Prescription Refill Rates Research Articles

The impact of side effects on adherence and persistence with oral anti-cancer agents in women diagnosed with early stage breast cancer: a systematic review of quantitative evidence protocol

REVIEW QUESTION/OBJECTIVE The objective is to examine the evidence on the impact of side effects on adherence and persistence with oral anticancer agents in women diagnosed with early stage breast cancer. This review aims to answer the following question: What is the impact of side effects on adherence and persistence with oral anticancer agents in women diagnosed with early stage breast cancer? INCLUSION CRITERIA Types of participants The quantitative component of this review will consider studies that include females 18 years of age or older, diagnosed with early stage breast cancer (stage I–IIIA, comprised of breast cancers that are confined to the breast or the breast and axillary lymph nodes). Studies will be included regardless of race or nationality of participants. Types of interventions This review will consider studies that evaluate the impact of side effects of oral anticancer therapy in comparison to no side effects. Reported side effects vary based on anticancer therapy and individual patient responses and may include night sweats, hot flashes, vaginal dryness, decreased libido, arthralgia, myalgia, nausea or weight gain. Any side effect reported as impacting adherence and/or persistence or any side effect evaluated for its impact on adherence and/or persistence in published studies will be included. Side effects reported as present or absent, side effects reported by severity, and/or side effects quantified using instruments or criteria defined in the study will be included. All side effects will be included. Types of outcomes This review will consider studies that include the following outcome measures: adherence and/or persistence rates. Methods to measure adherence and persistence include patient diaries, patient self-report, pill counts, microelectronic monitoring systems and prescription refill rates.

Intentional non-adherence to medications by older adults.

'The extent to which an individual's medication-taking behaviour and/or execution of lifestyle changes, corresponds with agreed recommendations from a healthcare provider', is a highly complex behaviour, defined as adherence. However, intentional non-adherence is regularly observed and results in negative outcomes for patients along with increased healthcare provision costs. Whilst this is a consistent issue amongst adults of all ages, the burden of chronic disease is greatest amongst older adults. As a result, the absolute prevalence of intentional non-adherence is increased in this population. This non-systematic review of intentional non-adherence to medication highlights the extent of the problem amongst older adults. It notes that age, per se, is not a contributory factor in intentionally non-adherent behaviours. Moreover, it describes the difference in methodology required to identify such behaviours in contrast to reports of non-adherence in general: the use of focus groups, semi-structured, one-to-one interviews and questionnaires as opposed to pill counts, electronic medication monitors and analysis of prescription refill rates. Using Leventhal's Common-Sense Model of Self-Regulation, it emphasizes six key factors that may contribute to intentional non-adherence amongst older adults: illness beliefs, the perceived risks (e.g. dependence, adverse effects), benefits and necessity of potential treatments, the patient-practitioner relationship, inter-current physical and mental illnesses, financial constraints and pharmaceutical/pharmacological issues (poly-pharmacy/regimen complexity). It describes the current evidence for each of these aspects and notes the paucity of data validating Leventhal's model in this regard. It also reports on interventions that may address these issues and explicitly acknowledges the lack of evidence-based interventions available to healthcare practitioners. As a result, it highlights five key areas that require urgent research amongst older adults: (1) the overlap between intentional and unintentional non-adherence, particularly amongst those who may be frail or isolated; (2) the potential correlation between symptomatic benefit and intentional vs. unintentional non-adherence to medication; (3) an evaluation of the source of prescribing (i.e. a long-standing provider vs. an acute episode of care) and the patient-prescriber relationship as determinants of intentional and unintentional non-adherence; (4) the decision-making processes leading to selective intentional non-adherence amongst older adults with multiple medical problems; and (5) the development and evaluation of interventions designed to reduce intentional non-adherence, specifically addressing each of the aspects listed above.

