Role In Medication Adherence Research Articles

How Does Anticipated HIV Stigma Affect Medication Adherence? A Longitudinal Path Analysis Model.

Prior research has documented that anticipated HIV stigma may play an important predictive role in medication adherence among people living with HIV (PLWH). However, longitudinal data on the mechanisms underlying this linkage are scarce. The current study aimed to explore the longitudinal mediation association among anticipated HIV stigma, medication adherence support, HIV self-management, and medication adherence. A four-wave sample consisting of 1,098 Chinese PLWH (Mage = 38.63, SD = 9.20; 63.9% male) with a six-month interval was used in the current study. Participants were asked to complete self-report questionnaires. A path analysis model was analyzed. Results indicate that anticipated HIV stigma at baseline was positively related to medication adherence at Time 4 (T4). Medication adherence support at Time 2 (T2) and HIV self-management at Time 3 (T3) serially mediated the anticipated HIV stigma at Time 1 (T1) and medication adherence at T4. These findings provide critical insights into the mediating roles of medication adherence support and HIV self-management in the relationship between anticipated HIV stigma and medication adherence over time. Such an understanding has important implications for the development of tailored interventions and public health strategies aimed at improving medication adherence among PLWH in the context of HIV-related stigma.

Multilevel Analysis of the Relationship Between Prescribing Institutions and Medication Adherence Among Patients With Hypertension and Diabetes in Korea.

This study investigated the relationship between prescribing institutions and medication adherence among patients newly diagnosed with hypertension and diabetes. This study investigated patients with new prescriptions for hypertension and diabetes in Korea in 2019 with using data collected from general health screenings. A multilevel logistic regression model was applied to explore the relationship between patients' first prescribing institution and their medication adherence, defined as a medication possession ratio (MPR) over 80%. The overall adherence rates were 53.7% and 56.0% among patients with hypertension and diabetes, respectively. The intraclass correlation coefficients were 13.2% for hypertension and 13.8% for diabetes (p<0.001), implying that the first prescribing institution had a significant role in medication adherence. With clinics as the reference group, all other types of hospitals showed an odds ratio (OR) less than 1.00, with the lowest for tertiary hospitals (OR, 0.30 for hypertension; 0.45 for diabetes), and the next lowest in health screening specialized clinics (OR, 0.51 for hypertension; 0.46 for diabetes). Among individual-level variables, female sex, older age, higher insurance premium level, and residing in cities were positively associated with adherence in both the hypertension and diabetes samples. This study showed that the prescribing institution had a significant relationship with medication adherence. When the first prescribing institution was a clinic, newly diagnosed patients were more likely to adhere to their medication. These results highlight the important role played by primary care institutions in managing mild chronic diseases.

The Importance of Medication Adherence in the Treatment of Actinic Keratosis: An Expert Consensus Panel

Background: Actinic keratosis (AK) is one of the most common dermatologic diagnoses. While there are several treatment options, many topical therapies have poor adherence due to duration of treatment and local skin reactions (LSRs).&#x0D; Objective: To review the available literature on the most commonly used patient-administered field-directed therapies for AK and create consensus statements on the role of medication adherence in improving AK outcomes.&#x0D; Methods: A literature search of PubMed was completed for English-language original research articles reporting efficacy, safety, and tolerability data for 5-FU, diclofenac gel, imiquimod cream, and tirbanibulin. Once the articles were selected, they were distributed to a panel consisting of seven dermatologists with extensive expertise in managing AKs. Each panelist reviewed the articles and assigned them a level of evidence based on Strength of Recommendation Taxonomy (SORT) criteria. The panelists then met to review and discuss the studies and created consensus statements on the management of AKs and the importance of medication compliance. A modified Delphi process was used to approve the adoption of each statement.&#x0D; Results: The literature search produced 1,326 articles that met search criteria. After screening these articles for relevance and applying the inclusion criteria, 17 articles were chosen to be reviewed by the panel and assigned a level of evidence based on SORT criteria. The panel then created six consensus statements that received a unanimous vote for adoption.&#x0D; Conclusion: While there are several options for the treatment of AK, there is little consensus on a standard of care. Clearance rates for the most common topical field therapies vary significantly but are also difficult to directly compare due to differences in methodology for measuring and assessing outcomes. Overall, it is clear that an efficacious, tolerable, and convenient treatment for AKs is critical to optimal adherence and management and, given the results of recent studies, tirbanibulin may be the best topical option for meeting these criteria.

