Significant Differences In Adherence Research Articles

Implementation strategies for monitoring adherence in real time (iSMART): A pilot randomized trial.

9115 Background: Helping patients to manage symptoms and adhere to oral anticancer agents (OACAs) is a major challenge in oncology. OACAs cause side effects that can lead to suboptimal adherence if not optimally managed, contributing to decreased effectiveness. Low-cost, text messaging approaches have shown promise, but have not been robustly studied in oncology. Guided by principles from implementation and behavioral science, we developed and tested the effect of an augmented intelligence chatbot on OACA adherence and symptom burden in patients with advanced lung cancer. Methods: We conducted a two-arm pilot randomized trial (NCT04347161) to evaluate the effect of the chatbot on OACA adherence and symptom burden compared to usual care. The chatbot engages patients via text messaging and applies natural language processing and machine learning to learn from interactions. Core functionalities include: 1) motivational daily adherence reminders, 2) longitudinal symptom monitoring with self-management support, and 3) bidirectional communication with clinical teams. Participants included English-speaking patients with advanced lung cancer treated with any of 9 OACAs targeting EGFR, ALK, or ROS-1. The primary outcome was 12-week adherence, measured using the microelectronic monitoring system (MEMS) and defined dichotomously if the patient achieved ≥95% adherent days or not. Secondary outcomes were assessed at baseline and 12 weeks using validated survey instruments, including symptom burden using the Edmonton Symptom Assessment System Total Distress Score (range 0-90), health-related quality of life (HRQOL) using EQ-5D-3L (range 0-100), and usability using Health-ITUES (range 1-5). We used multivariable logistic regression adjusting for stratification variables to test the chatbot’s effect on adherence (intent-to-treat analysis) and evaluated mean differences (by arm) in secondary outcomes using Fisher’s exact test. Results: From February 2021 to August 2022, 75 patients across 4 sites enrolled (median age 65 years, 64% female, 88% White, 21.3% high school education or lower); 50.7% (n=38) were randomized to intervention. Compared to usual care, we observed no significant differences in adherence in the intervention arm (78.8% vs 81.8%; aOR=1.7 95% CI: 0.3-9.4). However, in contrast to those in usual care, participants in the intervention arm had significantly greater decreases in symptom burden (mean difference: -2.7 vs 2.6; p<0.05) and increases in HRQOL (mean difference: 4.1 vs -4.8; p<0.05) from baseline to 12 weeks. Overall chatbot usability was high (mean score=3.9). Conclusions: In this pilot randomized trial, an augmented intelligence chatbot successfully reduced symptom burden and improved HRQOL but did not significantly alter OACA adherence. Chatbots are a potentially scalable strategy for improving symptom management that warrant study in larger randomized trials. Clinical trial information: NCT04347161 .

Remotely supervised at-home tDCS for veterans with persistent post-traumatic headache: a double-blind, sham-controlled randomized pilot clinical trial.

Currently, there are no FDA approved therapies for persistent post-traumatic headache (PPTH) secondary to traumatic brain injury (TBI). As such neither headache nor TBI specialists have an effective means to manage PPTH. Thus, the objective of the present pilot trial was to evaluate the feasibility and preliminary efficacy of a four-week at-home remotely supervised transcranial direct current stimulation (RS-tDCS) intervention for veterans with PPTH. Twenty-five (m = 46.6 ± 8.7 years) veterans with PPTH were randomized into two groups and received either active (n = 12) or sham (n = 13) RS-tDCS, with anodal stimulation over left dlPFC and cathodal over occipital pole. Following a four-week baseline, participants completed 20-sessions of active or sham RS-tDCS with real-time video monitoring over a period of four-weeks. Participants were assessed again at the end of the intervention and at four-weeks post-intervention. Primary outcomes were overall adherence rate (feasibility) and change in moderate-to-severe headache days per month (efficacy). Secondary outcomes were changes in total number of headache days, and PPTH-related functional outcomes. Adherence rate was high with 88% of participants (active = 10/12; sham = 12/13) fully completing tDCS interventions. Importantly, there was no significant difference in adherence between active and sham groups (p = 0.59). Moderate-to-severe headache days were significantly reduced within the active RS-tDCS group (p = 0.004), compared to sham during treatment (-2.5 ± 3.5 vs. 2.3 ± 3.4), and 4-week follow-up (-3.9 ± 6.4 vs. 1.2 ± 6.5). Total number of headache days was significantly reduced within the active RS-tDCS (p = 0.03), compared to sham during-treatment (-4.0 ± 5.2 vs. 1.5 ± 3.8), and 4-week follow-up (-2.1 ± 7.2 vs. -0.2 ± 4.4). The current results indicate our RS-tDCS paradigm provides a safe and effective means for reducing the severity and number of headache days in veterans with PPTH. High treatment adherence rate and the remote nature of our paradigm indicate RS-tDCS may be a feasible means to reduce PPTH, especially for veterans with limited access to medical facilities.Clinical Trial Registration: ClinicalTrials.gov, identifier [NCT04012853].

