Noncompliance In Patients Research Articles

The Impact of Educational Handouts on the Compliance Rate for Bariatric Patient Follow-Up Appointments.

Compliance rates for follow-up appointments are an issue for postoperative sleeve gastrectomy (SG) patients. Without consistent reinforcement and monitoring of patient progress, patients tend to gain the weight back, all of the medical improvements made are lost, and the ability to access patients for potential complications is denied. Patients need much reinforcement during their forever bariatric lifestyle, and the lack of consistent reminders may contribute to follow-up noncompliance and recidivism in SG patients. As time progresses, the follow-up appointment compliance rate decreases. Decreased follow-up can lead to a higher risk for complications such as asymptomatic esophagitis, and current recommendations suggest that esophagogastroduodenoscopy screening should occur 3years postoperatively. After 1 year, the follow-up compliance decreases dramatically so that by the 3-year postoperative period, very few patients are being seen and scheduled for interventions such as an esophagogastroduodenoscopy. The objective of this quality improvement project was to evaluate the effectiveness of a patient educational handout on SG bariatric patient follow-up visit compliance. A quasi-experimental design and retrospective chart review was chosen. An educational handout was developed. Preintervention retrospective chart review consisted of 441 SG patients expecting a follow-up in 12 to 48months. Postintervention included 3months of the handout intervention with data collection totaling 198 patients. Follow-up compliance for 4 year visits noted 0% preintervention/12.2% postintervention (P =.008), for 3 year visits 13.4% preintervention/12% postintervention (P =.846), for 2 year visits 26.3% preintervention/28.6% postintervention (P =.755), for 18months visits 26.3% preintervention/32.6% postintervention (P =.365), and for 12months visits 54.2% preintervention/34.1% postintervention (P =.011). In this quality improvement project, educational handouts did not have a statistical impact on follow-up compliance.

Nomogram model for predicting medication adherence in patients with various mental disorders based on the Dryad database

ObjectiveTreatment compliance among psychiatric patients is related to disease outcomes. How to assess patient compliance remains a concern. Here, we established a predictive model for medication compliance in patients with...

Sex disparity of DAPT noncompliance in patients with left main stem PCI with DES.

This retrospective study aims to explore the sex disparity in dual antiplatelet therapy (DAPT) noncompliance among left main stem percutaneous coronary intervention (PCI) patients with drug-eluting stent (DES) and identify predictors associated with non-adherence. Data were collected from the medical records of 1585 patients, including 1104 males and 481 females, who underwent left main stem PCI with DES. Baseline characteristics, angiographic features, and DAPT compliance rates at 1 month and 12 months were analyzed. Univariate logistic regression was used to identify predictors of DAPT noncompliance. The overall DAPT noncompliance rate at 1 month was 8.5%, increasing to 15.5% at 12 months. Females exhibited slightly higher noncompliance rates than males at both 1 month (15.6% vs 14.5%) and 12 months (28.1% vs 19.0%), although the difference was not statistically significant. Smoking status showed a modest impact on non-adherence, with current smokers exhibiting a lower noncompliance rate (14.9% at 1 month). Prior coronary artery disease history was associated with increased noncompliance at 12 months (18.9%). Angiographic characteristics, including lesion location and Syntax score, had no consistent association with DAPT noncompliance. This study highlights sex disparity in DAPT noncompliance among patients undergoing left main stem PCI with DES. Comorbidities, socioeconomic status, smoking status, and prior coronary artery disease history were identified as predictors of non-adherence.

Navigating Care Refusal and Noncompliance in Patients with Opioid Use Disorder

BackgroundFor many emergency physicians (EPs), deciding whether or not to allow a patient suffering the ill effects of opioid use to refuse care is the most frequent and fraught situation in which they encounter issues of decision-making capacity, informed refusal, and autonomy. Despite the frequency of this issue and the well-known impacts of opioid use disorder on decision-making, the medical ethics community has offered little targeted analysis or guidance regarding these situations. DiscussionAs a result, EPs demonstrate significant variability in how they evaluate and respond to them, with highly divergent understandings and application of concepts such as decision-making capacity, informed consent, autonomy, legal repercussions, and strategies to resolve the clinical dilemma. In this paper, we seek to provide more clarity to this issue for the EPs. ConclusionsSuccessfully navigating this issue requires that EPs understand the specific effects that opioid use disorder has on decision-making, and how that in turn bears on the ethical concepts of autonomy, capacity, and informed refusal. Understanding these concepts can lead to helpful strategies to resolve these commonly-encountered dilemmas.

