Promote Medication Adherence Research Articles

Satisfaction and Usability of a Commercially Available Medication Adherence App (Medisafe) Among Medically Underserved Patients With Chronic Illnesses: Survey Study.

Research supports the use of mobile phone apps to promote medication adherence, but the use of and satisfaction with these apps among medically underserved patients with chronic illnesses remain unclear. This study reports on the overall use of and satisfaction with a medication adherence app (Medisafe) in a medically underserved population. Medically underserved adults who received care for one or more chronic illnesses at a federally qualified health center (FQHC) were randomized to an intervention group in a larger randomized controlled trial and used the app for 1 month (n=30), after which they completed a web-based survey. Objective data on app usage were provided as secondary data by the app company. The participants were very satisfied with the app, with all participants (30/30, 100%) somewhat or strongly agreeing that they would recommend the app to family and friends. Participants strongly agreed (28/30, 93%) that the reminders helped them remember to take their medications at the correct time each day, and they (28/30, 93%) found the app easy to use. Additional features accessed by some included educational features and the adherence report. Participants noted the helpfulness of having a medication list on their phones, and some used it during medication reconciliation at doctor visits. Use of the Medfriend feature, which alerts a social support person if a medication is missed, was low (n=2), but those who used it were very positive about the feature. A commercially available medication adherence app was found to be useful by participants, and they were satisfied with the app and the additional features provided. The use of medication adherence mobile phone apps has the potential to positively influence chronic disease management in a medically underserved population on a large scale. ClinicalTrials.gov NCT05098743; https://clinicaltrials.gov/study/NCT05098743.

Lipid-lowering agent preferences among patients with hypercholesterolemia: a focus group study.

Non-adherence to lipid-lowering agents poses significant risks to patients and diminishes treatment effectiveness. Current understanding of patients' preferences regarding the characteristics of these agents is limited. This study aims to qualitatively identify the barriers to lipid-lowering medication adherence and the factors considered by patients with hypercholesterolemia when choosing lipid-lowering agents, and to inform the design of a medication preference study. Face-to-face focus group interviews were conducted with Cantonese-speaking patients diagnosed with hypercholesterolemia in Hong Kong. Patients were recruited by cardiologists at a university-affiliated hospital using convenience sampling. The interviews consisted of three parts: gathering patients' perceptions of disease and medication, identifying important factors in selecting lipid-lowering agents, and completing the medication preference tasks designed using the Discrete Choice Experiment (DCE) method. Thematic analysis was used to categorise the codes derived from the transcripts into higher-order themes. Twenty patients completed the focus group interviews on the university campus between January and March 2023. Four main themes emerged: medication management issues, patients' medication preferences, structure, and comprehension of preference tasks. Barriers to medication adherence included lack of knowledge, a high pill burden, poor communication with healthcare providers, minimal treatment decision involvement, limited access to medication information, side effects, and forgetfulness. Factors influencing medication choice were treatment regimen (i.e. the route and frequency of administration), effectiveness, side effects, doctors' opinions, drug interactions, and out-of-pocket costs. Despite suggestions for modifying attributes and levels, the medication preference tasks effectively reflected patients' trade-offs. The identified barriers to medication adherence and the factors influencing medication choice highlight the importance of considering patients' perspectives. These insights could assist decision-makers in selecting medications that align with patient preferences, thereby promoting medication adherence. A large-scale DCE preference study will be conducted in Hong Kong to quantify the relative importance of the attributes of lipid-lowering agents.

The cost-effectiveness of peer education on medication adherence in the elderly with hypertension: a randomized controlled trial