Chronic Care Model Based Nursing Interventions Improve Hypertension Patient’s Medication Compliance by Preventing Patients Forget and Fear

The goal of nursing intervention on chronic disease such as Hypertension is to improve the patient self-care, in which the Chronic care model could help to reach the best outcome. Research suggests the community, health workers, and regulations could improve the health. The purpose of this study was to apply nursing intervention based on chronic care model to medication adherence in hypertensive patients. This is quasi-experimental research used pre-post test control group design. 50 respondents of hypertension patients were recruited from Pucang Sewu, Pacar Keling and Tambak Rejo Surabaya Health Centres. The intervention was applicating nursing interventions based on the Chronic Care Model. The Mann Whitney U statistical analysis used to understand the effect of the intervention to the medication adherence in patients with hypertension. A total of 50 respondents who were divided into two groups, control and treatment, with each (n = 25). The distribution of characteristics in the two groups is homogeneous. Different test in the control group, there was no difference. The treatment group shown a significant difference in adherence before and after the intervention with p value 0.000 (p <0.05). This study found the reason of disobedient patient to medication, which is forget and fear to the side effect. The patient and the health care agree frequent reminder could be the solution to this problem. Chronic Care Model based nursing interventions can improve medication adherence in hypertensive patients by encourage the health care system to frequently remind patients.

Translated article] Adherence and quality of life in patients with chronic lymphocytic leukemia treated with oral antineoplastic drugs

ObjectiveTo evaluate adherence and quality of life to oral antineoplastic treatment in patients with chronic lymphocytic leukemia. To compare adherence and quality of life according to treatment subgroups and treatment-line subgroups. MethodsWe conducted a descriptive prospective study from June to November 2021 in a tertiary care hospital. Patients with chronic lymphocytic leukaemia, seen at the Oncology Pharmacy and treated with oral antineoplastic drugs for at least 6 months prior to inclusion in the study were included. Adherence was assessed using Morisky's 8 item Medication Adherence Scale and leftover pills counts, considering adherents if their adherence rate was ≥90%. Quality of life was assessed with Euro-Qol EQ-5D-3L questionnaire, Functional Assessment of Chronic Illness Therapy – Fatigue scale and QLQ-C30 questionnaire from European Organization for Research and Treatment of Cancer. Two interviews were scheduled: at the time of inclusion and at 3 months. The clinical history was reviewed and demographic and clinical variables were collected. The data statistical analysis was carried out with SPSS® 25.0 software. ResultsTwenty three patients were included, all of them showed an adherence rate higher than 90%; 20 patients were considered high adherent, and 3 patients médium adherent to treatment according to Morisky's 8 item Medication Adherence Scale. The results of the EQ-5D-3L questionnaire showed that the patients were all of them autonomous in their personal care and daily activities, 69.6% did not have any mobility problems and 78.3% did not have anxiety/depression; 56.5% had some type of pain. Eighteen patients had no fatigue, and 5 had mild/moderate fatigue according to Functional Assessment of Chronic Illness Therapy – Fatigue scale. The results of the EORTC QLQ-C30 questionnaire showed that patients had a high /healthy functional level, a good quality of life and a low level of symptoms. Analysis by treatment subgroups and by treatment-line subgroups did not show statistically significant differences in adherence or quality of life. ConclusionsPatients diagnosed with chronic lymphocytic leukemia and treated with oral antineoplastic therapies showed a high adherence rate and referred a good quality of life.