The Increased Ischemic Risk During the Early Period After Clopidogrel Noncompliance in Patients with Acute Coronary Syndrome: A Meta-Analysis.

Although dual antiplatelet therapy for secondary prevention in acute coronary syndrome (ACS) is highly recommended by current guidelines, P2Y12 inhibitor non-adherence often occurs and devastates prognosis. To evaluate whether the ischemic risk during the early period of clopidogrel noncompliance was increased among ACS patients, a comprehensive search of PubMed, Embase, and Web of Science was conducted to identify studies reporting early ischemic risk after clopidogrel noncompliance in ACS patients. The primary endpoint was a composite of death or myocardial infarction (MI). Effect sizes were synthesized in patients with or without revascularization. A total of 7 observational studies focusing on clopidogrel noncompliance were included in this meta-analysis, whereas no studies involving ticagrelor or prasugrel were retrieved. A significantly increased risk of death or MI 0 to 90 days after clopidogrel noncompliance was found compared with that during 90 to 180 or 90 to 360 days regardless of revascularization (incidence rate ratio [IRR]: 2.01, 95% confidence interval (CI): 1.62-2.49, P < .001, I2 = 9%) or not (IRR: 1.61, 95% CI: 1.05-2.48, P < .001, I2 = 74%). Patients undergoing percutaneous coronary intervention had a higher risk of death or MI 0 to 90 days after clopidogrel noncompliance compared with 90-180 or 90-360 days irrespective of drug-eluting stent or bare metal stent implantation (P < .05 for both). The early ischemic risk after clopidogrel noncompliance is significantly higher than the late risk in ACS patients. Antiplatelet noncompliance remains a serious concern.

Medication Non-Compliance in Patients with Schizophrenia Due To Familial, Environmental and Socio-Cultural Factors

Introduction: In schizophrenia, non-compliance with treatment leads to the disease burden in the community. It is considered as a challenge worldwide due to the need for long-term treatment and additional associated factors in Schizophrenia. Aim: The goal of the study is to identify patients with treatment non-compliance in schizophrenia and determine the related factors from environmental, socio-cultural and familial perspectives. Place and Duration: The study was carried out at the department of Behavioral Sciences, PGMI /AMC / LGH Lahore, Pakistan, from November 2021 to April 2022. Methods: The study included 100 patients with non-compliance to treatment in schizophrenia who visited the relevant psychiatric departments. For the research a descriptive cross-sectional design was chosen with non-random, purposive sample selection technique being utilised. Prior to the study, ethical approval from the authorities and informed consent from patients were obtained. Educated patients completed questionnaires whereas uneducated patients asked their relatives to provide such information on questionnaires. Results: Out of 100 participants, 56 were males and 44 were females, with a ratio of 1.4:1. The participants mean age was 32.25 ± 11.1. About 23% of them were uneducated, and above sixty percent (61%) had a family income &lt; 20,000 PKR rupees per month. A substantial percentage of family-members (15%) were unaware of their role and that of their family members, and the majority (77%) stated that people made a negative contribution. Factors contributing to treatment non-compliance included belief as a major life event (6%), perception about the disease being incurable (25%), lack of nearby treatment access (76%), migration (8%), forgetting an appointment with medical professional (18%), discontinuation of medication on the advice of a faith healer (16%), discontinuation of medication due to social stigma (14%), no follow-up being arranged (22%), and refusal to continue treatment (13%). Conclusions: The study aimed to identify the possible reasons for medication non-compliance in patients of schizophrenia from environmental, socio-cultural and familial perspectives. Many factors have been recognised that contribute indirectly or directly to the treatment non-compliance. Keywords: Non-Compliance, Compliance and Schizophrenia.

