Medication Adherence Patterns Research Articles

Differentiated service delivery framework for people with multidrug-resistant tuberculosis and HIV co-infection.

For people living with HIV/AIDS, care is commonly delivered through Differentiated Service Delivery (DSD). Although people with multidrug-resistant tuberculosis (MDR-TB) and HIV/AIDS experience severe treatment associated challenges, there is no DSD model to support their treatment. In this study, we defined patterns of medication adherence and characterized longitudinal barriers to inform development of an MDR-TB/HIV DSD framework. Adults with MDR-TB and HIV initiating bedaquiline (BDQ) and receiving antiretroviral therapy (ART) in KwaZulu-Natal, South Africa, were enrolled and followed through the end of MDR-TB treatment. Electronic dose monitoring devices (EDM) measured BDQ and ART adherence. Longitudinal focus groups were conducted and transcripts analyzed thematically to describe discrete treatment stage-specific and cross-cutting treatment challenges. 283 participants were enrolled and followed through treatment completion (median 17.8 months [IQR 16.5-20.2]). Thirteen focus groups were conducted. Most participants (82.7%, 234/283) maintained high adherence (mean BDQ adherence 95.3%; mean ART adherence 85.5%), but an adherence-challenged subpopulation with <85% cumulative adherence (17.3%, 49/283) had significant declines in mean weekly BDQ adherence from 94.9% to 39.9% (p<0.0001) and mean weekly ART adherence from 83.9% to 26.6% (p<0.0001) over 6 months. Psychosocial, behavioral, and structural obstacles identified in qualitative data were associated with adherence deficits in discrete treatment stages, and identified potential stage specific interventions. A DSD framework for MDR-TB/HIV should intensify support for adherence-challenged subpopulations, provide multi-modal support for adherence across the treatment course and account for psychosocial, behavioral, and structural challenges linked to discrete treatment stages.

The Current Status of Utilizing a Medication Record Handbook for Evaluating Shared Medication History: A Retrospective Study Using the Japanese National Claims Database.

While the coronavirus disease 2019 (COVID-19) pandemic has impacted medication adherence and consultation patterns, its effects on the medical practice and dispensary separation system of Japan remain unclear. Thus, the utilization of the medication record handbook (MRH) in both medical and dental areas remains uncertain. This study uses the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB); we analyzed the separation of medication prescription and dispensing in both medicine and dentistry, as well as estimated how much drug information is shared by utilizing a patient-carried MRH. The external prescription (EP) rate was used as the main indicator. We then analyzed the MRH utilization rate during outpatient medication guidance. During the pandemic, there was no distinctive change in the rate of EPs in both medicine and dentistry. Furthermore, an analysis between EPs, medical internal prescriptions (IPs), and dental IPs relative to the MRH utilization rate revealed significant correlations between EPs and medical IPs as well as medical and dental IPs. Conversely, no significant correlation was found between EPs and dental IPs. Therefore, our results suggest that active MRH implementation within healthcare facilities may lead to an increase in its utilization in dentistry.

Predictors and long-term patterns of medication adherence to glaucoma treatment in Denmark—an observational registry study of 30 100 Danish patients with glaucoma

BackgroundSelf-treatment with glaucoma medication (eye drops) has been associated with adherence challenges. Poor adherence results in worse outcomes in terms of visual field loss.ObjectiveTo investigate patterns in medication adherence among...

Association of oral disease-modifying agents and their adherence trajectories with annual relapses in multiple sclerosis