The role of medication adherence in the association between depressive symptoms and quality of life in older adults with type 2 diabetes mellitus

BackgroundAt present, the role of medication adherence in the association between depressive symptoms and quality of life (QOL) in older adults with type 2 diabetes mellitus (T2DM) was unclear. The purpose of this study was to explore the associations among depressive symptoms, medication adherence and QOL in older adults with T2DM.MethodsIn this cross-sectional study, 300 older adults with T2DM from the First Affiliated Hospital of Anhui Medical University were enrolled. Among them, 115 patients had depressive symptoms and 185 had no depressive symptoms. Univariate linear regression analysis was conducted to identify possible covariates. Univariate and multivariable linear regression analyses were performed to explore the associations between depressive symptoms and medication adherence or QOL in older adults with T2DM. Multiplicative interaction analysis was evaluated whether there was interaction effect between medication adherence and depressive symptoms on QOL of patients. Mediating effect analysis was used to analyze the medication effect of medication adherence on depressive symptoms and QOL in older adults with T2DM.ResultsDecreased medication adherence was observed in patients with depressive symptoms (β = -0.67, 95%CI: -1.10, -0.24) after adjusting for covariates. Depressive symptoms were associated with decreased QOL in older adults with T2DM (β = -5.99, 95%CI: -7.56, -4.42). The mediating analysis revealed that depressive symptoms were associated with decreased medication adherence (β = -0.67, 95%CI: -1.09, -0.25). Medication adherence was linked with increased QOL of older adults with T2DM (β = 0.65, 95%CI: 0.24, 1.06). Depressive symptoms were correlated with decreased QOL of older adults with T2DM (β = -5.56, 95%CI: -7.10, -4.01). The percentage mediated by medication adherence on depressive symptoms and QOL in older adults with T2DM was 10.61%.ConclusionMedication adherence might mediate depressive symptoms and QOL of older adults with T2DM, which might provide a reference for the improvement of QOL of these patients.

“A STUDY ON MEDICATION ADHERENCE AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS ATTENDING GOVERNMENT HEALTH CARE FACILITIES OF RAIPUR DISTRICT”

Introduction: Diabetes mellitus is a chronic progressive disorder characterized by high levels of blood glucose. Patient's role in medication adherence is inversely proportional to the severity &amp; complication of diabetes. Adherence to medication is essential to obtain a therapeutic benet for diabetes. Hence, this study has been conducted to assess medication adherence among patients with type 2 diabetes mellitus attending government healthcare facilities of the Raipur district. To nd out the magnitude of Objective: adherence to prescribed medication among type 2 diabetic patients attending government health care facilities of Raipur district. Material And Method: A facility based cross-sectional study was conducted in government health care facilities selected by simple random sampling of Raipur district during November 2020 to November 2022. A total of 460 patients with more than 6 months duration of type-II Diabetes Mellitus were interviewed by using structured questionnaire after obtaining verbal consent from them. Medication adherence were assessed on Morisky medication adherence Scale (MMAS-8 scale) from the range of 0 to 8. If patients scored maximum 8 considered as high adherence, if patients scored 6-7 considered as moderate adherence, if patients scored of &lt;6 considered as poor adherence. Out of 460 study subjects, it was Result: observed that about 21% were found highly adherent to medications, 28% moderately adherent and 51.1% were showing low adherence for diabetic medication. Overall medication adherence was very low in study s Conclusion: ubjects. It is clear that there is a serious need for healthcare professionals to address the problem of adherence to prescribed medications to individuals with diabetes mellitus

The relationship between self efficacy and medication adherence in elderly with hypertension

