Medication-taking Behavior Research Articles

Beta Testing a Novel Smartphone Application to Improve Medication Adherence

We developed and beta-tested a patient-centered medication management application, PresRx optical character recognition (OCR), a mobile health (m-health) tool that auto-populates drug name and dosing instructions directly from patients' medication labels by OCR. We employed a single-subject design study to evaluate PresRx OCR for three outcomes: (1) accuracy of auto-populated medication dosing instructions, (2) acceptability of the user interface, and (3) patients' adherence to chronic medications. Eight patients beta-tested PresRx OCR. Five patients used the software for ≥6 months, and four completed exit interviews (n = 4 completers). At baseline, patients used 3.4 chronic prescription medications and exhibited moderate-to-high adherence rates. Accuracy of auto-populated information by OCR was 95% for drug name, 98% for dose, and 96% for frequency. Study completers rated PresRx OCR 74 on the System Usability Scale, where scores ≥70 indicate an acceptable user interface (scale 0-100). Adherence rates measured by PresRx OCR were high during the first month of app use (93%), but waned midway through the 6-month testing period (78%). Compared with pharmacy fill rates, PresRx OCR underestimated adherence among completers by 3%, while it overestimated adherence among noncompleters by 8%. Results suggest smartphone applications supporting medication management are feasible and accurately assess adherence compared with objective measures. Future efforts to improve medication-taking behavior using m-health tools should target specific patient populations and leverage common application programming interfaces to promote generalizability. Our medication management application PresRx OCR is innovative, acceptable for patient use, and accurately tracks medication adherence.

Perceptions and experiences of taking oral medications for the treatment of Type 2 diabetes mellitus: a systematic review and meta-synthesis of qualitative studies.

To explore patients' perceptions and experiences of taking oral medications for the pharmacological management of Type 2 diabetes mellitus. Cinahl, EMBASE, Medline and PsycINFO databases were searched in 2014 to identify qualitative studies exploring patients' perceptions or experiences of taking medications for the management of Type 2 diabetes. Key concepts and themes were extracted and synthesized using meta-ethnography. Eight studies were included. Primary study findings were synthesized to develop three higher-order constructs that moved beyond the results of individual studies. The first construct, Medications for diabetes: a necessary evil, outlines how patients' negative perceptions of medication risks co-exist with a resounding view that medications are beneficial. Passive patients but active experimenters highlights the contrast between patients' passive acceptance of medication prescriptions and the urge to actively experiment and adjust doses to optimize medication use in daily life. Finally, Taking oral medication for Type 2 diabetes: a unique context describes features specific to the Type 2 diabetes medication experience, including lack of symptoms and the perceived relationship between medication and diet, which may influence adherence. Medication-taking for Type 2 diabetes is a unique adherence context, which requires the development of condition-specific interventions. The present findings indicate patients understand the need for medications but adjust dosage and timing in their daily lives. This review suggests providers should acknowledge patient preferences in the development of management strategies, and highlights an opportunity to direct the motivation evident in patients' experimentation towards potentially more beneficial medication-taking behaviours.

Scaling up health knowledge at European level requires sharing integrated data: an approach for collection of database specification.

Computerized health care databases have been widely described as an excellent opportunity for research. The availability of “big data” has brought about a wave of innovation in projects when conducting health services research. Most of the available secondary data sources are restricted to the geographical scope of a given country and present heterogeneous structure and content. Under the umbrella of the European Innovation Partnership on Active and Healthy Ageing, collaborative work conducted by the partners of the group on “adherence to prescription and medical plans” identified the use of observational and large-population databases to monitor medication-taking behavior in the elderly. This article describes the methodology used to gather the information from available databases among the Adherence Action Group partners with the aim of improving data sharing on a European level. A total of six databases belonging to three different European countries (Spain, Republic of Ireland, and Italy) were included in the analysis. Preliminary results suggest that there are some similarities. However, these results should be applied in different contexts and European countries, supporting the idea that large European studies should be designed in order to get the most of already available databases.