THE RELATIONSHIP BETWEEN SELF-CARE MANAGEMENT AND QUALITY OF LIFE IN DIABETES MELLITUS PATIENTS IN IBNU SINA GRESIK HOSPITAL

Introduction: Non-adherence to self-care is often found in diabetes mellitus (DM) patients. Non-compliance in DM patients in performing self-care can affect the quality of life of patients. This study aimed to explain the relationship between self-care management and the quality of life of DM patients. Methods: This research design was analytically observational with a cross-sectional approach. The sample in this study was 80 respondents of DM patients treated at RSUD Ibnu Sina Gresik with a purposive sampling technique. They collected data using a questionnaire and statistical test of this study using the Spearman test. Results: The results are that the majority of self-care management is sufficient (67.5%) for as many as 54 people and good quality of life (86.2%) for as many as 69 people. The results of the correlation test using the spearman test obtained a p-value of 0.000 (p-value &lt;0.05), and the correlation coefficient value is positive (r=0.479), which means that there is a significant relationship between self-care management and the quality of life of patients with diabetes mellitus in RSUD Ibnu Sina Gresik. Conclusions: Improved self-care management is associated with improving the quality of life of patients with diabetes mellitus in RSUD Ibnu Sina Gresik.

A Comprehensive Investigation of "Oral Thin Films" As a Treatment for Noncompliance in Young Patients and Elderly Individuals

A Comprehensive Investigation of "Oral Thin Films" As a Treatment for Noncompliance in Young Patients and Elderly Individuals

Compliance of Radiotherapy Treatment at a Tertiary Cancer Center in India—A Clinical Audit

Abstract Introduction Noncompliance to planned radiotherapy (RT) treatment is associated with inferior outcomes and also serves as an indicator of quality of care offered to the patients. Identification of the rate of noncompliance and its causative factors can help us develop an insight toward implementing mitigation measures thereby improving the quality of treatment. Objective To ascertain the incidence of noncompliance and the factors affecting the same in patients offered RT appointments. Materials and Methods We retrospectively reviewed the records of patients from January 1, 2019, to December 31, 2019, who were noncompliant (defaulted RT simulation or defaulted initiation of RT or defaulted planned RT during the course of RT but excluding planned/unplanned treatment breaks or early conclusions prescribed by the treating radiation oncologist) for the planned RT treatment. Results Of the 8,607 appointments (7,699 external beam RT and 908 brachytherapy) given to the patients attending the radiation oncology outpatient department in the year 2019, a total of 197 (2.28%) patients were found to be noncomplaint. Ninety-seven patients defaulted RT simulation (49.2%), 53 defaulted RT starting (26.9%), and 47 defaulted while on RT (23.9%). Half of these had either head–neck (29.9%) or gynecological (20.8%) malignancies. Patients with breast cancers had the least noncompliance rates (0.02%). The cause for noncompliance was ascertained in 135 patients (68.5%). The common causes of noncompliance were the desire to continue treatment closer to home (21.5%) followed by logistic (17%), lack of confidence in the curative potential of the planned therapy (17%), and financial reasons (11.8%). Patients with head–neck and gynecological malignancies were more often with advanced staged disease and were planned multimodal treatment protocols. The majority of the 23 patients who defaulted palliative RT were planned for fractionated treatments (73.9%). Conclusion The incidence of noncompliance in patients planned for RT in our institute can be considered optimum. Appropriate counseling of patients at the time of scheduling appointment, upfront identification of patients at high risk of noncompliance, and assisting patients with financial and logistic challenges are imperative to ensure adherence to planned treatment schedule.

Methodological approach to risk prediction noncompliance in patients with myocardial infarction

Aim. To develop a methodological approach in order to predict the risk of noncompliance in patients with myocardial infarction.Methods. 416 patients were questioned in the single-centered, prospective, non-randomized study using the original author's method. The patients were treated in specialized cardiological departments of the city of Kemerovo with the diagnosed myocardial infarction. The methodological approach to predicting the risk of non-compliance in patients with myocardial infarction covered 29 factors in 6 main blocks: sociodemographic and socio-economic characteristics, health status, medical and pharmaceutical culture of the patient, awareness of medical and pharmaceutical services, patient adherence to medical recommendations.Results. Patients with myocardial infarction were characterized by insufficient adherence to the therapy, low awareness of the disease, which can negatively affect the longterm disease prognosis. The identification of a large number of subjective factors limiting adherence to the therapy is the reason for the widespread use of noncompliance risk measurement among patients with myocardial infarction, which will allow determining the range of the risk group for each individual patient.Conclusion. The adherence to the treatment of patients with myocardial infarction is revealed as 80% which is indicated as low and requires the prophylactic use of educational and psychological programs that increase medical and social awareness and readiness to comply with the doctor's recommendations, and also justifies the need for complex risk measurement of non-compliance patients for personalized identification and addressing risk factors for poor adherence to therapy.