BackgroundReal-world effectiveness can vary across oral disease-modifying agents (DMAs) and their adherence trajectories in patients with multiple sclerosis (MS). However, previous studies have not considered longitudinal adherence patterns while evaluating oral DMAs. ObjectivesThis study aimed to evaluate the association of oral DMAs and their adherence trajectories with annualized relapse rate (ARR) in patients with MS. MethodsThis retrospective observational cohort study based on the 2015–2019 MarketScan Commercial Claims and Encounters Database involved continuous enrolled adults (18–64 years) with ≥1 MS diagnosis (ICD-9/10-CM:340/G35) and ≥ 1 oral DMA prescription. Patients were grouped into incident fingolimod (FIN), teriflunomide (TER), and dimethyl fumarate (DMF) users based on the index DMA with a one-year washout period. Annual DMA adherence trajectories based on the monthly Proportion of Days Covered (PDC) one year after treatment initiation were identified using Group-Based Trajectory Modeling (GBTM). The validated claims-based ARR was evaluated during the one-year follow-up period using generalized boosted model-based inverse probability treatment weights with negative binomial regression model. ResultsThe study cohort consisted of 994 MS patients who initiated with FIN (23.0%), TER (22.3%), and DMF (54.7%) during the study period. GBTM grouped eligible patients into three adherence trajectories: complete adherers (59.2%), slow decliners (23.8%), and rapid decliners (17.0%). The proportion of complete adherers varied across the oral DMAs (FIN: 67.1%, TER: 55.4%, and DMF: 57.4%). The negative binomial regression modeling revealed that, while there was no difference in ARR across the three DMAs, rapid decliners (adjusted incidence rate ratio[aIRR]: 1.6, 95% CI: 1.1–2.4) had a higher rate of relapses compared to completely adherent patients. The type of oral DMAs did not moderate the relationship between ARR and the adherence trajectory groups. ConclusionsAdherence trajectories classified as rapid decliners were associated with a higher ARR than complete adherers after adjusting for their type of oral DMAs. Longitudinal medication adherence patterns are critical in reducing relapse rates in MS.

Avaliação da adesão à terapêutica em doentes com Diabetes Tipo 2 e hipertensão arterial: Adesão à medicação nas doenças crónicas

Aims: Assessment of medication adherence in newly diagnostic and treated patients with Type 2 Diabetes Mellitus and Arterial Hypertension, in the Primary Health Care Units of Lisbon and Tagus Valley. Methods: This is an observational and retrospective cohort study. The population is composed of newly diagnosed patients with Type 2 Diabetes Mellitus and Arterial Hypertension, at the beginning of treatment. Data was extracted from the Lisbon and Tagus Valley Regional Health Administration Information System. Medication adherence was assessed in three periods: patients started therapy or not after the professional's prescription (initiation); medication possession rate during the follow-up period (MPR) (implementation) and medication discontinuation, marks the end of therapy (discontinuation). Results: An initiation rate of 84.2% was obtained in patients with both diseases (98% for oral antidiabetic therapy and 84.6% for antihypertensive therapy). The implementation rates (MPR) for both diseases was only 3.4% (4.2% were considered adherent to oral antidiabetic therapy and 8.5% to antihypertensive therapy). The discontinuation rate was 3.4% (5.5% for oral antidiabetic therapy and 13.2% for antihypertensive therapy). Most patients initiate taking drugs after prescription but very few patients have a MPR enough to consider them having good adherence. Moreover, few patients discontinue the medication. Conclusions: Patients had a higher implementation rate to antihypertensive therapy but, on the other hand, were more persistent to the oral antidiabetic therapy. Through this new assessment, the medication adherence pattern seems to be influenced by the patient and by the disease itself.

Assessing the performance of group-based trajectory modeling method to discover different patterns of medication adherence.

It is well known that medication adherence is critical to patient outcomes and can decrease patient mortality. The Pharmacy Quality Alliance (PQA) has recognized and identified medication adherence as an important indicator of medication-use quality. Hence, there is a need to use the right methods to assess medication adherence. The PQA has endorsed the proportion of days covered (PDC) as the primary method of measuring adherence. Although easy to calculate, the PDC has however several drawbacks as a method of measuring adherence. PDC is a deterministic approach that cannot capture the complexity of a dynamic phenomenon. Group-based trajectory modeling (GBTM) is increasingly proposed as an alternative to capture heterogeneity in medication adherence. The main goal of this paper is to demonstrate, through a simulation study, the ability of GBTM to capture treatment adherence when compared to its deterministic PDC analogue and to the nonparametric longitudinal K-means. A time-varying treatment was generated as a quadratic function of time, baseline, and time-varying covariates. Three trajectory models are considered combining a cat's cradle effect, and a rainbow effect. The performance of GBTM was compared to the PDC and longitudinal K-means using the absolute bias, the variance, the c-statistics, the relative bias, and the relative variance. For all explored scenarios, we find that GBTM performed better in capturing different patterns of medication adherence with lower relative bias and variance even under model misspecification than PDC and longitudinal K-means.