Cardiac Iron Overload In Sickle-Cell Disease

IntroductionChronically transfused sickle cell disease (SCD) patients have lower risk of endocrine and cardiac iron overload load than comparably transfused thalassemia major patients. The mechanisms for this protection remain controversial but likely reflects lower transferrin saturation and circulating labile iron pools because of chronic inflammation and regeneration of apotransferrin through erythropoiesis. However, cardioprotection is incomplete; we have identified 6 patients out of the 201 patients (3%) followed at our Institution who have prospectively developed cardiac iron. We present the clinical characteristics of these patients to identify potential risk factors for cardiac iron accumulation. MethodsCardiac, hepatic, and pancreatic iron overload were assessed by R2* Magnetic Resonance Imaging (MRI) techniques as extensively described by our laboratory. The medical records of the selected patients were reviewed for demographic data, for transfusion and chelation history and for hematologic and biochemical parameters. ResultsTable 1 describes clinical characteristics of the six patients at the time they developed detectable cardiac iron (R2* ≥ 50 ms). Patient 6 was included because he showed a R2* of 49 Hz that was increasing rapidly.Five of the six patients were managed on simple transfusions. Five patients had been on chronic transfusion for more than 11 years. The three patients who developed cardiac iron the earliest (3.7 – 14 years of transfusions) had more efficient suppression of endogenous red cell production (HbS levels 2-5%) compared with patients who required longer transfusional exposure (HbS levels 13.3 – 41%). All patients had qualitatively poor chelation compliance (<50%), based upon their prescription refill rate. All patients had serum ferritin levels exceeding 4600 and liver iron concentration (LIC) greater than 22 mg/g. Pancreatic R2* was greater than 100 Hz in every patient studied (5/6).Figure 1 shows the longitudinal relationship between iron overload in the heart and in the other organs for each patient; initial iron levels are shown in black. Cardiac R2* appears increase dramatically once a critical LIC “threshold” is reached, qualitatively similar to the 18 mg/g threshold observed in thalassemia major patients. Cardiac R2* rose proportionally to pancreas R2*, similar to thalassemia major patients, with all of the patients having pancreas R2* > 100 Hz at the time cardiac iron was detected. [Display omitted] ConclusionsCardiac iron overload occurs in a small percentage of chronically transfused SCD patients and is only associated with exceptionally poor control of total body iron stores. Duration of chronic transfusion is clearly important but other factors, such as levels of effective erythropoiesis, may also contribute to cardiac risk. The relationship between cardiac iron and pancreas R2* suggests that pancreas R2* can serve as a valuable screening tool for cardiac iron in SCD patients. Disclosures:Berdoukas:ApoPharma inc: Consultancy. Coates:ApoPharma inc, Novartis, Shire: Consultancy. Wood:Novartis: Consultancy, Honoraria; Shire: Consultancy, Research Funding; ApoPharma: Consultancy, Honoraria, Use of deferiprone in myocardial infarction, Use of deferiprone in myocardial infarction Patents & Royalties.

Educational and supportive interventions for improving adherence to inhalation therapy in people with chronic respiratory diseases: A systematic review protocol

Review question/objective The objective of this systematic review is to identify the best available research evidence related to the effectiveness of educational and supportive interventions for improving adherence to inhalation therapy in people with chronic respiratory diseases, focusing on measures of adherence and health outcomes. The specific review questions to be addressed are: 1. What is the effectiveness of educational and supportive interventions for improving adherence to inhalation therapy in terms of inhalation regimens and inhalation techniques in people with chronic respiratory diseases? 2. What is the effectiveness of educational and supportive interventions for improving adherence to inhalation therapy on health service utilization and patient outcomes including symptoms, pulmonary function, and quality of life? 3. What is the effectiveness of various designs, in terms of components, modes and intensities, of educational and supportive interventions for improving adherence to inhalation therapy? Inclusion criteria Types of participants This review will consider studies that include adults aged 18 or above, with a clinical diagnosis of chronic respiratory disease and prescribed self-administered inhalation therapy as a long term regular treatment, irrespective of the type of inhaler used. For the purposes of this review, "chronic respiratory diseases" is defined by WHO in 2007 as "the chronic diseases of the airways and other structures of the lung" (p.5). 1 Inhalation therapy is defined as "a treatment in which a substance is administered to the respiratory tract with inspired air". 6 This review will focus on inhalation of drugs. Those studies with prescribed administration of oxygen and water will be excluded. There is no universal standard for how long a treatment is undertaken to be defined as a "long term treatment". Acute episodic drug treatments, such as a course of antibiotics, will be excluded. Types of interventions of interest All educational interventions, with or without supportive programs, designed to improve the chronic respiratory disease sufferers inhalation technique and adherence to their prescribed inhalation therapy will be considered. Those studies that involve comparison of different types of inhalation medications, inhaler devices or inhalation methods to improve the adherence to inhalation therapy will be excluded. For the TRUNCATED AT 350 WORDS

