Medication Adherence Outcomes Research Articles

The role of clinical pharmacist in the management of resistant hypertension.

Hypertension is a major contributor to global cardiovascular morbidity and mortality. Treatment-resistant hypertension (TRH) presents a significant management challenge, requiring a pharmacist-physician collaborative model to achieve sustained blood pressure (BP) control. This study aims to evaluate the impact of a clinical pharmacy interventions on BP control, medication adherence, and patient outcomes in patients with TRH in a primary care setting. A randomized controlled trial was conducted involving 142 patients with TRH at two primary care clinics. Participants were randomly assigned to either the intervention group, receiving clinical pharmacy services including medication reviews and personalized counseling, or the control group, receiving standard care. Medication adherence was assessed using the Medication Adherence Rating Scale, and patient outcomes, including BP control and quality of life (QoL), were measured over a 6-month period. The intervention group demonstrated a significant improvement in medication adherence compared to the control group (p < 0.001), with an effect size of - 1.75. Clinical parameters, such as BP (mean reduction in BP: 27.9/13.4mmHg), showed more favorable outcomes in the intervention group (p = 0.003). Furthermore, patients receiving clinical pharmacy services reported higher QoL scores (p < 0.001) and expressed higher satisfaction with medication management. Clinical pharmacy interventions significantly enhance medication adherence and improve patient achievement of target BP goals in TRH patients. Incorporating clinical pharmacy services into routine care can lead to better health management and increased patient QoL. Further research is needed to explore long-term benefits and cost-effectiveness.

Study protocol for a randomized control trial investigating the effectiveness of a multifaceted mHealth approach on adherence to antihypertensive treatment among patients in Pakistan

Background &amp; Objectives: Poor medication adherence is an essential contributor to Pakistan’s high prevalence of uncontrolled hypertension. This study will be aimed to assess the efficacy of a one-of-a-kind developed intervention in improving medication adherence and treatment outcomes in hypertension patients. Methods: Twleve months duration long randomized controlled trial from January to December 2021 will be carried out at Shaikh Zayed Medical Complex (SZMC), Lahore. A total of 440 patients aged 18 years and older diagnosed with hypertension in the last month with non- adherence to antihypertensive therapy &lt;80% of pills used in the last 30 days and have access to a smartphone will be randomized into either the intervention group (n=220) or the control group (n=220). For the intervention arm, a comprehensive intervention, the “Multi-Aid-Package,” consisting of seven items: written, voice, and graphics messages, animated video, educational material, and a 24/7 help service, has been designed. Standard care will be provided to the control group. The primary outcome will be improved adherence to antihypertensive medication, while the secondary outcome will be an alteration in systolic blood pressure (SBP). The analysis will be intention to treat. Conclusion: According to this study, if the multifunctional Multi-Aid-Package proves to be a useful mobile health tool for improving hypertension patients’ medication adherence, it will also significantly affect systolic blood pressure. In Pakistan and other comparable low- and middle-income countries LMICs, the Multi-Aid-Package ought to be taken into consideration as a means of enhancing adherence to medications among hypertension patients. Trial registration: ClinicalTrials.gov NCT04577157. doi: https://doi.org/10.12669/pjms.41.1.9272 How to cite this: Arshed M, Mahmud AB, Umer MF, Mashhadi F, Kawish AB. Study protocol for a randomized control trial investigating the effectiveness of a multifaceted mHealth approach on adherence to antihypertensive treatment among patients in Pakistan. Pak J Med Sci. 2025;41(1):22-28. doi: https://doi.org/10.12669/pjms.41.1.9272 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

TELEMEDICINE AND ITS EFFECT ON CHRONIC DISEASE MANAGEMENT IN REMOTE COMMUNITIES

Background: Chronic diseases, such as diabetes, hypertension, and cardiovascular conditions, are leading causes of morbidity and mortality worldwide. These diseases disproportionately affect rural populations due to limited access to healthcare and resources. Telemedicine offers a transformative solution to address these disparities by providing remote healthcare delivery. This study investigates the effectiveness of a telemedicine-based intervention in improving medication adherence, health-related quality of life (HRQoL), and clinical outcomes in a rural population in Sindh, Pakistan. Objective: To evaluate the impact of a telemedicine-based chronic disease management program on medication adherence, HRQoL, and clinical outcomes in rural Sindh, Pakistan. Methods: This quasi-experimental study was conducted from June 2023 to January 2024 in rural Sindh. A total of 84 participants with chronic conditions were recruited and divided into two groups: the control group received standard face-to-face care, while the experimental group participated in a telemedicine program. Participants acted as their own controls, with pretest-post-test comparisons. Baseline data included medication adherence rates, HRQoL scores, and clinical metrics such as blood pressure and blood glucose levels. The telemedicine program provided weekly consultations, health education, and self-monitoring tools, with data collected through validated questionnaires and medical records. Statistical analyses included paired t-tests and logistic regression. Results: Medication adherence improved significantly from 65% at baseline to 88% post-intervention. HRQoL scores increased from 50 ± 8 to 72 ± 6. Among hypertensive participants, blood pressure decreased by an average of 14 ± 4 mmHg, while diabetic participants experienced a mean reduction of 25 ± 8 mg/dL in blood glucose levels. No adverse events were reported, and participant satisfaction exceeded 90%, highlighting the feasibility and acceptability of the telemedicine model. Conclusion: Telemedicine significantly improved chronic disease management in rural Sindh by enhancing medication adherence, HRQoL, and clinical outcomes. These findings support the integration of telemedicine into rural healthcare strategies to reduce disparities and improve access to quality care.