Aspirin nonsensitivity in patients with vascular disease: Assessment by light transmission aggregometry (aspirin nonsensitivity in vascular patients)

BackgroundAspirin is a key antiplatelet therapy for the prevention of thrombotic events in patients with cardiovascular disease. Studies suggest that ≈20% of patients with cardiac disease suffer from aspirin nonsensitivity, a phenomenon characterized by the inability of 81 mg aspirin to inhibit platelet aggregation and/or prevent adverse cardiovascular events. ObjectivesTo investigate aspirin nonsensitivity in patients with vascular disease and assess the consequences of aspirin nonsensitivity. MethodsOne hundred fifty patients presenting to St. Michael’s Hospital’s outpatient clinics with evidence of vascular disease (peripheral arterial disease or carotid artery stenosis) and a previous prescription of 81 mg of aspirin were recruited in this study. Light transmission aggregometry with arachidonic acid induction was used to determine sensitivity to aspirin. Patients with a maximum aggregation ≥20% in response to arachidonic acid were considered aspirin nonsensitive, as per previous studies. ResultsOf the 150 patients recruited, 36 patients (24%) were nonsensitive to 81 mg of aspirin. Of these 36 nonsensitive patients, 30 patients provided a urine sample for urine salicyluric acid analysis (a major metabolite of aspirin). Urine analysis demonstrated that 14 patients were compliant and 16 were noncompliant with their aspirin therapy. Major adverse cardiovascular events and major adverse limb events were significantly higher in the nonsensitive patients compared to sensitive patients (hazard ratio, 3.68; P< 0.001). ConclusionThese data highlight the high prevalence of aspirin nonsensitivity and noncompliance in patients with vascular disease and emphasizes the urgent need for improved medical management options for this patient population.

Sociodemographic Factors Associated With Decreased Compliance to Prescribed Rehabilitation After Surgical Treatment of Knee Injuries in Pediatric Patients.

Background:Rehabilitation is an important component of care in postsurgical knee patients, especially as it pertains to return to preinjury activity level. Despite the established significance of rehabilitation in improving outcomes after certain surgical procedures, there is a lack of investigation into compliance rates and factors that affect compliance in pediatric patients.Purpose/Hypothesis:The purpose of this study was to evaluate sociodemographic factors associated with noncompliance in pediatric patients after knee surgery to characterize health disparities in this population. Our hypothesis was that certain sociodemographic factors would be associated with decreased compliance.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A retrospective review of medical records was used to gather data on compliance rate, demographics, and socioeconomic factors for pediatric patients undergoing rehabilitation after knee surgery. Compliance rate was determined by counting the total scheduled appointments, cancellations, and no-shows (defined as visits for which patients did not show up and did not provide notification of cancellation). Various types of knee injuries were included in this study. Data were evaluated using bivariate analyses in addition to hierarchical linear and binary logistic regression to assess for associations between sociodemographic factors and compliance rate.Results:Our total sample size was 186 patients. When compared with patients from non–single-parent households, patients from single-parent households were found to have a lower rate of physical therapy compliance (72.2% vs 80.1%; P < .001), were less likely to reach the 85% compliance threshold (9.1% vs 42.4%; P < .001), and had an increased amount of cancellations and no-shows (16.7 vs 11.7 visits; P = .02). Although a small sample size, Hispanic/Latino patients were shown to have a lower achievement of the 85% compliance threshold compared with non-Hispanic/Latino patients (0% vs 38.2%; P = .04). Increased distance from the rehabilitation clinic was associated with lower achievement of the 85% compliance threshold (P = .033).Conclusion:Overall, there were several significant demographic and socioeconomic variables associated with rehabilitation compliance, specifically single-parent status, distance to rehabilitation clinic, and ethnicity. These results suggest potential predictors of decreased compliance that warrant prospective investigation.

