Non-adherent Patients Research Articles

Evaluation of quality of life in psychiatric patients and their adherence to drug medication in tertiary care hospital

Background: There are very few studies in the literature highlighting the factors responsible for non-adherence to drugs. In spite of many advances in the pharmacotherapy of mental disorders, non-adherence to drugs still remains as a critical and challenging task which hampers the psychiatric patient’s quality of life with poor clinical outcomes. Aim and Objectives: The aim of this study was to evaluate the drug medication adherence and assessment of quality of life in psychiatric disorder patients. Materials and Methods: The study was conducted over a period of 3 months at outpatient department of Psychiatry. Before the conduct of the study, informed consent was taken. Patients diagnosed with psychiatric illness and consuming at least one psychotropic drug for more than a month were enrolled. Medication adherence and non-adherence were evaluated by medication rating scale. Quality of life parameter was assessment by satisfaction Questionnaire-Short Form scale. Results: In the present study, it was observed that 22% of the psychiatric patients were non-adherence to drug treatment. It was interesting to find that 34% of the patients opined lack of insight about their illness. About 26% of the psychiatric patients had a negative medication attitude toward drug treatment and 15% of them opined that they do not have family support. The overall sense of well-being which was assessed by the quality of life enjoyment and satisfaction scores among adherent and non-adherent patients was 8.81 ± 0.66 and 3.00 ± 0.36, respectively which was statistically significant. Conclusion: It was observed that 22% of the psychiatric patients showed non-adherence to drug treatment. Lack of patient’s insight about the illness, their negative attitude needs necessary steps to be taken to reduce non-adherence patterns. Specific measures can be adopted to increase the quality of life enjoyment and satisfaction in psychiatric patients.

A Multivariate Study on the Adherence With Non-invasive Ventilation in People With Obstructive Sleep Apnea.

Obstructive Sleep Apnea (OSA) is a sleep disorder that affects a significant number of people worldwide. While Continuous Positive Airway Pressure (CPAP) devices have been proven to be effective in relieving symptoms, ensuring consistent use of those devices throughout the year can be challenging for a lot of patients. The present quantitative observational study in non-invasive ventilation for OSA patients explores adherence and attempts to identify independent predicting factors and year-round adherence differences in a large sample of OSA patients from Greece. Data from 1987 OSA patients using Continuous Positive Airway Pressure (CPAP) devices were collected in 2023. Factors evaluated in the study included the Apnea-Hypopnea Index (AHI), mask type, mask leaks and hours of CPAP device usage. The majority were males (77.2%), aged over 60 years (57.9%). CPAP use varied, with 14.0% in their first year, 44.2% for 2-4 years, and 41.7% for <4 years. Adherence was highest in more than 4 years users (54.9%) and nasal/pillow mask users (59.1%). Seasonal adherence varied, with summer having the most non-adherent patients (32.8%). Multinomial logistic regression showed BMI, mask type and seasonal severity influenced adherence. Full-face masks positively impacted adherence (OR=0.585, p=0.001). Non-adherence was associated with higher mask leaking in spring (OR=3.051, p=0.018) and usage of CPAP for < 4 years (OR=3.855, p=0.001). For 50% and 75% adherence, seasonal mask leaking and usage duration influenced adherence. CPAP device data can provide valuable insights to OSA therapy compliance. Seasonality plays an important role in adherence to the CPAP device use as is the type of mask with relation to air leaking.

Advanced Technologies of Drug Delivery to the Posterior Eye Segment Targeting Angiogenesis and Ocular Cancer.

Retinoblastoma (RB), a childhood retinal cancer is caused due to RB1 gene mutation which affects the child below 5 years of age. Angiogenesis has been proven its role in RB metastasis due to the presence of vascular endothelial growth factor (VEGF) in RB cells. Therefore, exploring angiogenic pathway by inhibiting VEGF in treating RB would pave the way for future treatment. In preclinical studies, anti-VEGF molecule have shown their efficacy in treating RB. However, treatment requires recurrent intra-vitreal injections causing various side effects along with patient nonadherence. As a result, delivery of anti-VEGF agent to retina requires an ocular delivery system that can transport it in a non-invasive manner to achieve patient compliance. Moreover, development of these type of systems are challenging due to the complicated physiological barriers of eye. Adopting a non-invasive or minimally invasive approach for delivery of anti-VEGF agents would not only address the bioavailability issues but also improve patient adherence to therapy overcoming the side effects associated with invasive approach. The present review focuses on the eye cancer, angiogenesis and various novel ocular drug delivery systems that can facilitate inhibition of VEGF in the posterior eye segment by overcoming the eye barriers.

