billion in March 2020 and declining to 3.5 billion in April, then increasing at 3-month intervals until December 2020. The number of tablets per fill increased slightly over time, with the largest increase (from 66.7 to 68.6) during February-March, 2020. Tablets were dispensed through retail channels (99.7 billion), mail-order (14.7 billion), and long-term care (5.3 billion). Rates of patients initiating new medications decreased during 2020 compared to prior years. Fills did not vary significantly by drug class. A sharp increase in BP fills occurred with COVID-19 emergence, suggesting patients may have secured medications in preparation for potential access limitations. A decrease in new fills, indicating decreased initiation and/or modification of treatment regimens, suggests need for efforts to re-engage patients in the healthcare system and provide alternative ways to obtain medication refills and adjustments.

Impact of a pharmacist collaborative drug therapy management protocol on utilization of a discharge prescription program and hospital readmissions.

To evaluate the impact of a collaborative drug therapy management (CDTM) agreement allowing a pharmacist to automatically prescribe refills of discharge medications to patients' preferred outpatient pharmacy on utilization of a hospital discharge prescription program and hospital readmission rates. This was a single-center, quasi-experimental pre-post intervention study. Patients aged 18 years or older discharged from the cardiology services to home were eligible for inclusion in the study. The CDTM agreement was initiated on July 1, 2019. Patients discharged to home from July 1, 2018, to June 30, 2019, were assigned to the historical control group. The primary outcome was the difference in the proportion of patients who used the bedside medication delivery service at hospital discharge between the groups. Secondary outcomes included 30-day hospital readmissions and a descriptive analysis of medications prescribed by a pharmacist through the program. A χ2 test was used to assess the primary outcome, and multivariable logistic regression was used to assess hospital readmissions. In total, 1,704 and 2,200 patients were discharged in the control and CDTM groups, respectively. The CDTM group had a greater proportion of patients who participated in the discharge prescription program compared to the historical control group (77.8% vs 68.7%; P < 0.0001). There was no difference in 30-day hospital readmission rate between the groups (adjusted odds ratio, 1.01; 95% confidence interval, 0.83-1.23; P = 0.94). A CDTM protocol to improve the availability of medication refills at a patient's regular outpatient pharmacy improved utilization of a bedside medication delivery service but did not change 30-day readmission rates.

185 Cannabis Dependence and Health Care Utilization Following Cervical and Lumbar Spine Fusions: National Database Analysis

INTRODUCTION: Recent increases in cannabis use have been associated with broader legalization and social acceptance. Smoking tobacco leads to a higher incidence of pseudoarthrosis and complications following spinal fusion. However, little research has been done regarding the impact of cannabis on outcomes following spine fusions. METHODS: The IBM MarketScan Database (2009-2019) was used to identify patients who underwent single or multilevel cervical or lumbar fusions. Patients were categorized based on cannabis abuse disorder. Inpatient hospitalization outcomes (length of stay, discharge disposition, complications, payments), post-discharge outcomes (reoperation, readmission, outpatient services, medication refills, payments), and complications were analyzed at 6- and 12- months following index procedure. Exact match was used to control for unbalanced demographics. SAS 9.4 was used for data analysis. RESULTS: The exact match cohort had 2958 cervical fusion patients (1479 with a cannabis-related disorder) and 3204 lumbar fusion patients (1602 with a cannabis-related disorder). For cervical fusion, no significant difference between patients with and without cannabis-related disorder was found for most peri- and postoperative complications, overall complications, or discharge home. Users had significantly higher occurrence of sepsis (1.1% vs 0.3%, P = 0.0073) and significantly lower hospitalization payments ($18541 vs. $21137, P=0.0019). For lumbar fusion, no difference was found for overall complications or specific peri- and postoperative complications. Users had significantly lower hospitalization payments ($22612 vs. $29013, P = 0.0002). In both the cervical and lumbar groups, no differences were found in reoperation. Opioid use was lower for users directly post-operation, but higher 3-12 months post-operation. CONCLUSIONS: Cannabis dependence and abuse disorders are not associated with worsened perioperative outcomes in patients undergoing single or multilevel cervical or lumbar fusions.

