Patient Adherence Research Articles

Adherence and Quality of Life in Adult Patients With Haemophilia A, Haemophilia B and Von Willebrand Disease: A National Cross-Sectional Survey.

New treatments for patients with bleeding disorders (PWB) have emerged, including products with extended half-life and subcutaneous administration. These less frequent treatments can potentially enhance quality of life (QoL), but adherence becomes critically important. To investigate adherence and QoL among PWB and explore the correlation between treatment adherence and QoL in adult patients with haemophilia A (HA), haemophilia B (HB) and Von Willebrand disease (vWD) in Denmark. This survey used disease-specific patient-reported questionnaires: Veritas-PRO and Veritas-PRN to measure adherence, and Haemo-A-QoL and VWD-QoL to assess QoL. Responses were obtained from 149 patients with HA, 32 with HB and 118 with vWD. Adherence was reported by 87.1% of patients on prophylaxis and 71.2% of patients treated on demand, according to Veritas-PRO and Veritas-PRN cut-off scores. High QoL was generally reported, decreasing with age in HA and HB, but not in vWD. Danish patients with HA, HB and vWD reported high QoL and high adherence to prescribed treatments. There was no correlation between treatment adherence and QoL among the different patient groups. These findings highlight the need for further research to better understand adherence behaviours and identify opportunities to further improve QoL in PWB.

Drug utilization and medication adherence for the treatment of psoriatic arthritis: an Italian study.

This study aims to evaluate the persistence, treatment adherence and drug cost associated with biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in the management of psoriatic arthritis (PsA) in Italy, with a focus on biosimilar drugs. This was a retrospective observational study involving eight hospital pharmacies, between January 2017 and December 2020, on naïve patients with at least one b/tsDMARD dispensation indicated for PsA. Patients were followed up for 12 months and persistence and adherence were evaluated by proportion of days covered (PDC). The originator and biosimilar for adalimumab and etanercept were compared. Furthermore, the real annual cost per patient based on adherence to therapy was calculated. Patients initiating b/tsDMARDs for PsA had a mean persistence of 263 days and 48.6% remained persistent for 1 year. Adherent patients (PDC ≥ 0.8) were 47.6% for the overall population. Similar persistence and adherence were observed between patients treated with the adalimumab originator and its biosimilar, while patients treated with the etanercept originator showed lower persistence and adherence compared to those treated with its biosimilar (mean persistence: 222 vs. 267 days, patient persistent at 1 year: 29.4% vs. 51.5%, mean PDC: 0.53 vs. 0.70, adherent patients: 23.5% vs. 51.5%). The average annual drug cost ranged from €8,724 (etanercept) to €14,783 (ustekinumab), with an annual saving of more than €2,500 by using biosimilars. Poor adherence to medications contributes to suboptimal clinical outcomes. The comparison between biosimilar and originator offers further evidence in support of the biosimilar to optimizing resources in healthcare.

Adverse Drug Reactions and Predictors of Medication Adherence in Patients with Prostate Cancer.

Adherence to therapy with prostate cancer medicines is critical for delaying the progression of disease and enhancing health outcomes. To determine patients' medication adherence, the predictors of adherence, and the frequency and types of adverse drug reactions (ADRs) in persons with prostate cancer. A serial entry-point cross-sectional study of patients with prostate cancer was conducted in 3 cancer hospitals in Nigeria over a 12-month period (January 7, 2022, to January 3, 2023). Data on medication adherence were self-reported by patients, and data on ADRs were obtained from hospital records. Descriptive and inferential statistical analyses were performed, and p less than 0.05 was considered statistically significant. Of the 133 study participants, most 112 (84.2%) reported high medication adherence. The cost of drugs was the most frequently reported potential barrier to adherence (n = 63, 47.4%). Adherence was significantly dependent on family history of cancer (df = 3, F = 4.557, p = 0.005) and health-related quality of life (HRQOL) (ß = 0.275, T = 2.170, p = 0.032) but not illness perception (ß = 0.046, T = 0.360, p = 0.72). Adverse events were observed in 36 participants (27.1%) and were deemed to be "possible ADRs" (n = 19, 53%) or "probable ADRs" (n = 17, 47%); all were nonpreventable and expected (100%), and most (n = 31, 86%) were within the level 1 category of severity. Loss of erection and low libido was the most frequently reported ADR (n = 14, 39%). In this study, medication adherence was high, with cost being a potential barrier to adherence. Family history of cancer and HRQOL significantly predicted medication adherence. The medications were well tolerated, and observed ADRs had minor severity. Policies targeting the reduction of cost-related factors for prostate cancer medications are essential.