Sequential model for predicting patient adherence in subcutaneous immunotherapy for allergic rhinitis.

Subcutaneous Immunotherapy (SCIT) is the long-lasting causal treatment of allergic rhinitis (AR). How to enhance the adherence of patients to maximize the benefit of allergen immunotherapy (AIT) plays a crucial role in the management of AIT. This study aims to leverage novel machine learning models to precisely predict the risk of non-adherence of AR patients and related local symptom scores in 3years SCIT. The research develops and analyzes two models, sequential latent-variable model (SLVM) of Stochastic Latent Actor-Critic (SLAC) and Long Short-Term Memory (LSTM). SLVM is a probabilistic model that captures the dynamics of patient adherence, while LSTM is a type of recurrent neural network designed to handle time-series data by maintaining long-term dependencies. These models were evaluated based on scoring and adherence prediction capabilities. Excluding the biased samples at the first time step, the predictive adherence accuracy of the SLAC models is from 60% to 72%, and for LSTM models, it is 66%-84%, varying according to the time steps. The range of Root Mean Square Error (RMSE) for SLAC models is between 0.93 and 2.22, while for LSTM models it is between 1.09 and 1.77. Notably, these RMSEs are significantly lower than the random prediction error of 4.55. We creatively apply sequential models in the long-term management of SCIT with promising accuracy in the prediction of SCIT nonadherence in AR patients. While LSTM outperforms SLAC in adherence prediction, SLAC excels in score prediction for patients undergoing SCIT for AR. The state-action-based SLAC adds flexibility, presenting a novel and effective approach for managing long-term AIT.

Obstructive sleep apnea alters microRNA levels: Effects of continuous positive airway pressure.

Obstructive sleep apnea (OSA) has been linked to cytokine-mediated chronic inflammatory states. Continuous positive airway pressure (CPAP) is an established therapy for OSA, but its effects on inflammation remain unclear. A recent study from our group identified soluble cytokine receptors altered in OSA patients and modified by CPAP adherence. However, the upstream regulatory pathways responsible for these shifts in proinflammatory cascades with OSA and CPAP therapy remained unknown. Accordingly, this study mapped OSA and CPAP-modulated soluble cytokine receptors to specific microRNAs and then tested the hypothesis that OSA and CPAP adherence shift cytokine-related microRNA expression profiles. Plasma samples were collected from patients with OSA (n=50) at baseline and approximately 90 days after CPAP initiation and compared to referent control subjects (n=10). Patients with OSA were further divided into cohorts defined by adherence vs nonadherence to CPAP therapy. The microRNAs that mapped to soluble cytokine receptors of interest were subjected to quantitative polymerase chain reaction. At baseline, increased hsa-miR-15a-5p, hsa-miR-15b-5p, hsa-miR-16-5p, hsa-miR-195-5p, hsa-miR-424-5p, hsa-miR-223-3p, and hsa-miR-223-5p were observed in patients with OSA compared to controls (p<0.05). In CPAP adherent patients (n=22), hsa-miR233-3p and hsa-miR233-5p decreased at follow-up (p<0.05) whereas there was no change in miR levels from baseline in non-adherent CPAP patients (n=28). The miRs hsa-miR233-3p and hsa-miR233-5p mapped to both proinflammatory and innate immunity activation; the inflammasome. A specific set of microRNAs, including hsa-miR233-3p and hsa-miR233-5p, may serve as a marker of inflammatory responses in patients with OSA, and be used to assess attenuation of inflammasome activation by CPAP.

A Proposal of a Student Run Clinic Medical School Elective to Improve Adherence to Postoperative Follow-Up.