BackgroundPeer education is an effective approach for promoting medication adherence in hypertensive patients, but there is limited evidence on its cost-effectiveness analysis. This study aimed to evaluate the cost -effectiveness of peer education for improving medication adherence in the elderly with hypertension.MethodsThis randomized clinical trial involved 74 elderly individuals with hypertension who were referred to health centers affiliated to Mashhad University of Medical Sciences in 2019. Educational content was presented over six sessions across six weeks by a peer in the intervention group, and a health center nurse in the control group. Data was collected before the intervention, immediately after intervention, and at 3 and 6 weeks post-intervention using the Morisky Medication Adherence Scale. Data analysis was performed by SPSS (Ver. 23) with both descriptive and statistical test. Cost-effectiveness analysis of the educational methods measured the impact on medication adherence scores for each group.ResultsThe medication adherence score was 7.33 ± 0.41 and 6.37 ± 0.76 at 6 weeks post educational sessions in the intervention and control groups, respectively. There was a significant difference in mean score of medication adherence at the end of the intervention, as well as at 3 and 6 weeks post-intervention between the groups (p < 0.001). Additionally, the results indicated that peer education approach was more cost-effective than routine education.ConclusionsPeer education programs promote medication adherence in elderly with hypertension and are more cost-effective than routine education in health centers. Healthcare managers can improve medication adherence and reduce costs with employing peers to educate older individuals with hypertension.Trial registrationThis study was registered in the Iranian Registry of Clinical Trials (registration number: IRCT20180519039710N1). Registration date: July 29, 2018.

How ethical is the use of financial incentives to promote medication adherence among patients with serious mental illness? - a scoping review of the literature

Poor adherence to medication treatment in those with serious mental illness is common. Typical solutions and consequences in Western, formal psychiatric care settings often involve coercive measures such as involuntary hospital admissions and treatment, and out-patient commitments, with serious infringements on civil liberty. We examine the relatively unfamiliar, controversial and under-explored area of using financial incentive (FI) to enhance medication adherence in this population through a comprehensive scoping literature review, focusing on the ethical aspects of this practice. From nineteen qualified papers, we identified seven key themes of ethical “concerns,” and opposing arguments on whether FI is: (1) itself a form of coercion affecting autonomy; (2) leading to erosion of a proper consent process; (3) causing indirect and unintended harm; (4) worsening multiple levels of stigma related to mental illness; (5) associated with loss of intrinsic motivation of treatment; (6) associated with misuse of the fund itself; and (7) potentially leading to negative impact on therapeutic relationships. The ethics review shows a moderate receptivity to the use of FI in some specific and individualized circumstances; exceptions for those with poor insight and lacking treatment capacity are particularly relevant in order to avoid other forms of coercion. Additional highlights of the review include the optimal amount, duration, scope, and target population of the FI, and need for rigorous attention to psychoeducation, process, therapeutic relationships, stigma, and not lose sight of ultimately aiming to improve on patients’ insight, autonomy, quality of life and intrinsic motivation in this controversial approach.

Improving Timely Medication Access for Endocrinology and Diabetes Patients: A Quality Improvement Initiative

ABSTRACT Introduction Managing chronic conditions such as endocrinology and diabetes requires consistent access to medications. Traditional methods of medication refill often involve in-person visits to healthcare providers or pharmacies, posing challenges for patients. Online medication refill services offer a promising solution to improve accessibility and convenience. Methods This is a digital-based solution using online medication refill services to enhance the management of endocrinology and diabetes medication refills. It examines the process of online medication refill, including patient registration, refill request submission, verification, provider input, processing, and pickup or delivery. Results Online medication refill services empower patients to easily request refills from the comfort of their homes, streamlining the refill process, and reducing walk-in pressure in clinics. The online medication refill with the option for home delivery option eliminates the need for patients to visit the hospital, further enhancing the patient experience. Before implementing the online medication refill solution, 26 patients will come to the clinic as walk-ins to request medication refills. The average waiting time for each patient is 45 minutes. Each provider will be interrupted for an average of 10 minutes to accommodate the request. The overall processing time required for each walk-in patient to submit the medication request is 1 hour on average. After implementing the online medication refill intervention, zero patients come to the clinic as walk-ins and hence, no interruption to the daily regular clinics. The overall processing time required for submitting the online medication request is now 2 minutes. These interventions promote medication adherence and patient engagement by facilitating access to medications and offering educational resources. Conclusion Online medication refill services represent a valuable tool in the comprehensive management of endocrinology and diabetes. They offer accessibility, convenience, and patient empowerment, potentially improving health outcomes and enhancing the overall patient experience.

Optimizing the Use of Personal Values to Promote Medication Adherence: A Randomized Controlled Trial Comparing Affective and Behavioral Responses to Theory-Driven Domain Congruent Versus Incongruent Values Approaches.