Public deliberation to assess patient views on biosimilar medication switching for the treatment of inflammatory bowel disease

BackgroundBiosimilars are highly similar, but not identical, versions of originator biologic medications. Switching patients to biosimilars presents an opportunity to mitigate rising drug costs and expand patient access to important biologic therapies. However, decreased patient acceptance and adherence to biosimilar medications have been reported, which can lead to loss of treatment response, adverse reactions, and inefficient resource utilization. Understanding patient perceptions of biosimilars and biosimilar switching is needed to inform patient-centered care strategies that promote efficient resource utilization.MethodsWe used democratic deliberation methods to solicit the informed and considered opinions of patients regarding biosimilar switching. Patients with inflammatory bowel disease (IBD; n = 29) from the Veterans Health Administration (VHA) participated in 5-hour deliberation sessions over two days. Following educational presentations with experts, participants engaged in facilitated small group discussions. Transcripts and facilitators’ notes were used to identify key themes. Participants completed surveys pre- and post-deliberation to collect sociodemographic and clinical features as well as to assess IBD treatment knowledge and attitudes toward care and approaches to biosimilar switching.ResultsFive major themes emerged from the small group discussions in the context of biosimilar switching: 1) concerns about adverse consequences and unclear risk-benefit balance; (2) importance of communication and transparency; (3) desire for shared decision making and patient involvement in treatment decisions; (4) balancing cost-saving with competing priorities; and (5) advocating for individualized care and prioritization based on risk levels. These views led participants to favor approaches that prioritize switching the sickest patients last (i.e., those with poorly controlled disease) and that offer patients control and choices around biosimilar switching. Participants also expressed preferences for combining elements of different approaches to maximize fairness.ConclusionsApproaches to biosimilar switching should consider patients’ desires for transparency and effective communication about biosimilar switching and engagement in their medical decision-making as part of patient-centered care. Incorporating patient preferences around biosimilar switching is critical when navigating the quality and affordability of care in resource constrained settings, both within the VHA and in other healthcare systems.

Breaking the mold: nontraditional approaches to allergen immunotherapy for environmental allergens.

Allergen immunotherapy is a disease-modifying treatment for allergic diseases. The predominant traditional immunotherapy is through subcutaneous administration of allergens to gradually desensitize allergic individuals. While effective, traditional allergen immunotherapy approaches are often lengthy, time consuming for patients and can result in local or systemic adverse reactions. Nontraditional immunotherapies are emerging as promising alternatives, offering potentially more convenient, safe and efficacious treatment options. This review sought to comprehensively examine the safety, efficacy and performance of various nontraditional immunotherapies for environmental allergens. Nontraditional immunotherapy approaches covered in this review include sublingual, local nasal, intralymphatic rush and ultra-rush immunotherapy, allergoid, microbial and anti-IgE immunotherapies. Nontraditional immunotherapies show significant promise in addressing the limitations of traditional subcutaneous immunotherapy. Methods like intralymphatic and rush immunotherapy offer shorter treatment regimens, enhancing patient adherence and convenience. The co-administration of probiotics or monoclonal antibodies, like omalizumab, with AIT appears to improve treatment efficacy and safety. Despite these advancements, further large-scale, long-term studies are needed to establish standardized protocols, dosing and validate long-term effects of these nontraditional immunotherapies. Standardizing outcome measurements across studies is crucial for accurate comparisons of nontraditional immunotherapies prior to widespread clinical adoption of these innovative techniques.

Effectiveness of Antileishmanial Treatments in Three Endemic Areas of Colombia: A Community-Based Cohort Study.