176 Use of Computed Assisted Neuronavigation During Spine Fusions and Long-term Health Care Utilization: An Exact Matched Analysis of National Administrative Database

INTRODUCTION: Computer assisted neuronavigation (CAN) during spine fusions has increasing being utilized in the United States. The impact of CAN on long-term health care utilization is not well defined. METHODS: MarketScan database were queried using the ICD-9/10 and CPT 4th edition, from 2003 to 2019. We included patients ≥ 18 of age who underwent spine fusions with at least 2 years follow-up. Outcomes were repeat fusions or new fusions, length of stay (LOS), discharge disposition, hospital re-admissions, outpatient services, and medication refills for up to 24 months following the index procedure. RESULTS: Of 183,620 patients who underwent spine fusions during the study years, 5046 (2.75%) were identified to have CAN used for the fusions. Exact matching was successful for 4861/5046 (96%) in the CAN group. CAN had no effect on LOS, home discharge, or complications at index hospitalization and 30-days post discharge. However, CAN was associated with a $7667 difference in median payments ($60501 vs $52834, p &lt; .0001). CAN was associated with lower rates of repeat fusions at 6-months (3% vs. 4%), 12 months (2% vs. 3%) and 24 months (5% vs. 6%) following the index procedure, p &lt; 0.05. Patients who underwent CAN had lower payments at 6 months ($5186 vs $5527, p: 0.0159), 12 months ($10267 vs $11262, p: 0.0207) and 24 months ($21453 vs $24355, p: 0.0021). CONCLUSIONS: CAN is increasing being used for spine fusions primarily for thoraco-lumbar procedures. No difference in complications, discharge disposition and LOS were noted across the cohorts at index hospitalization, with higher index payments with CAN use. CAN was associated with lower rates of repeat fusions and corresponding health care utilization for up-to 24 months following the index procedures compared to non-CAN cohort.

Intraoperative MRI use in transsphenoidal surgery for pituitary tumors: Trends and healthcare utilization

BackgroundIntraoperative magnetic resonance imaging (iMRI) use in transsphenoidal approach (TSA) for pituitary tumors (PTs) has been reported to improve the extent of resection (EOR). The aim of this study is to report the trends and the impact of iMRI on healthcare utilization in patients who underwent TSA for PTs. Materials and methodsMarketScan database were queried using the ICD-9/10 and CPT-4, from 2004 to 2020. We included patients ≥ 18 years of age PTs with > 1 year follow-up. Outcomes were length of stay (LOS), discharge disposition, hospital/emergency room (ER) re-admissions, outpatient services, medication refills and corresponding payments. ResultsA cohort of 10,192 patients were identified from the database, of these 141 patients (1.4%) had iMRI used during the procedure. Use of iMRI for PTs remained stable (2004–2007: 0.85%; 2008–2011: 1.6%; 2012–2015:1.4% and 2016–2019: 1.46%). No differences in LOS (median 3 days each), discharge to home (93% vs. 94%), complication rates (7% vs. 13%) and payments ($34604 vs. $33050) at index hospitalization were noted. Post-discharge payments were not significantly different without and with iMRI use at 6-months ($8315 vs. $ 7577, p = 0.7) and 1-year ($13,654 vs. $ 14,054, p = 0.70), following the index procedure. ConclusioniMRI use during TSA for PTs remained stable with no impact on LOS, complications, discharge disposition and index payments. Also, there was no difference in combined index payments at 6-months, and 1-year after the index procedure in patients with and without iMRI use for PTs.

Secure Messaging for Diabetes Management: Content Analysis

Secure messaging use is associated with improved diabetes-related outcomes. However, it is less clear how secure messaging supports diabetes management. We examined secure message topics between patients and clinical team members in a national sample of veterans with type 2 diabetes to understand use of secure messaging for diabetes management and potential associations with glycemic control. We surveyed and analyzed the content of secure messages between 448 US Veterans Health Administration patients with type 2 diabetes and their clinical teams. We also explored the relationship between secure messaging content and glycemic control. Explicit diabetes-related content was the most frequent topic (72.1% of participants), followed by blood pressure (31.7% of participants). Among diabetes-related conversations, 90.7% of patients discussed medication renewals or refills. More patients with good glycemic control engaged in 1 or more threads about blood pressure compared to those with poor control (37.5% vs 27.2%, P=.02). More patients with good glycemic control engaged in 1 more threads intended to share information with their clinical team about an aspect of their diabetes management compared to those with poor control (23.7% vs 12.4%, P=.009). There were few differences in secure messaging topics between patients in good versus poor glycemic control. Those in good control were more likely to engage in informational messages to their team and send messages related to blood pressure. It may be that the specific topic content of the secure messages may not be that important for glycemic control. Simply making it easier for patients to communicate with their clinical teams may be the driving influence between associations previously reported in the literature between secure messaging and positive clinical outcomes in diabetes.

Poor adherence to antiretroviral therapy among adult people living with HIV initiated during the COVID-19 epidemic waves - observations at the University Teaching Hospital in Lusaka, Zambia.