Barriers to medication adherence for the secondary prevention of stroke: a qualitative interview study in primary care.

BackgroundMedications are highly effective at reducing risk of recurrent stroke, but success is influenced by adherence to treatment. Among survivors of stroke and transient ischaemic attack (TIA), adherence to medication is known to be suboptimal.AimTo identify and report barriers to medication adherence for the secondary prevention of stroke/TIA.Design and settingA qualitative interview study was conducted within general practice surgeries in the East of England, UK.MethodPatients were approached by letter and invited to take part in a qualitative research study. Semi-structured interviews were undertaken with survivors of stroke, caregivers, and GPs to explore their perspectives and views around secondary prevention and perceived barriers to medication adherence. Key themes were identified using a grounded theory approach. Verbatim quotes describing the themes are presented here.ResultsIn total, 28 survivors of stroke, including 14 accompanying caregivers and five GPs, were interviewed. Two key themes were identified. Patient level barriers included ability to self-care, the importance people attach to a stroke event, and knowledge of stroke and medication. Medication level barriers included beliefs about medication and beliefs about how pills work, medication routines, changing medications, and regimen complexity and burden of treatment.ConclusionPatients who have had a stroke are faced with multiple barriers to taking secondary prevention medications in UK general practice. This research suggests that a collaborative approach between caregivers, survivors, and healthcare professionals is needed to address these barriers and facilitate medication-taking behaviour.

GRAND-4: the German retrospective analysis of long-term persistence in women with osteoporosis treated with bisphosphonates or denosumab.

SummaryThis retrospective database study assessed 2-year persistence with bisphosphonates or denosumab in a large German cohort of women with a first-time prescription for osteoporosis treatment. Compared with intravenous or oral bisphosphonates, 2-year persistence was 1.5–2 times higher and risk of discontinuation was significantly lower (P < 0.0001) with denosumab.IntroductionPersistence with osteoporosis therapies is critical for fracture risk reduction. Detailed data on long-term persistence (≥2 years) with bisphosphonates and denosumab are sparse.MethodsFrom the German IMS® database, we included women aged 40 years or older with a first-time prescription for bisphosphonates or denosumab between July 2010 and August 2014; patients were followed up until December 2014. The main outcome was treatment discontinuation, with a 60-day permissible gap between filled prescriptions. Two-year persistence was estimated using Kaplan–Meier survival curves, with treatment discontinuation as the failure event. Denosumab was compared with intravenous (i.v.) and oral bisphosphonates separately. Cox proportional hazard ratios (HRs) for the 2-year risk of discontinuation were calculated, with adjustment for age, physician specialty, health insurance status, and previous medication use.ResultsTwo-year persistence with denosumab was significantly higher than with i.v. or oral bisphosphonates (39.8 % [n = 21,154] vs 20.9 % [i.v. ibandronate; n = 20,472] and 24.8 % [i.v. zoledronic acid; n = 3966] and 16.7–17.5 % [oral bisphosphonates; n = 114,401]; all P < 0.001). Patients receiving i.v. ibandronate, i.v. zoledronic acid, or oral bisphosphonates had a significantly increased risk of treatment discontinuation than did those receiving denosumab (HR = 1.65, 1.28, and 1.96–2.02, respectively; all P < 0.0001).ConclusionsTwo-year persistence with denosumab was 1.5–2 times higher than with i.v. or oral bisphosphonates, and risk of discontinuation was significantly lower with denosumab than with bisphosphonates. A more detailed understanding of factors affecting medication-taking behavior may improve persistence and thereby reduce rates of fracture.