Patient nonadherence to healthcare follow-up appointments is an ever-growing problem leading to worsened health outcomes and increased morbidity and mortality. Social factors, namely lack of transportation, are commonly implicated as a cause for the lack of following up. Medical students make up a significant portion of the healthcare team but are mostly viewed as passive learners on clinical rotations and do not receive many active opportunities to engage in direct clinical care. Here, an elective for 4th year medical students where students operate a clinic and work alongside residents to hold virtual surgical follow-up appointments to assess for complications and monitor healing is proposed. This could potentially bypass many of the social barriers that patients face while giving students a more direct role in patient care and a focused educational experience while reducing stress on the physical healthcare clinic system.

Non-Adherence to Anti-Retroviral Therapy Among Adult People Living with HIV in Ethiopia: Systematic Review and Meta-Analysis.

Human immunodeficiency virus remains a global public health problem. Despite efforts to determine the prevalence of non-adherence to ART and its predictors in Ethiopia, various primary studies presented inconsistent findings. Therefore, this review aimed to determine the pooled prevalence of non-adherence to ART and identify its predictors. We have searched PubMed, Google Scholar and Web of Science databases extensively for all available studies. A weighted inverse-variance random-effects model was used to compute the overall non-adherence to ART. The pooled prevalence of non-adherence to ART was 20.68% (95% CI: 17.74, 23.61); I2 = 98.40%; p < 0.001). Educational level of primary school and lower [AOR = 3.5, 95%CI: 1.7, 7.4], taking co-medications [AOR = 0.45, 95%CI: 0.35, 0.59], not using memory aids [AOR = 0.30, 95%CI: 0.13, 0.71], depression [AOR = 2.0, 95%CI: 1.05, 3.79], comorbidity [AOR = 2.12, 95%CI: 1.16, 3.09), under-nutrition [AOR = 2.02, 95%CI: 1.20, 3.43], not believing on ART can control HIV [AOR = 2.31, 95%CI: 1.92, 2.77], lack of access to health facilities [AOR = 3.86, 95%CI: 1.10, 13.51] and taking ART pills uncomfortably while others looking [AOR = 5.21, 95%CI: 2.56, 10.53] were significantly associated with non-adherence to anti-retroviral therapy. The overall pooled prevalence of non-adherence to ART was considerably high in Ethiopia. Educational status, taking co-medications, not using memory aids, depression, comorbidity, under nutrition, not believing on anti-retroviral therapy controls HIV, lack of access to health facilities and taking ART pills uncomfortably were independent predictors of non-adherence to ART in Ethiopia. Therefore, healthcare providers, adherence counselors and supporters should detect non-adherence behaviors and patients' difficulties with ART early, and provide intensive counseling to promote adherence.

Depression and comorbid obstructive sleep apnea: Association between positive airway pressure adherence, occurrence of self-harm events, healthcare resource utilization, and costs

ObjectivePrevious studies have shown that treatment of obstructive sleep apnea (OSA) with positive airway pressure (PAP) therapy in patients with depression may improve depression symptoms and response to antidepressant therapy. We investigated the association between PAP therapy adherence, self-harm events, healthcare resource utilization (HCRU), and costs over 2 years in a national sample of patients with pre-existing depression and newly diagnosed comorbid OSA. MethodsAdministrative claims data were linked to objective PAP therapy usage. Inverse probability treatment weighting was used to compare outcomes over 2 years across PAP adherence levels. The predicted numbers of emergency room (ER) visits and hospitalizations by adherence level were assessed using risk-adjusted generalized linear models. Results37,459 patients were included. Relative to non-adherent patients, consistently adherent patients had fewer self-harm events (0.04 vs 0.05, p < 0.001) after 1 year, and significantly (all p < 0.001) fewer ER visits (0.66 vs 0.86) and all-cause hospitalizations (0.13 vs 0.17), and lower total ($11,847 vs $11,955), inpatient hospitalization ($1634 vs $2274), and ER visit ($760 vs $1006) costs per patient in the second year of PAP therapy. Consistently adherent patients showed lower risk for hospitalizations and ER visits. LimitationsUsing observational claims data, we were unable to assess clinical characteristics including sleep, sleepiness, and daytime symptoms, or important social determinants of health. We were limited in assessing care received outside of the included health plans. ConclusionConsistent adherence to PAP therapy over 2 years was associated with improved HCRU outcomes for patients with pre-existing depression newly diagnosed with comorbid OSA.