Abstract 4118668: Understanding Medication Adherence to Oral Anticoagulants in Atrial Fibrillation Management: Patient and Provider Perspectives in a Mixed Methods Study

Background: Atrial fibrillation (AF) increases risk of stroke. National guidelines recommend oral anticoagulant (OAC) use to reduce this risk. Medication adherence is pivotal for effective AF management, necessitating an understanding of adherence barriers. Aims: This mixed-methods study aimed to identify patient and provider factors influencing OAC adherence. Methods: Patients with nonvalvular AF and OAC prescriptions were sampled from a large community health system serving seven states. A stratified random sample of 2,000 patients was surveyed by mail, achieving a 13.3% response rate (266 patients). Twenty-eight semi-structured interviews were conducted with a purposive sample of patient survey respondents. Eligible providers were surveyed by email, resulting in a 3% response rate (78 providers). Survey data were analyzed descriptively and using multivariable regression models. Interview data were analyzed thematically. Results: Of 213 patients with an adherence score available, 31.5% reported non-adherence. Nonadherent patients were more likely to report poor healthcare experiences, including discrimination in a healthcare setting and poorer mental/emotional health. Receiving information from providers was significantly associated with adherence, especially among younger patients and those with fewer chronic conditions. High self-efficacy score was associated with adherence, particularly among older and rural patients. Interview analyses showed provider communication about AF medications, perceptions of AF as a serious illness, and a sense that medication was helping manage AF were all important for medication adherence. In contrast, most providers (87%) perceived high non-adherence among AF patients, citing forgetfulness, cost, and side effects as the main reasons. Providers’ responses indicate a need for improving communication and support for addressing adherence barriers. Conclusion: Most patients reported adherence to their medications, with adherence being associated with positive healthcare experiences and better mental/emotional health. Providers perceived relatively low adherence among their patients but aligned with patients on the need for improved communication and shared decision making. Tools that encourage discussion with patients and open communication between providers and patients are pivotal for optimizing patient care and enhancing medication adherence and treatment outcomes.

A Cross-Sectional Study Identifying Medication Adherence Technologies (MATech) in Sweden Using Behavior Change Techniques.

Poor medication adherence is a well-recognized problem, and behavior change techniques (BCTs) have shown promise in improving patient adherence to prescribed drug treatment. Through the utilization of medication adherence technologies (MATech), these BCT interventions could be delivered effectively in a person-centered way. MATech can be defined as systems, services or physical devices (hardware), with a digital component, used to support patients in their drug utilization. However, there is a lack of knowledge regarding their availability and to what extent they apply evidence-based BCTs. This study aimed to identify and describe MATech with BCT interventions available in the Swedish language. A cross-sectional survey study was conducted in 2023. After identifying potential MATech developers by contacting umbrella organizations in the private sector, public agencies and regions, and conducting an app search, a survey was distributed to 381 potential MATech developers. Included MATech were in Swedish, used by patients, incorporated a BCT intervention, and had survey response from the developer. The survey was based on the BCT taxonomy and the framework of attributes from the COST ENABLE project, and included questions regarding BCT features. Following correspondence with 189 potential developers, 32 with products of interest responded to the survey, and 21 MATech were identified (12 standalone software and nine hardware solutions). Among the 21 MATech identified, nine were hardware and ten were specifically designed for a particular disease or medication. The majority of technologies incorporated BCTs of reminding the patient to take the medication (81%), information about the treatment (71%) and providing feedback on the monitoring of medication adherence or clinical outcomes (76%). Swedish-language MATech employing BCTs are available, encompassing both hardware and software solutions. There is a need to enhance the visibility of these technologies, enabling patients to discover and utilize the support they provide.