PRM8 - Development of a Systematic Review Search Filter to Identify Medication Adherence Studies

Search filters or hedges are commonly used in systematic reviews to identify studies fulfilling specific criteria. Currently, there are no published filters that focus on identifying studies specific to patients’ medication-taking behavior, i.e. adherence, compliance or persistence. This research aims to develop and validate a medication adherence filter using schizophrenia as a case example. Published literature reviews assessing adherence in schizophrenia were identified from years 2000 to present in the English language, and were used as a reference. A filter search strategy was developed for adherence concepts using the titles of references identified in the reviews. This filter was used to search for medication adherence studies in schizophrenia in MEDLINE and Embase. This process was reiterated until studies included in the reference review articles were captured. 21 published reference review articles were found on schizophrenia and adherence, which cited a total of 180 relevant studies. In the first iteration of the search strategy using the adherence filter, 142 studies were identified, thus capturing 79% of studies included in the reference reviews. After further revision and assessment of the missing articles, the final search filter was able to identify 89% of the reference articles. To our knowledge, this is the most comprehensive filter validation exercise for adherence at this time. The proposed filter was shown to be sensitive in the schizophrenia patient population and may be adapted to other disease areas after further testing.

Medication-Taking Behaviors in People With CKD and Multiple Chronic Conditions: A Meta-Ethnographic Synthesis of Qualitative Studies

Medication-Taking Behaviors in People With CKD and Multiple Chronic Conditions: A Meta-Ethnographic Synthesis of Qualitative Studies

Patient vs provider reports of aberrant medication-taking behavior among opioid-treated patients with chronic pain who report misusing opioid medication.

During long-term opioid therapy for chronic noncancer pain, monitoring medication adherence of patients with a history of aberrant opioid medication-taking behaviors (AMTB) is an essential practice. There is limited research, however, into the concordance among existing monitoring tools of self-report, physician report, and biofluid screening. This study examined associations among patient and provider assessments of AMTB and urine drug screening using data from a randomized trial of a cognitive-behavioral intervention designed to improve medication adherence and pain-related outcomes among 110 opioid-treated patients with chronic pain who screened positive for AMTB and were enrolled in a pain program. Providers completed the Aberrant Behavior Checklist (ABC) and patients completed the Current Opioid Misuse Measure (COMM) and the Chemical Coping Inventory (CCI). In multivariate analyses, ABC scores were compared with COMM and CCI scores, while controlling for demographics and established risk factors for AMTB, such as pain severity. Based on clinical cutoffs, 84% of patients reported clinically significant levels of AMTB and providers rated 36% of patients at elevated levels. Provider reports of AMTB were not correlated with COMM or CCI scores. However, the ABC ratings of experienced providers (nurse practitioners/attending physicians) were higher than those of less experienced providers (fellows) and were correlated with CCI scores and risk factors for AMTB. Associations between patient- and provider-reported AMTB and urine drug screening results were low and largely nonsignificant. In conclusion, concordance between patient and provider reports of AMTB among patients with chronic pain prescribed opioid medication varied by provider level of training.

Medication Adherence: Truth and Consequences

Improving medication adherence may have a greater influence on the health of our population than in the discovery of any new therapy. Patients are nonadherent to their medicine 50% of the time. Although most physicians believe nonadherence is primarily due to lack of access or forgetfulness, nonadherence can often be an intentional choice made by the patient. Patient concealment of their medication-taking behavior is often motivated by emotions on the part of both provider and patient, leading to potentially dire consequences. A review of the literature highlights critical predictors of adherence including trust, communication and empathy, which are not easily measured by current administrative databases. Multifactorial solutions to improve medication adherence include efforts to improve patients’ understanding of medication benefits, access and trust in their provider and health system. Improving providers’ recognition and understanding of patients’ beliefs, fears and values, as well as their own biases is also necessary to achieve increased medication adherence and population health.