Introduction: The elderly will experience a decrease in health status caused by either disease or nature, so they are at risk of suffering from hypertension. Hypertension can be controlled by medication adherence. Self-efficacy is a factor that plays an important role in medication adherence. The important role of self-efficacy lies in a person's self-knowledge, which refers to self-confidence in achieving hypertension treatment goals. To identify the relationship between self-efficacy and the level of medication adherence in the elderly with hypertension. Methods: This study used a cross-sectional method with a random sampling technique. The sample of this study was 60 older people in Mejing Wetan. The measuring instrument used was MASES-R to measure self-efficacy and MMAS-8 to measure medication adherence. Univariate analysis used descriptive statistical analysis, while Bivariate analysis with SPSS used the Chi-Square analysis method. There will be a significant relationship if p is &lt; 0.05. Results: The results showed that the respondents' self-efficacy is dominated by the moderate category (41.7%), (73.3%) respondents were disobedient in taking medication, and the significance value was p=0.000. It indicated a significant relationship between self-efficacy and medication adherence as p&lt;0.05. In addition, the correlation results were very strong (r=0.781). Conclusion: There was a strong relationship and a positive direction between self-efficacy and the level of medication adherence in the elderly with hypertension

Association between health literacy and medication adherence in chronic diseases: a recent systematic review.

Poor medication adherence is a serious barrier to successful chronic disease management. Previous reviews reported that low health literacy could be associated with medication non-adherence but conclusions were uncertain. The aim of this systematic review was to clarify the relationship between health literacy and medication adherence in adults with chronic diseases. A secondary objective was to identify the factors that influence medication adherence. Publications analyzing the relationship between health literacy and adherence in adults with chronic diseases were identified through 6 databases between 2015 and 2020. A quality assessment was conducted in order to improve the interpretation of the relationship between health literacy and medication adherence. A narrative synthesis was then performed to describe the relationship between health literacy and medication adherence. The factors influencing medication adherence were then analyzed as a secondary outcome. Among the 27 studies, 17 and 10 were considered to be of good and medium methodological quality, respectively. Concerning the relationship between health literacy and adherence, 14 reported a positive relationship, 1 study suggested a negative relationship, 3 found mixed results, and 9 reported not finding a relationship. Patient-related factors such as medication beliefs, self-efficacy, or medication knowledge, as well as demographic factors such as ethnic minority and incomes influence medication adherence. The present review confirms an unclear relationship between health literacy and medication adherence. Although health literacy plays a substantial role in medication adherence, other factors must be taken into account when addressing non-adherence.

Role of DSM5 Anxious Distress Specifier Interview in symptoms severity and medication adherence in 1st episode mania

Introduction-Anxious Distress Specifier is one of the newly added specifier in diagnosis and managment of bipolar disorder.This unique item may paly a role in not only the symptoms severity but also the degree of adherence to the psychotropics. -DSM5 Anxious distress specifier is not well studied in the 1st manic episode of bipolar disorder.Objectives1-To study the role of DSM5 Anxious Distress Specifier in the symptoms severity of 1st diagnosed manic episode 2-To investigate its role in medication adherence in thses patientsMethods1-DSM 5 Anxious distress specifier interview which includes 5 items : a- Keyed up or tense b-Restlessness c-Impaired concentration. d-Sense of foreboding e-Loss of control 2-The Young Mania Rating Scale (YMRS) is one of the most frequently utilized rating scales to assess manic symptoms. The scale has 11 items and is based on the patient’s subjective report of his or her clinical condition 3-Drug Attitude Inventory:consists of a questionnaire that is completed by the patient, pertaining to various aspects of the patient’s perceptions and experiences of treatment.Results1-There is a positive correlation between the mean score of Young mania Rating scale in 1st episode manic patients and the mean score of DSM5 Anxious Distress specifier Interview 2-The presence of high score of DSM5 Anxious Distress Specifier Interview is positively correlated to the mean score of Drug Attitude Inventory during the follow up visits after controlling the 1st episode maniaConclusionsThe presence of high levels of Anxious Distress in the 1st episde mania affected the symptoms severity and medication adherenceDisclosureNo significant relationships.