Design And Development of Smart Pill Box

A smart pill box is a high-tech device that helps people manage their medication schedule more effectively. This device eliminates the risk of medication errors that can happen due to forgetting to take medicine at the right time or in the right amount. With several features that make it easy to handle medication regimens, smart pill boxes are typically connected to an app on the user's smartphone or tablet. This app offers many functions to track medication adherence, such as providing reminders for dosage, sending alerts when it's time to refill, and helping with scheduling doctor's appointments. Smart pill boxes have sensors which detect when medication has been taken, and they can alert family members or caregivers if a dose is missed. Additionally, some models use machine learning algorithms to analyze medication adherence patterns and provide personalized feedback. Smart pill boxes come in various sizes and configurations, from simple single-dose devices to more complex systems with voice reminders and multiple medication capabilities. They can also be useful for people with visual or hearing impairments. Overall, smart pill boxes are innovative and effective technology to help people with medication management and improve patient outcomes. Keywords: Arduino UNO, Medication management, Medication schedule, Patient Outcomes, Healthcare.

Determinants of medication adherence and impact of mobile telephony, pillbox interventions on compliance and glycemic control among patients with type 2 diabetes

Abstract Background: Medication adherence has been linked to improved glycemic control, fewer complications from diabetes, fewer hospitalizations, reduced health care expenses, and a decreased mortality rate. The medication adherence pattern, reason, and factors associated with poor medication adherence among patients living with type 2 diabetes mellitus were determined, and the impact of two interventions to improve medication adherence was assessed. Materials and Methods: The medication adherence patterns of 240 people living with diabetes were determined using the Morisky Green Levine Medication Adherence Scale-4 and categorized into low, medium, and high adherence patterns. Patients with poor medication adherence (low and medium pattern) scores were randomized into short message service (SMS) and pillbox interventions, and the impact of Interventions on compliance and glycemic control was determined. Results: Results demonstrate that 3% of patients living with type 2 diabetes have low, 43% medium, and 54% have high medication adherence patterns. The most common reason cited for non-adherence was (88%) followed by lack of finance (5%) and multiple medications (4%). A positive association of injectable dosage forms, number of drugs, and treatment modalities with adherence was found. SMS and pillbox intervention improved medication adherence among individuals with diabetes who had poor adherence, which translated into good glycemic control. Conclusions: The improvement in drug compliance and glycemic control was found to be equivocal among the SMS and pillbox intervention groups. The inclusion of interventions into the institutional education program and counseling by health care workers will motivate patients to adopt these interventions to improve drug compliance and glycemic control.

Trajectories of adherence to extended treatment with direct oral anticoagulants and risks of recurrent venous thromboembolism and major bleeding.