The effectiveness of treatment of cutaneous leishmaniasis (CL) in rural settings remains underexplored. This study assessed the effectiveness of standard antileishmanial treatments using a community-based approach supported by mobile health (mHealth) in three rural areas of Colombia. From January 2018 to September 2021, we assessed treatment outcomes, adherence, and adverse drug reactions in CL patients, with the support of the Guaral+ST app. Treatment decisions were made by providers at health facilities at each site in accordance with national guidelines, whereas treatment follow-up and presumptive case identification were made by trained community leaders and health agents at the community level. In total, 231 participants received antileishmanial treatment (63 received miltefosine, 110 meglumine antimoniate, and 58 pentamidine). Disease presentation was mild (median number of lesions = 1, interquartile range [IQR]: 1-2) and of short duration (1.5 months, IQR: 1-3). The strategy yielded information on the therapeutic outcomes in 81% of study participants. Effectiveness, measured as the proportion of cure at 90 to 180 days, was 86.3% (95% CI: 73.3-93.48) for miltefosine; 77.6% (67.5-85.3) for meglumine antimoniate, and 73.1% (59.0-83.6) for pentamidine. The effectiveness of pentamidine in children ≤10 years old was 79.4% (61.6-90.3). This is one of the few reports of effectiveness of pentamidine in children with prospective data collection in the Americas. Adverse drug reactions occurred in 32% of patients, most frequently with meglumine antimoniate. Our findings demonstrate that standard antileishmanial treatments are effective in rural areas where the disease is endemic and that mHealth has a pivotal role in improving patient follow-up and data collection on therapeutic outcomes.

Revolutionizing Transdermal Patches: Navigating Clinical Challenges and Technological Progress

ransdermal patches, conceived to extend drug release, enhance bioavailability, and foster patient adherence, witnessed their inaugural approval by the USFDA in the 1980s. These patches, varying in size, constitute medicinal formulations with one or more active components that permeate the bloodstream through the skin. This review undertakes a comprehensive examination of recent strides in transdermal patch technology, encompassing critical facets such as their merits and demerits, advancements in microneedle technology, the evolution of transdermal patch generation, the integration of Artificial Intelligence, and the role of 3D printing technology. Additionally, the focus is placed on USFDA-approved patches. Various literature databases viz. Science Direct, PubMed, and Web of Sciences were explored for this research. The review furnished insights into the application of 3D printing technology in the fabrication of transdermal patches and disseminated information on USFDA-approved patches. The exploration delved into diverse strategies aimed at augmenting the efficiency of drug delivery and promoting patient compliance. Major transdermal products being marketed with details of their active substance have been discussed. Various applications of artificial intelligence in drug delivery have been summarized. It may be summarized that transdermal patch technology is not a thing of the past but a technology to stay and meet the demands of drug delivery in the present and future.

Prescribing Pattern and Medication Adherence in Patients with Epilepsy in a Tertiary Neuro-Center, Kathmandu

Abstract Background Epilepsy is a chronic condition characterized by unusual, frequent, excessive, and self-terminating neuronal firing. Adherence to medication is crucial to achieve the intended therapeutic outcome. However, not much research has been done on drug adherence in our context. Thus, the purpose of this study is to investigate the antiseizure medication prescribing pattern, medication adherence, and associated factors. Methodology A cross-sectional, analytical research was done on randomly selected epileptic patients through interview and documentary analysis using a semi-structured interview schedule and the eight-item Morisky Medication Adherence Scale (MMAS-8). The clinical and demographic characteristics were described using descriptive statistics (median, interquartile range [IQR], frequency, and percentage). The Shapiro–Wilk and chi-squared tests were used to examine the factors influencing medication adherence and the relationships between research variables. The analysis was performed using SPSS version 16. Result From a total of 104 patients, 77.3% were males, the median age was 29 years (IQR: 16), the majority (42.3%) had higher secondary education, 15.4% had secondary education and 5.8% were illiterate, 25% were job holders, 26% were laborers, 41.3% were from province 3, and 16.3% were from province 4. Two-thirds (63.5%) of the patients were highly adherent to antiseizure medication and 54.8% were seizure free for more than 2 years.The most common type of epilepsy diagnosed was generalized epilepsy (54.8%). Seizures were usually treated with monotherapy (65.4%), with sodium valproate being the most often used single antiseizure medicine (26.8%), followed by carbamazepine (16.3%) and levetiracetam (15.4%). Additionally, sodium valproate was the medication most frequently used in polytherapy for epilepsy. There was a strong association established between adherence and drug therapy type, age, adverse drug reaction, and seizure control. The study revealed that adherence was not significantly associated with factors such as gender, occupation, regional distribution, or type of epilepsy. Conclusion Low adherence was observed in 36.5% of patients. As a significant association was observed between medication adherence and seizure control, health care providers should focus on improving medication adherence. Evaluation of adherence needs to be a regular component of managing epilepsy. Further patients who do not stick to their drug regimens should receive more attention and assistance. It will support better therapy results.