Insights Learned from College Students with Mental Illness in a University Collaborative Health System

Problem Statement: Examining the experience of mental illness among college student participants when they are prescribed medication provides the potential to gain insight into medication adherence in addition to other healthcare service issues and barriers with mental illness in a university collaborative healthcare system that students face. Purpose and Methodology: Photovoice methodology allows individuals to use cameras to photograph their everyday health and work realities, thereby focusing on issues of greatest concern and communicating these issues to policy makers, healthcare providers, and influential advocates who can be mobilized to make change. Researchers provided disposable cameras to the participants. These participants captured photographs of their everyday experiences that reflect their individual perspective on their lives with medications. Once the photographs were collected, the researchers held group and individual reflection sessions with the photographers to discuss their photographs and how their photographs essentially gave them a voice about their medications. The researchers then qualitatively analyze the discussions and photographs to develop general themes regarding the research group. Finally, dialog was held between research participants and healthcare providers with the goal of education and action-oriented change. Findings and Conclusions: The study included 12 college students prescribed one or more medications to gather descriptive rich data regarding use of photovoice methodology, to assess the collective and individual experience of prescription medication use in this group, and to share findings with a small group of healthcare providers and staff on campus. Photovoice research methodology has not yet been applied to medication-taking behavior of a college student specific population. The perspective on student experiences provided by this research may be able to enhance the delivery of medications, mental health services and awareness for students within the university campus and the broader community.

Insights Learned from College Students with Mental Illness in a University Collaborative Health System

Problem Statement: Examining the experience of mental illness among college student participants when they are prescribed medication provides the potential to gain insight into medication adherence in addition to other healthcare service issues and barriers with mental illness in a university collaborative healthcare system that students face. Purpose and Methodology: Photovoice methodology allows individuals to use cameras to photograph their everyday health and work realities, thereby focusing on issues of greatest concern and communicating these issues to policy makers, healthcare providers, and influential advocates who can be mobilized to make change. Researchers provided disposable cameras to the participants. These participants captured photographs of their everyday experiences that reflect their individual perspective on their lives with medications. Once the photographs were collected, the researchers held group and individual reflection sessions with the photographers to discuss their photographs and how their photographs essentially gave them a voice about their medications. The researchers then qualitatively analyze the discussions and photographs to develop general themes regarding the research group. Finally, dialog was held between research participants and healthcare providers with the goal of education and action-oriented change. Findings and Conclusions: The study included 12 college students prescribed one or more medications to gather descriptive rich data regarding use of photovoice methodology, to assess the collective and individual experience of prescription medication use in this group, and to share findings with a small group of healthcare providers and staff on campus. Photovoice research methodology has not yet been applied to medication-taking behavior of a college student specific population. The perspective on student experiences provided by this research may be able to enhance the delivery of medications, mental health services and awareness for students within the university campus and the broader community.

Basal insulin persistence, associated factors, and outcomes after treatment initiation among people with type 2 diabetes mellitus in the US

Objective To assess basal insulin persistence, associated factors, and economic outcomes for insulin-naïve people with type 2 diabetes mellitus (T2DM) in the US.Research design and methods People aged ≥18 years diagnosed with T2DM initiating basal insulin between April 2006 and March 2012 (index date), no prior insulin use, and continuous insurance coverage for 6 months before (baseline) and 24 months after index date (follow-up period) were selected using de-identified administrative claims data in the US. Based on whether there were ≥30 day gaps in basal insulin use in the first year post-index, patients were classified as continuers (no gap), interrupters (≥1 prescription after gap), and discontinuers (no prescription after gap).Main outcome measures Factors associated with persistence – assessed using multinomial logistic regression model; annual healthcare resource use and costs during follow-up period – compared separately between continuers and interrupters, and continuers and discontinuers.Results Of the 19,110 people included in the sample (mean age: 59 years, ∼60% male), 20% continued to use basal insulin, 62% had ≥1 interruption, and 18% discontinued therapy in the year after initiation. Older age, multiple antihyperglycemic drug use, and injectable antihyperglycemic use during baseline were associated with significantly higher likelihoods of continuing basal insulin. Relative to interrupters and discontinuers, continuers had fewer emergency department visits, shorter hospital stays, and lower medical costs (continuers: $10,890, interrupters: $13,674, discontinuers: $13,021), but higher pharmacy costs (continuers: $7449, interrupters: $5239, discontinuers: $4857) in the first year post-index (p < 0.05 for all comparisons). Total healthcare costs were similar across the three cohorts. Findings for the second year post-index were similar.Conclusions The majority of people in this study interrupted or discontinued basal insulin treatment in the year after initiation; and incurred higher medical resource use and costs than continuers. The findings are limited to the commercially insured population in the US. In addition, persistence patterns were assessed using administrative claims as opposed to actual medication-taking behavior and did not account for measures of glycemic control. Further research is needed to understand the reasons behind basal insulin persistence and the implications thereof, to help clinicians manage care for T2DM more effectively.