BACKGROUND: Little is known about medication adherence patterns and their association with effectiveness and safety among patients with venous thromboembolism (VTE) receiving direct oral anticoagulant (DOAC) therapy beyond 3-6 months of initial treatment. OBJECTIVE: To examine the associations between adherence trajectories of extended treatment with DOAC and the risks of recurrent VTE and major bleeding among patients with VTE. METHODS: We conducted a retrospective cohort study of patients with incident VTE who completed 6 months of initial anticoagulant treatment and received either DOAC extended therapy or no extended therapy using MarketScan Commercial and Medicare Supplemental databases (2013-2019). We used group-based trajectory models to identify distinct adherence patterns during extended treatment. Using inverse probability treatment weighted Cox proportional hazards models, we examined the association between the adherence trajectories and the risks of recurrent VTE and major bleeding. RESULTS: Among 10,960 patients with extended treatment with DOACs (rivaroxaban, apixaban, dabigatran, edoxaban) and 5,133 patients with no extended treatment, we identified 4 distinct trajectories (consistently high, gradually declining, rapidly declining, and no extended treatment). Compared with the no extended treatment group, the groups with consistently high adherence (hazard ratio = 0.09, 95% CI = 0.05-0.17) and with gradually declining adherence (0.13, 0.03-0.53) showed decreased recurrent VTE risk without increased major bleeding risk (consistently high adherence 1.19, 0.71-1.99; gradually declining adherence 1.96, 0.81-4.70). There was no difference in the risk of recurrent VTE (0.34, 0.10-1.16) for the group with rapidly declining adherence, but this group was associated with increased major bleeding risk (2.65, 1.01-6.92). CONCLUSIONS: Our findings underscore the clinical importance of continuing and remaining adherent to extended DOAC treatment without increased major bleeding risk for patients with VTE. DISCLOSURES: This research was supported by the BMS/Pfizer Alliance American Thrombosis Investigator Initiated Research Program. The funding source had no role in the design, collection, analysis, or interpretation of the data or the decision to submit the article for publication. Dr Lo-Ciganic reported receiving research funding from Merck Sharp & Dohme Corp. Dr Dietrich reported receiving honorarium for training and education from BMS/Pfizer. Dr DeRemer is a stockholder of Portola Pharmaceuticals and reported receiving personal fees for advisory board meeting from BMS. No other disclosures were reported.

Adherence to daily, oral TDF/FTC PrEP during periconception among HIV-exposed South African women.

Daily, oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) as pre-exposure prophylaxis (PrEP) reduces HIV acquisition for African women. Adherence is key to efficacy and patterns of adherence can be highly variable in real-world settings. Using group-based trajectory modeling (GBTM), we sought to identify distinct patterns of periconception PrEP adherence and evaluate potential baseline predictors of such adherence trajectories. We conducted a single-arm longitudinal study for women aged 18-35 years living in Durban, South Africa with personal or partner plans for pregnancy with a partner with HIV or of unknown serostatus. Participants were offered safer conception counseling, including daily oral PrEP; women who initiated PrEP were given a bottle with an electronic pillcap that recorded when device opens. Weekly adherence to daily PrEP was modeled using GBTM with a censored normal outcome distribution as a function of weeks since PrEP initiation. The number and functional form of the adherence trajectory groups were primarily selected based on Bayesian information criteria (BIC) and confirmed by mean estimated probabilities of group membership. A multivariable version of the selected model assessed baseline predictors of membership in adherence trajectory groups. Overall mean (95% CI) adherence to PrEP was 63% (60%, 67%). We identified four groups of women with distinct patterns of adherence: (1) high (i.e., ≥6 doses per week) steady adherence throughout follow-up (22% of PrEP initiators); (2) moderate (i.e., 4-5 doses per week), but steady adherence (31%); (3) initially high, but consistently declining adherence (21%); and (4) initially moderate adherence, followed by a rapid decline and subsequent rebound (26%). In multivariable-adjusted analyses, older age was associated with membership in the high, steady adherence group as compared to the group identified with an adherence trajectory of initially high, then decline, and finally a rebound. GBTM is useful for exploring potential heterogeneity in longitudinal patterns of medication adherence. Although a large proportion of women in this study achieved high levels of adherence by electronic pillcap initially, far fewer women maintained these levels consistently. Knowledge of different adherence trajectories could be used to develop targeted strategies for optimizing HIV prevention during periconception.

Marginal structural models with latent class growth analysis of treatment trajectories: Statins for primary prevention among older adults.