Caregiver Expressed Emotion, Quality of Life and Medication Adherence among People Living with Schizophrenia in Nigeria

Background: People Living with Schizophrenia (PLWS) are expected to live longer than before the advent of psychotropic drugs. Relationship of Caregiver Expressed Emotion and Medication Adherence to Quality of Life in African PLWS is not known. The aim of the study was to determine the relationship between the levels of caregiver expressed emotion, quality of life and medication adherence among people living with schizophrenia. Method: Data were collected on Socio-demographic and Schizophrenia Clinical Characteristic, Quality of Life, Caregiver Expressed Emotion (EE) and Medication adherence using Socio-demographic and Schizophrenia Clinical Characteristics questionnaire, World Health Organization Quality of Life (WHOQoL) - Brief, Caregiver Level of EE scale and Morisky Medication Adherence Scale (MMAS) respectively. Results: Caregiver EE was significantly associated with the physical and environmental domains of QoL (p = 0.011 and p = 0.001 respectively). Poor medication adherence correlated positively with the negative attitude and low tolerance sub-scales of the level of EE scale (p = 0.019 and p &lt; 0.001). Medication adherence related significantly to the overall, health-related and physical domains of QoL (p &lt; 0.001, p = 0.017 and p = 0.031). Medication adherence was also a positive predictor of overall QoL (p &lt; 0.001). Conclusion: The High EE has been found to be closely related to the patients’ QoL. The role of medication adherence in promoting QoL among PLWS has been re-emphasized by the findings.

Associated Factors and Pharmacists' Role in Medication Adherence and Glycemic Control : A Study in Outpatients With Diabetes at Hue University Hospital, Vietnam.

Objective: To evaluate medication adherence, associated factors, and the role of pharmacists in adherence and outcome treatments in outpatients with diabetes at Hue University Hospital. Type 2 diabetes (T2DM) is a chronic illness that requires daily treatment. Poor adherence to antidiabetic medication can have negative consequences for patients. Data on medication adherence and programs to improve adherence for patients with diabetes in Vietnam are lacking. Methods: A pre-post study was conducted on 354 outpatients diagnosed with T2DM at Hue University Hospital. Participants were interviewed, counseled, and educated by a pharmacist once. The researchers assessed medication adherence levels and glycemic outcomes before and around three months after the intervention. Results: The prevalence of achieving adherence before the intervention was 65.0%. Factors associated with achieving medication adherence were medication regimen (P = 0.001) and controlled glycemic target (P < 0.001). The most common nonadherence behavior was forgetting to take antidiabetic medication. After the intervention, the prevalence of achieving adherence rose to 74.6%, and patients reported that they were more likely to remember to take antidiabetic medications (with statistical significance). The prevalence of achieving the glycemic target (both glycated hemoglobin and fasting plasma glucose) rose from 21.8% (before the intervention) to 31.1% (after the intervention). Conclusions: A significant proportion of patients did not achieve medication adherence. Medication adherence is associated with better glycemic outcomes. The role of pharmacists in patient education, medication counseling, and reminding is beneficial in terms of improving adherence levels and glycemic outcomes.

A study on prescribing pattern and medication adherence in elderly COPD and bronchial asthma patients in a tertiary care teaching hospital

Background: Chronic obstructive pulmonary disease and bronchial asthma are common among elderly people and have become a major public health concern of today. The purpose of this study is to identify the prescription pattern and role of medication adherence in the COPD and bronchial asthma. Prescription pattern monitoring (PPMS) are mainly focus on prescribing, dispensing, administering of drugs they promote appropriate use of monitored drugs and reduction of abuse/misuse.Methods: A hospital based prospective observational study was conducted at department of medicine in Rajah Muthiah Medical College and Hospital. A total of 90 patients were enrolled based on inclusion and exclusion criteria and the data was collected using designed data collection form.Results: Out of 90 patients, male (81.10%) and female (18.90%) are reported with COPD and bronchial asthma. On prevalence 57 (63.34%) of patients with co-morbidities and without co-morbidities 33 (36.66%). Among co-morbidity patients, 38.90% of patients has type-2 diabetes mellitus. PPA indicate that cephalosporins (46.68%), macrolides (38.88%) class of antibiotic are used prominently along with corticosteroids of hydrocortisone 47 (62.66%) and prednisolone 28 (37.34%). 47 (62.66%) patients received expectorants and anti-tussive in that, Ipratropium bromide + levosalbutamol (50%) are commonly prescribed.Conclusions: This study concludes that COPD and bronchial asthma was most predominant in elderly patients and its treated with mainly antibiotics and corticosteroids with bronchodilators in the way of inhalers and nebulizers. The rational use of drugs and patient counselling reflects a better medication adherence.