Refusal of prescribed drug therapy (absolute non-adherence) after acute myocardial infarction/unstable angina: data from prospective observation in the LIS-3 registry

Aim. Within the LIS-3 register of acute coronary syndrome (ACS), to evaluate the phenomenon of complete refusal of treatment (absolute non-adherence) after discharge from the hospital of patients diagnosed with acute myocardial infarction (AMI)/unstable angina (UA): to study the characteristics of absolutely nonadherent patients, disease outcomes after 2.5 years after first contact.Material and methods. The study was conducted within the framework of the LIS-3 register. This part of the study included patients who survived ACS and were discharged from the hospital in the first 9 months of 2014 (104 people) and patients who survived ACS and were discharged from the hospital in the first 9 months of 2018 (223 people). Of the 327 patients who survived after AMI/UA, 226 patients remained alive by the time of the first survey (on average 3 years after discharge). The created questionnaire was used, which includes questions about possible long-term outcomes, adherence to visits to medical and preventive institutions (health facilities) and adherence to drug therapy. 221 people answered questions about treatment, 11 (5%) of them did not take any drug therapy (absolutely non-adherent). On average, 29 months (2.5 years) after the initial survey, a repeat survey of completely non-adherent patients or their relatives was carried out, information was collected on the vital status of these patients, repeated cardiovascular events and on the use of recommended drug therapy, about visiting a health facility.Results. When comparing the clinical and demographic characteristics of patients who were adherent and completely non-adherent to the prescribed therapy, no significant differences were noted. By the time of the repeat survey, 4 patients from among those who were completely non-adherent had died, 2 had suffered ACS. Of the 6 patients who survived, at the time of re-contact, 2 had not started taking medications, explaining that they were feeling well, 2 had resumed taking medications in full, 2 — partially, contact with 1 patient was lost.Conclusion. A certain proportion of patients who have suffered AMI/UA completely refuse the prescribed treatment, mainly because they feel well. The likelihood of death and recurrent cardiovascular events in such patients is extremely high.

Understanding Medication Nonadherence in Crohn's Disease Patients: A Qualitative Evaluation.

Immune-modifying medications are widely available and recognized as valuable by most gastroenterologists. However, approximately 40% of patients with Crohn's disease (CD) do not comply with regimens using these medications, resulting in complications, hospitalization, and surgeries. We sought to identify factors that motivate adherence or nonadherence with medication recommendations for CD. We conducted qualitative interviews with patients living with CD who were identified as adherent or nonadherent to immune-modifying medication recommendations by their treating gastroenterologist. Semistructured interview guides were developed based on an established framework for understanding health behaviors. We conducted content analysis of the resulting qualitative data using an inductive-deductive approach to identify emergent themes that influence medication decision-making. Twenty-five patients with CD completed interviews for this study. Interviews were independently coded and analyzed for thematic content. Two broad domains emerged comprising (1) themes reflected in the Theoretical Domains Framework and (2) novel themes specific to medication decision-making in CD. Adherent patients conveyed a sense of trust in science and healthcare provider expertise, while nonadherent patients were more likely to express beliefs in their ability to self-manage CD, concern about risks associated with medication, and a general ambivalence to treatment. There are clear cognitive, behavioral, and relational factors that guide patients' medication-related decision-making. Several of the factors share features of other behavioral change and decision-making processes, while others are specific to the experience of patients with CD. A fuller understanding of these factors is essential to developing effective behavioral interventions to improve adherence to evidence-based treatment recommendations.