Barriers to Cardiac Rehabilitation Enrollment and Secondary Prevention Adherence in Patients with Coronary Heart Disease Following Percutaneous Coronary Intervention: A Cross-sectional Survey.

This study aimed to evaluate adherence to secondary prevention measures and to identify barriers to cardiac rehabilitation enrolment among patients with coronary heart disease after percutaneous coronary intervention. An observational cross-sectional survey was conducted through computer-assisted telephone interviews to assess recently treated percutaneous coronary intervention patients at the Prince Sultan Cardiac Center in Saudi Arabia. Out of 104 surveyed patients with coronary heart disease, 85 (82%) were male, with an average age of 59.5 years. The obesity rate was 28% (n = 29), with a high prevalence of comorbidities: 82 (79%), 63 (61%), and 62 (60%) patients had hyperlipidemia, diabetes, and hypertension, respectively. Despite high medication compliance (97%), adherence to secondary prevention measures was low (21%). Adherence to physical exercise and weight monitoring for fluid body build-up was notably poor at 35% and 9%, respectively. Only 11 (10.6%) patients were referred for cardiac rehabilitation, of whom only four (36.4%) attended. Significant barriers such as a lack of staff contact, insufficient physician support, and distance to cardiac rehabilitation facilities were particularly noted by 69% of rural patients. This study underscores the significant cardiac risk factors and low adherence to secondary prevention measures among post revascularization patients with coronary heart disease in Saudi Arabia. Low referral and other organizational barriers, as well as the travel distance to hospital-based cardiac rehabilitation, hinder program enrolment. To improve cardiac rehabilitation accessibility, it is crucial to revise the discharge plans, implement automated referral systems, expand the services across all regions, and utilize alternative delivery models.

Scoping Review on Health Literacy and Its Effect on Medication Adherence in Chronic Disease Patients

Scoping Review on Health Literacy and Its Effect on Medication Adherence in Chronic Disease Patients

EFFECTS OF SOCIOECONOMIC AND CLINICAL FACTORS ON TREATMENT ADHERENCE IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASES PATIENT: FOCUS ON INHALATION THERAPY

Objective: Chronic obstructive pulmonary disease (COPD) refers to a persistent blockage of airflow that requires bronchodilator medication for the rest of one’s life. The goal of the treatment can only be met when the patient is adhering to the prescribed medicine. This study identifies and analyzes how clinical and socioeconomic factors affect COPD patients’ drug adherence to given therapy. The impact of our findings will reduce socioeconomic inequality in COPD management which will improve adherence to drugs and overall physical well-being. Methods: The hospital-based cross-sectional studies were conducted at the Department of TB and CD for 6 months in a tertiary care hospital. A total of 55 patients diagnosed with COPD participated in the study after signing the informed constant. The individual patients were interviewed using MMAS-8 and Kuppuswamy scale questionnaires. The data were analyzed by Chi-square test to determine the correlation between medication adherence and socioeconomic status in patients with COPD. Results: Among 55 COPD patients included in the study, their mean age was 62.2(+10.76) years. Out of the total participants: Significant associations between the medication adherence scale (MMRS-8) scores and the Kuppuswamy scale were found as p<0.0001, indicating that medication adherence was influenced by the patient’s socioeconomic status. In addition, the BORG scale which is used to measure exercise tolerance in COPD that found to have a significant correlation with an MMAS-8 score of p=0.03. Conclusion: Our study found that a person with low socioeconomic levels will have poor adherence to inhaler therapy, leading to poor health outcomes like exacerbation and low physical activity due to shortness of breath.