Adherencia y calidad de vida en los pacientes con leucemia linfocítica crónica tratados con antineoplásicos orales

ObjectiveTo evaluate adherence and quality of life to oral antineoplastic treatment in patients with chronic lymphocytic leukemia. To compare adherence and QoL according to treatment subgroups and treatment-line subgroups. MethodsWe conducted a descriptive prospective study from June to November 2021 in a tertiary care hospital. Patients treated at the Oncology Pharmacy with a diagnosis of chronic lymphocytic leukemia and treatment with oral antineoplastics for at least 6 months before inclusion in the study were included. Adherence was assessed using Morisky’s 8 item Medication Adherence Scale and leftover pills counts, considering adherents if their adherence rate was ≥ 90%. Quality of life was assessed with Euro-Qol EQ-5D-3L questionnaire, Functional Assessment of Chronic Illness Therapy – Fatigue scale and QLQ-C30 questionnaire from European Organization for Research and Treatment of Cancer. Two interviews were scheduled: at the time of inclusion and at 3 months. Variable collected: demographic data, clinical data (disease and treatment); and response (scores obtained from questionnaires and adherence rate). The data statistical analysis was carried out with SPSS® 25.0 software. ResultsTwenty three patients were included, all of them showed an adherence rate higher than 90%; 20 patients were considered high adherent, and 3 patients medium adherent to treatment according to Morisky’s 8 item Medication Adherence Scale. The results of the EQ-5D-3L questionnaire showed that the patients were all of them autonomous in their personal care and daily activities, 69.6% did not have any mobility problems and 78.3% did not have anxiety/depression; 56.5% had some type of pain. Eighteen patients had no fatigue, and 5 had mild/moderate fatigue according to Functional Assessment of Chronic Illness Therapy – Fatigue scale. The results of the EORTC QLQ-C30 questionnaire showed that patients had a high /healthy functional level, a good quality of life and a low level of symptoms. Analysis by treatment subgroups and by treatment-line subgroups did not show statistically significant differences in adherence or quality of life. ConclusionsPatients diagnosed with chronic lymphocytic leukemia and treated with oral antineoplastic therapies showed a high adherence rate and referred a good quality of life.

Relationship between adherence to dietary treatment and binge-eating disorder in obese patients.

the binge eating disorder (BED) is the eating disorder that most affects the obese population, and BED is an aspect that possibly interferes with the rate of adherence to nutritional treatment, which is also low in individuals with chronic non-communicable disease. to examine the relationship between adherence to dietary treatment and BED presence in obese individuals. this cohort study was conducted with a sample of 73 obese individuals at a nutrition and metabolic disease outpatient unit. Anthropometric data were collected, and a three-day food record was used for dietary assessment. BED was identified using the Binge Eating Scale, and patients were divided into two groups (BED and non-BED controls). Patients were reassessed at three-month follow-up. Data were analyzed using Student's t-tests and generalized estimating equations with Bonferroni correction. Adherence to dietary treatment was assessed by calculating differences between recommended and actual energy intakes. BED was identified in 28.7 % of obese individuals. There was no significant difference in adherence to dietary treatment between BED and control patients. Both groups showed similar eating habits and physical activity levels throughout the study period. obesity is one of the factors contributing to the lack of adherence to nutritional guidelines. The importance of cognitive methods in dietary treatment programs should be further investigated.

Assessment of Preventive Strategies Compliance Among HIV/AIDS Patients Attending Federal Teaching Hospital Katsina, Nigeria

A high level of compliance is required to achieve the desired outcomes of treatment among HIV/AIDS patients. There is paucity of information about compliance to preventive strategies in Katsina State of Northern Nigeria. In this study, a questionnaire was developed, validated, and applied to evaluate adherence to prevention strategies in HIV/AIDS patients attending the Federal teaching hospital, Katsina (FTH) in Nigeria using an investigative descriptive study design. The questionnaire was distributed to 303 respondents that were randomly selected out of 1, 250 population of FTH, and all were returned for data analysis. Descriptive statistics, chi-square and t-tests were used to describe the respondent’s demographic information, test the main and sub-hypotheses. Results showed. Results showed significantly higher adherence to prevention strategies among HIV/AIDS patients attending FTH, Katsina (x2 194.55 df 3 p<0.05). HIVAIDS patients attending the FTH, Katsina are subject to guidelines for preventing transmission of HIV/AIDS (x2202.939 df 3 p<0.05). There was also a significant gender-based difference in adherence to prevention strategies among HIV/AIDS patients attending FTH, Katsina (t 25.690 df 301, p value 0.000). Among HIV/AIDS patients attending the FTH, Katsina, there was a significant difference in adherence to prevention strategies based on educational status (t 219.094 df 302, p-value 0.000). Based on location, there was a significant difference in adherence to prevention strategies among HIV/AIDS patients attending the FTH, Katsina (t 23.038 df 301, p-value 0.000). Results from this study shows that HIV/AIDS patients attending Federal Teaching Hospital Katsina significantly adhere to preventive guidelines for curbing the transmission of HIV/AIDS. However to further achieve the desired quality of life improvements for individual subjects and reduce prevalence in the society, concerted efforts are needed to promote compliance to therapy.