Latent class growth analysis is increasingly proposed as a solution to summarize the observed longitudinal treatment into a few distinct groups. When latent class growth analysis is combined with standard approaches like Cox proportional hazards models, confounding bias is not properly addressed because of time-varying covariates that have a double role of confounders and mediators. We propose to use latent class growth analysis to classify individuals into a few latent classes based on their medication adherence pattern, then choose a working marginal structural model that relates the outcome to these groups. The parameter of interest is defined as a projection of the true marginal structural model onto the chosen working model. Simulation studies are used to illustrate our approach and compare it with unadjusted, baseline covariates adjusted, time-varying covariates adjusted, and inverse probability of trajectory groups weighted adjusted models. Our proposed approach yielded estimators with little or no bias and appropriate coverage of confidence intervals in these simulations. We applied our latent class growth analysis and marginal structural model approach to a database comprising information on 52,790 individuals from the province of Quebec, Canada, aged more than 65 and who were statin initiators to estimate the effect of statin-usage trajectories on a first cardiovascular event.

Pola Peresepan Obat Glaukoma di Poli Spesialis Mata Rumah Sakit X di Kabupaten Sidoarjo Periode Desember 2022 – Februari 2023

Glaucoma is a chronic optic neuropathy disease characterized by occlusion of the optic disc, narrowing of the field of view, and increased intraocular pressure. This study aimed to determine the pattern of glaucoma medication adherence in the ophthalmology polyclinic of Hospital X in Sidoarjo Regency for the period December 2022 - February 2023. This study was descriptive, non-experimental, and retrospective data collection. The results of this study obtained 127 prescription sheets. Based on the gender, 94 women (74.04%) and 33 men (25.98%). The most common age group suffered by patients aged over 65 years was 44 people (34.65%). 3 groups are most widely prescribed, namely the non-selective Beta blocker group (Timolol 0.5% eye drops) obtained 63 prescriptions (49.61%) with the rule of daily use 2 x 1 drop, the Systemic Carbonic Anhydrase Inhibitor group (Acetazolamide 500 mg tablets ) obtained 9 prescriptions (7.09%) with the rule of daily use 1 to 2 times 1 tablet, the Prostaglandin Analog group (Latanoprost 0.005% eye drops) obtained 4 prescriptions (3.15%) with the rule of using 1 drop at night. The prescribing pattern for the glaucoma drug that was most often prescribed was Timolol 0.5% eye drops, which obtained 63 prescriptions (49.61%).

Medication adherence trajectory of patients with chronic diseases and its influencing factors: A systematic review.

To synthesize the published studies on medication adherence trajectories among patients with chronic diseases and identify the influencing factors. Systematic review. Medline (Ovid), Embase (Ovid) and Web of Science core collection were searched from database inception to 1 July 2022. Potentially eligible articles were independently screened by three reviewers using set inclusion and exclusion criteria. The Joanna Briggs Institute critical appraisal checklist for cohort studies was used to appraise the quality of the included articles. Three reviewers independently evaluated the quality, extracted data and resolved differences by consensus. Results were presented using descriptive synthesis, and the prevalence of recategorised medication adherence trajectories was calculated from the published data. Fifty studies were included. Medication adherence trajectories among patients with chronic diseases were synthesized into six categories: adherence, non-adherence, decreasing adherence, increasing adherence, fluctuating adherence and moderate adherence. Low and moderate evidence showed that (1) patient-related factors, including age, sex, race, marital status and mental status; (2) healthcare team and system-related factors, including healthcare utilization, insurance and primary prescriber specialty; (3) socioeconomic factors including education, income and employment status; (4) condition-related factors including complications and comorbidities and (5) therapy-related factors including the number of medications, use of other medications, and prior medication adherence behaviours were factors influencing the medication adherence trajectory. Marital status and prior medication adherence behaviour were the only influencing factors with moderate evidence of an effect. The medication adherence trajectory among patients with chronic diseases varied widely. Further studies are warranted to determine contributory factors. Healthcare providers should be aware that patients' medication adherence has different trajectories and should take appropriate measures to improve patients' medication adherence patterns. None. As a systematic review, patients and the public were not involved.

Utility of Big Data to Explore Medication Adherence in Māori and Non-Māori Community-Dwelling Older Adults with Heart Failure in Aotearoa New Zealand: A Cross-sectional Study.