Comment évaluer l’adhésion médicamenteuse ? Le point sur les méthodes

Identifying the difficulties of the patient towards following his medication regimen remains complex for the healthcare provider. This can be explained by the multidimensional character of medication adherence and, actually, the evaluation of this phenomenon. The objective of this work was to review the various methods to measure medication adherence. We performed a search on PubMed completed by a manual one. Two types of measure are described. The "direct" methods are based on the measurement of the level of medicine or metabolite in blood or urine, measurement of biologic markers in blood or measurement of physiologic or clinical markers. The "indirect" methods are represented by the analysis of the administrative databases (prescription, rate of prescription refills); pill counts; electronic medication monitors; the self-reported measures by the patient or his close relations (questionnaires, diaries, interviews); the opinion of the healthcare provider. None of these tools supplants the others, each having limits either of feasibility, or reliability. In the end, it is the crossing of the information stemming from these various equipments that allows an idea on the adherence behavior of the patient and especially, dimensions on which he is most in trouble. The identification of these difficulties can allow the healthcare provider to develop behavioral and organizational skills tailored to the patient follow-up.

A Digital Health Solution for Using and Managing Medications: Wirelessly Observed Therapy

Taking oral medication on a prescribed schedule can be a nuisance, especially for elderly individuals and busy people with lots of things on their minds. Nonetheless, taking medication as prescribed is important for maintaining health and well-being. In cases where medication use is part of a clinical trial, taking prescribed medication is important to the entire investigation and outcome of the study, including the determination of whether a drug is effective and safe.

Allergen Immunotherapy: More Stuttering than Finishing

Allergen immunotherapy is an allergic disease modifying intervention that is most efficacious when administered in appropriate doses for an adequate duration of therapy. The rate of adherence to intended courses of immunotherapy and factors contributing to premature cessation of treatment are not well described. We report the rate of allergen extract prescription refills for a large healthcare system.

Current Practice and Perception of Screening for Medication Adherence in Inflammatory Bowel Disease

BackgroundAdherence to medication in inflammatory bowel disease (IBD) improves outcomes. Current practices of screening for adherence to IBD medications are unknown. The goal of this study was to determine current practice and perception of screening for medication adherence among US-based gastroenterologists.MethodsA survey was mailed electronically to gastroenterologists whose electronic-mail address was listed in the American College of Gastroenterology database. Physicians who cared for IBD patients were invited to answer.ResultsAbout 6830 surveys were sent to gastroenterologists nationwide, and 395 physicians who cared for IBD patients completed the survey. The true response rate is unknown, as the number of physicians caring for IBD patients in the database is unknown. About 77% (n=303) of physicians who responded stated they screen for adherence to medication. Of the 77% of physicians who screened for adherence, only 19% (n=58) use accepted measures of screening for adherence (pill counts, prescription refill rates, or adherence surveys). The remaining 81% used patient interview to screen for adherence, a measure considered least accepted to determine adherence, as it overestimates adherence. The average number of IBD patients observed in 1 week had no statistical significance in predilection for screening (P=0.82). Private practice physicians (P=0.05), younger physicians (P=0.03), and physicians with fewer years of experience (P=0.02) all were more likely to screen. About 95% of responders thought determining a low adherer to medicine was important because an intervention can increase adherence.ConclusionsThe majority of gastroenterologists surveyed recognize that adherence to medication is important and improves outcomes. The majority of physicians in this study are screening for nonadherence in IBD, but are not using accepted measures for adherence detection. If this study truly reflects the majority of physicians nationwide, changing the way physicians screen for adherence, may detect more low adherers to medication.