Development and Evaluation of Fluoxetine Fast Dissolving Films: An Alternative for Noncompliance in Pediatric Patients

The most used pharmaceutical formulations for children are syrups, suppositories, soft chewable capsules, and mini-tablets. Administrating them might create an administration discomfort. This study aimed to develop and evaluate orodispersible films (ODFs) for pediatric patients in which the fluoxetine (FX) is formulated in the polymeric matrix. Six FX fast dissolving films (10 mg FX/ODF), FX1, FX2, FX3, FX4, FX5, and FX6, were prepared by solvent casting technique. In the composition of the ODFs, the concentration of the hydroxypropyl methylcellulose and the concentration of the propylene glycol were varied. Each formulation of fluoxetine ODF was evaluated by determining the tensile strength, folding endurance, disintegration, behavior in the controlled humidity and temperature conditions, and adhesiveness. All the obtained results were compared with the results obtained for six ODFs prepared without FX. The disintegration time of the FX ODFs was of maximum 88 s for FX2. Via the in vitro releasing study of the FX from the ODFs it was noticed that FX1 and FX2 allow a better release of the drug 99.98 ± 3.81% and 97.67 ± 3.85% being released within 15 min. From the obtained results it was also confirmed that FX ODFs were found to follow first-order release kinetic.

Evaluating Medication Habits in Medical Mission Patients: A Cross-Sectional Study.

BackgroundShort-term medical missions (STMMs) are a highly debated and largely understudied form of international volunteer work. With growing dedication to health care abroad, research evaluating their impact is crucial to ensure continued interventions are effective in improving medical care. STMM care varies in length, frequency, size, location, services offered, and country of origin and destination. This makes systematic evaluation of STMMs difficult. In addition, the transient nature of patient visits makes trending STMM’s impact on long-term health outcomes complex.Despite intermittent availability, primary care missions offering pharmaceutical supplies have the unique opportunity to provide continued care to the community via free prescription supplies each visit. Given the challenges with measuring long-term outcomes in this population, it is unknown if these donated medications have any impact on patient health outcomes. As medication noncompliance is known to hinder health outcomes, our study chose to evaluate patient medication habits to see if these prescription supplies were being utilized appropriately. To our knowledge, no study has surveyed medical mission patients to explore their access and utilization of medication.MethodsA cross-sectional study was conducted using a patient survey to identify risks and/or factors associated with medication noncompliance in patients visiting the medical mission, Waves of Health (WOH). For over 10 years, WOH has organized biannual seven-day trips to the Dominican Republic. The multi-question survey was translated into the native language, Spanish with Dominican dialect. Noncompliance was defined through the survey question “Did you run out of your prescription medication at all during the past year?” Spanish speaking participants, of both sexes and age ≥18 years old, who visited the mission clinic in November 2019 met inclusion for this study. Patients from Haiti or age <18 years old were excluded. Participation was voluntary.Survey items were dichotomized for univariate analysis to identify factors associated with running out of medication. To explore predictors of running out of medicine, we performed multivariate logistic regression analysis by ENTER method. ResultsOf 127 patients, over half (58.3% [74]) reported running out of medication. Inadequate access to healthcare, daily medication use, and rationing personal medications were all significantly associated with running out of medicine. Frequency of WOH visits was not associated with running out of medication. Multivariate regression showed that being on daily medication and rationing personal medications were statistically significant predictors of running out of medicines. Access to healthcare, frequency of WOH visits, and WOH medication supply were not predictors of running out of medication.Conclusion Mission interventions to improve medication practices should be explored due to the high number of patients who reported improper utilization of medication. In order to improve health outcomes in primary care settings, patients must play an active role in their care and understand the importance of taking their medication as prescribed for optimal disease management. Primary care STMMs may relieve short-term health concerns, but without proper utilization of chronic disease medications, it is unclear if STMMs role is impactful in long-term health outcomes.