Medication adherence improves morbidity and mortality-related outcomes in heart failure, and knowledge of patterns of medication adherence supports patient and clinician decision-making. Routinely collected national data facilitate the exploration of medication adherence and associated factors in older adults with heart failure, including the association between ethnicity and adherence. There are known inequities in access to medicines between Māori (Indigenous People of Aotearoa New Zealand) and non-Māori, yet ethnic variation in medicines adherence in community-dwelling older adults with heart failure has not been explored. Here we identify medication adherence rates for community-dwelling older adults diagnosed with heart failure and differences in adherence rates between Māori and non-Māori. Cross-sectional analysis of interRAI (comprehensive standardised assessment) data in a continuously recruited national cohort from 2012 to 2019. Overall, 13,743 assessments (Māori N=1526) for older community-dwelling adults with heart failure diagnoses were included. The mean age of participants was 74.5years [standard deviation (SD) 9.1years] for Māori and 82.3 years (SD 7.8years) non-Māori. In the Māori cohort, 21.8% did not adhere fully to their medication regimen, whereas in the non-Māori cohort, this figure was 12.8%. After adjusting for confounders, the Māori cohort were more likely to be medication non-adherent than non-Māori [prevalence ratio 1.53, 95% confidence interval (CI) 1.36-1.73]. There was a significant disparity between Māori and non-Māori concerning medication adherence. Given the international use of the interRAI-HC assessment tool, these results have significant transferability to other countries and allow the identification of underserved ethnic groups for which culturally appropriate interventions can be targeted.

Prescription auditing and assessment of medication adherence patterns in patients with diabetic foot ulcer.

Diabetic foot ulcer (DFU) is a serious infectious disease, which can be managed very well through proper medication, but if left untreated it may lead to amputation of the affected area leading to permanent immobility which will compromise the patient's quality of life. To carry out prescription auditing and to assess medication adherence patterns among DFUpatients. A prospective interview-based study was carried out in the surgery department among inpatients aged above 18 years diagnosed with a DFU. A disease specific medication adherence questionnaire consisting of 15 questions was developed, validated and implemented among 65 patients. All the relevant data were analyzed and subjected to statistical analysis. The majority (49.2%) of the population had an intermediate adherence pattern followed by high adherence (43%) during the first visit, later the reassessment after the counseling, reports a gradual increase in adherence pattern. Prescription auditing reveals the intensity of drug burden, on anaverage a prescription might carry 8 drugs and more than 95.3% of prescribed drugs were in injectable form. This study highlights the depth of drug burden through prescription auditing and the necessity of proper patient counseling and educating the patient about the importance of medication adherence for limiting disease progression.

Study on drug utilization evaluation of anti epileptic drugs

INTRODUCTION: Drug utilization evaluation (DUE) also referred as drug utilization reviews (DUR) or medication utilization evaluation (MUE) are defined as an authorized, structured, ongoing review of healthcare provider prescribing, pharmacist dispensing, and patient use of medication. Anti-epileptic drugs (AEDs) are those which are used for epilepsy and also for other neurological disorders. METHODOLOGY: A prospective observational questionnaire based cross sectional study in 200 patients of various departments receiving at least one AEDs. The subjects were included in the study only after they met the criteria for the study and after properly filling a informed consent form. The data was obtained by a questionnaire format and it is evaluated for utilization patterns, medication adherence. The cost of AEDs were calculated to evaluate total costs on each drug. RESULTS: Out of 200 patients, 140 were male and 60 were female. The age group 11- 20 years were found prominent with epilepsy. The average number of AEDs per patient was found to be 1.54. Among all the drugs prescribed phenytoin was the most common drug prescribed 148 (47.89%) for the treatment, followed by lorazepam 59 (19.09 %) and sodium valproate 27 (8.73 %). Maximum of the patients are high in utilization patterns and also in medication adherence. The chi-square value was 1.1373 and 1.3886 for medication adherence and utilization patterns respectively. CONCLUSION: Medication adherence was also high in patients which was found using morisky medication adherence scale. The utilization pattern was also 82 % by the patients. The cost effectiveness was done by comparing the costs of drugs prescribed during the study. It was found that topiramate is having high cost which can be burden to patient to adhere the therapy.