Coronavirus disease 2019 (COVID-19)-related disruptions in healthcare services and clinical outcomes have been predicted and documented. However, little is known about how antiretroviral therapy (ART) adherence disruptions caused by the COVID-19 pandemic have manifested amidst the 'Undetectable = Untransmittable' campaign initiative. Using a patient's viral load as a proxy for medication adherence, our study aimed to determine the adherence to ART on first-line medications among adult people living with human immunodeficiency virus (PLWHIV) at the University Teaching Hospital in Lusaka, Zambia during the pandemic. This was a hospital-based cross-sectional study. Secondary data of PLWHIV registered to receive ART from the Adult Infectious Disease Centre was extracted from the SmartCare® electronic health record system to constitute a resultant data set that this study used. The data extraction form was used to extract values of dependent (ART adherence measured by viral load detectability) and independent variables and imported them into the statistical analysis tool, STATA version 16.1 MP. Descriptive statistics of individual characteristics, testing for associations using Pearson's chi-square test, and stratified and combined multivariable logistic regression were performed. Of the 7,281 adult PLWHIV included in this study, 9.0% (95% CI 8.3-9.6%) were virally detectable. Estimates of the odds ratios of detectable viral load remained significantly higher among adult PLWHIV who were initiated on ART after the U=U campaign was launched in Zambia and were on a monthly 2.51 (1.31-9.03) or 6-monthly 4.75 (3.52-6.41) dispensing of a dolutegravir-based regimen and those on 6-monthly dispensing of an efavirenz-based regimen 4.67 (2.16-10.08) compared to their counterparts. Overall estimates showed us the same picture 4.14 (3.22-5.31), having adjusted for all other predictor variables. We found that a high proportion of people with detectable viral load in the study population, irrespective of medication refill interval and type of regimen, was concentrated among adult PLWHIV who started treatment during the COVID-19 epidemic waves, as compared to those who started treatment before the pandemic. This observed disparity suggests the inherent impact of the pandemic on the adherence to ART among adult PLWHIV in Lusaka, Zambia. This further illustrates how exposed program responses are to external shocks, especially in already weakened health systems, and the need to create program response buffers and resilient program-specific strategies to minimize the effect of external disruptions.

Psychosocial and behavioral correlates of self-efficacy in treatment adherence in older patients with comorbid hypertension and type 2 diabetes

BackgroundAdhering to clinical prescriptions is known to protect against the effects of uncontrolled hypertension and of acute and chronic cardiovascular diseases, including diabetes. Contextually, positive associations between self-care behaviors and psychological constructs, such as self-efficacy, are widely acknowledged in the literature. However, still little is known about the psychological factors underlying the patient’s self-efficacy. This study aimed to investigate the psychosocial and behavioral correlates of self-efficacy related to treatment adherence in older patients with comorbid hypertension and type 2 diabetes mellitus.Participants and procedureItalian and Polish patients (≥ 65 years; N = 180) consecutively responded to self-report questionnaires measuring psycho-social (i.e., beliefs about medicines, perceived physician’s communication effectiveness, medication-specific social sup-port, self-efficacy) and behavioral factors (i.e., pharmacological adherence, medications refill adherence, intentional non-adherence) related to treatment adherence. Between-group comparisons and regression analyses were performed.ResultsFisher’s least significant difference (LSD) test showed significant differences between the Italian and Polish groups in all questionnaires (p &lt; .01) with the Italian patients reporting more satisfactory scores. Younger age (β = .08, p = .045), female gender (β = 1.03, p = .042), higher medication refills adherence (β = –.07, p = .024), lower intentional non-adherence (β = –.03, p = .009), positive beliefs about medications (β = .13, p &lt; .001), better quality of communication with the physician (β = .09, p &lt; .001), and stronger perceived medication-specific social support (β = .06, p = .001) were significantly associat-ed with self-efficacy related to treatment adherence.ConclusionsFuture research and interventions should leverage psychosocial and behavioral factors to address self-efficacy contributing to enhancing adherence to clinical prescriptions.

Automatic medication refills to improve glycaemic control among patients with diabetes and low medication adherence

BackgroundMedication adherence impacts health outcomes. Healthcare organisations implementing system-level interventions have potential for greater spread and sustainability than individual-level interventions. Within the integrated US Veterans Health Administration, a multidisciplinary team...