Adherence to lifestyle therapy in patients with chronic heart failure and comorbidity

Background: Influence of comorbidity on adherence to lifestyle therapy in patients with chronic heart failure (CHF) have not been studied yet. The aim of this study was to investigate awareness and adherence to lifestyle therapy in patients with CHF and comorbidity.Мethods: Two hundred and three patients with CHF (130 males and 73 females, mean age was 61.8±9.6 years) were studied. CHF was defined according to ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure, in 2016. Age-adjusted Charlson comorbidity index was calculated. Awareness of lifestyle modifications was determined using a questionnaire developed in our clinic and used in previous scientific studies. Quality of life was estimated using SF-36 Health Status Survey. Psychological state and attitude to condition were estimated using Minnesota Multiphasic Personality Inventory, the Personal Questionnaire of Behterevsk’ Institute, characterological questionnaire by K. Leonhard. Follow-up period was 1 year.Results: The awareness about lifestyle modifications in patients with CHF ranged from 38.9% (daily control of body weight) to 87.2% (limited salt intake). Adherence to lifestyle therapy was from 7.9% (daily weight control) to 37.9% (limited salt intake). Age-adjusted Charlson comorbidity index was 5.0±2.1 points. Patients with high comorbidity (Charlson comorbidity index &gt;6 points) had decreased of quality of life, both in the physical and the psychological aspects. There were no differences in adherence to lifestyle therapy in patients with CHF, depending on comorbidity. Nonadherent patients were characterized by sensitive type of attitude to their condition, emotional lability, exclusion as a type of defense mechanism and negative coping strategies.Сonclusions: Nonadherence to lifestyle therapy in patients with CHF was associated with maladaptive type of attitude to their condition, which was more common in patients with high comorbidity.

Adherence to lifestyle therapy in patients with chronic heart failure and comorbidity

Background: Influence of comorbidity on adherence to lifestyle therapy in patients with chronic heart failure (CHF) have not been studied yet. The aim of this study was to investigate awareness and adherence to lifestyle therapy in patients with CHF and comorbidity.Мethods: Two hundred and three patients with CHF (130 males and 73 females, mean age was 61.8±9.6 years) were studied. CHF was defined according to ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure, in 2016. Age-adjusted Charlson comorbidity index was calculated. Awareness of lifestyle modifications was determined using a questionnaire developed in our clinic and used in previous scientific studies. Quality of life was estimated using SF-36 Health Status Survey. Psychological state and attitude to condition were estimated using Minnesota Multiphasic Personality Inventory, the Personal Questionnaire of Behterevsk’ Institute, characterological questionnaire by K. Leonhard. Follow-up period was 1 year.Results: The awareness about lifestyle modifications in patients with CHF ranged from 38.9% (daily control of body weight) to 87.2% (limited salt intake). Adherence to lifestyle therapy was from 7.9% (daily weight control) to 37.9% (limited salt intake). Age-adjusted Charlson comorbidity index was 5.0±2.1 points. Patients with high comorbidity (Charlson comorbidity index &gt;6 points) had decreased of quality of life, both in the physical and the psychological aspects. There were no differences in adherence to lifestyle therapy in patients with CHF, depending on comorbidity. Nonadherent patients were characterized by sensitive type of attitude to their condition, emotional lability, exclusion as a type of defense mechanism and negative coping strategies.Сonclusions: Nonadherence to lifestyle therapy in patients with CHF was associated with maladaptive type of attitude to their condition, which was more common in patients with high comorbidity.

Adherence to lifestyle therapy in patients with chronic heart failure and comorbidity

Background: Influence of comorbidity on adherence to lifestyle therapy in patients with chronic heart failure (CHF) have not been studied yet. The aim of this study was to investigate awareness and adherence to lifestyle therapy in patients with CHF and comorbidity.Мethods: Two hundred and three patients with CHF (130 males and 73 females, mean age was 61.8±9.6 years) were studied. CHF was defined according to ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure, in 2016. Age-adjusted Charlson comorbidity index was calculated. Awareness of lifestyle modifications was determined using a questionnaire developed in our clinic and used in previous scientific studies. Quality of life was estimated using SF-36 Health Status Survey. Psychological state and attitude to condition were estimated using Minnesota Multiphasic Personality Inventory, the Personal Questionnaire of Behterevsk’ Institute, characterological questionnaire by K. Leonhard. Follow-up period was 1 year.Results: The awareness about lifestyle modifications in patients with CHF ranged from 38.9% (daily control of body weight) to 87.2% (limited salt intake). Adherence to lifestyle therapy was from 7.9% (daily weight control) to 37.9% (limited salt intake). Age-adjusted Charlson comorbidity index was 5.0±2.1 points. Patients with high comorbidity (Charlson comorbidity index &gt;6 points) had decreased of quality of life, both in the physical and the psychological aspects. There were no differences in adherence to lifestyle therapy in patients with CHF, depending on comorbidity. Nonadherent patients were characterized by sensitive type of attitude to their condition, emotional lability, exclusion as a type of defense mechanism and negative coping strategies.Сonclusions: Nonadherence to lifestyle therapy in patients with CHF was associated with maladaptive type of attitude to their condition, which was more common in patients with high comorbidity.