Differences in medication adherence by sex and organ type among adolescent and young adult solid organ transplant recipients.

Identification of differences in medication adherence by sex or organ type may help in planning interventions to optimize outcomes. We compared immunosuppressive medication adherence between males and females, and between kidney, liver and heart transplant recipients. This multicenter study of prevalent kidney, liver and heart transplant recipients 14-25 years assessed adherence 3 times (0, 3, 6 months post-enrollment) with the BAASIS self-report tool. At each visit, participants were classified as adherent if they missed no doses in the prior 4 weeks and non-adherent otherwise. Adherence was also assessed using the coefficient of variation (CV) of tacrolimus trough levels; CV < 30% was classified as adherent. We used multivariable mixed effects logistic regression models adjusted for potential confounders to compare adherence by sex and by organ. Across all visits, males (n=150, median age 20.4 years, IQR 17.2-23.3) had lower odds of self-reported adherence than females (n=120, median age 19.8 years, IQR 17.1-22.7) (OR 0.41, 95% CI 0.21-0.80) but higher odds of adherence by tacrolimus CV (OR 2.50, 95% CI 1.30-4.82). No significant differences in adherence (by self-report or tacrolimus CV) were noted between the 184 kidney, 58 liver, and 28 heart recipients. Females show better self-reported adherence than males but greater variability in tacrolimus levels. Social desirability bias, more common in females than males, may contribute to better self-reported adherence among females. Higher tacrolimus variability among females may reflect biologic differences in tacrolimus metabolism between males and females rather than sex differences in adherence. There were no significant differences in adherence by organ type.

Abstract 15213: Physical Activity Engagement Among African Americans, African Immigrants, Afro-Caribbeans, and Non-Hispanic White Participants in the 2010-2018 National Health Interview Survey (NHIS)

Introduction: Physical inactivity rates are increasing, with higher rates among non-Hispanic Black adults compared to their non-Hispanic White counterparts. However, a comparison of physical activity (PA) engagement across Black Ethnic subgroups in the U.S. has yet to be documented. The purpose of this study was to examine PA engagement rates among African American, African immigrant, and Afro-Caribbean adults compared with White adults. Hypothesis: We hypothesized that significant differences in adherence to PA recommendations across ethnic groups, with lower adherence to recommendations among the Black Ethnic subgroups compared with their White counterparts. Methods: We included data from non-Hispanic White, African American, Afro-Caribbean, and African immigrant adults from the 2010-2018 National Health Interview Survey in these analyses. Using generalized linear models, we compared levels of PA [meeting the moderate-to-vigorous physical activity (MVPA) recommendations] by race/ethnic group adjusting for age and sex. Results: Data from 202,273 adults (mean age 48 years; 31% college/graduate degree; 52% female; 32% with obesity) were included. Among the total sample 49.6% of participants met the MVPA recommendations, while 50.4% did not. Unadjusted pooled analysis across the 9-year period, showed that a majority of White participants (52%) adhered to the MVPA guidelines, compared to only 42% of African Americans, 41% of Afro-Caribbeans, and 47% of African immigrants (all p s&lt;0.01). Similarly, in adjusted models, higher levels of PA were seen among White adults (52% adhering to MVPA guidelines), compared with African American (41%), Afro-Caribbean (41%), and African immigrant adults (42%) ( p s&lt;0.01) (Table). Conclusions: Higher levels of inactivity are seen across Black subgroups in the U.S. compared with their White peers, likely contributing to higher disease burden, highlighting the importance of focused interventions within these groups.

Long-term adherence to imported fire ant subcutaneous immunotherapy

BackgroundImported fire ant (IFA) whole-body extract subcutaneous immunotherapy (IT) is a safe and effective treatment for IFA hypersensitivity, with a recommended length of treatment of 3 to 5 years. ObjectiveTo evaluate long-term IFA IT adherence in patients with IFA allergy living in an endemic area. MethodsDuring 2007 to 2014, patients with IFA-sting systemic reactions and a recommendation to start IFA IT were prospectively enrolled in this study. Subjects were contacted annually for interval IT adherence. Institutional review board approval was obtained. ResultsA total of 87 subjects, ages 2 to 64 years, with a recommendation to initiate IFA IT, were enrolled. Subjects were predominantly adult (76%) and female (55%), and 30% had asthma. Of these patients, 77 (89%) initiated treatment within 1 year of recommendation; 18 (23%) adhered to a 3-year course; and 10 (13%) adhered to a 5-year course. At 3 years, there were no significant differences in adherence between male and female subjects (28% vs 19%, P = .33), children and adults (25% vs 22%, P = .79), or those with or without asthma (30% vs 20%, P = .31). Adherence in subjects with mild initial reactions was lower than in subjects with moderate-to-severe reactions (0% vs 25%, P = .05) at 3 years only. Conventional buildup and concurrent flying Hymenoptera venom immunotherapy were predictive of adherence. Reasons for discontinuation were relocation to a nonendemic area (29%) and inconvenience (27%). ConclusionThis study showed poor long-term adherence to IFA IT at 3 and 5 years. Initial sting severity, buildup protocol, and concurrent flying Hymenoptera venom immunotherapy were predictors for long-term IT adherence.