Patients’ Experiences With the Fit of Virtual Atrial Fibrillation Care During the Pandemic: Qualitative Descriptive Study

In-person health care has been the standard model of care delivery for patients with atrial fibrillation (AF). Despite the growing use of remote technology, virtual health care has received limited formal study in populations with AF. Understanding the virtual care experiences of patients in specialized AF clinics is essential to inform future planning of AF clinic care. This qualitative descriptive study aimed to understand patients' virtual AF clinic care experiences during the COVID-19 pandemic. Participants were recruited from a pool of patients who were receiving care from an AF clinic and who were enrolled in a larger survey study. A total of 8 virtual focus groups (n=30) were conducted in 2 waves between March 2021 and May 2021. Facilitators used a semistructured discussion guide to ask participants questions about their experiences of virtual care and the perceived quality of virtual care and technology support. Three team members initially open coded group data to create a preliminary coding framework. As the analysis progressed, with subsequent focus groups, the code clusters were refined. The participants were primarily male (21/30, 70%), aged ≥65 years (20/30, 67%), and college graduates (22/30, 73%). Patients found virtual care to be highly beneficial. Central to their experiences of virtual care was its fit or lack of fit with their health needs, which was integrally connected to communication effectiveness and their preferred virtual care future. Practical benefits included flexibility, convenience, and time and cost savings of virtual care. Virtual care fit occurred for small, quick, and mundane issues (eg, medication refills) but was suboptimal for new and more complex issues that patients thought warranted an in-person visit. Fit often reflected the effectiveness of communication between patient and provider and that of in-clinic follow-up. There was near-complete agreement among participants on the acceptability of virtual communication with their providers in addressing their needs, but this depended on adequate reciprocal communication. Without the benefit of in-person physical assessments, patients were uncertain and lacked confidence in communicating the needed, correct, and comprehensive information. Finally, participants described concerns related to ongoing virtual care with recommendations for their preferred future using a hybrid model of care and integrating patient-reported data (ie, blood pressure measurements) in virtual care delivery. Virtual care from a specialty AF clinic provides practical benefits for patients, but they must be weighed against the need for virtual care's fit with patients' needs and problems. The stability and complexity of patients' health needs, their management, and their perceptions of communication effectiveness with providers and clinics must be considered in decisions about appointment modality. Patients' recommendations for future virtual care through use of hybrid models together with systems for data sharing have the potential to optimize fit.

Increasing role of counterincision for high submuscular penile prosthesis reservoir placement

AbstractBackgroundInflatable penile prosthesis (IPP) reservoir placement into the high submuscular (HSM) space is safe and well tolerated. Recent studies have proposed that reservoirs placed via an abdominal counterincision (CI) may offer more precise and durable positioning as compared with a transinguinal (TI) approach.AimHerein we compare the CI-HSM and TI-HSM techniques with respect to operative time, pain control, and postoperative complications.MethodsWe reviewed our penile prosthesis database at a large single-surgeon tertiary referral center from 2014 to 2021 to compare those who underwent virgin reservoir placement via the CI-HSM technique vs the TI-HSM technique. Statistical analysis was performed with the Mann-Whitney U test for continuous variables and the chi-square test and Fisher exact test for discrete variables.OutcomesOperative time, postoperative complications, morphine milligram equivalents prescribed, and postoperative correspondence were compared between patients undergoing the CI-HSM and TI-HSM techniques.ResultsAmong 456 virgin IPP implants, the CI-HSM technique was used in 34 cases (7.5%) and the TI-HSM technique in 422 cases (92.5%). Of these 456 cases, 92 (20.2%) were combined with ancillary procedures such as artificial urinary sphincter, urethral sling, or penile plication (6/34, CI; 86/422, TI). Cases employing the CI-HSM technique had a 19.9% greater median operative time: 81.5 minutes (IQR, 69.3-106.5) vs 68 minutes (IQR, 57.8-80.3; P &amp;lt; .01). A similar proportion of patients in the CI-HSM group (2/34, 5.9%) were treated for infection as in the TI-HSM group (17/422, 4.0%; P = .64). Reservoir herniation was seen in 12 patients in the TI-HSM group (2.8%) and in none of the CI-HSM group, but this did not reach significance (P &amp;gt; .99). No differences were identified between patients in the TI-HSM and CI-HSM groups with regard to postoperative morphine milligram equivalents prescribed, narcotic medication refills, or postoperative correspondence.Clinical ImplicationsCI-HSM reservoir placement was associated with similar surgical outcomes to TI-HSM without increased infection risk or need for narcotic pain management.Strengths and LimitationsAlthough this study is a large contemporary series addressing a clinically important subject, it is limited by its retrospective preliminary nature and nonrandomized unmatched design. Patient pain regimens were assessed via discharge prescriptions, although data regarding narcotic consumption were not available in the medical record.ConclusionsIPP reservoir placement via the CI-HSM technique is safe and well tolerated. Increased operative time of the CI-HSM technique as compared with the TI-HSM technique is clinically negligible given its potential safety benefits of direct visualization of reservoir placement.