Educational programmes for improving medication adherence among older adults with coronary artery disease: a systematic review and meta-analysis

Abstract Background Coronary artery disease (CAD) is the leading cause of death worldwide. Adhering to CAD medications is the priority of its treatment. However, medication adherence is suboptimal among older adults with CAD. Educational programmes are widely used and recommended in improving medication adherence among older adults with CAD. However, the evidence about the effects of educational programmes on medication adherence among older adults with CAD is limited. Aim To evaluate the best available research evidence on the effects of educational programmes designed for improving medication adherence among older adults with CAD. Methods 12 English databases and five Chinese databases were searched from inception to January 2024. Randomised controlled trials or quasi-experimental studies examining the effects of educational programmes for improving medication adherence among older adults with CAD were included. The educational programmes included a set of planned activities aiming at improving the knowledge, attitudes, and skills of medication adherence. The outcome of medication adherence was measured by either objective or subjective methods. The quality of the included studies was assessed by the Cochrane Risk of Bias Tool v2 or the Risk of Bias In Non-randomised Studies of Interventions tool. Meta-analysis was conducted using random-effect models as appropriate. Narrative synthesis was conducted if the results of the included studies were not appropriate or possible for meta-analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Approach was used to assess the certainty of evidence. Results 5,607 records were retrieved and 5,599 records were excluded. Seven studies including six randomised controlled trials and one quasi-experimental study were included. Two studies were rated as low risk of bias. Five studies were rated as some concerns or moderate risk of bias due to inadequate information on blinding, allocation concealment, and the analysis of data according to the intention-to-treat principle. The results showed that the educational programmes were associated with significant improvements in medication adherence at immediately post-intervention (Standardised mean difference (SMD): 1.61, 95% CI: 0.03 to 3.19, P=0.05, Low quality of evidence), and at one to six months post-intervention (SMD: 1.13, 95% CI: 0.33 to 1.94, P=0.006, Moderate quality of evidence). Narrative synthesis found that the educational programmes potentially improved medication adherence over six months post-intervention. Conclusions The results show that the educational programmes could improve medication adherence among older adults with CAD. Designing the educational programmes with theoretical frameworks would be helpful to address the complex health needs of the older adults with CAD. More rigorous evaluation of the effectiveness of the programmes on long-term medication adherence of the older adults is warranted.Figure 1.Immediate post-interventionFigure 2.Medium-term post-intervention

Medication adherence and antithrombotic therapy outcomes: insights from a post-hoc analysis of the AFIRE trial

Abstract Background The AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease) trial established noninferiority in efficacy and superiority in safety endpoints of rivaroxaban monotherapy over rivaroxaban plus antiplatelet therapy (combination therapy) in patients with atrial fibrillation (AF) and stable coronary artery disease (CAD). However, the impact of medication adherence to rivaroxaban on AFIRE study outcomes remains unclear. Purpose This post-hoc analysis aimed to explore the influence of medication adherence on AFIRE trial results. Methods Among 2,120 patients, participants were classified into adherent and non-adherent groups based on self-reported measures, which were further verified through on-site visits to the facilities. Adherent patients were defined as those who reported consistently taking their medication as prescribed. The primary efficacy endpoint comprised stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or all-cause death, including cerebral events. Analysis also examined differences in the primary efficacy endpoint between adherent and non-adherent patients. Results Of the 2,120 patients, 2,012 (94.9%) were adherent to rivaroxaban, while 108 (5.1%) were non-adherent. Among adherent patients, rivaroxaban monotherapy showed significantly better efficacy outcomes compared to combination therapy (hazard ratio [HR] 0.73; 95% confidence interval [CI] 0.54–0.98; p=0.04, Figure 1A). However, primary efficacy outcomes did not significantly differ among non-adherent patients (HR 0.64, 95% CI 0.23–1.81, p=0.40, Figure 1B). Adherent patients exhibited improved outcomes relative to non-adherent patients, though this difference was not statistically significant (HR 1.68; 95% CI 0.99–2.85; p=0.05, Figure 2A). In clinically high-risk patients with a history of angina pectoris, those who demonstrated adherence to medication (n=1281) exhibited significantly better efficacy outcomes compared to non-adherent patients (n=68) (HR 1.97; 95% CI 1.09–3.56; p=0.03, Figure 2B). Conclusions Rivaroxaban monotherapy versus combination therapy showed favorable efficacy outcomes in patients with good adherence, consistent with the overall AFIRE trial. However, these benefits were not observed in non-adherent patients. Adherence to rivaroxaban is crucial for achieving its maximum therapeutic effect as monotherapy.Figure1Figure2

Determinants of medication non-adherence among patients with chronic diseases at community pharmacy settings in South Gondar Zone, Northwest Ethiopia: a multicenter cross-sectional study.