Self-affirmation theory (SAT) and acceptance and commitment therapy (ACT) embody competing approaches to leveraging personal values to motivate behavior change but are rarely compared in the domain of health behavior. This study compares these theory-driven values-based interventions for promoting medication adherence. To compare affective and behavioral responses to competing values-based medication adherence interventions. In this three-armed randomized trial, participants with cancer (n = 95) or diabetes (n = 97) recruited online using Prolific and prescribed daily oral medication for that disease completed a one-session online writing intervention leveraging (1) a domain incongruent (DI) value, where the value was not connected to medication adherence; (2) a domain congruent (DC) value, where the value was connected to adherence; or (3) a control condition, focused on medication adherence procedures. There were no main effects of conditions on reported medication adherence at the 1-month follow-up. During the intervention, positive affect was higher in the values conditions than control (p < .001), and trended higher in DI versus DC (p = .054). Negative affect did not vary between the values and control groups (p = .093) but was lower in DI versus DC (p = .006). Improvements in positive affect over the course of the intervention were associated with increased adherence behavior for individuals who started with low levels of positive affect (p = .003). Disease type did not moderate findings. Consistent with SAT, focusing on DI values led to more positive and less negative affect than connecting values directly to behavior in a threatening domain such as chronic illness. For some participants, increases in positive affect predicted greater adherence.

Oral Diabetes Medication Videos on Douyin: Analysis of Information Quality and User Comment Attitudes.

Oral diabetes medications are important for glucose management in people with diabetes. Although there are many health-related videos on Douyin (the Chinese version of TikTok), the quality of information and the effects on user comment attitudes are unclear. The purpose of this study was to analyze the quality of information and user comment attitudes related to oral diabetes medication videos on Douyin. The key phrase "oral diabetes medications" was used to search Douyin on July 24, 2023, and the final samples included 138 videos. The basic information in the videos and the content of user comments were captured using Python. Each video was assigned a sentiment category based on the predominant positive, neutral, or negative attitude, as analyzed using the Weiciyun website. Two independent raters assessed the video content and information quality using the DISCERN (a tool for assessing health information quality) and PEMAT-A/V (Patient Education Materials Assessment Tool for Audiovisual Materials) instruments. Doctors were the main source of the videos (136/138, 98.6%). The overall information quality of the videos was acceptable (median 3, IQR 1). Videos on Douyin showed relatively high understandability (median 75%, IQR 16.6%) but poor actionability (median 66.7%, IQR 48%). Most content on oral diabetes medications on Douyin related to the mechanism of action (75/138, 54.3%), precautions (70/138, 50.7%), and advantages (68/138, 49.3%), with limited content on indications (19/138, 13.8%) and contraindications (14/138, 10.1%). It was found that 10.1% (14/138) of the videos contained misinformation, of which 50% (7/14) were about the method of administration. Regarding user comment attitudes, the majority of videos garnered positive comments (81/138, 58.7%), followed by neutral comments (46/138, 33.3%) and negative comments (11/138, 8%). Multinomial logistic regression revealed 2 factors influencing a positive attitude: user comment count (adjusted odds ratio [OR] 1.00, 95% CI 1.00-1.00; P=.02) and information quality of treatment choices (adjusted OR 1.49, 95% CI 1.09-2.04; P=.01). Despite most videos on Douyin being posted by doctors, with generally acceptable information quality and positive user comment attitudes, some content inaccuracies and poor actionability remain. Users show more positive attitudes toward videos with high-quality information about treatment choices. This study suggests that health care providers should ensure the accuracy and actionability of video content, enhance the information quality of treatment choices of oral diabetes medications to foster positive user attitudes, help users access accurate health information, and promote medication adherence.

The role of family support in medication adherence and quality of life among tuberculosis patients: A scoping review.