How temporal patterns of medication adherence to antidepressants, bisphosphonates and statins are associated with healthcare cost

ABSTRACT We evaluate benefits of measuring temporal patterns of medication use using group-based trajectory modelling (GBTM) by finding associations between medication adherence (MA) and healthcare costs for which inconsistent results have been reported. We conducted a retrospective cohort study of 9,287, 1,660 and 10,242 users of antidepressants, bisphosphonates and statins, respectively, between 2012 and 2016, who participated in the 45 and Up Study in New South Wales, Australia. Associations between MA and subsequent 1-year healthcare cost components from generalized linear models and two-part models were compared across medications and MA measure types including GBTM and proportion of days covered (PDC). Compared to adherers, antidepressant users with declining adherence showed increased inpatient costs ($643 at p < 0.05). Bisphosphonate users with declining and consistently low adherence showed decreased osteoporotic inpatient costs ($387 at p < 0.05 and $419 at p < 0.05, respectively). All types of nonadherence were associated with reduced cost of the respective medications. GBTM revealed relationships between specific nonadherence types and healthcare costs, even in cases where no relationship was identified using the combined nonadherence PDC measure. With additional insights into the dynamics of nonadherence, GBTM could help clinicians and health policymakers design effective MA interventions, leading to improved health outcomes and pharmaceutical use.

Adherence levels and patterns for multiple cardiac medications prescribed to patients with incident atrial fibrillation events.

Using advanced longitudinal analyses, this real-world investigation examined medication adherence levels and patterns for incident atrial fibrillation (AF) patients with significant cardiovascular and noncardiovascular multimorbid conditions for each of 5 medication classes (β-blockers, calcium channel blockers/digoxin, antiarrhythmics, anticoagulants, antiplatelets). The population was derived from a large cohort covering a wide age spectrum/diversified US geographical areas/wide range of socioeconomic-disability status. The patients were drawn from 3 different health plans. Adherence was defined in terms of the proportion of day covered (PDC), and its patterns were modelled in terms of group-based trajectory, with each pattern profiled in terms of comorbid history, demographic variables and health plan factors using multinomial regression modelling. The total population consisted of 1 978 168 patients, with the AF cohort being older (average age of 64.6years relative to 44.7years for the non-AF cohort) and having fewer females (47.8% relative to 55.4 for the non-AF cohort). The AF cohort had significant cardiovascular/noncardiovascular multimorbidities and was much sicker than the non-AF cohort. A 6-group based trajectory solution appears to be the most logical outcome for each medication class according to assessed criteria. For each medication class, it consisted of one consistent adherent group (PDC ≥ 0.84), one fast declining group (PDC ≤ 0.11) and 4 intermediate nonadherence groups (slow decline [0.30-0.74 PDC range], occasional users [0.24-0.55 PDC range] and early gap/increased adherence [0.62-0.75]). The most consistent adherent groups were much lower than 50% of the total population and equal to 12.5-27.0% of the population, with the fast declining nonadherent pattern in the 5.6-35.0% of the population and the intermediate nonadherence equal to ~61% of the population. Our findings confirm that medication adherence is of major concern among multimorbid patients, with adherence levels lower much than those reported in the literature. There are 3 patterns of intermediate nonadherence (slow decline, occasional users, early gap/increased adherence), which were found to be eligible for interventions aimed at improving their adherence levels for each medication class. This may help improve cardiovascular medication adherence using large medication nonadherence improvement programmes.