Medication non-adherence is a significant public health concern in managing patients with chronic diseases, and community pharmacists are on the frontline in the management of chronic medications. Chronic diseases require lifelong pharmacotherapy and understanding the determinants of medication adherence has paramount importance to develop strategies that improve medication adherence and treatment outcomes. Thus, this study aimed to assess the magnitude of medication non-adherence and its contributing factors among patients with chronic diseases attending community pharmacies in South Gondar Zone, Northwest Ethiopia. A multicenter cross-sectional study was conducted at community pharmacies in South Gondar Zone from September 01 to October 30, 2023. Medication adherence was assessed using a structured questionnaire using the Adherence in Chronic Diseases Scale (ACDS). Statistical Package for Social Sciences (SPSS) version 25 was used for analysis. Association between the outcome variable and independent variables was performed using binary logistic regression and a p-value of <0.05 was considered statistically significant. Among three hundred and eighty six (386) study participants recruited in this study, more than half of them 222 (57.51%, 95%CI: 52.4% - 62.5%) were low adherent to their medications. Concerning determinants of medication non-adherence; the presence of side effects (AOR =2.1, 95%CI=1.33-3.29), unable to get ever counseling from community pharmacists (AOR=2.3, 95%CI= 1.46-3.58), and poor about their medications (AOR=3.1, 95% CI= 1.96-4.82) were significantly associated with patients' non-adherence to medications. The medication adherence level in this study was suboptimal, with a significant proportion of the patients being non-adherent to their medications. The presence of side effects, unable to get ever counseling, and poor knowledge about their medications were statistically significant factors of poorer medication adherence. Hence, healthcare professionals, especially community pharmacists, have a crucial role in designing the schedule for health education concerning the needs of these patients in community pharmacy settings.

Impact of a clinical pharmacist-led, artificial intelligence–supported medication adherence program on medication adherence performance, chronic disease control measures, and cost savings

BackgroundChronic diseases are the leading cause of disability and death in the United States. Clinical pharmacists have been shown to optimize health outcomes and reduce health care expenditures in patients with chronic diseases through improving medication adherence. ObjectiveThe primary objective of this study was to evaluate a pharmacist-led, artificial intelligence (AI)–supported medication adherence program on medication adherence, select disease control measures, and health care expenditures. MethodsThis was a multicenter, retrospective, quasi-experimental evaluation from January 2019 to December 2019 (preimplementation) and January 2021 to December 2021 (postimplementation). This pharmacy-driven service focuses on improving medication adherence and patient outcomes through AI-supported analytics, individual patient case review, and pharmacist-led individual patient outreach. The primary end point was to determine whether implementation improved medication adherence in 3 medication-related measures: medication adherence for hypertension (MAH), medication adherence for cholesterol (MAC), and medication adherence for diabetes (MAD). Secondary outcomes were to evaluate reductions in select chronic diseases control measures and cost savings of this service after implementation of this service. ResultsThis medication adherence service was deployed across 10,477 patients: 60.6% of patients were in at least 1 medication-related measure, generating 2762 actionable medication adherence gaps. After the implementation of this pharmacist-led program, medication adherence improved in all 3 disease state measures (MAH 5.9% improvement, MAC 7.9% improvement, MAD, 6.4% improvement), and Medicare Star ratings also improved. The percentage of patients with diabetes who reached their A1c goal also increased (75.5%-81.7%). Furthermore, reductions in overall health care expenditures were seen per member per month in patients who were adherent in comparison with those who were nonadherent (hypertension 31% cost savings, hyperlipidemia 25% cost savings, diabetes 32% cost savings). ConclusionThis clinical pharmacist–driven service leveraged technology and patient connection to increase medication adherence in patients with chronic disease states and led to improvement in select disease control measures and substantial health care cost savings.

Use of the Android-Based Application "LEUMYLO TRACKER" to Monitor Treatment Adherence in Chronic Myelocytic Leukaemia Patients

Leukaemia is a life-threatening cancer globally, characterized by the replacement of normal bone marrow elements with abnormal blood cells. Among various types, Chronic Myeloid Leukaemia (CML) poses significant health concerns, particularly in Asia. Managing CML requires strict adherence to targeted therapies like tyrosine kinase inhibitors, which is often challenging due to complex treatment schedules and side effects. Information and communication technologies, such as Android-based applications, can offer innovative solutions to improve medication adherence. This study aims to design, develop, and evaluate the effectiveness of an Android-based application, "LEUMYLO TRACKER," in monitoring treatment adherence among CML patients. The research uses a quasi-experimental design with a developmental research approach. The study involved 51 CML patients undergoing therapy at the Haematology Oncology Medical Internal Medicine Polyclinic, Cipto Mangunkusumo Hospital, selected through systematic random sampling. The primary factors studied were medication adherence using the Probabilistic Medication Adherence Scale and clinical response. The application development involved needs analysis, user interface design, and implementation of features such as medication reminders, adherence tracking, side effect notes, educational information, and communication capabilities with medical personnel. The application was developed using the Android platform and tested with a small group of patients to gather feedback and assess usability. Results from the univariate analysis indicated that 52.9% of respondents had good clinical responses, while 74.5% adhered to their medication regimen. Bivariate analysis showed a significant relationship between medication adherence and clinical response (p = 0.029), with non-adherent patients having a sixfold higher risk of poor clinical response. The LEUMYLO TRACKER application proved beneficial in improving adherence by providing automatic medication reminders and allowing real-time data collection for clinical evaluation. In conclusion, the LEUMYLO TRACKER application effectively enhanced medication adherence and clinical outcomes in CML patients. Its features, such as medication reminders and educational information, supported patients in managing their treatment schedules more consistently. The application also facilitated better communication between patients and medical personnel, allowing timely interventions. Ensuring ease of use and data security is crucial for maximizing the application's benefits. This study highlights the potential of mobile health applications in improving chronic disease management and patient outcomes.