Treatment Non-Compliance in Patients with Schizophrenia

INTRODUCTION: Non-compliance to medication in Schizophrenia is a common problem. It leads to frequent recurrence of Psychosis which has negative impact on individuals and their families. Understanding and reducing non-adherence is therefore a key challenge to quality care for patients with Schizophrenia. This study was conducted with the aim of determining the incidence and factors associated with medication non-compliance among patients suffering from schizophrenia.&#x0D; MATERIAL AND METHODS: This cross-sectional study included 94 schizophrenic subjects who visited psychiatric OPD of tertiary level hospital. Disproportionate stratified random sampling method was applied to collect the data. Socio-demographic data sheet, data sheet to collect the various factors of compliance and the 8-item Morisky Medication Adherence Scale (MMAS-8) were used for data collection by interview method. &#x0D; RESULTS: The prevalence of non-compliance was 89.4%. With regards to association between noncompliance and demographic characteristics, there was high non-compliance rate in age below 40 years (54.2%), male (52.1%), married (64.8%) and low economic status (52%). Medication non-compliance were high in patients with medication side effects dizziness (60.6%), sedation (66%), longer duration of illness (92.8%) &amp; having 1-3 pills (47.8%).&#x0D; CONCLUSION: Medication Non-Compliance in Schizophrenia was high. Measures that can increase compliance like psycho-educational programmes on compliance and the active involvement of the relatives and significant others in the management of patients of mentally ill patients are recommended.

Treatment Non-Compliance in Bipolar Affective Disorder Patients: A Study from a Tertiary Care Centre in Nepal

Background: Treatment Non-compliance is a major challenge in the treatment of Bipolar Affective Disorder as it can give rise to lots of unwanted consequences. Therefore, understanding various reasons for non-compliance and taking steps to reduce it is a key step in minimizing the unwanted consequences. Thus, This study was done to identify the pattern of non-compliance in patients with Bipolar Affective Disorder.&#x0D; Methods: This was a cross-sectional study including 76 patients who attended Psychiatry OPD of Universal College of Medical Sciences. Socio-demographic datasheet, Datasheet for various factors related to non-compliance, Morisky 8-Item Medication Adherence Scale (MMAS-8) and Descriptive summaries of socio-demographic and contributing factors for all patients were used to record the data.&#x0D; Results: Out of a total of 76 patients, males (55.2%) were slightly higher than Females. The mean age of participants was 35.78±12.25 years. About 76.8% of the patients were non-compliant. High non-compliance was seen in age below 40 years (48.7%), male (52.6%) and duration of illness up to 15 years (78.9%), having up to 3 pills (44.7%) and having previous treatment history (60.5%).&#x0D; Conclusion: Treatment non-compliance was very high in patients with BPAD. Appropriate measures need to be taken care of to reduce non-compliance.

Treatment Non-Compliance In Patients Suffering From Schizophrenia And Bipolar Affective Disorder (BPAD): A Comparative Study

Introduction: Non-adherence to appropriately prescribed medication for psychiatric disorders prevents patients from realizing the full benefits of their treatment and negatively impacts on individuals, their families and the healthcare system. Understanding and reducing non-adherence is therefore a key challenge to quality care for patients with psychiatric disorders. This finding highlights the prevalence, consequence of non-adherence and barriers to adherence. Therefore, the main objective of this study was to determine the incidence and factors associated with medication non-compliance among patients suffering from schizophrenia and bipolar affective disorders.&#x0D; Material and Method: This cross-sectional study included 94 schizophrenia and 76 bipolar affective disorder subjects who were visited psychiatric OPD of tertiary level hospital and disproportionate stratified random sampling method. An anonymous socio-demographic as well contributing factor questionnaire pre tested, semi structured pro forma by interview method and a clinical proforma designed by Morisky, the 8-item Morisky Medication Adherence Scale (MMAS-8) were used for data collection.&#x0D; Results: The prevalence of non-compliance was 88%, the independent predictors of non-compliance were; seeking for traditional/spiritual treatment, weight gain as side effects of drugs , increased number of medication (p=0.038), beginning of medication start (p=0.057), unemployment (p=0.059), low level of insight/education (p=0.044), male as gender (p=0.016).&#x0D; Conclusion: Based on the outcome of the study, we recommend the development of psycho-educational programmes on compliance and the active involvement of the relatives and significant others in the management of patients of mentally ill patients.