Corrigendum to: Medication-taking behaviour in New South Wales patients with type 2 diabetes: an observational study.

This study aimed to (1) determine adherence to diabetes medication in type 2 diabetes (T2D) patients; (2) describe respondents' attitudes and beliefs about medications, and barriers to adherence; and (3) to model predictors of non-adherence. Data were collected using online and postal surveys. Diabetes patients aged ?18 years who were members of the Australian Diabetes Council were invited to participate. Main outcome measures were adherence to diabetes medication using 8-item Morisky Medication Adherence Score (MMAS-8) and beliefs about medication using the Beliefs about Medicines Questionnaire. A total of 543 T2D patients responded to the survey. The median (interquartile range) MMAS-8 score was 6.8 (5.0-7.0). The prevalence of adherence (MMAS-8 score ?6) was 64.6%. The proportion of respondents who expressed concern about taking medications was 53.6%. Potential predictors of adherence included age (OR, 1.83; 95% CI, 1.19-2.82), concern about medication (OR, 0.91; 95% CI, 0.87-0.96), knowledge of diabetes (OR, 0.85, 95% CI, 0.73-0.99), having difficulty in paying for medication (OR, 0.51; 95% CI ,0.33-0.79), having more than one regular pharmacy (OR, 0.59; 95% CI, 0.36-0.95), and using insulin (OR, 0.49; 95% CI, 0.30-0.81). Adherence to taking diabetes medication in a sample of the Australian T2D patient population was suboptimal. An understanding of medication-taking behaviour will assist health-care professionals to deliver appropriate and effective interventions to enhance adherence and optimise diabetes control in T2D patients.

Factors associated with anti-retroviral therapy adherence among people living with HIV visiting IRT Perundurai medical college hospital link ART centre, Perundurai, Tamilnadu, India

Background: National AIDS control organisation aims to provide wholesome management to PLHIV. This is ensured by universal access to free and comprehensive care, support and treatment in health delivery facilities across the country by dynamic linkages and referral mechanism for monitoring, mentoring, decentralization and specialized care and treatment. Objective of the study was to analyse factors associated with ART adherence among PLHIV visiting IRT Perundurai Medical College Hospital link ART centre, Tamilnadu, India. Methods: A prospective observational study was conducted during June 2015 to May 2016. All PLHIV receiving ART drugs as per protocol from LAC were included. Results: 139 clients were registered for treatment and follow up till May 2016 in our centre. 31 were transferred to nearby ART, link ART centres. Currently 98 (38 male; 60 female) were utilizing our services. Majority of the patients were on ZLN followed by TLE and ZLE. Most of clients were from rural areas belonging to low or low middle income group. Common occupation was found to be farming and cattle rearing. Most women were housewives. The average age in present study was 38.3 years. Oldest was 73 years old male and youngest 10 years old female. Family support and benefits of ART drugs tops the list of facilitators; supply chain, alcohol issues, family issues were commonly observed barriers. Conclusions: Our results supported the measurement of multiple dimensions of medication-taking behaviours in order to avoid overestimating adherence to ART. Investigation of factors associated with long term adherence would require elaborate and constant follow-ups than in this study period.