Comparing Continuous and Binary Group-based Trajectory Modeling Using Statin Medication Adherence Data.

Of 58 medication adherence group-based trajectory modeling (GBTM) published studies, 74% used binary and 26% used continuous GBTM. Few studies provided a rationale for this choice. No medication adherence studies have compared continuous and binary GBTM. The objective of this study was to assess whether continuous versus binary GBTM: (1) impacts adherence trajectory shapes; and (2) results in the differential classification of patients into adherence groups. Patients were prevalent statin users with myocardial infarction hospitalization, 66+ years old, and continuously enrolled in fee-for-service Medicare. Statin medication adherence was measured 6 months prehospitalization using administrative claims. Final GBTM specifications beyond default settings were selected using a previously defined standardized procedure and applied separately to continuous and binary (proportion of days covered ≥0.80) medication adherence measures. Assignment to adherence groups was compared between continuous and binary models using percent agreement of patient classification and the κ coefficient. Among 113,296 prevalent statin users, 4 adherence groups were identified in both models. Three groups were consistent: persistently adherent, progressively nonadherent, and persistently nonadherent. The fourth continuous group was moderately adherent (progressively adherent in the binary model). When comparing patient assignment into adherence groups between continuous and binary trajectory models, only 78.4% of patients were categorized into comparable groups (κ=0.641; 95% confidence interval: 0.638-0.645). The agreement was highest in the persistently adherent group (∼94%). Continuous and binary trajectory models are conceptually different measures of medication adherence. The choice between these approaches should be guided by study objectives and the role of medication adherence within the study-exposure, outcome, or confounder.

Abstract P135: The Role Of Digital Health In The Management Of Hypertension

Introduction: Digital health involves the use of technology to delivery health care. It is associated with improved clinical outcomes in various populations. We assessed its role in medication adherence in adults with hypertension. Methods: Data from the 2018 National Health Interview Survey data was used. We analyzed 8,224 respondents with hypertension representing about 69 million United States adults. The independent variables were: Use of the internet to (1) to look up health information (2) to fill a prescription and (3) to schedule a medical appointment and use of an email (4) to communicate with a healthcare provider. The dependent variable was anti-hypertensive medication adherence. Chi-square analysis was used to identify group differences and a logistic regression was used to analyze the association between digital health utilization and anti-hypertensive medication adherence. Results: Of the study population, 7,387/8,224 (89.8%) of the respondents reported adherence to anti-hypertensive medications. Those who were adherent were predominantly &gt; 65 years of age, 4141/7387 (47.8%) and earned &gt; $75,000/yearly, 580/2581 (25.2%). The use of internet to look up health information as compared to those who do not, was associated with 30% reduced odds of medication adherence [OR 0.71, 95% CI 0.59, 0.86, p=&lt;.001]. However, this was insignificant after adjusting for covariates [AOR 0.92, 95% CI 0.89, 1.22, p=0.551]. Using the internet to fill up prescription as compared to those who do not, was associated with 47% odds of medication adherence [OR 1.47, CI 1.14,1.90, p=0.003]. This odd increased further after adjusting for covariates [AOR 1.95, CI 1.37,2.78, p=&lt;.001]. No significant association was found in the relationship between medication adherence and scheduling a medical appointment with the internet or communicating with a provider via email even after adjusting for covariates. Conclusion: Increase adherence to anti-hypertensive medications is associated with online refill of prescriptions. This means that the use of digital health technologies in hypertensive populations can lead to better health outcomes. Future studies should evaluate other aspects of digital health use in hypertensive populations.