Out-of-Pocket Prescription Drug Savings for Medicare Beneficiaries with Asthma and COPD Under the Inflation Reduction Act.

High and rising prescription drug costs for asthma and chronic obstructive pulmonary disease (COPD) contribute to medication nonadherence and poor clinical outcomes. The recently enacted Inflation Reduction Act includes provisions that will cap out-of-pocket prescription drug spending at $2,000 per year and expand low-income subsidies. However, little is known about how these provisions will impact out-of-pocket drug spending for Medicare beneficiaries with asthma and COPD. To estimate the impact of the Inflation Reduction Act's out-of-pocket spending cap and expansion of low-income subsidies on Medicare beneficiaries with obstructive lung disease. We calculated the number of Medicare beneficiaries ≥ 65years with asthma and/or COPD and out-of-pocket prescription drug spending > $2,000/year, and then estimated their median annual out-of-pocket savings under the Inflation Reduction Act's spending cap. We then estimated the number of beneficiaries with incomes > 135% and ≤ 150% of the federal poverty level who would become newly eligible for low-income subsidies under this policy. Respondents to the 2016-2019 Medical Expenditure Panel Survey (MEPS). Annual out-of-pocket prescription drug spending. An annual estimated 5.2 million Medicare beneficiaries had asthma and/or COPD. Among them, 360,160 (SE ± 38,021) experienced out-of-pocket drug spending > $2,000/year, with median out-of-pocket costs of $3,003/year (IQR $2,360-$3,941). Therefore, median savings under the Inflation Reduction Act's spending cap would be $1,003/year (IQR $360-$1,941), including $738/year and $1,137/year for beneficiaries with asthma and COPD, respectively. Total annual estimated savings would be $504 million (SE ± $42M). In addition, 232,155 (SE ± 4,624) beneficiaries would newly qualify for low-income subsidies, which will further reduce prescription drug costs. The Inflation Reduction Act will have major implications on out-of-pocket prescription drug spending for Medicare beneficiaries with obstructive lung disease resulting in half-a-billion dollars in total out-of-pocket savings per year, which could ultimately have implications on medication adherence and clinical outcomes.

Enhancing Outcomes in Opioid Use Disorder Treatment: An Economic Evaluation of Improving Medication Adherence for Buprenorphine Through Blister-Packaging.

The opioid epidemic has severely impacted the US over the last 15 years. Buprenorphine is a partial opioid agonist indicated for the treatment of opioid use disorder (OUD) and is recognized as an effective treatment when taken as prescribed. However, adherence rates have been low in real-world settings. Blister-packaging has been shown to promote medication adherence across a variety of disease states, although it has never been studied in OUD. An economic analysis was conducted to assess the impact of increased adherence of blister-packaged buprenorphine on health care resource utilization (HCRU) and health care costs for 10,000 patients initiating therapy for OUD. The model analyzed a commercially insured population within the US over a one-year time horizon. Medication adherence was defined in the model as proportion of days covered (PDC) of at least 80%. Literature-based references were used to inform both the impact of blister-packaging on the number of patients who became adherent as well as the impact of medication adherence on HCRU and health care costs. Model input uncertainty was assessed in one-way sensitivity analyses. With the implementation of blister-packaging buprenorphine, adherence rates increased from 37.1% of patients in the pre-intervention period to 45.3%, resulting in an additional 818 patients becoming adherent post-intervention. The increase in adherence led to a reduction of medical costs of $12,138,757 (-$1,214 per-patient (PP)). Specifically, inpatient costs decreased by $7,127,073 (-$713 PP) while outpatient costs decreased by $5,013,319 (-$501 PP). Pharmacy costs increased by $3,432,705 ($343 PP). Despite the increase in pharmacy costs, total health care costs saw a reduction of $8,559,684 (-$856 PP). Blister-packaging buprenorphine for treatment of OUD has potential to improve medication adherence and health outcomes while reducing HCRU and health care costs. Future studies are necessary to assess the real-world application and impact of blister-packaging buprenorphine for OUD across various patient populations and health care settings.