Let Visuals Tell the Story: Medication Adherence in Patients with Type II Diabetes Captured by a Novel Ingestion Sensor Platform

BackgroundChronic diseases such as diabetes require high levels of medication adherence and patient self-management for optimal health outcomes. A novel sensing platform, Digital Health Feedback System (Proteus Digital Health, Redwood City, CA), can for the first time detect medication ingestion events and physiological measures simultaneously, using an edible sensor, personal monitor patch, and paired mobile device. The Digital Health Feedback System (DHFS) generates a large amount of data. Visual analytics of this rich dataset may provide insights into longitudinal patterns of medication adherence in the natural setting and potential relationships between medication adherence and physiological measures that were previously unknown.ObjectiveOur aim was to use modern methods of visual analytics to represent continuous and discrete data from the DHFS, plotting multiple different data types simultaneously to evaluate the potential of the DHFS to capture longitudinal patterns of medication-taking behavior and self-management in individual patients with type II diabetes.MethodsVisualizations were generated using time domain methods of oral metformin medication adherence and physiological data obtained by the DHFS use in 5 patients with type II diabetes over 37-42 days. The DHFS captured at-home metformin adherence, heart rate, activity, and sleep/rest. A mobile glucose monitor captured glucose testing and level (mg/dl). Algorithms were developed to analyze data over varying time periods: across the entire study, daily, and weekly. Following visualization analysis, correlations between sleep/rest and medication ingestion were calculated across all subjects.ResultsA total of 197 subject days, encompassing 141,840 data events were analyzed. Individual continuous patch use varied between 87-98%. On average, the cohort took 78% (SD 12) of prescribed medication and took 77% (SD 26) within the prescribed ±2-hour time window. Average activity levels per subjects ranged from 4000-12,000 steps per day. The combination of activity level and heart rate indicated different levels of cardiovascular fitness between subjects. Visualizations over the entire study captured the longitudinal pattern of missed doses (the majority of which took place in the evening), the timing of ingestions in individual subjects, and the range of medication ingestion timing, which varied from 1.5-2.4 hours (Subject 3) to 11 hours (Subject 2). Individual morning self-management patterns over the study period were obtained by combining the times of waking, metformin ingestion, and glucose measurement. Visualizations combining multiple data streams over a 24-hour period captured patterns of broad daily events: when subjects rose in the morning, tested their blood glucose, took their medications, went to bed, hours of sleep/rest, and level of activity during the day. Visualizations identified highly consistent daily patterns in Subject 3, the most adherent participant. Erratic daily patterns including sleep/rest were demonstrated in Subject 2, the least adherent subject. Correlation between sleep /rest and medication ingestion in each individual subject was evaluated. Subjects 2 and 4 showed correlation between amount of sleep/rest over a 24-hour period and medication-taking the following day (Subject 2: r=.47, P<.02; Subject 4: r=.35, P<.05). With Subject 2, sleep/rest disruptions during the night were highly correlated (r=.47, P<.009) with missing doses the following day.ConclusionsVisualizations integrating medication ingestion and physiological data from the DHFS over varying time intervals captured detailed individual longitudinal patterns of medication adherence and self-management in the natural setting. Visualizing multiple data streams simultaneously, providing a data-rich representation, revealed information that would not have been shown by plotting data streams individually. Such analyses provided data far beyond traditional adherence summary statistics and may form the foundation of future personalized predictive interventions to drive longitudinal adherence and support optimal self-management in chronic diseases such as diabetes.

The association between health beliefs and medication adherence among patients with type 2 diabetes.