Tuberculosis (TB) remains one of the leading infectious diseases globally, causing high mortality rates. A significant factor contributing to this issue is nonadherence to treatment, which is influenced by family support and impacts the quality of life (QoL) of patients. The purpose of this study was to describe the role of family support in enhancing medication adherence and improving QoL in individuals with TB. This study utilized a scoping review method to examine literature from the PubMed, Scopus, and EBSCO databases. The keywords used in the search included "social support OR online social support OR perceived social support OR family support" AND "Tuberculosis OR TB OR TBC" AND "medication adherence OR medication compliance OR drug adherence OR drug compliance OR adherence OR compliance OR lost to follow-up" AND "QoL OR HRQoL OR health-related QoL." The inclusion criteria were full-text articles in English, primary research studies, and publications from the last 10 years (2012-2022). Thirteen articles met the inclusion criteria, with sample sizes ranging from 50 to 1342 respondents, predominantly using cross-sectional methods. The study found that family support is crucial in promoting medication adherence and positively influencing the QoL of TB patients. Family members provide emotional and practical support, including supervision of medication intake and encouragement of healthy habits. This support enhances patients' confidence, motivation, and overall treatment outcomes. The findings underscore the indispensable role of family support in addressing the complex interplay between medication adherence and QoL for individuals with TB.

Understanding the impact of pandemics on long-term medication adherence: directly observed therapy in a tuberculosis treatment cohort pre- and post-COVID-19 lockdowns

BackgroundThe COVID-19 pandemic negatively impacted tuberculosis (TB) treatment services, including directly observed therapy (DOT) programs used to promote medication adherence. We compared DOT adherence embedded in a research study before and after COVID-19 lockdowns in South Africa.MethodsWe analyzed data from 263 observational study participants undergoing drug susceptible (DS)-TB DOT between May 2017 to March 2022. Participants enrolled before October 2019 were considered ‘pre-COVID-19’ and those enrolled after September 2020 were considered ‘post-COVID-19 lockdown groups. Negative binomial regression models were used to compare DOT non-adherence rates between the two lockdown groups. We then conducted a sensitivity analysis which only included participants enrolled in the immediate period following the first COVID-19 lockdown.ResultsDOT non-adherence rate was higher in the post-COVID-19 lockdown group (aIRR = 1.42, 95% CI = 1.04–1.96; p = 0.028) compared to pre-COVID-19 lockdown period, adjusting for age, sex, employment status, household hunger, depression risk, and smoked substance use. DOT non-adherence was highest immediately following the initial lockdown (aIRR = 1.74, 95% CI = 1.17–2.67; p = 0.006).ConclusionThe COVID-19 lockdowns adversely effected adherence to TB DOT in the period after lockdowns were lifted. The change in DOT adherence persisted even after adjusting for socioeconomic and behavioral variables. We need a better understanding of what treatment adherence barriers were exacerbated by COVID-19 lockdowns to improve outcomes in post-pandemic times.Trial registrationClinicalTrials.gov Registration Number: NCT02840877. Registered on 19 July 2016.

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

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

The Predictors of Medication Adherence among TB Patients on the E-Refill Prescription System in Health Care Facilities in Lagos State

Background: Tuberculosis (TB) has continued to be a major health concern to man and has affected majority of the population around the world. In the World Health Organisation (WHO)’s estimate, Nigeria is second in Africa and seventh in the world with regard to cases. Since Lagos is the most populous state in Nigeria, it has made a high number of tuberculosis cases. Since there is no cure for TB without taking the prescription drugs, noncompliance has been as frequent as the disease, leading to treatment failure, drug resistant TB and increased cost of healthcare. The e-refill prescription system which is an electronic prescription refill system is targeted to increase medical compliance amongst TB patients consequently improving overall health.  Aim: The purpose of this study is therefore to evaluate the factors which determine medication compliance among TB patients on the e-refill prescription in health facilities in Lagos state.  Setting: Various healthcare facilities across Lagos.  Methodology: This study employed the cross-sectional method. For sampling, we opted for a purposive sampling approach to select the patients. The sample size, determined using the Kish formula, comprised approximately 338 TB patients. In order to collect data on critical factors such as patient’s satisfaction, factors influencing e-refill medication adherence, and the willingness to adopt the e-refill system, this study made use of in-depth interview and semi- structured question. Furthermore, the collected data was analysed with SPSS software, with two team members independently coding the interview transcripts to identify emerging themes and resolve discrepancies through consensus discussions.  Results: A large proportion of the participants fell between the ages of 28 to 38 years (45.9%), (53.0%) were married, and the Yoruba ethnic group dominated the population at (49.4%). Most patients received care from government- owned facilities (75.1%). 68.6% considered medical adherence important. Of factors influencing medical adherence, (47%) said that forgetfulness often affected their adherence, and (23.7%) cited the side effect. Of those surveyed, 54.4% expressed interest in using the e- Refill system, and 60.7% were knowledgeable about it. Ease of use (32.8%) and system trust (29.9%) are the main variables influencing readiness to utilise the e-Refill system.  Conclusion: The e-Refill system has shown potential for success in improving medication adherence among TB patients in Lagos state. However, it is important to address challenges such as limited access to healthcare and reluctance among certain patient groups need to be addressed. To get maximum result possible from the system, it is important to take steps to enhance patient engagement, address stigma associated with the illness, and ensure sustained support over the duration of the treatment.  Contribution: The study highlights the significance of niche interventions geared towards promoting medication adherence and improving TB treatment outcomes in resource-constrained environments.