Medication Adherence and Health Outcomes: A Public Health Perspective

Medicine is a two-edged sword: while it can treat a patient's illness, when applied carelessly, it also has the potential to do more harm than good. Ensuring that patients receive appropriate medication for their clinical condition at the appropriate time, by the appropriate channel, and in the appropriate doses should be the top priority for any healthcare system. Polypharmacy can be helpful because numerous morbidities are common, but it can also have unintended harmful effects. The co-morbidity-polypharmacy score uses the patient's physiological age rather than their chronological age to predict how their therapy will turn out. Any departure from the medication's intended therapeutic impact may be regarded as a drug-related issue. The purpose of this study was to examine the effects of clinical pharmacist interventions on drug-related issues in prescriptions for polypharmacy as well as the cost-benefit analysis of clinical pharmacy services. The particular goals were to recognise and address drug-related issues, find out how well health care providers received clinical pharmacist interventions, analyse the cost-benefit of clinical pharmacy services, and create and suggest a clinical pharmacists intervention form to standardise and record drug-related issues.

Exploring the impact of subjective well-being on medication adherence: A cross-sectional study among individuals with multiple chronic diseases

BackgroundMedication non-adherence is a significant barrier to optimal treatment goals. The study explores the association between subjective well-being (SWB) and medication adherence among Lebanese individuals with multiple chronic diseases and identifies additional factors that may influence adherence in this population. MethodsAn exploratory, cross-sectional study was conducted for three months at six community pharmacies. Adherence was assessed using the Adherence to Refills and Medication Scale Arabic Lebanese Version (ARMS-A). The SWB was measured using the Arabic Scale of Happiness (ASH), Love of Life Scale (LLS), Arab Hope Scale (AHS), and Satisfaction with Life Scale (SWLS). Spearmen's Rho correlation analyzed the association between ARMS-A and SWB constructs. Binary logistic regression identified predictors of adherence among individuals with chronic diseases and on multiple chronic medications. ResultsOf 400 participants, 106 (26.5 %) with a 95 % CI, 0.22–0.31, were adherent. Lower medication adherence (reflected in higher ARMS-A scores) was associated with lower SWB (p = 0.01). Multivariate analysis showed that lower education (OR=2.21, 95 % CI, 1.01–4.81), lack of a specific diet (OR = 1.64, 95 % CI, 1.01–2.69), and frequent hospital and/or emergency visits (OR=3.29, 95 % CI, 1.75–6.17 for 2 visits; OR = 2.71, 95 % CI, 1.43–5.14 for ≥3 visits) significantly increased the odds of non-adherence to chronic treatment. However, higher income (OR = 0.06, 95 % CI, 0.01–0.38), healthcare provider occupation (OR = 0.42, 95 % CI, 0.21–0.48), and having diabetes mellitus (OR = 0.59, 95 % CI, 0.36–0.96) correlated with better adherence. ConclusionA significant portion of participants failed to adhere to their prescribed chronic medications, influenced by multicomplex socioeconomic, psychological, and health-related factors. These findings demonstrate the need for culturally-tailored, pharmacist-led interventions to improve medication adherence and overall health outcomes.

Do Orally Disintegrating Tablets Facilitate Medical Adherence and Clinical Outcomes in Patients with Post-stroke Dysphagia?

Orally disintegrating tablets (ODTs) dissolve rapidly in contact with saliva and have been reported to facilitate oral administration of medications in swallowing difficulties. However, their clinical benefits remain unclear because no previous studies have examined whether ODTs facilitate medication adherence and clinical outcomes in patients with post-stroke dysphagia. This study evaluated the association between ODT prescriptions and clinical benefits using high-dimensional propensity score (hd-PS) matching to adjust for confounding factors. Using a large Japanese commercial medical and dental claims database, we identified patients aged ≥ 65years with post-stroke dysphagia between April 2014 and March 2021. To compare 1-year outcomes of medication adherence, cardiovascular events, and aspiration pneumonia between patients taking ODTs and non-ODTs, we performed hd-PS matching. We identified 11,813 patients without ODTs and 3178 patients with ODTs. After hd-PS matching, 2246 pairs were generated. Medication adherence for 1year, based on the proportion of days covered, was not significantly different between the non-ODT and ODT groups before (0.887 vs. 0.900, P = 0.999) and after hd-PS matching (0.889 vs. 0.902, P = 0.977). The proportion of cardiovascular events (0.898 vs. 0.893, P = 0.591) and aspiration pneumonia (0.380 vs. 0.372, P = 0.558) were also not significantly different between the groups. This study found no significant differences in medication adherence, cardiovascular diseases, or aspiration pneumonia between the non-ODT and ODT groups in patients with post-stroke dysphagia. Both groups achieved a proportion of days covered exceeding 80%. Clinicians may consider prescribing ODTs or non-ODTs based on patient preferences rather than solely on post-stroke conditions.