Teaching pediatric cardiology fellows to communicate serious news: a pilot study

BackgroundPediatric cardiology fellows often deliver serious news to families. Effective clinician-patient communication is the basis of strong therapeutic relationships and improves health outcomes, increases patient adherence, and enhances patient satisfaction. Communication training improves physicians’ communication skills, ability to deliver serious news, and meet the informational and emotional needs of patients and family members. However, there is little data surrounding pediatric cardiology fellows competencies or training in communication skills.MethodsPediatric cardiology fellows participated in a 3-hour communication training session. The session used VitalTalk methodology and was facilitated by two VitalTalk facilitators. Fellows spent 1 h learning the skills of delivering serious news and responding to emotion and 2 h in role play with standardized actors followed by a brief group wrap-up activity. Participants took an anonymous, electronic pre- and post-survey and an 8-month follow-up survey via REDCap. Participants were asked about their preparedness and comfort performing certain communication skills and leading challenging conversations specific to pediatric cardiology. Response options used a combination of 0 (low comfort/preparedness) to 100 (high comfort/preparedness) point scales and multiple choice.Results9 fellows participated in the training and 100% completed all three surveys. Eight were first-year fellows and 1 was a third-year fellow. Finding the right words, balancing honesty with hope, and clinical and prognostic uncertainty were the top three factors that contributed to making conversations difficult. Following the course, there was a significant increase in fellow preparedness to communicate a new diagnosis of congenital heart disease, discuss poor prognoses, check understanding, and respond to emotion and an increase in fellow comfort responding to emotions. Four fellows reported using the skills from this training course in various clinical settings at 8-month follow up.ConclusionsCommunicating serious news effectively is a skill that can be learned in a sustainable way and is essential in the field of pediatric cardiology. Our study demonstrates that an interactive, VitalTalk course can improve preparedness and comfort to deliver serious news in a cohort of pediatric cardiology trainees. Future studies are needed to evaluate translation of skills to clinical practice and durability of these skills in larger cohorts.

12442 Effectiveness Of An Electronic Decision Support Algorithm To Optimize Recommendation Of SGLT2i And GLP-1RA In Patients With Type 2 Diabetes Upon Discharge From Internal Medicine Wards

Abstract Disclosure: E. Jaffe: None. I. Ayalon-Dangur: Grant Recipient; Self; Boehringer Ingelheim. A. Grossman: None. H. Hendel: None. Y. Oved: None. A. Shaked: None. I. Shimon: None. B. Basharim: None. M. Abo Molhem: None. R. McNeil: None. R. Abuhasira: None. T. Shitrit: None. L. Azulay Gitter: None. R. El Saleh: None. T. Shochat: None. N. Eliakim-Raz: None. Background: Type 2 diabetes mellitus (T2DM) is a major cause of morbidity and mortality. Current guidelines recommend the use of glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients with T2DM with or at high risk for cardiovascular disease to reduce mortality. Despite the established benefit, many studies found low treatment rates with these medications in eligible patients. The aim of our study is to examine the effectiveness of a clinical decision support (CDS) algorithm that was developed in our institution, in improving the recommendation rate of SGLT2i and GLP-1RA upon discharge from hospitalization in internal medicine wards. Methods: Our algorithm was developed to automatically recommend SGLT2i and GLP-1RA for T2DM patients based on current guidelines. Data was collected from electronic medical records of all T2DM patients ≥18 years old who were eligible for SGLT2i or GLP-1RA and hospitalized for any reason in one of five internal medicine wards in Beilinson Hospital. The primary outcome was to evaluate the rate of physician recommendation of SGLT2i or GLP-1RA at hospital discharge for eligible patients pre-algorithm implementation (January 2021-December 2021) versus post-algorithm implementation (April 2023-September 2023). Results: A total of 1318 patients were included in the pre-algorithm group and 970 were included in the post-algorithm group. Median age was 75 and 73 years in the pre- and post-algorithm groups, respectively. In the pre-algorithm group, 62% were males vs 60% in the post-algorithm group. Median length of hospitalization was three days and four days in the pre- and post-algorithm groups, respectively. The rate of SGLT2i and GLP-1RA recommendation for eligible patients was 8.50% (112 of 1318 patients) in the pre-algorithm group and 22.68% (220 of 970 patients) in the post-algorithm group. The odds ratio of the recommendation rate in the post vs pre-algorithm group was 3.151, 95% confidence interval 2.467– 4.025, p<0.0001. Conclusion: The results of this study demonstrate the benefit of an algorithm as part of a CDS system to improve recommendation rates of SGLT2i and GLP-1RA for eligible patients upon discharge from hospitalization. Future studies should assess the impact of the algorithm on prescription rates, patient adherence, and long-term outcomes. Presentation: 6/2/2024