Sex X Time Interactions in Lp(a) and LDL-C Response to Evolocumab.

The aim of this study was to evaluate whether there were significant sex x time interactions in lipoprotein(a) (Lp(a)) and low-density lipoprotein cholesterol (LDL-C) response to treatment with the Proprotein Convertase Subtilisin/Kexin type 9 inhibitor (PCSK9i) Evolocumab, in a real-life clinical setting. For this purpose, we pooled data from 176 outpatients (Men: 93; Women: 83) clinically evaluated at baseline and every six months after starting Evolocumab. Individuals who had been on PCSK9i for less than 30 months and nonadherent patients were excluded from the analysis. Over time, absolute values of Lp(a) plasma concentrations significantly decreased in the entire cohort (p-value < 0.001) and by sex (p-value < 0.001 in men and p-value = 0.002 in and women). However, there were no sex-related significant differences. Absolute plasma concentrations of LDL-C significantly decreased over time in the entire cohort and by sex (p-value < 0.001 always), with greater improvements in men compared to women. The sex x time interaction was statistically significant in LDL-C (all p-values < 0.05), while absolute changes in Lp(a) were not influenced by either sex or time (all p-value > 0.05). Our data partially reinforce the presence of differences in response to treatment to PCSK9i between men and women and are essential to gain a better understanding of the relationship between LDL-C and Lp(a) lowering in response to PCSK9i. Further research will clarify whether these sex-related significant differences translate into a meaningful difference in the long-term risk of ASCVD.

One-Year Medication Treatment Patterns, Healthcare Resource Utilization, and Expenditures for Medicaid Patients with Schizophrenia Starting Oral Atypical Antipsychotic Medication

Oral atypical antipsychotic (OAAP) medications are the most commonly prescribed treatment for the management of schizophrenia symptoms. This retrospective study, using Medicaid claims data (2016–2020), followed patients for 12 months after initiating OAAP therapy. Study outcomes included OAAP adherence, switching, augmentation, healthcare resource utilization (HRU), and expenditures. All-cause and schizophrenia-related HRU and expenditures were compared between adherent and nonadherent cohorts. Among 13,007 included patients (39.1 ± 12.8 years of age, 57.0% male, 36.1% Black, 31.8% White, 9.7% Hispanic), 25.7% were adherent to OAAPs (proportion of days covered [PDC] ≥ 0.8). During the 1-year follow-up period, Black individuals were in possession of an OAAP for an average of 166 days compared to 198 and 202 days for White and Hispanic patients, respectively. Approximately 16% of patients switched OAAP medications and 3.2% augmented therapy with an OAAP added to their index medication. Nearly 40% of patients were hospitalized during follow-up and 68.4% had emergency department (ED) visits. A greater proportion of nonadherent patients had all-cause inpatient (41.7% vs. 34.1%, p < 0.001) and ED visits (71.7% vs. 58.8%, p < 0.001) compared to adherent patients. Annual total healthcare expenditures were $21,020 per patient; $3481 higher for adherent versus nonadherent patients. Inpatient expenditures comprised 44.6% and 30.6% of total expenditures for nonadherent and adherent patients, respectively. Hospitalized patients’ total expenditures were $23,261 higher compared to those without a hospitalization. Adherence to OAAP medication is suboptimal and associated with increased utilization of costly hospital and ED resources. Efforts to improve therapies and increase medication adherence could improve clinical and economic outcomes among individuals with schizophrenia.