Oral thin films as a remedy for noncompliance in pediatric and geriatric patients.

Pediatric and geriatric patients experience swallowing difficulties for traditional oral dosage forms, such as tablets. Further, microbial contamination, chemical stability, unpleasant taste and swallowing large volumes of fluids have led to low therapeutic efficacy and patient noncompliance. The emergence of oral thin films has resulted in dramatic improvements in compliance and drug therapy outcomes in pediatric and geriatric patients. Oral thin films do not require water for administration, are readily hydrated upon contact with saliva, adhere to the mucosa and disintegrate ideally under 1 min. This article provides an overview of oral thin films, modern trends in their formulation and characterization, available commercial products, information to fill knowledge gaps and future potential and economic prospects of oral thin film technology, with emphasis on their use in the pediatric and geriatric patient groups.

Abstract 173: Predictors of Medication Noncompliance in Patients with an Acute Myocardial Infarction

Background: Aspirin, P2Y12 inhibitors, Statins, Angiotensin-Converting-Enzyme Inhibitor/Angiotensin II Receptor Blockers and Beta Blockers improve outcomes for patients with an Acute Myocardial Infarction (AMI). Despite this, some patients remain noncompliant with medications. We investigated potential predictors of medication noncompliance in patients with an AMI. Method: We examined adult patients with an AMI enrolled in a quality improvement program (QIP). Patients discharged prior to enrollment or those discharged to skilled nursing facilities were excluded. The primary outcome was medication noncompliance at the first follow up visit - defined as not taking at least 1 of the medications listed above. Multivariate logistic regression was used to identify risk factors for noncompliance. Results: Among 173 patients enrolled in the QIP, 119 patients (Mean age 64 +/- 1 year; 32% Females) had data regarding their follow-up office visit, of which 32% of patients were noncompliant. Table 1 lists the univariate and multivariate predictors of noncompliance. Among 25 clinical and socio-demographic variables examined, we found that needing help with medical care, or being a primary care giver to others were each associated with a roughly 5 fold higher risk of medication noncompliance. Conclusion: A significant number of patients with an AMI are noncompliant with their medications. Social support programs should focus efforts on providing patients with the help needed at home to ensure compliance with care.

The Value of Licensed Clinical Social Worker Pre-Implant Assessment in Predicting Non-Compliance in Durable Mechanical Circulatory Support Device Patients

Purpose Patient (pt) compliance is vital to the success of durable mechanical circulatory support (DMCS). During acute decompensation of heart failure, Advanced Heart Failure Centers are tasked with making timely decisions regarding candidacy for DMCS. History of non-compliance (NC) and predicting future NC can be difficult to assess during this acute phase. Licensed Clinical Social Workers (LCSW) assess pts pre-implant for possible NC after DMCS. The purpose of this study is to determine whether LCSW pre-implant assessment is effective in predicting NC after DMCS and whether this is affected by a history of substance abuse. Methods Between 2007-2018, our LCSWs evaluated 255 pts prior to DMCS and assessed them as low risk vs high risk for NC. After DMCS, NC was defined as exhibiting one of the following: Missed > 3 clinic appointments or 3 lab draws, or documentation of not taking medications correctly or not following MD instructions > 3 occasions. The DMCS pts were divided into Compliant vs Non-Compliant and compared by LCSW pre-implant risk assessment. In addition, the NC pts were divided by those with a history of substance abuse vs those without. Results Following DMCS, there were 219 Compliant pts and 36 NC pts. LCSWs pre-implant risk assessment (use of SIPAT tool in addition to adherence/substance abuse history) identified 41.7% of NC pts as high risk (for NC) while only 6.7% of Compliant pts were noted to be high risk pre-implant. For those NC pts, the additional risk of a history of substance abuse further increased the accuracy of the LCSW pre-implant risk assessment. (See Table) Conclusion Our current LCSW pre-implant risk assessment appears effective in predicting NC in our DMCS patient population. Advanced Heart Failure Centers can use this data (high risk for NC after DMCS) for decision making when considering pts for DMCS or for more aggressive interventional techniques to prevent NC after DMCS placement.