A Descriptive Cross-sectional Study on Medication Adherence of Oral Antidiabetic Agents in Diabetes Mellitus Patients and an Overview on Clinical Pharmacist's Role in Medication Adherence in Government Headquarters Hospital Tiruppur

Aim and Objectives: In this study, the level of adherence to medications and factors influencing nonadherence to oral antidiabetic medications among patients with type 2 diabetes mellitus was assessed. This study also ascertained the clinical pharmacist role in improving medication adherence. Materials and Methods: This is a descriptive cross-sectional study based on prospective analysis of data collected from 150 cases in the general medicine department at the secondary care Government Headquarters Hospital, Tiruppur, Tamil Nadu state, India. The study was carried out over 6 months duration, from March 2019 to August 2019. Results: In the study, of 150 patients 60% were adherent, while 40% showed low adherence. Apparently, the subjects aged below 50 years showed 100% adherence and age group of 80–89 showed the least adherence of 12.5%. Out of 83 (55%) males and 67 (45%) females enrolled in the study, 50 (60.24%) of the former and 40 (59.70%) of the latter were found to be adherent. The rate of nonadherence in married and unmarried population was found to be 40.71% and 30%, respectively. Patients who had graduated from college/university showed 100% adherence whereas, the illiterate patients showed the least adherence of 32%. Moreover, the subjects who had their onset in the age between 20–29 years were 100% adherent and the least adherence of 33% were shown by subjects with onset age between 70–79. Patients with monotherapy were more adherent (77.8%) to the therapy when compared to the patients who were on polytherapy (43.6%) and the patients with diabetic complications showed 40% of adherence and the patients without any complications showed 86.15% of adherence. Eventually, the patients who did not experience any side effects showed good adherence (79.2%) compared to the ones with side effects who showed poor adherence (20.8%) to the therapy. Finally, the adherence among the patients who never consumed alcohol was found to be 69.9% whereas, patients who consumed alcohol everyday was found to be only 33.3%. Conclusion: Majority of the patients were found to be adherent towards oral antidiabetic agents; thus, influence of clinical pharmacist in adherence was evident in this study. The major barriers for medication adherence found were being older age, having low level of education, late onset of disease, presence of side effects and complications, polytherapy, and consumption of alcohol.

Knowledge, beliefs, and practice of pregnant women regarding medication use during pregnancy: a hospital-based cross-sectional study

The purpose of this study was to assess the knowledge, beliefs, and practice (KBP) of pregnant women on medication use during pregnancy, and to identify the factors influencing KBP. A cross-sectional study was conducted in the Department of Obstetrics & Gynaecology of a tertiary care hospital over a period of nine months. Pregnant women receiving at least one medication were included in the study. A 19-item questionnaire was developed, validated, and used for assessing the KBP of pregnant women. Logistic regression analysis was used to identify the factors influencing the KBP. A total of 422 pregnant women with a mean (SD) age of 24.6 (4.05) years were included in the study. Pregnant women were having less knowledge on ‘unsafe medications’ and ‘important medications’ during pregnancy, wrong belief on ‘stopping all medications during pregnancy’, and less practice of ‘asking Pharmacist how to take medications’. It was identified hat the age, education, occupation, and area of living were the factors influencing the knowledge and practice of pregnant women on medication use. This study identified the need for improvement in knowledge and practice of pregnant women who are young, having nil or low level of education, no occupation, and living in rural areas. IMPACT STATEMENT What is already known on this subject? Knowledge and beliefs on medication use play a vital role in medication adherence among pregnant women. Crisis in rural healthcare along with socio-demographic conditions and literacy status of Indian women may have contributed to the lack of understanding about use of medications during pregnancy. What the results of this study add? The knowledge of pregnant women was found to be insufficient on ‘unsafe medications’ and ‘important medications’ during pregnancy. Majority of the pregnant women believe that it is better for the foetus if they ‘stop taking all medications during pregnancy’. ‘Not asking Pharmacist how to take medications’ is one important practice in India contributes less knowledge on medication use. What the implications are of these findings for clinical practice and/or further research? There is a need for improvement in knowledge and practice of medication use among pregnant women who are young, having nil or low level of education, no occupation, and living in rural areas.