Relationship between adherence to bictegravir/emtricitabine/tenofovir alafenamide fumarate and clinical outcomes in people with HIV in Japan: a claims database analysis

A lack of adherence to long-term antiretroviral therapy may impact viral suppression. The current study examined the relationship between medication adherence and clinical outcomes in people with human immunodeficiency virus infection (PWH) receiving bictegravir, emtricitabine, and tenofovir alafenamide fumarate (B/F/TAF). A retrospective cohort study using two Japanese claims databases was conducted. Adherence was measured by the proportion of days covered (PDC). Patients were grouped into 3 PDC category and persistence was estimated by Kaplan-Meier method. Cox regression analysis was performed to investigate whether the PDC was associated with treatment discontinuation. Among 952 patients, 820 (86.1%), 95 (10.0%), and 37 (3.9%) patients were grouped into the PDC ≥ 90%, 80– < 90%, and < 80% groups, respectively. Across all PDC groups, more than 90% of patients who received B/F/TAF were receiving treatment at 1 year. There was no significant difference in the risk of discontinuation between the lower PDC groups (80– < 90% and < 80%) and the PDC ≥ 90% group (0.400 [0.096, 1.661]; 2.244 [0.663, 7.594], hazard ratio [95% confidence interval], respectively). A drug resistance test was implemented for 15 patients, none of whom discontinued B/F/TAF after the test. The results suggest that events that could cause discontinuation, such as virologic failure, were not associated with PDC.

Preventing medication errors in patients with decompensated heart failure and cognitive impairment following hospital discharge, in Saudi Arabia

Abstract Background Heart failure (HF) is a progressive health challenge, with an increased prevalence of 30% in older adults. It is estimated that approximately 50% of patients with HF have a degree of cognitive impairment, affecting adherence to self-care and medication taking. Therefore, medication errors are becoming a global health challenge and account was estimated at 44.4% in Saudi Arabia. Purpose To explore the perspectives of patients with cognitive impairment and their caregivers on the pre-discharge medication education received. Methods A qualitative study, using semi-structured interviews. 7 dyads were recruited from a Cardiac center in Saudi Arabia The purposive sample was selected of patients who are identified as having cognitive impairment, as assessed by Montreal Cognitive Assessment scale (MoCA). Caregivers were nominated by the respective patient. Interviews were audio recorded, transcribed in Arabic, and translated into English. Transcripts were checked for authenticity. Data were analysis using thematic analysis. Results Most patients identified as male (n=5), including both patients with mild cognitive impairment (n=4) and moderate cognitive impairment (n=3). Four major themes were identified Complexity of Medication Management: Patients and caregivers struggle with the multifaceted nature of medication regimens, indicating a need for simplified schedules and clear instructions. Importance of Clear Communication and Education: There’s a critical need for comprehensive, understandable information about the indications and side effects of the medications. This should be tailored to individual learning preferences. Crucial Role of Caregiver Support: Caregivers have an important role in ensuring medication adherence. Some highlighted the benefit of being included in educational interventions. Challenges with Post-Discharge Support: All participants expressed a sense of abandonment post-discharge, with difficulties in accessing follow-up. Conclusion The study highlights the need for simplified medication regimens, enhanced communication, and comprehensive education for heart failure patients with cognitive impairment and their caregivers. Addressing these interconnected challenges through a multifaceted approach is crucial for improving medication management, adherence, and overall patient outcomes.

From symptoms to solutions: Addressing major depressive episodes in a multiple sclerosis patient

ABSTRACT Multiple Sclerosis (MS) is a chronic autoimmune disease that causes demyelination in the central nervous system, leading to significant physical and cognitive impairments. Depression is a common comorbidity in MS patients, further complicating their treatment and negatively affecting their quality of life. This study aimed to examine the impact of comorbid depression on medication adherence and clinical outcomes in MS patients, emphasizing the need for integrated psychiatric care. A detailed evaluation was conducted on an MS patient presenting symptoms of depression. This included a full psychiatric assessment, laboratory tests to rule out other medical conditions, and neuroimaging to confirm the MS diagnosis. The patient showed severe symptoms of depression, including psychomotor retardation, weight loss, and sleep disturbances. After starting treatment with escitalopram, the patient showed significant improvement in depressive symptoms within one month, highlighting the effectiveness of tailored psychiatric interventions in managing depression in MS patients.