Twelve-Month Persistency with Oral 5-Aminosalicylic Acid Therapy for Ulcerative Colitis: Results from a Large Pharmacy Prescriptions Database

Patients receiving 5-aminosalicylic acid (5-ASA) require long-term therapy to achieve good outcomes. Persistency (duration of time from initiation to discontinuation of therapy) is therefore an important consideration. To evaluate persistency in patients receiving various oral 5-ASA formulations. This retrospective, 12-month, cohort study examined new-starter patients (any age and diagnosis) from a large United States pharmacy database who filled a prescription for oral 5-ASA [Lialda(®), Asacol(®), Pentasa(®) 250 or 500 mg, balsalazide (generic and Colazal(®)), and olsalazine (Dipentum(®))] between March and September 2007. Persistency was evaluated monthly on the basis of prescription refill rates. Prescription and refill records were identified for 44,191 patients receiving oral 5-ASA. After 1 year, 20% of patients receiving Lialda were considered persistent and classified as continuing (refilling within a timeframe of up to twice the duration of the prescription), compared with 9% receiving Asacol, 7 (250 mg) and 10% (500 mg) receiving Pentasa, 10% receiving balsalazide, and 10% receiving Dipentum. Overall persistency with oral 5-ASA therapy was low. However, patients receiving once-daily Lialda had significantly higher persistency after 1 year of treatment than patients receiving other oral 5-ASA therapies.

Current Practice and Perception of Screening for Medication Adherence in Inflammatory Bowel Disease: Results of a Nationwide Survey

Purpose: A recent paper from President Obama's chief healthcare advisor calls for medication adherence as a priority for healthcare reform, as adherence to medication in chronic diseases improves outcomes; with the inflammatory bowel diseases being no exception. The current practice of physician screening for medication adherence is unknown. The goal of this study was to determine current practice and perception of screening for medication adherence in the USA in IBD. Methods: A ten-question survey was mailed electronically to gastroenterologists whose electronic-mail address was listed in the American College of Gastroenterology database. Physicians who cared for IBD patients were invited to answer the survey. Results: 6,830 surveys were sent to gastroenterologists nationwide. 395 physicians who cared for IBD patients fully completed the survey. The true response rate is unknown as the number of physicians caring for IBD patients in the database is unknown. 77% (n=303) of physicians who responded stated they screen for adherence to medication. Of the 77% that screened for adherence, only 19% (n=58) use accepted measures of screening for adherence (pill counts, prescription refill rates, or adherence surveys). The remaining 81% used patient interview to screen for adherence, a measure considered least accepted to determine adherence, as it overestimates adherence. The average number of IBD patients seen in one week, type of practice (academic versus private), number of years post training, or age had no statistical significance in predilection or preference of screening. 89% of responders thought screening was very important or important versus 11% who thought screening was somewhat important or not important. 99% of responders thought improving adherence would improve health related outcomes. 95% of responders thought determining a low adherer to medicine was important because an intervention can increase adherence. 74% of responders would use an adherence survey in practice if one were validated for IBD in at least 75% of encounters. 48% would use it in every patient. Conclusion: The vast majority of gastroenterologists surveyed recognize that adherence to medication is important and improves outcomes. The majority of physicians are screening for non-adherence in IBD patients, but are not using accepted measures for adherence detection. Changing the way physcians screen for adherence may detect more low adherers to medication.

COPD Management in Primary Care: An Observational, Community Pharmacy–Based Study

Chronic obstructive pulmonary disease (COPD) is a prevalent disease that is frequently treated in primary care. However, data regarding the primary care management of COPD are scarce. Such observational data are necessary to detect problem areas and to develop targeted interventions for improvement of COPD management. To provide a detailed description of (1) drug therapy, (2) drug adherence, (3) inhalation technique, and (4) health status of patients with COPD recruited via community pharmacies. A cross-sectional, observational study was conducted in 93 pharmacies in Belgium. Participants (N = 555) completed a questionnaire collecting information on personal characteristics, smoking history, influenza vaccination, COPD medication, and adverse effects. Adherence to COPD maintenance medication was analyzed 1 year retrospectively through prescription refill rates. Inhalation technique was scored using a checklist. Health status was evaluated with the St. George's Respiratory Questionnaire, the Clinical COPD Questionnaire, and the Modified Medical Research Council dyspnea scale. The mean age of the patients was 68.6 years; 73.7% were men and 37.2% were current smokers. The influenza vaccination status was significantly lower in patients aged less than 65 years (65.7%) than in patients aged 65 years or more (86.2%) (p < 0.001). Fixed combinations of inhaled corticosteroids and long-acting beta(2)-agonists were the most frequently used COPD medications (75.4%). About 48% of patients were underadherent (<80% adherence), 47% were adherent (80-120% adherence) and 5% were overadherent (>120% adherence). Predictors for underadherence were age and number of drugs. Twenty-one percent of patients made major inhalation technique errors with rescue medication; these were all errors in handling pressurized metered-dose inhalers (pMDIs). This observational study on COPD management in primary care highlights 4 main aspects that could be improved: (1) drug adherence, (2) inhalation technique with pMDIs, (3) influenza vaccination in COPD patients younger than 65 years, and (4) smoking cessation.