Group B Streptococcus Screening and Treatment Adherence in Pregnancy: A Retrospective Cohort Study and Opportunities for Improvement

Pregnancy is a time of increased healthcare screening, and past adherence to evolving guidelines informs best practices. Although studies of Group B Streptococcus guideline adherence have focused primarily on treatment of Group B Streptococcus carriers, this study broadly evaluated long-term adherence to both Group B Streptococcus screening and treatment guidelines. Adherence was evaluated across provider types (obstetrics and gynecology, certified nurse midwives, and family medicine). We conducted a retrospective cohort study. Demographic and clinical information were extracted from all prenatal care and delivery patients at a single institution in a single year. Vancomycin prescriptions in pregnancy were tracked for 10 years to determine long-term adherence. Adherence was defined as no deviation from 2010 Group B Streptococcus screening and treatment guidelines. Adherence occurred in 89% (1,610/1,810) of patients. Reasons for deviations from guidelines could not always be determined. There was no significant difference in maternal age, race, prenatal provider type, provider type at delivery, gestational age at delivery, delivery mode, or whether antibiotic sensitivities were performed between compliant and noncompliant groups. Significant differences in adherence were found between obstetric clinics (high-risk obstetrics clinic, maternal‒fetal medicine fellows clinic, continuity of care clinic, and faculty private clinic) (p<0.0001) and between the faculty family medicine clinic and resident family medicine clinic (p=0.001). Vancomycin prescription practice did not change significantly over the10-year period. High rates of adherence to Group B Streptococcus screening and treatment guidelines in pregnancy have positive implications for reducing antibiotic resistance. Given evolving guidelines, there is a need to periodically evaluate adherence and to re-educate providers about standard practices and best documentation practices.

Treatment satisfaction and pharmacological adherence in patients with chronic diseases

Abstract Funding Acknowledgements Type of funding sources: None. Background There are many factors that influence patient adherence to treatment, including complexity and frequency of dosing, convenience and treatment satisfaction. Patient satisfaction with the results of treatment is a strong motivation for systematic continuation of treatment. Lack of satisfaction with treatment may negatively affect the level of adherence. This relationship is often suggested in articles, but there is still a lack of evidence on the relationship between treatment satisfaction and treatment adherence in chronically ill patients. The aim of the study was to assess the treatment satisfaction and evaluate the relationship between treatment satisfaction and pharmacological adherence in patients with hypertension, type 2 diabetes and heart failure. Material and methods The study included 197 inpatients (110 male, mean age 61.23±14.34) with hypertension (n=55), type 2 diabetes (n=42) and heart failure (n=100). The following instruments were used: the Treatment Satisfaction with Medicines Questionnaire (SATMED-Q) to assess the patient satisfaction with the treatment received and the Adherence to Refills and Medication Scale (ARMS) for evaluating adherence. Socio-demographic and clinical data were obtained from patients’ medical records. Results In the comparative analysis, patients with heart failure were older (67.59±11.93 vs. 62.51±14.62 vs. 60.83±13.23), were male (68.0% vs. 47.27% vs. 30.95%), had 2 or more additional diseases (55. 0% vs. 23.64% vs. 47.62%), more frequently took 5 or more tablets daily (71.0% vs. 50.91% vs. 54.76%), were more frequently hospitalized (61.0% vs. 14.55% vs. 40.48%) compared to the other groups. Patients obtained the highest scores in the domain of undesirable side effects (85.32±28.62) and the lowest in the domains of satisfaction with medical care (61.61±28.36) and impact of treatment on daily activities (66.54±26.90). However, there were no statistically significant differences in adherence of patients differing by chronic disease (HTN: 17.56±5.21 vs. DM: 18.21±5.34 vs. HF: 17.23±4.36; p=0.791). In correlation analysis, all ARMS subscales correlated significantly and negatively with all SATMED-Q subscales, so the higher the adherence level (lower ARMS score) the lower the treatment satisfaction. Linear regression analysis showed that adherence to pharmacological recommendations measured by the ARMS questionnaire was an independent determinant of treatment satisfaction in all study groups, and a higher ARMS score (lower adherence level) decreased treatment satisfaction (HTN: -2.088 vs. DM: -1.879 vs. HF: -0.942). Conclusions Treatment satisfaction has a significant impact on pharmacological adherence in patients with hypertension, type 2 diabetes and heart failure. The more satisfied the patient is with the treatment, the better their pharmacological adherence.