Type 2 diabetes is a major risk factor for cardiovascular disease and microvascular complications. Approximately 20.5% of adults between the ages of 20-79 are diagnosed with type 2 diabetes in Saudi Arabia. Nonadherence with type 2 diabetes medications is an established contributor to higher prevalence in other countries. No published studies have used a theoretical framework to explain or predict medication-taking behavior in Saudi Arabian type 2 diabetes (T2D) patients. The purpose of this study was to investigate type 2 diabetes medication adherence using a theoretical framework, the Health Belief Model (HBM). The specific objectives were to 1) assess self-report of medication-taking in a Saudi T2D convenience sample; 2) investigate self-reported HBM constructs for T2D, its complications, and medication-taking in this sample, and 3) test the ability for self-reported health beliefs to predict specific medication-taking behaviors among the sample. A cross-sectional study was conducted in a convenience sample at an outpatient pharmacy in Saudi Arabia. Adult type 2 diabetes patients on at least one prescribed diabetes medication, who were cognitively capable, and came themselves for prescription pickup, were eligible to participate. Patients completed a questionnaire or were interviewed. Data were collected for demographics, medical history, self-reported medication adherence, and type 2 diabetes medication-taking HBM items. Three measures collected self-report of medication adherence: new multi-dimensional adherence measure (MDAM), previously validated stage of change, and medication-taking recall- 7days (MTR-7). Descriptive statistics were generated and regression analyses were used to explain self-report of adherence. Just over half (54%) of the 220 participants were male, mean age was 52±11.2 years, and most (59%) had less than high school education. Approximately 58% were on oral medications only and the rest were on either insulin alone or a combination of oral and insulin; 16.7% reported knowing their hemoglobin A1C (A1C). For adherence, most reported taking the prescribed dose every time taken; however, 60% were not taking it the prescribed number of times per day and 50%, not the prescribed time of day (interval). Over 40% reported low adherence on stage of change and MTR-7. Perceived susceptibility, perceived medication benefits, and self-efficacy were significant HBM predictors for medication adherence (R2=0.42). The MDAM has research and practice potential because it evaluates sub-behaviors of medication-taking separately and as a score. Patient perceptions and beliefs should be assessed as part of a patient-centered medication adherence intervention.

Behavioral Interventions to Improve Asthma Outcomes for Adolescents: A Systematic Review

Factors at multiple ecological levels, including the child, family, home, medical care, and community, impact adolescent asthma outcomes. This systematic review characterizes behavioral interventions at the child, family, home, medical system, and community level to improve asthma management among adolescents. A systematic search of PubMed, SCOPUS, OVID, PsycINFO, CINAHL, and reference review databases was conducted from January 1, 2000, through August 10, 2014. Articles were included if the title or abstract included asthma AND intervention AND (education OR self-management OR behavioral OR technology OR trigger reduction), and the mean and/or median age of participants was between 11 and 16 years. We compared populations, intervention characteristics, study designs, outcomes, settings, and intervention levels across studies to evaluate behavioral interventions to improve asthma management for adolescents. Of 1230 articles identified and reviewed, 24 articles (21 unique studies) met inclusion criteria. Promising approaches to improving adherence to daily controller medications include objective monitoring of inhaled corticosteroid adherence with allergist and/or immunologist feedback on medication-taking behavior and school nurse directly observed therapy. Efficacy at increasing asthma self-management skills was demonstrated using group interactive learning in the school setting. This systematic review is not a meta-analysis, thus limiting its quantitative assessment of studies. Publication bias may also limit our findings. Novel strategies to objectively increase controller medication adherence for adolescents include allergist and/or immunologist feedback and school nurse directly observed therapy. Schools, the most common setting across studies in this review, provide the opportunity for group interactive learning to improve asthma knowledge and self-management skills.

Adverse Drug Reactions, Medication Adherence and Physicians’ Prescribing Behavior: Which Relationship? a Database Analysis on Statin use