Assessment of adherence to cinacalcet by prescription refill rates in hemodialysis patients

Secondary hyperparathyroidism is common among dialysis patients and leads to numerous complications including cardiovascular disease and renal osteodystrophy. Cinacalcet, an oral daily calcimimetic agent that sensitizes the calcium receptor to serum calcium, is approved for treatment of secondary hyperparathyroidism in dialysis patients. We identified 101 patients who received their first cinacalcet prescription between November 2004 and April 2005. All patients were participating in a Missouri state-funded pharmacy program providing free or low cost medications. We tracked the cinacalcet refill rate and refills for another control medication prescribed to each patient. The average cinacalcet refill rate over the first 12 months was 56% vs. 64% for the control medication (P=0.02). Good adherence, defined as >80% medication possession ratio over the 12 months, was 29% for cinacalcet and 33% for the control medication (P=0.68). Additionally, the refill rate for cinacalcet fell significantly over five quarterly periods from 53% in the first quarter to 37% in the 5th quarter. We conclude that dialysis patients' adherence to medications, including cinacalcet, is poor even when medications are provided at a nominal cost. Poor cinacalcet adherence would be expected to impair long-term control of SHPT. In a reimbursement system where injectable, but not oral medications, are bundled with dialysis payments there may be pressure to move patients to oral medications. The poor compliance found in this study highlights the potential adverse effects of movement toward self-administered oral therapy.

Amlodipine/Atorvastatin

Amlodipine/atorvastatin (Caduet) is a single-tablet, fixed-dose combination of the dihydropyridine calcium channel antagonist amlodipine and the HMG-CoA reductase inhibitor atorvastatin. The bioavailability of amlodipine and atorvastatin with a single-tablet, fixed-dose amlodipine/atorvastatin combination was not significantly different to that with coadministered separate amlodipine and atorvastatin tablets. In well controlled clinical trials in patients with hypertension and dyslipidaemia, once-daily amlodipine and atorvastatin (administered as the single-tablet, fixed-dose combination or coadministered as two separate tablets) effectively reduced systolic BP (SBP) and low-density lipoprotein cholesterol (LDL-C) levels, and enabled more patients to achieve BP and LDL-C goals than single-agent or placebo therapy. There was no modification of the effect of amlodipine on SBP when administered in combination with atorvastatin and there was no modification of the effect of atorvastatin on LDL-C when administered in combination with amlodipine. In noncomparative, titration-to-goal, open-label 'real-world' trials, the single-tablet, fixed-dose combination of amlodipine/atorvastatin enabled patients with hypertension and dyslipidaemia to achieve both BP and LDL-C goals. Administration of a single tablet of amlodipine/atorvastatin, compared with coadministration of these agents as two separate tablets, improved patient adherence, according to a retrospective study that utilized prescription refill rates from a large US insurance database. Data from the large, randomized, double-blind, placebo-controlled ASCOT-LLA trial also demonstrated that the combination of amlodipine-based therapy and atorvastatin was effective in preventing cardiovascular (CV) endpoints in hypertensive patients at risk of CV disease (CVD). In summary, amlodipine/atorvastatin offers a convenient and effective approach to improving adherence and managing CV risk in hypertensive patients with dyslipidaemia or at risk of CVD.