Does race-ethnicity affect upper airway stimulation adherence and treatment outcome of obstructive sleep apnea?

Untreated obstructive sleep apnea (OSA) is associated with excessive daytime sleepiness, decreased quality of life, and cardiovascular disease. Positive airway pressure is the first-line therapy for OSA; however, adherence is difficult. Upper airway stimulation is a Food and Drug Administration-approved treatment of OSA. The objective of this study was to evaluate for a difference in treatment efficacy and adherence of upper airway stimulation therapy for OSA between individuals who are White and non-White using data from the ADHERE registry. ADHERE registry is a multicenter prospective study of real-world experience of upper airway stimulation for treatment of OSA in the United States and Europe. Propensity score matching was used to create a balanced dataset between the White and non-White groups. t-Tests at a significance level of 5% were used to compare numeric values between groups. There were 2,755 participants of the ADHERE registry: 27 were excluded due to not having a race identified, 125 participants identified as non-White, 2,603 identify as White, and 27 did not provide race information. Propensity score matching was used to select 110 participants, with 55 White and 55 non-White for the noninferiority analysis. We did not find a difference in adherence, treatment apnea-hypopnea index, changes in Epworth Sleepiness Scale score, or clinical global impression after intervention score between White and non-White individuals. Our study found that there was no statistically significant difference in adherence or efficacy with upper airway stimulation therapy between White and non-White individuals. However, the percent of non-White people implanted is low, which suggests a need to expand access to this therapy for non-White populations with OSA who cannot tolerate positive airway pressure therapy. Khan M, Stone A, Soose RJ, etal. Does race-ethnicity affect upper airway stimulation adherence and treatment outcome of obstructive sleep apnea? J Clin Sleep Med. 2022;18(9):2167-2172.

Adherence to oral anti-cancer therapies in older patients is similar to that of younger patients.

The use of oral anti-cancer therapies is becoming increasingly common in the management of cancers, raising the question of adherence. The objective of this study was to assess adherence to oral anti-cancer therapies, as well as the impact of various factors that may influence it. Patients starting oral chemotherapy (tyrosine kinase inhibitor or cytotoxic) were followed up for 3 months using a medication diary, which was given to the patient by the pharmacist during a multidisciplinary consultation. Adherence was assessed using the diary, as well as by counting the tablets they brought back. One hundred and fifty patients were included in the study. The main oral chemotherapy agents prescribed were palbociclib (23.3%), everolimus (18.7%), and capecitabine (13.3%). The adherence at the end of the 3 months, by means of dose intensity (i.e. percent of the dose prescribed that has been taken), was 95.5%. No significant difference in adherence was found based on age, sex, family circumstances, health status, co-medication, type of oral therapy, tumor location, number of previous treatment lines, or presence of toxicity. The main reasons for non-adherence were forgetting (50%) and toxicity (21%). Fifty-seven patients prematurely discontinued the study: 40.3% for toxicity and 36.8% for disease progression. Adherence in this study is high in comparison to literature, which can be explained by close multidisciplinary follow-up. Moreover, no significant difference was observed between younger and older patients.

Adherence to oral anticoagulation in a Belgium atrial fibrillation population measured by a medical event monitoring system