The Effect of an mHealth Self-Monitoring Intervention (MI-BP) on Blood Pressure Among Black Individuals With Uncontrolled Hypertension: Randomized Controlled Trial.

Hypertension is one of the most important cardiovascular disease risk factors and affects >100 million American adults. Hypertension-related health inequities are abundant in Black communities as Black individuals are more likely to use the emergency department (ED) for chronic disease-related ambulatory care, which is strongly linked to lower blood pressure (BP) control, diminished awareness of hypertension, and adverse cardiovascular events. To reduce hypertension-related health disparities, we developed MI-BP, a culturally tailored multibehavior mobile health intervention that targeted behaviors of BP self-monitoring, physical activity, sodium intake, and medication adherence in Black individuals with uncontrolled hypertension recruited from ED and community-based settings. We sought to determine the effect of MI-BP on BP as well as secondary outcomes of physical activity, sodium intake, medication adherence, and BP control compared to enhanced usual care control at 1-year follow-up. We conducted a 1-year, 2-group randomized controlled trial of the MI-BP intervention compared to an enhanced usual care control group where participants aged 25 to 70 years received a BP cuff and hypertension-related educational materials. Participants were recruited from EDs and other community-based settings in Detroit, Michigan, where they were screened for initial eligibility and enrolled. Baseline data collection and randomization occurred approximately 2 and 4 weeks after enrollment to ensure that participants had uncontrolled hypertension and were willing to take part. Data collection visits occurred at 13, 26, 39, and 52 weeks. Outcomes of interest included BP (primary outcome) and physical activity, sodium intake, medication adherence, and BP control (secondary outcomes). We obtained consent from and enrolled 869 participants in this study yet ultimately randomized 162 (18.6%) participants. At 1 year, compared to the baseline, both groups showed significant decreases in systolic BP (MI-BP group: 22.5 mmHg decrease in average systolic BP and P<.001; control group: 24.1 mmHg decrease and P<.001) adjusted for age and sex, with no significant differences between the groups (time-by-arm interaction: P=.99). Similar patterns where improvements were noted in both groups yet no differences were found between the groups were observed for diastolic BP, physical activity, sodium intake, medication adherence, and BP control. Large dropout rates were observed in both groups (approximately 60%). Overall, participants randomized to both the enhanced usual care control and MI-BP conditions experienced significant improvements in BP and other outcomes; however, differences between groups were not detected, speaking to the general benefit of proactive outreach and engagement focused on cardiometabolic risk reduction in urban-dwelling, low-socioeconomic-status Black populations. High dropout rates were found and are likely to be expected when working with similar populations. Future work is needed to better understand engagement with mobile health interventions, particularly in this population. ClinicalTrials.gov NCT02955537; https://clinicaltrials.gov/study/NCT02955537. RR2-10.2196/12601.

INFORM-AF II-Phase 1 pilot randomised controlled trial evaluating the effect of an atrial fibrillation digital education programme: study protocol.

To evaluate the effect of a novel, co-designed, digital AF educational program, 'INFORM-AF', to reduce re-hospitalisation of people with AF. The secondary aims are to examine the effect of the intervention on: (a) reducing cardiovascular-related hospitalisation, (b) increasing medication adherence, AF-related knowledge, and Atrial fibrillation (AF)-related quality of life and (c) determining the cost-effectiveness of the intervention. AF is an increasingly prevalent cardiac arrythmia that involves complex clinical management. Comprehensive education is essential for successful self-management of AF and is associated with positive health-related outcomes. There has been an increase in technology-based education for AF. However, its effects on hospitalisation, medication adherence and patient-reported outcomes are unclear. A prospective, randomised (1:1), open-label, blinded-endpoint, multicentre clinical trial. Eligible participants are aged 18 years or above, diagnosed with AF, and own a smartphone. The study will be conducted at two metropolitan hospitals. In the intervention group, participants will receive the AF educational program delivered via Qstream®. In the control group, participants will receive the Stroke Foundation 'Living with AF' booklet. The primary outcome is re-hospitalisation within 12 months from an indexed presentation or hospital admission. This clinical trial is part of a developing program of work that will examine mHealth educational-behavioural interventions on cardiovascular outcomes. Findings from this pilot study will inform the development of a digital educational framework for patients living with AF. There remain many gaps in providing high-quality patient education for patients with AF. This trial will test a new theory-driven, smartphone-based education program on important clinical outcomes, including rehospitalisation. This study evaluates a novel, co-designed, digital AF educational program, 'INFORM-AF', to reduce the re-hospitalisation of people with AF. Study results are expected to be reported in 2025. Findings are expected to inform practice recommendations for AF patient education that may be included in future clinical practice guideline recommendations. SPIRIT Checklist. JL is a consumer co-researcher on the project and provided critical input into intervention design, and feedback and input across the study duration.