Evaluating digital adherence support in asthma: The ADITION non-interventional study

IntroductionPoor adherence to asthma maintenance therapy is associated with worse outcomes. A solution could be digital adherence support. This study evaluated asthma control and adherence in patients using mometasone furoate/indacaterol/glycopyrronium (MF/IND/GLY) with a digital support system, or using any inhaled corticosteroid/long-acting β2-agonist/long-acting muscarinic antagonist combination (ICS/LABA/LAMA) without support.MethodsThis prospective, non-interventional, multicentre, open-label study enrolled adults with asthma in Germany. Prior to inclusion, treatment was initiated with MF/IND/GLY with digital support, or with any ICS/LABA/LAMA without digital support. The primary endpoint was change in Asthma Control Test (ACT) at 6 months.ResultsOf 222 and 203 patients in the MF/IND/GLY plus digital support and ICS/LABA/LAMA groups, respectively, 76.1% and 74.9% completed follow-up. Baseline mean ACT total scores were 17.0 and 14.7, with mean changes from baseline at 6 months of 3.0 and 4.1; following propensity matching (N=92/group), mean (95% CI) changes were similar in the two groups, with overlapping CIs (2.9 [1.9, 3.9] and 4.0 [3.0, 5.1]). At enrolment, patients were overall moderately adherent to maintenance therapy, with limited changes over the study. The overall incidence of adverse events was similar in the two groups (29.5% and 27.3% patients).ConclusionsPatients using MF/IND/GLY with digital support had similar improvements in asthma control to those receiving ICS/LABA/LAMA alone, with minimal changes in adherence. These results illustrate the challenges in evaluating asthma control and adherence in non-interventional studies. Further studies are required to evaluate the value of digital support systems, and how they can be used to optimise inhaler adherence.

An Exogenous Ketone Ester Slows Tumor Progression in Murine Breast and Renal Cancer Models.

Ketone esters (KEs) exhibit promise as anti-cancer agents but their impact on spontaneous metastases remains poorly understood. Although consumption of a ketogenic diet (KD) that is low in carbohydrates and high in fats can lead to KE production in vivo, the restrictive composition of KDs may diminish adherence in cancer patients. We investigated the effects of an exogenous ketone ester-supplemented (eKET), carbohydrate-replete diet on tumor growth, metastasis, and underlying mechanisms in orthotopic models of metastatic breast (4T1-Luc) and renal (Renca-Luc) carcinomas. Mice were randomized to diet after tumor challenge. Administration of KEs did not alter tumor cell growth in vitro. However, in mice, our eKET diet increased circulating β-hydroxybutyrate and inhibited primary tumor growth and lung metastasis in both models. Body composition analysis illustrated the overall safety of eKET diet use, although it was associated with a loss of fat mass in mice with renal tumors. Immunogenetic profiling revealed divergent intratumoral eKET-related changes by tumor type. In mammary tumors, Wnt and TGFβ pathways were downregulated, whereas in renal tumors, genes related to hypoxia and DNA damage repair were downregulated. Thus, our eKET diet exerts potent antitumor and antimetastatic effects in both breast and renal cancer models, albeit with different modes of action and physiologic effects. Its potential as an adjuvant dietary approach for patients with diverse cancer types should be explored further.