An alternative methodology for the prediction of adherence to anti HIV treatment

BackgroundSuccessful treatment of HIV-positive patients is fundamental to controlling the progression to AIDS. Causes of treatment failure are either related to drug resistance and/or insufficient drug levels in the blood. Severe side effects, coupled with the intense nature of many regimens, can lead to treatment fatigue and consequently to periodic or permanent non-adherence. Although non-adherence is a recognised problem in HIV treatment, it is still poorly detected in both clinical practice and research and often based on unreliable information such as self-reports, or in a research setting, Medication Events Monitoring System caps or prescription refill rates. To meet the need for having objective information on adherence, we propose a method using viral load and HIV genome sequence data to identify non-adherence amongst patients.Presentation of the hypothesisWith non-adherence operationally defined as a sharp increase in viral load in the absence of mutation, it is hypothesised that periods of non-adherence can be identified retrospectively based on the observed relationship between changes in viral load and mutation.Testing the hypothesisSpikes in the viral load (VL) can be identified from time periods over which VL rises above the undetectable level to a point at which the VL decreases by a threshold amount. The presence of mutations can be established by comparing each sequence to a reference sequence and by comparing sequences in pairs taken sequentially in time, in order to identify changes within the sequences at or around 'treatment change events'. Observed spikes in VL measurements without mutation in the corresponding sequence data then serve as a proxy indicator of non-adherence.Implications of the hypothesisIt is envisaged that the validation of the hypothesised approach will serve as a first step on the road to clinical practice. The information inferred from clinical data on adherence would be a crucially important feature of treatment prediction tools provided for practitioners to aid daily practice. In addition, distinct characteristics of biological markers routinely used to assess the state of the disease may be identified in the adherent and non-adherent groups. This latter approach would directly help clinicians to differentiate between non-responding and non-adherent patients.

Objective evaluation of adjunctive glaucoma therapy

Abstract Purpose: To measure adherence with electronic monitoring in two populations of subjects: those using once‐daily prostaglandin analogs (q.d.), and those on adjunctive medicine to the prostaglandin analog. Methods: Single‐site, open‐label, non‐randomized, parallel, 60 day study. 62 open angle glaucoma or ocular hypertension adult subjects currently using either a topical prostaglandin as sole ocular hypotensive medical therapy q.d. (“1‐drug” subjects, n=31) or a topical prostaglandin plus an adjunctive topical ocular hypotensive product either q.d., twice‐daily (b.i.d.), or three‐times‐daily (t.i.d.) in the same eye(s) (“2‐drug” subjects, n = 31). An electronic event medication monitoring device was used to record each opening of the bottle containing the ocular hypotensive medication. The main outcome measures were dosing errors (number of under or over‐adherence events) and coverage (proportion of pharmacological duration covered by dosing) relative to ophthalmologist‐prescribed regimen. Results: Adherence to the prostaglandins q.d. was good in both groups by all measures (≤10% of subjects with &gt;5 dosing errors and mean coverage of 97.2±6.1%). Adherence to the second medication in the 2‐drug group was poorer (37% of subjects with &gt; 5 dosing errors and mean coverage of 85.6 ± 12.6%). For the subjects on β‐adrenoceptor antagonists, 24.8±18.4% of doses were taken at less than 10 hour intervals (over‐adherence). Conclusions: The use of electronic monitoring provides more information than simple “pill count,” bottle weighing methods, or prescription refill rate, as it incorporates a time component. We found that more complex dosing regimens result in poorer adherence, although q.d. drugs in a complex dosing regimen were found to have good adherence.

Adherence in Glaucoma: Objective Measurements of Once-Daily and Adjunctive Medication Use