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): The AF-EduCare study is a project supported by the Fund for Scientific Research, Flanders (T002917N). The AF-EduApp study is supported by an BMS/Pfizer European Thrombosis Investigator Initiated Research Program (ERISTA) grant. Background Treatment with oral anticoagulation (OAC) is one of the main pillars in the management of atrial fibrillation (AF). Therapy adherence to both VKA and NOAC is important. Education and intake monitoring are recommended to improve therapy adherence. Purpose The main purpose of this project was to evaluate the effect of personalized follow-up strategies on therapy adherence to OAC in AF patients. Methods In a multicentre, Belgian randomized controlled trial, the AF-EduCare/AF-EduApp study, the effect of different personalized education strategies (i.e. in-person, online or app-based education) is evaluated on clinical outcome parameters of AF patients compared to standard care (SC). One of the outcome parameters is therapy adherence to OAC. During the first 3 months of the trial, patients’ adherence to NOAC or VKA was measured with the Electronic Medication Event Monitoring System (MEMS). The MEMS cap fits on a medication bottle and registers the date and time of every bottle opening. Regimen adherence was defined as the the number of days with the correct number of openings according to the specific OAC regimen divided by the total number of monitored days. As dabigatran has to be stored in the original package to protect it from moisture and VKAs have a variable scheme between patients, a proxy-medication (i.e. another oral drug that needed to be taken once or twice daily and on the same moment of the day as dabigatran or VKA) was chosen to measure medication adherence. Patients in the education groups received a MEMS cap with LCD screen providing direct feedback by showing the number of openings within 24h. A small sample of the SC group also received a MEMS cap as controls, but without LCD screen to minimally trigger these patients. Results A total of 593 AF patients underwent adherence monitoring, of which 514 (86.7%) in the intervention group and 79 (13.3%) in the SC group. The mean age was 70.1±7.7 years, mean time since AF diagnosis was 5.8±6.9 years, and mean CHA2DS2-VASc score was 3.2±1.5. Overall adherence was high: 94.8% of the patients had an adherence &amp;gt;80% and 80.9% had an adherence &amp;gt;90%. A small but significant difference in adherence was observed between the intervention groups and the standard care group (intervention group 97% (5-100); SC 96%(24-100); p=0.024; Figure1). Also between the four study groups a significant difference was seen (in-person 97% (93.5-99); online 98% (94-100); app-based 98% (92-99); p=0.049) driven by a significant difference between the online and SC group (p=0.009). Conclusion Overall adherence to OAC in all study groups and even in SC was high. The high adherence percentage in the SC group could be related to the Hawthorne effect of using the MEMS. Nevertheless, electronic monitoring and targeted education slightly improved therapy adherence further in the intervention groups.

The Effect of Dissemination Pathways on Uptake and Relative Costs for a Transdiagnostic, Self-guided Internet Intervention for Reducing Depression, Anxiety, and Suicidal Ideation: Comparative Implementation Study.

BackgroundSelf-guided web-based programs are effective; however, inadequate implementation of these programs limits their potential to provide effective and low-cost treatment for common mental health problems at scale. There is a lack of research examining optimal methods for the dissemination of web-based programs in the community.ObjectiveThis study aimed to compare the uptake, reach, relative costs, and adherence associated with 3 community-based pathways for delivering a low-intensity web-based transdiagnostic mental health program. The 3 dissemination pathways were social media advertising, advertising in general practice, and advertising in pharmacies.MethodsParticipants were recruited on the web, from general practices, or from community pharmacies; completed a screener for psychological distress; and were offered the 4-week FitMindKit program—a 12-module psychotherapeutic intervention. Uptake was defined as the number of participants who enrolled in the web-based program; reach was defined as the rate of uptake per exposure; and costs were calculated based on staff time, equipment, and advertising. Adherence was assessed as the number of modules of FitMindKit completed by the participants.ResultsUptake comprised 1014 participants who were recruited through the 3 dissemination pathways: on the web (991/1014, 97.73%), in general practice (16/1014, 1.58%), and in pharmacy (7/1014, 0.69%). Reach was highest for social media: 1 in every 50 people exposed to web-based advertising took up the intervention compared with 1 in every 441 in general practitioner clinics and 1 in every 1708 in pharmacies. The dissemination cost was US $4.87 per user on social media, US $557 per user for general practitioner clinics, and US $1272 per user for pharmacy dissemination. No significant differences in adherence were observed between the conditions, whereas all pathways showed an underrepresentation of men and linguistic diversity.ConclusionsThe web-based dissemination pathway was the most efficient and cost-effective for delivering a self-guided internet-based mental health program to people in the community. More research is needed to identify how best to engage men and those with culturally diverse backgrounds in web-based interventions.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12618001688279; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376113

Adherence to Treatment of Diabetes in Patients Suffering from Co-Morbid Depression