60-LB: Oral Diabetes Medication Adherence in Emerging Adults with Youth-Onset Type 2 Diabetes: TODAY2 iCount Study

Background: Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY2) participants have youth-onset type 2 diabetes (T2D) and often poor glycemic control. The role of medication adherence is unknown. Aims: To assess oral diabetes medication adherence in the TODAY2 cohort; To assess participant factors related to adherence. Methods: Participants provided data at TODAY2 visits and at 3 monthly unannounced phone pill counts. Those taking ≥80% of pills were classified “high adherent,” those taking &amp;lt;80% of pills were defined “low adherent.” If not taking oral medications (meds) they were asked reasons and adjudicated (no need for meds vs. non-adherent). The unadjusted association of each factor with adherence status was assessed by ANOVAs (continuous variables) and Pearson χ-square (categorical variables). Factors with p&amp;lt;0.2 were entered into logistic models for adherence. Results: Of 381 individuals, 224 were either taking oral meds (n=190) or taking none though meds were recommended (n=34) [mean age 25 yrs, 67% female, 18% white, 34% black, 39% Hispanic, 84% &amp;lt;$36K income]. Per pill counts, 66.1% were low adherent (includes 15.2% adjudicated non-adherent). Unadjusted results: HbA1c was lower in high vs. low adherent groups (9.2% vs. 10.0%, p&amp;lt;0.04). Racial/ethnic differences in adherence (55.3% non-Hispanic whites, 60.2% Hispanics, 85.7% non-Hispanic blacks were low adherent, p&amp;lt;0.002). Of those with/without insurance, 65.5%/91.4% were low adherent (p&amp;lt;0.004). After adjustment, race/ethnicity (p&amp;lt;0.02) and insurance status (p&amp;lt;0.007) remained related to adherence. HbA1c, age, gender, education, income, employment, BMI, T2D duration, family history, and no. of complications did not relate to adherence. Conclusion: In emerging adults with youth-onset T2D, poor adherence to oral diabetes meds was common, and significantly more likely in those without health insurance and in non-Hispanic blacks. Interventions are needed to improve adherence and outcomes. Disclosure P.M. Trief: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. S. Kalichman: None. D. Wang: None. K. Drews: None. B. Anderson: None. R.S. Weinstock: Board Member; Self; JDRF. Consultant; Self; Insulogic LLC. Research Support; Self; Boehringer Ingelheim International GmbH, Diasome Pharmaceuticals, Inc., Eli Lilly and Company, Insulet Corporation, Jaeb Center for Health Research, Kowa Research Institute, Inc., Medtronic, Tolerion, Inc. Funding National Institutes of Health (R01DK110456)

1200Changes in nocturnal blood pressure post-renal denervation: comparison of treatment versus control groups in SYMPLICITY HTN-3