To determine with electronic monitoring an objective measurement of adherence in two populations of subjects: those using once-daily prostaglandin analogs as sole ocular hypotensive therapy (one-drug group) and those requiring an adjunctive medicine to the prostaglandin analog (two-drug group). Single-site, open-label, nonrandomized, parallel design of 60 days. Sixty-two consecutive adult subjects with a diagnosis of open-angle glaucoma (OAG) or ocular hypertension: 31 were taking one drug and 31 were taking two drugs. An electronic event medication monitoring device was used to record each bottle opening. The main outcome measures were dosing errors (number of under-adherence or over-adherence events) and coverage (proportion of pharmacologic duration covered by dosing) relative to the ophthalmologist-prescribed regimen. Adherence to the prostaglandins once daily was good in both groups by all measures (<or=10% of subjects with more than five dosing errors and mean coverage of 97.2% +/- 6.1%). Adherence to the second medication in the two-drug group was poorer (37% of subjects with more than five dosing errors and mean coverage of 85.6% +/- 12.6%). For the subjects using beta-adrenoceptor antagonists, 24.8% +/- 18.4% of doses were taken at less than 10-hour intervals (over-adherence). The incorporation of a time component in electronic monitoring provides more information than prescription refill rate or other methods. We found that more complex dosing regimens result in poorer adherence, although once-daily drugs in a complex dosing regimen were found to have good adherence.

5-ASA prescription refill rates for ulcerative colitis are Independent of formulation &amp; dosing regimens

5-ASA prescription refill rates for ulcerative colitis are Independent of formulation &amp; dosing regimens

5-ASA prescription refill rates for ulcerative colitis are Independent of formulation &amp; dosing regimens

5-ASA prescription refill rates for ulcerative colitis are Independent of formulation &amp; dosing regimens

5-ASA Prescription Refill Rates for Ulcerative Colitis Are Independent of Formulation and Dosing Regimens

5-ASA Prescription Refill Rates for Ulcerative Colitis Are Independent of Formulation and Dosing Regimens

P0692 MEDICATION ADHERENCE IN PEDIATRIC CROHN???S DISEASE

Introduction: Despite the importance of medical therapy in treating Crohn’s Disease (CD), there is a lack of published data regarding medication adherence (MedAd) in children. Aims: 1) To determine the prevalence of adherence to prescribed mesalamine preparations (5ASA) and 6-mercaptopurine (6MP) or azathioprine (Aza) in children with CD. 2) To determine predictors of MedAd. 3) To evaluate parent, pt and physician perceptions of MedAd. Methods: Pts (<20 yrs) with CD taking oral 5ASA or 6MP/Aza for 6 mos prior to study entry. Data obtained included demographics, concurrent medications, PCDAI, and pharmacy records for the preceeding 6 mos. A validated formula was used to calculate prescription (Rx) refill rates (RRs). RR = Cumulative days’ supply obtained/Total days to next Rx fill ×100. “Adherence” was defined as RR >/=75%. Parents, pts and physicians completed short questionnaires regarding MedAd. Chi-Squared test, t-test, linear regression analyses and Kappa statistics were performed to identify statistical significance. Results: 53 pts were enrolled (33M:20F; 75%W:25%AA). Mean age 14.2 ± 3.2 yrs; median disease duration 23 mos. 87% of pts had been prescribed 5ASA, 72% 6MP/Aza, and 58% both. Median RRs: 5ASA 51%; 6MP/Aza 80%. 39.5% of pts were adherent to 5ASA and 54% adherent to 6MP/Aza. 72% of pts were off prednisone at time of enrollment. For pts on either 5-ASA or 6MP/Aza, being off prednisone significantly increased the RR (p=0.05). For pts taking both medication classes, the RR of one medication was highly predictive of the RR for the other (p<0.01). For 6MP/Aza, the RR was significantly higher if a parent (p=0.01) or pt (p=0.001) reported that the medication had been taken daily the previous week compared to <7d. Pts who said they were excellent or very good at taking their medications on average had an RR of 36% higher for 5ASA (p=0.04)and 54% higher for 6MP/Aza (p=0.001)than pts who reported their MedAd as fair or poor. Kappa statistics comparing parent and pt perceptions of MedAd were 0.57 for 5ASA and 0.69 for 6MP/Aza. Kappa statistics comparing physician perceptions with either parents or pts ranged from 0.28 to 0.45. Conclusion: Pediatric pts with CD have poor adherence to commonly prescribed medications. 6MP/Aza tended to have better adherence than mesalamine. Adherence to one medication class was significantly predictive of adherence to the other. Parents agreed relatively well with pts about pt mesalamine adherence and very well about pt 6MP/Aza adherence. Physician perceptions of adherence did not agree well with that of either parents or pts. The impact of poor adherence on disease outcomes in children with CD needs to be further addressed.