Machine learning-based prediction of medication refill adherence among first-time insulin users with type 2 diabetes

AimsThe prevalence of Type 2 Diabetes Mellitus (T2DM) is projected to be 7 % in 2030. Despite its need for long-term diabetes care, the adherence rate of injectable medications such as insulin is around 60 %, lower than the acceptable threshold of 80 %. This study aims to create classification models to predict insulin adherence among adult T2DM naïve insulin users. MethodsClinical data were extracted from Taipei Medical University Clinical Research Database (TMUCRD) from January 1st, 2004 to December 30th, 2020. A patient was regarded as adherent if his/her medication possession ratio (MPR) was at least 80 %. Seven domains of predictors were created, including demographics, baseline medications, baseline comorbidities, baseline laboratory data, healthcare resource utilization, index insulins, and the concomitant non-insulin T2DM medications. We built two Xgboost models for internal and external testing respectively. ResultsUsing a cohort of 4134 patients from Taiwan, our model achieved the Area Under the curve of the Receiver Operating Characteristic (AUROC) of the internal test was 0.782 and the AUROC of the external test was 0.771. the SHAP (SHapley Additive exPlanations) value showed that the number of prescribed medications, the number of outpatient visits, and laboratory data were predictive of future insulin adherence. ConclusionsThis is the first study to predict adherence among adult naïve insulin users. The developed model is a potential clinical decision support tool to identify possible non-adherent patients for healthcare providers to design individualized education plans.

P28 Medication Non-Adherence in Patients with Varying Levels of Depression Symptoms Measured Using the Medication Adherence Reasons Scale

P28 Medication Non-Adherence in Patients with Varying Levels of Depression Symptoms Measured Using the Medication Adherence Reasons Scale

Abstract A017: Evaluation of ¡Salud! por la Vida, an educational intervention to increase colorectal cancer screening in federally qualified health centers in Puerto Rico

Abstract Introduction: Colorectal cancer (CRC) is the leading cause of cancer-related deaths in Puerto Rico (PR) and third among Hispanics in the United States (US). Screening rates in PR are relatively low compared to the mainland US. Objective: To evaluate the effectiveness of “¡Salud! por la Vida”, an evidence-based educational intervention designed to increase CRCS. Methods: The educational intervention “¡Salud! por la Vida” (SPLV) was implemented in 10 Federally Qualified Health Clinics (FQHC) in PR to increase CRC screening (CRCS) rates in non-adherent patients aged 50 to 75. SPLV was conducted as a group randomized controlled trial from July 2017 to July 2020. The intervention included a baseline survey collecting 198 variables and a follow-up survey 4 to 6 months later, which included 148 variables to measure the effectiveness of the educational program in increasing CRCS. The initial surveys had some changes to improve the data entry process. Consequently, the database required an updated data analysis consisting of data exploration, data cleaning, and statistical analysis. Prior to calculating results, data cleaning included identifying missing variables, inconsistencies in the data, and missing data. The final dataset for this project concerns participants who completed the follow-up survey, divided into intervention and control groups. The analysis calculated basic demographics in proportions, such as age, education, sex, marital status, annual income, health insurance coverage, and first-degree family history of CRC. Furthermore, the two groups were compared regarding CRCS rates, specifically those of colonoscopy, fecal occult blood test (FOBT), and having completed any CRCS. Results: A total of 445 individuals participated in the study. At baseline, 332 were from the control group and the rest from the intervention group. The follow-up survey was completed by 295 participants in the control group and 78 participants in the intervention group, for a total of 373 at follow-up. The mean age of participants who completed the study was 58.9, with 68.9% of participants being women. 70.5% had an education of high school or less, 45.3% were married or living together, 93% earned less than $20,000 a year, 87.9% had government health insurance, and 88.2% had no first-degree family history of CRC. CRCS tests were completed by 60.2% of those in the intervention group and 38.3% of control group participants (p-value 0.001). FOBTs were done by 55.1% and 36.9% of the intervention and control group participants, respectively (p-value 0.005). In the intervention group, 10% of the participants completed a colonoscopy, while in the control group, 3% had completed a colonoscopy (p-value 0.02). Conclusion: CRCS rates were higher in the intervention groups, for both colonoscopy (p-value 0.008) and FOBT (p-value 0.003), as well as any CRCS test (p-value 0.0004). The SPLV intervention significantly increased CRC screening rates and provided evidence to disseminate this educational effort to FQHCs in PR. Citation Format: Jomarie Jiménez-González, Fernando E. Betancourt-Vélez, Ileska M. Valencia-Torres, Yara Sánchez-Cabrera, Luis R. Pericchi-Guerra, María E. Fernández, Vivian Colón-López. Evaluation of ¡Salud! por la Vida, an educational intervention to increase colorectal cancer screening in federally qualified health centers in Puerto Rico [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A017.