Urban-Rural Differences in the Association of eHealth Literacy With Medication Adherence Among Older People With Frailty and Prefrailty: Cross-Sectional Study.

With advances in science and technology and improvements in health literacy, more studies have focused on frailty prevention by promoting medication adherence, emphasizing the role of eHealth literacy. However, the association between eHealth literacy and medication adherence in frail older adults has not been well studied, and it is unknown whether urban-rural differences exist in this relationship. This study aims to examine the relationship between eHealth literacy and medication adherence in older people with different frailty statuses, emphasizing variations between rural and urban areas. Between November and December 2020, a total of 4218 urban and rural community members (aged ≥60 years) in China were recruited as participants using a multistage random sampling method. A face-to-face structured questionnaire survey was conducted to collect information on demographic characteristics, eHealth literacy (consisting of application, evaluation, and decision dimensions), and medication adherence. eHealth literacy was assessed using the Chinese version of the eHealth Literacy Scale developed by Norman and Skinner, and medication adherence was measured using the 4-item Morisky scale. We used a general descriptive analysis and stratified logistic regression models to examine how eHealth literacy is linked to medication adherence and urban-rural differences. There were 4218 respondents, of which 2316 (54.9%) lived in urban areas and 1902 (45.1%) in rural areas, respectively. After adjusting for potential confounders, among participants with prefrailty, eHealth literacy was associated with medication adherence in urban areas in terms of less application (adjusted odds ratio [AOR] 1.16, 95% CI 0.82-1.63), less evaluation (AOR 1.29, 95% CI 0.92-1.81), and less decision ability (AOR 1.20, 95% CI 0.86-1.68); eHealth literacy was linked with medication adherence in the rural areas in terms of less application (AOR 1.10, 95% CI 0.56-2.13), less evaluation (AOR 1.05, 95% CI 0.61-1.79), and less decision ability (AOR 1.10, 95% CI 0.64-1.90). Among frail participants, less eHealth literacy (AOR 0.85, 95% CI 0.48-1.51), along with its dimensions, including less application (AOR 0.85, 95% CI 0.47-1.54), evaluation (AOR 0.89, 95% CI 0.50-1.57), and decision ability (AOR 0.99, 95% CI 0.55-1.76), were associated with medication adherence in urban areas; less eHealth literacy (AOR 0.89, 95% CI 0.48-1.65), along with its dimensions, including less application (AOR 1.23, 95% CI 0.62-2.44), evaluation (AOR 0.98, 95% CI 0.53-1.82), and decision ability (AOR 0.90, 95% CI 0.49-1.67), were associated with medication adherence in rural areas. The results of this study suggest that there is an association between eHealth literacy and medication adherence among older people with frailty and prefrailty. To promote medication adherence, eHealth literacy can be helpful in tailoring interventions.

Mapping out a Medication Adherence Promotion System (MAPS): Can it reduce graft rejection in pediatric liver transplantation?

Mapping out a Medication Adherence Promotion System (MAPS): Can it reduce graft rejection in pediatric liver transplantation?

Propelling Nurse-Led Structured Intervention to Enhance Self-Care among Patients with Chronic Heart Failure (PROACT-HF): A Cluster Randomized Controlled Trial Study Protocol.