Pharmacological treatment plays an essential role in controlling chronic conditions such as hypercholesterolemia; however, patients' adherence to long-term therapies for chronic diseases is crucial to achieve optimal health outcomes (1). Further than medication adherence, pharmacological care is affected by the prescribing inappropriateness and adverse drug reactions (ADRs) (2). ADRs can lead to a perceived lack of therapy effectiveness and subsequent suboptimal adherence. Conversely, poor adherence to chronic disease medications may potentially lead to adverse drug events (ADEs), suggesting a bidirectional causal link between non-adherence to prescribed drug therapy and ADEs/ADRs occurrence (6). In the last decade, the use of statins showed a positive trend in Italy, consistently with the recent revisions of the statin reimbursement criteria (NOTA 13) by the Italian Medicines Agency (Agenzia Italiana del Farmaco) (3). Nevertheless, recent real practice analyses documented suboptimal rates of adherence to statin therapy in different Italian outpatient settings (4;5), resulting in poor low-density lipoprotein cholesterol (LDL-C) control, increased risk for cardiovascular events and increasing healthcare costs. For this reason, we explored the association between serum level of the enzyme creatine phosphokinase (CPK), the number of its measurements and adherence to statin therapy in a large Italian cohort of dyslipidemic patients, with the ultimate aim to evaluate the impact of statin-induced, muscle-related ADRs on patients' therapy adherence, and how this relationship may compromise the efficacy of physicians' prescribing choices and health outcomes in clinical practice. A retrospective cohort study was performed using data from databases of 4 Local Health Units (LHUs) located in Emilia-Romagna, Toscana and Umbria regions, with an overall population of about 1.1 millions of inhabitants. All subjects aged ≥ 18 years with a first prescription for statins in the period between January 1, 2007 and June 30, 2008 were included. All statin prescriptions over a 12 months follow-up period were analyzed to assess treatment adherence. Baseline and follow-up LDLC levels were considered. All CPK measurements in the follow-up period were analyzed. A total of 71855 patients (51% men, average age 68.6 ± 10.6 years) were included. Among them, 31544 (43.9%) were monitored for LDL-C at least one time during the follow-up period: only 37.4% of these patients achieved LDL-C target. 23.6% of patients underwent at least one serum CPK measurement: out of range values were identified in 37.8% of them. However, they were not switched to other statin drug and/or dosage. Depending on the increase of CPK measurements, patients with steadily normal values of CPK showed a better medication-taking behavior compared to patients whose CPK values were out of normal range. Furthermore, a greater percentage of switching to other statin drug and/or dosage was observed in patients with out of range CPK levels compared to those with normal serum CPK levels. Our findings indicate that physiological serum CPK levels were associated with greater adherence to statin therapy, supporting a causal link between non-adherence behavior and muscle-related ADRs occurrence. Since statin benefits are associated with their chronic use, physicians should be aware about the relevance of monitoring their patients for this harmful link to prevent unsuitable therapeutic decisions, further decreasing adherence, and achieve long-term health outcomes.

PMS95 - Medication-Taking Behaviour in Women with Postmenopausal Osteoporosis (Op) Treated with Denosumab or Monthly Oral Bisphosphonates (Obps)

PMS95 - Medication-Taking Behaviour in Women with Postmenopausal Osteoporosis (Op) Treated with Denosumab or Monthly Oral Bisphosphonates (Obps)

Update on denosumab in the management of postmenopausal osteoporosis: patient preference and adherence.

Patient adherence to many osteoporosis treatments, primarily bisphosphonates, is generally poor, thus leading to a significant reduction in antifracture efficacy. Patient perceptions about the necessity of the prescribed medication to treat osteoporosis and the concerns about the potential adverse effects are important and potentially modifiable determinants of adherence, in addition to other factors, such as difficult dosing regimens and high dosing frequency. Denosumab (Dmab) is a fully human monoclonal antibody against the receptor activator of nuclear factor-κB ligand (RANKL), which, through the prevention of the RANKL/RANK interaction, inhibits osteoclast-mediated bone resorption and significantly reduces the risk of vertebral, nonvertebral, and hip fractures. It is administered subcutaneously every 6 months for the treatment of postmenopausal osteoporosis. Preference and adherence to Dmab treatment were assessed in various clinical trials. Although with some limitations, available data suggest that Dmab is preferred to bisphosphonates, produces greater satisfaction than bisphosphonates, and would be preferentially chosen for long-term treatment. Moreover, patient perceptions about the necessity of Dmab treatment clearly outweigh the concerns about the injections, and positive beliefs about treatment positively influence medication-taking behavior. According to these data, Dmab may represent a reasonable alternative to bisphosphonates, particularly for osteoporotic women in whom a suboptimal or even poor adherence to oral treatments is expected.