Objective: The objective of this study was to explore the adherence to diabetic management in patients with co-morbid depression presenting in Diabetes Management Centre, Services Hospital Lahore and to compare it with adherence to treatment of diabetes in patients not suffering from co-morbid depression. Method: The sample (N=94) was all diabetic patients with either type 1 or type 2 diabetes and presenting at outpatient department, Diabetes Management Centre, Services Hospital Lahore and who are suffering from depression according to DSM-5 Criteria. Cross-sectional study designed was being used. Result: A one-way anova was used. Results showed that there was a significant difference in adherence to treatment between diabetic patient with co-morbid depression and diabetic patient without co-morbid depression at p&lt;.05 for four groups [F (3, 88) =6.108, P=0.001). A Tukey post hoc test revealed that adherence of diabetic patient with no depression (97.43± 14.69) had statistically significant different than diabetic patient with mild depression (77.85± 21.76, p = .002) and moderate depress diabetic patient (80.43±28.20, p = .027). There was no statistically significant difference between diabetic patient without depression and with severe depression (90.27± 21.38, p = .922). Conclusion: The study concluded that diabetic patient without co-morbid depression are better adhered to treatment than those with comorbid depression diabetic patient. The impact of demographic factors should explore in future study. Keywords: Adherence, diabetes, co-morbid depression

Effective interventions to improve long-term physiotherapy exercise adherence among patients with lower limb osteoarthritis. A systematic review

IntroductionOsteoarthritis (OA) is a chronic condition. Physiotherapy is known to be beneficial for people with OA. Patient adherence to physiotherapy exercise is essential for the effective management of OA.ObjectivesTo determine different methods used to enhance physiotherapy exercise adherence for a period of more than 12 months among patients with OA and to report the most effective methods to enhance exercise adherence among people with lower limb OA.DesignSystematic review.MethodsPubMed, Pedro, Web of Science, and EMBASE databases were searched for randomized controlled trials, cohort studies, case-control studies, and cross-sectional studies published in the English language from 2000 to 2020. The literature search was done on 27 August 2020. Two researchers independently conducted the screening, eligibility assessment, data extraction, methodology quality assessment using the PEDro scale, and risk of bias assessment using RoB2. A narrative synthesis of key outcomes is presented, percentage of adherence rate; Preferred Reporting Items for Systematic Review was used to report the review. Meta-analysis was not performed due to heterogeneity of studies. The study protocol was registered in Prospero (Prospero ID: CRD42020205653).ResultsThe primary search strategy identified 5839 potentially relevant articles, of which 5157 remained after discarding duplicates. After screening based on title and abstract, 40 papers were potentially eligible for inclusion. Five of these papers met all predefined eligibility criteria. Introducing methods to enhance exercise adherence has caused a significant increase in exercise adherence for less than 6 or 12 months. There were no significant differences in adherence for more than 12 months with different methods. The results indicate that booster-sessions (89.69%) and telephone-linked communication (86%) had higher percentages for exercise adherence. Secondary outcomes such as pain, stiffness and function show positive outcomes with increasing exercise adherence. However, there were no significant differences on these secondary outcomes.ConclusionThe booster sessions and telephone-linked communication appear to enhance exercise adherence for more than 12 months among patients with OA. However, the number of high-quality studies is inadequate to confirm our findings. Therefore, more studies with higher methodological quality are needed to determine the best strategies to enhance long-term exercise adherence among people with OA.

Endorsement of the TRIPOD statement and the reporting of studies developing contrast-induced nephropathy prediction models for the coronary angiography/percutaneous coronary intervention population: a cross-sectional study

ObjectiveClear and specific reporting of a research paper is essential for its validity and applicability. Some studies have revealed that the reporting of studies based on the clinical prediction models...

The effect of drug information service using leaflet media and medication reminder chart on adherence and blood pressure of hypertensive patients in primary health care

Abstract Background: Treatment adherence is an important factor affecting blood pressure control in hypertensive patients. Intervention in pharmacy service can improve medication adherence and lower blood pressure. Objective: This study aimed to evaluate the effect of drug information service using leaflets and MRC on the level of patient compliance and lowering blood pressure. Method: The research design was a quasi-experimental pre-and post-design with control, the intervention group (n=20), and the control group (n=20). The patient adherence was measured using the MGLS questionnaire at the beginning and the end of the study. The intervention was performed by distributing a drug information leaflet and medication reminder chart (MRC). The differences of adherence pre and post-intervention were analyzed using paired t-test, while the differences in adherence and blood pressure between the control and the intervention group were analyzed using the Mann-Whitney test. Results: The results showed that there was a significant difference in adherence between pre and post-intervention (p&lt;0.001). A significant difference was also found in the level of adherence between the control group and the intervention group (p&lt;0.001). Whereas the decrease of systolic (p=0.396) and diastolic (p=0.564) blood pressure in the intervention group and control group was not different significantly. Conclusion: Drug information services using leaflets and MRCs affected patient adherence to medication, but did not interfere with the decrease of systolic and diastolic blood pressure. Keywords: leaflets, medication reminder chart, adherence, blood pressure