Heart Failure (HF) is a common chronic disease that has a high readmission rate and is associated with worsening symptoms and major financial impacts. Disease management implemented during or after an HF hospitalization has been shown to reduce hospitalization and mortality rates. Particularly for outpatients, it is necessary to provide self-care interventions. Structured nurse-led support such as timely follow-ups, including phone calls, is beneficial for improving self-care assessments. Evidence for nurse-led support has been investigated but is less than conclusive. The aim of this study is to compare the effectiveness of a nurse-led structured intervention for outpatients with chronic HF against the usual medical care in terms of self-care behaviors and occurrence of symptom exacerbation or rehospitalization. This is a cluster-randomized controlled trial. A total of 40 facilities with certified HF nurses will be allocated to two-arm clusters at a 1:1 ratio, randomly to the intervention or usual care arms. A total of 210 participants will be assigned from the hospital. Participants will be adults aged 18 years or older diagnosed with chronic HF who are classified as Stage C according to the ACCF/AHA Heart Failure staging system. In the intervention group, patients will receive structured nursing support. This begins with weekly support, including phone calls, for the first month, then transitions to monthly support thereafter. The aim is to ensure the stability of their living conditions, promote medication adherence, and encourage self-management. In the control group, patients will receive the usual care. Primary outcomes will assess the improvement or continuation of self-care behavior as measured by changes in EHFScBS (European Heart Failure Self-Care Behavior Scale) scores. Secondary outcomes include occurrence of readmission within 30 days, 3 months, 6 months, and 1 year after discharge, duration of home care until readmission, and blood levels of BNP and NT-proBNP.

Patient, family, and community factors associated with medication adherence among people with hypertension or diabetes: A cross-sectional analysis

BackgroundWhile suboptimal medication adherence remains an obstacle to the management of hypertension and diabetes in China, few studies have investigated associated factors with medication adherence on different dimensions simultaneously. ObjectiveTo systematically examine associated patient, family, and community factors with suboptimal medication adherence among people with hypertension and/or type 2 diabetes in China. MethodsThe study stratified a random sample of 622 adults aged 45 years or older with hypertension and/or type 2 diabetes from three southeast cities in China in 2019. Trained interviewers used the Morisky Green Levine Medication Adherence Scale, Self-Efficacy to Manage Chronic Disease (SEMCD) Scale, and the Family Adaptability, Partnership, Growth, Affection, and Resolve (APGAR) Scale to assess medication adherence, self-efficacy, and family function, respectively. Participants also reported their perceived satisfaction with community health services (quantity, quality, affordability, and overall acceptance). The study used the multivariable logistic regression to assess the association of patient, family, and community factors with suboptimal medication adherence. ResultsAmong the participants, 42.9% reported suboptimal medication adherence. In the multivariable logistic regression model, male participants (odds ratio [OR] = 0.55, p = 0.001) had higher medication adherence compared to females. Having a self-efficacy score that was lower than or equal to the sample mean was significantly associated with lower adherence (OR = 1.44, p = 0.039). Participants unsatisfied with the affordability of community health services and medicine had lower adherence (OR = 2.18, p = 0.028) than those neutral or satisfied. There were no significant associations between family function and medication adherence. ConclusionsSex, self-efficacy, and perceived affordability of community health services were important factors associated with medication adherence. Healthcare professionals are recommended to consider multiple factors and leverage services and resources in community health centers when promoting medication adherence.

Supporting direct acting antiviral medication adherence and treatment completion in a sample of predominantly rural veterans with hepatitis C and substance use disorders

BackgroundClinic-based interventions are needed to promote successful direct acting antiviral (DAA) treatment for chronic hepatitis C virus (HCV) infection in patients with substance use disorders (SUDs) among rural Veterans.MethodsWe implemented a clinic-based intervention which used motivational interviewing (MI) techniques to promote medication adherence and treatment completion with 12 weeks of DAA treatment among rural Veterans with chronic HCV and SUDs. Patients received an MI session with a licensed psychologist at baseline and at each two-week follow-up visit during DAA treatment. Patients received $25 per study visit completed. Patients were to attend a laboratory visit 12 weeks after treatment completion to assess for sustained virologic response (SVR).ResultsOf the 20 participants who enrolled, 75% (n = 15) completed the planned 12-week course of treatment. Average adherence by pill count was 92% (SD = 3%). Overall SVR was 95% (19/20).ConclusionsWe demonstrated that a clinic-based intervention which incorporated frequent follow up visits and MI techniques was feasible and acceptable to a sample of predominantly rural Veterans with chronic HCV and SUDs.Clinical trial registrationRegistered at ClinicalTrials.gov (NCT 02823457) on July 1, 2016. https://clinicaltrials.gov.