Abstract Background Renal denervation (RDN) impacts blood pressure (BP) differently than anti-hypertensive medications by providing a non-reversible 24-hour change in sympathetic tone that is independent of patient adherence. This might lead to differences in the pattern of BP reduction over the 24-hour period related to diurnal variations in sympathetic tone compared with the timing of drug dosing on BP. This “always on” impact of RDN on BP was observed in the 24-hour Ambulatory BP (ABPM) measurements in the SPYRAL HTN-ON MED and OFF MED trials and raises the question of whether this might also be seen in prior studies of RDN. Purpose It is hypothesized that SYMPLICITY HTN-3 did not meet its primary efficacy endpoint, in part, due to improved medication adherence and subsequent BP reductions in the control group. We hypothesized that examination of 24-hour ABPM in HTN-3 would illustrate the effects of improved medication adherence in the control group and reveal differences in the pattern of BP reduction between RDN and control groups, thereby demonstrating an impact on sympathetically mediated BP. Methods 24-hour ABPM measurements were obtained at baseline and 6 months post-randomization per protocol. ABPM was measured and recorded every 30 minutes and a minimum of 21 daytime and 12 night-time acceptable measurements were required for inclusion in the analysis. Mean and standard error of BP were calculated at each timepoint. Night-time was defined as 1:00–6:00AM. Results The figure shows hourly mean ABPM at baseline and 6 months for RDN (A) and sham-control groups (B). Changes in ABPM from baseline to 6 months for RDN and sham control groups are shown in (C). Both the RDN and control groups experienced lower mean hourly BP during the day. In contrast, BP reductions from baseline were greater at night and during the pre-awakening morning hours (1:00–6:00AM) in the RDN group compared with the sham control group. ANCOVA baseline BP-adjusted treatment difference for night-time SBP between RDN and control groups was −3.4 mmHg [95% confidence intervals: −6.7, −0.2; p=0.039]. One possible explanation may be that plasma levels of some antihypertensive medications (such as hydralazine and furosemide) may be lower during night-time hours, lessening the effect of BP reduction in the control group. Conclusions Analysis of 24-hour ABPM measurements in the RDN group of HTN-3 demonstrate a consistent separation of curves at 6 months compared with baseline. This separation is also seen in the control group in HTN-3 but is minimal at night-time and in the early morning periods, a time when some medications' impact on BP is lessened. Analyses of ABPM data in additional studies (SYMPLICITY HTN-Japan and SPYRAL First-In-Man trials) are planned to further investigate the role of medication adherence in BP reduction after RDN. Acknowledgement/Funding The SYMPLICITY HTN-3 trial is funded by Medtronic.

Patient Compliance with Deep Vein Thrombosis Prophylaxis after Total Hip and Total Knee Arthroplasty

Even though the Centers for Medicare and Medicaid Services is penalizing hospitals for readmissions, and postoperative prophylaxis has demonstrated reduced complications associated with deep vein thrombosis (DVT), few studies have examined patient compliance with (DVT) prophylaxis at home. A survey querying DVT prophylaxis management and adherence was administered to patients who were within the one to three-month postoperative period after a total knee or total hip replacement. A total of 103 patients completed the survey. A considerable number of patients (17.0%) were non-adherent to DVT prophylaxis. Patients had a lower understanding of the side effects of their DVT prophylaxis, with 30% responding that they had a poor to simple understanding. There is a high rate of non-compliance and there is a poor understanding of complications related to venous thromboembolism prophylaxis. As the population undergoing arthroplasties grows, this study demonstrates the importance of investigating the role of medication adherence in the rate of postoperative DVT.

Medication review services in community pharmacy

Pharmacists play a crucial role in medication adherence; however, many patients and health professionals are unaware of this vital resource. Rosemary Adsley explains the value that medicine reviews can have on patient experience, quality of care, and cost to the NHS

Demonstrating a Technology-Mediated Intervention to Support Medication Adherence in Community-Dwelling Older Adults in Primary Care: A Feasibility Study

Background: Medication non-adherence can lead to significant morbidity and mortality. This 4-week feasibility study aims to demonstrate that the eDosette intervention can be implemented with older adults in primary care. Method: Fifty-six older adults from four primary care sites in Southwestern Ontario, Canada participated. The intervention involved generating, for pharmacist review, weekly medication administration records based on transmitted data captured by the eDosette. The primary outcome is implementation feasibility defined by recruitment, adherence rates, frequency of captured missed and late doses, descriptions of clinical work resulting from the intervention, and participant feedback. Results: The recruitment rate was 24% (57/240); one withdrew due to personal reasons. The mean observed adherence rate was 82% (range 49%-100%). Overall, participants missed 505 and took 2,105 doses late; 118 clinical decisions occurred with 72 unique medication changes in 31 participants. Participants found the eDosette easy to use and did not feel that they were viewed negatively because of their potential non-adherence. Conclusion: The eDosette intervention could be feasibly implemented in primary care with older adults. Providing information about when an older adult takes their medications could play a role in medication adherence by prompting more informed discussions between the older adult and primary care clinicians.