A Novel Remote Patient and Medication Monitoring Solution to Improve Adherence and Persistence With Inflammatory Bowel Disease Therapy (ASSIST Study): Protocol for a Randomized Controlled Trial

Inflammatory bowel diseases (IBDs) are chronic inflammatory conditions of the gastrointestinal tract. Although adherence to IBD therapies is associated with improved clinical outcomes, overall adherence is poor. Consequently, there is a critical need to develop interventions that monitor adherence in real time and identify reasons for nonadherence to support clinical teams in initiating effective interventions. Recently, electronic- and web-based platforms have been developed to monitor adherence and guide interventions. A novel remote therapy monitoring (RTM) technology, the Tappt digital health system, has been developed to monitor real-time medication adherence patterns through smart label technologies, capture patient-reported outcomes and barriers to care, and process patient data through algorithms that trigger personalized digital and human touch points between clinical visits. Such a digital health solution enables care teams to proactively identify and mitigate nonadherence and worsening clinical outcomes. We propose a 12-month multicenter randomized controlled trial to assess the effectiveness of the Tappt digital health system on adherence, clinical outcomes, and health care use among patients diagnosed with IBD starting a new oral or subcutaneous therapy. The digital health system intervention will provide automatic measurement of medication adherence via smart labels for pill bottles or injectors as well as a monitoring platform for providers. The system will prompt patients to complete a two-item assessment of symptoms monthly using the PRO-2 scales for UC and Crohn disease, from which increased symptoms will be alerted to providers. Participants will be randomized 2:1 to the intervention group or the control group, which will receive standard of care. All participants are required to complete questionnaires at baseline as well as at 12, 26, and 52 weeks. Assuming an adherence rate of 0.65 and 0.9 among control and intervention participants, respectively, we will need to enroll 123 participants: 82 (66.7%) in the intervention group and 41 (33.3%) controls. We will compare adherence as measured by the medication possession ratio, defined as the number of days of supply of medication obtained during the observation period out of the total number of days in the observation period, in participants using the RTM versus those receiving standard of care. We will also compare clinical outcomes and health care use in participants using the RTM versus those receiving standard of care. We anticipate starting recruitment in December 2022. Effective medication adherence monitoring and intervention programs need to be cost-efficient, pose little or no burden to the patient, record reliable data in real time, and provide actionable insights to the health care team. We anticipate the Tappt digital health system to improve the medication possession ratio, clinical outcomes, and health care use compared with standard of care. ClinicalTrials.gov NCT05316584; https://clinicaltrials.gov/ct2/show/NCT05316584. PRR1-10.2196/40382.

Racial and Ethnic Differences in Risk Factors and Outcomes in Adults With Acute Myocardial Infarction.

Introduction Understanding racial/ethnic differences in patients with acute myocardial infarction (AMI) lays the foundation for more equitable health care. This study evaluated racial/ethnic differences in risk factors, treatment, and outcomes in patients with AMI. Methods This retrospective study included patients aged 18-50 years hospitalized for AMI between 2006 and 2016. Cox regression models were used to evaluate the association of race/ethnicity with all-cause mortality. Results Among 1753 patients hospitalized for type 1 AMI (median age 44 years, 85% male), 35.8% self-identified as White, 9.4% non-Hispanic Black, 37.6% Hispanic, 14.5% Asian, and 2.6% as other. Compared to White patients, Black patients were more likely to have hypertension (53.1% vs 32.2%, p < 0.001) and Hispanic patients were more likely to have diabetes (28.2% vs 15.5%, p < 0.001) and obesity (23.9% vs 17.7%, p = 0.008). There were no substantial differences in revascularization rates or initial medical treatment. However, adherence to statin therapy was lower among Black and Hispanic patients (50.3% and 58.6% for Black and Hispanic vs 67.4% and 72.3% for White and Asian patients, respectively). Over a median follow-up of 7.5 years, Black patients had higher all-cause mortality (unadjusted hazard ratio = 1.88, 95% confidence interval = 1.09-3.24) compared to White patients, but this difference was no longer significant after adjustments (adjusted hazard ratio = 1.32, 95% confidence interval = 0.74-2.36). Discussion and Conclusion There are racial/ethnic differences in risk factors and medication adherence patterns in adults with AMI. To achieve equitable care, programs with tailored intervention addressing needs of different groups should be developed.