Predictive modeling of medication adherence in post myocardial infarction patients: a bayesian approach using beta-regression.

Predicting medication adherence in post myocardial infarction (MI) patients has the potential to improve patient outcomes. Most adherence prediction models dichotomize adherence metrics and status. This study aims to develop medication adherence prediction models that avoid dichotomizing adherence metrics and to test whether a simplified model including only 90-days adherence data would perform similarly to a full multivariable model. Post MI adult patients were followed for 1-year post the event. Data from pharmacy records were used to calculate proportion of days covered (PDC). We used Bayesian beta-regression to model PDC as a proportion, avoiding dichotomization. For each medication group, statins, P2Y12 inhibitors and aspirin, two prediction models were developed, a full and a simplified model. 3692 patients were included for model development. The median (Inter quartile range) PDC at 1-year for statins, P2Y12 inhibitors and aspirin was 0.8 (0.33, 1.00), 0.79 (0.23, 0.99) and 0.79 (0.23, 0.99), respectively. All models showed good fit to the data by visual predictive checks. Bayesian R2 for statins, P2Y12 inhibitors and aspirin models were 61.4%,71.2% and 55.2%, respectively. The simplified models showed similar performance compared with full complex models as evaluated by cross validation. We developed Bayesian multilevel models for statins, P2Y12 inhibitors and aspirin in post MI patients that handled 1-year PDC as a proportion using the beta-distribution. In addition, simplified models, with 90-days adherence as single predictor, had similar performance compared with full complex models.

The Influence of Medication Non-Adherence on the Occurrence of Drug-Resistant Tuberculosis

Drug-resistant tuberculosis (DR-TB) presents a significant challenge to global TB control efforts, with medication non-adherence identified as a major contributing factor. This study aimed to investigate the influence of medication non-adherence on the occurrence of DR-TB in Serang City, Indonesia. Utilizing an observational analytic study with a case-control design, the research included 76 TB patients, comprising 38 DR-TB cases and 38 drug-sensitive TB controls. Data were collected from secondary sources and validated questionnaires and analyzed using univariate and bivariate methods, including Chi-square tests and Odds Ratios (OR). The findings revealed a significant relationship between medication non-adherence and DR-TB, with an OR of 11.56, indicating that non-adherent patients are 11.5 times more likely to develop DR-TB compared to adherent patients. However, demographic factors such as age, occupation, and education did not significantly influence the incidence of DR-TB. The study concludes that medication non-adherence is a critical risk factor for the development of DR-TB, underscoring the need for targeted interventions to improve treatment adherence, particularly through educational campaigns and community-based support. Health authorities are encouraged to implement intensive educational programs focused on the risks of non-adherence and ensure that TB treatment is accessible and supported by community health workers. Policymakers should allocate sufficient resources to these initiatives to effectively reduce the incidence of DR-TB.

Integrating the Memory Support Intervention into the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): can improving memory for treatment in midlife and older adults improve patient outcomes? Study protocol for a randomized controlled trial

BackgroundPoor memory for treatment is associated with poorer treatment adherence and poorer patient outcomes. The memory support intervention (MSI) was developed to improve patient memory for treatment with the goal of improving patient outcomes. The aim of this study protocol is to conduct a confirmatory efficacy trial to test whether a new, streamlined, and potent version of the MSI improves outcomes for midlife and older adults. This streamlined MSI is comprised of constructive memory supports that will be applied to a broader range of treatment content. The platform for this study is the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C). We will focus on midlife and older adults who are low income and experiencing mobility impairments.MethodsParticipants (N = 178) will be randomly allocated to TranS-C + MSI or TranS-C alone. Both intervention arms include eight 50-min weekly sessions. Assessments will be conducted at pre-treatment, post-treatment, 6-, and 12-month follow-up (6FU and 12FU). Aim 1 will compare the effects of TranS-C + MSI versus TranS-C alone on sleep and circadian functioning, daytime functioning, well-being, and patient memory. Aim 2 will test whether patient memory for treatment mediates the relationship between treatment condition and patient outcomes. Aim 3 will evaluate if previously reported poor treatment response subgroups will moderate the relationship between treatment condition and (a) patient memory for treatment and (b) treatment outcome. Exploratory analyses will compare treatment condition on (a) patient adherence, patient-rated treatment credibility, and patient utilization of treatment contents, and (b) provider-rated acceptability, appropriateness, and feasibility.DiscussionThis study has the potential to provide evidence for (a) the efficacy of a new simplified version of the MSI for maintaining health, well-being, and functioning, (b) the wider application of the MSI for midlife and older adults and to the treatment of sleep and circadian problems, and (c) the efficacy of the MSI for sub-groups who are likely to benefit from the intervention.Trial registrationClinicalTrials.gov NCT05986604. Registered on 2 August 2023.