Systematic review and meta-analysis of interventions to promote medication adherence among children, adolescents, and young adults with medical conditions.

This meta-analysis examined the efficacy of adherence-promotion interventions for children, adolescents, and young adults prescribed a medication for > 90 days as part of a treatment regimen for a medical condition. A systematic literature review was conducted to identify randomized controlled trials of adherence-promotion interventions published between 2013 and 2023 and including children, adolescents, and/or young adults with a medical condition. A total of 38 articles representing 39 trials met inclusion criteria. A narrative synthesis was conducted to summarize included trials and a random-effects model was used to compute an overall intervention effect. Effect sizes by adherence outcome assessment methodology, participant age, and technology use were also computed. Pediatric adherence-promotion interventions demonstrate a medium effect with those randomized to an intervention displaying greater improvements in medication adherence than those randomized to a comparator condition (SMD = 0.46, 95% CI: 0.31, 0.60, n = 37; 95% Prediction Interval: -0.32, 1.23). Adherence interventions for children, adolescents, and young adults with medical conditions increase adherence.

1077-P: Optimizing In-Clinic Conversations Using Data Science and AI to Promote Medication Adherence

1077-P: Optimizing In-Clinic Conversations Using Data Science and AI to Promote Medication Adherence

Do pharmacists have roles in Tuberculosis? A Narrative Review

Tuberculosis (TB) is a disease that is caused by bacteria called, “Mycobacterium tuberculosis”. It usually affects the lungs. Pharmacists can play an important role in facilitating optimal pathways to the care of tuberculosis. This narrative review aims to describe the multiple roles of different types of pharmacists in tuberculosis. It analyses the role of different types of pharmacists in the prevention, diagnosis, and treatment of tuberculosis. This narrative review is divided into four main sections: (1) the role of the pharmacist in tuberculosis in medication management; (2) the pharmacists’ role in tuberculosis patient support and education; (3) public health collaboration; and (4) role of the pharmacist in resource-limited settings. In the first section, the review presents the roles of pharmacists in medication management, such as dispensing, preventing drug-resistant TB, and promoting medication adherence. The second section describes counseling, and diagnosis, and refers to the role of pharmacists in tuberculosis patient support and education. The third section includes public health roles such as prevention of TB transmission and involvement in DOTS (Directly Observed Treatment, Short-Course). Finally, the role of pharmacists in resource-limited settings, such as, the role in low- and middle-income countries and other roles are described, along with strategies to strengthen the role of pharmacists in tuberculosis. Professional support, improved public sector patient care, and media campaigns would help strengthen the role of pharmacists in tuberculosis. In efforts to align with the WHO’s new End TB Strategy 2016–2035, health systems should consider utilizing hospital, clinical, industrial, community, and other types of pharmacists to assist in improving tuberculosis identification, diagnosis, and treatment to prevent morbidity and mortality.

Implementation of a multicomponent medication adherence promotion system is associated with a decrease in late T-cell-mediated rejection.

Poor immunosuppression adherence in pediatric recipients of liver transplant (LT) contributes to late T-cell-mediated rejection (TCMR) in ~90% of cases and increases the risk of mortality. A medication adherence promotion system (MAPS) was found to reduce late rejection in pediatric recipients of kidney transplants. Using quality improvement methodology, we adapted and implemented the MAPS in our LT clinic. Our primary outcome was population-level rates of late TCMR, measured as a monthly incident rate. Three-hundred fourteen patients undergoing LT are currently cared for at our institution. One-hundred sixty-two (52%) are females with a median age of 16 years and a median age at LT of 2 years. Preimplementation, monthly rejection rates were 0.84 rejections per 100 patient-months. After iterative implementation of MAPS over 2.3 years, monthly rejection rates decreased to 0.46 rejections per 100 patient-months, a 45% decrease in late TCMR. Implementation of MAPS was associated with a sustained 45% decrease in TCMR at a single center, suggesting that quality improvement tools may help improve clinical outcomes. MAPS may be an important tool to ensure long-term allograft health. Future studies should rigorously test MAPS across a multicenter sample.