Impact of screening programme to prevent anal cancer in high-risk patients with HIV.

We assessed the impact of a nationwide screening programme to reduce the risk of anal cancer in a large cohort of high-risk patients with HIV. From a large database from one referral centre, all high-risk patients with HIV (men who have sex with men, history of anal or genital warts, or previous cervix human papillomavirus-related lesions) who were eligible to enter the French anal cancer screening programme (2011-2020) were retrospectively included. Adherence to the screening programme was defined as no interval >18 months between two visits. Standardized management included perianal visualization and standard anoscopy with biopsies of macroscopic abnormalities. Overall, 700 patients with HIV were included (median follow-up 8.4 years [interquartile range 4.3-9.2] and 1491.6 patient-years), and 336 had one or more proctology visit. A total of 13 patients were diagnosed with anal squamous cell carcinomas. The risk of anal cancer was higher with anal intra-epithelial neoplasia grade 3 (AIN3; hazard ratio [HR] 44.5 [95% confidence interval {CI} 11.2-176.6], p < 0.001), AIN2 (HR 11.9 [95% CI 2.1-66.9], p = 0.005), or high-grade dysplasia (HR 23.4 [95% CI 7.9-69.1], p < 0.001) than with low-grade dysplasia or no lesion. Among the patients who were strictly adherent to the screening programme (4.6% [32/700]), we did not report any AIN or anal cancer, but we also did not observe any significant reduction in the risk of anal cancer (p = 0.51), AIN3 (p = 0.28), high-grade dysplasia (p = 0.19), or any AIN lesions (p = 0.10) compared with non-adherent patients. In contrast, screened patients were more likely to be diagnosed with anal warts (HR 3.71 [95% CI 2.14-6.42], p < 0.001). Macroscopic high-grade dysplasia lesions are associated with a higher risk of developing anal cancer. Despite finding no cases of cancer during the screening programme, we also did not demonstrate a clear benefit from our screening programme for the prevention of anal cancer in high-risk patients with HIV.

Relación entre adherencia a entecavir y efectividad en pacientes con hepatitis B crónica

Purposeto evaluate adherence of patients with chronic hepatitis B initiated on entecavir as first-line treatment and to correlate adherence with effectiveness. Methodsobservational retrospective study performed between January 2007 and June 2013. Patients treated with entecavir for at least one year were included. A patient was considered to be adherent if median adherence was > 95%. Virological response (HBV DNA < 20UI/ml by Polymerase Chain Reaction), biochemical response (normalized level of alanine amino transferase [AAT]) and serological response (loss of hepatitis B surface antigen [HBsAg]) was assessed at month 12. Results85 patients were included. The median adherence rate was 94.2 (SD 12.8)%. 85.7% of the adherent patients achieved a virological response in contrast with 71.4% of the nonadhe-rent patients (OR:2,40; IC95%:0,60-9,54;p = 0,19). 87.9% of the adherent patients and 85.7% of the nonadherent patients showed normalized level of AAT (OR:1,21; IC95%:0,22-6,60;p = 0,56). Two adherent patients showed clearance of hepatitis B surface antigen. Conclusionthe median adherence is not high. Nonadherent patients have a trend towards a higher rate of virological failure so it is necessary to promote improved adherence to treatment.