Barriers to the Completion of Radiation Therapy in Cervical Cancer Treatment in Nigeria: A Review of Socioeconomic, Geographical, and Psychosocial Factors.

Cervical cancer is a major health concern in Nigeria, where it is one of the primary causes of cancer-related deaths among women. Despite the crucial role of radiation therapy in treating cervical cancer, many patients in Nigeria do not complete their prescribed treatment courses. This review examines the barriers contributing to this issue. Factors such as low awareness and utilization of Pap smears, inadequate HPV vaccination, financial constraints, insufficient radiotherapy infrastructure, and the psychological burden of cancer treatment are explored. Limited screening and vaccination efforts exacerbate the high incidence of cervical cancer in Nigeria. Financial barriers are a primary obstacle, with many patients unable to afford the high cost of radiotherapy. Nigeria's radiotherapy infrastructure is severely lacking leading to significant treatment delays and cancellations. Geographical barriers further complicate access, as many patients must travel long distances to reach treatment centers. Psychosocial issues, including anxiety and depression, significantly impact treatment adherence and completion. These psychological factors, coupled with the physical side effects of radiotherapy, contribute to high rates of treatment interruption. To address these challenges, the review suggests enhancing cervical cancer prevention through increased human papillomavirus (HPV) vaccination and screening, expanding radiotherapy capacity by increasing the number of treatment centers, and providing comprehensive support systems to address financial and psychosocial barriers. By implementing these strategies, it is possible to improve treatment adherence and outcomes for cervical cancer patients in Nigeria.

Impact of an SMS intervention to support type 2 diabetes self-management: DiabeText clinical trial.

Complications arising from uncontrolled Type 2 Diabetes Mellitus (T2DM) pose a significant burden on individuals' well-being and healthcare resources. Digital interventions may play a key role in mitigating such complications by supporting patients to adequately self-manage their condition. To assess the impact of DiabeText, a new theory-based, patient-centered, mobile health intervention integrated with electronic health records to send tailored short text messages to support T2DM self-management. Pragmatic, Phase III, 12-month, two-arm randomized clinical trial with T2DM primary care patients in Spain. 742 participants with suboptimal glycemic control (HbA1c>7.5) were randomly allocated to a control (usual care) or intervention (DiabeText) group. The DiabeText group received, in addition to usual care, 165 messages focused on healthy lifestyle and medication adherence. glycated hemoglobin (HbA1c). medication possession ratio, quality of life (EQ-5D-5L), diabetes self-efficacy (DSES); and self-reported adherence to medication, Mediterranean diet (MEDAS-14), and physical activity (IPAQ). Over the 12-month period, we observed no significant differences in HbA1c between the intervention and the control groups (Beta=-0.025 (-0.198 to 0.147; p=0.772)). In comparison with the control group, the DiabeText group showed significant (p<0.05) improvements in self-reported medication adherence (OR=1.4; 95%CI: 1.0 to 1.9), DSES (Cohen's d=0.35), and EQ5D-5L (Cohen's d=0.18) scores; but not in the rest of secondary outcomes. DiabeText successfully improved quality of life, diabetes self-management, and self-reported medication adherence in primary care patients with T2DM. Further research is needed to enhance its effects on physiological outcomes.