Suboptimal Medication Research Articles

Clinical correlates of medication adherence in individuals with bipolar disorder and comorbid hypertension.

Individuals with bipolar disorder (BD) have high rates of suboptimal medication adherence, medical illness, and premature mortality, largely from cardiovascular causes. This analysis examined the association between adherence to antihypertensive and BD medications and clinical symptoms in patients with BD and comorbid hypertension (HTN) from an ongoing trial to optimize adherence. Inclusion criteria were a BD diagnosis, treatment with antihypertensives, adherence challenges, and poorly controlled HTN. Adherence was measured via self-report using the Tablets Routine Questionnaire and using eCAP, an electronic pillcap which captures openings. Average systolic blood pressure (SBP) was calculated from 12 readings over 1week. The Montgomery-Asberg Depression Rating Scale (MADRS) and the Brief Psychiatric Rating Scale (BPRS) assessed BD symptoms. A total of 83 participants with BD and HTN were included. Adherence to BD and antihypertensive medications were positively correlated. eCAP openings showed more missed doses than self-reported antihypertensive adherence. BD medication adherence was positively correlated with BPRS at baseline; antihypertensive adherence was negatively correlated with SBP at screening. Antihypertensive adherence improved and SBP decreased between screening and baseline. Adherence levels fluctuated over time and differed based on measurement method in people with comorbid BD and HTN. Self-reported BD adherence was positively related to global psychiatric symptoms and antihypertensive adherence was related to better SBP control. Monitoring both medication and blood pressure led to change in self-reported adherence. BD symptom severity may indicate poor adherence in patients with BD and should be considered in treatment planning.

Variations in antihypertensive medication treatment and blood pressure control among Veterans with HIV and existing hypertension

BackgroundHypertension is a leading risk factor for cardiovascular disease among patients living with HIV (PLWH). Understanding the predictors and patterns of antihypertensive medication prescription and blood pressure (BP) control among PLWH with hypertension (HTN) is important to improve the primary prevention efforts for this high-risk population. We sought to assess important patient-level correlates (eg, race) and inter-facility variations in antihypertension medication prescriptions and BP control among Veterans living with HIV (VLWH) and HTN. MethodsWe studied VLWH with a diagnosis of HTN who received care in the Veterans Health Administration (VHA) from January 2018 to December 2019. We evaluated HTN treatment and blood pressure control across demographic variables, including race, and by medical comorbidities. Data were also compared among VHA facilities. Predictors of HTN treatment and control were assessed in 2-level hierarchical multivariate logistic regression models to estimate odds ratios (ORs). The VHA facility random-effects parameters from the hierarchical models were used to calculate the median odds ratios to characterize the variation across the different VHA facilities. ResultsA total of 17,468 VLWH with HTN (mean age 61 years, 97% male, 54% Black, 40% White) who received care within the VHA facilities in 2018-2019 were included. 73% were prescribed antihypertension medications with higher prescription rates among Black vs White patients (75% vs 71%) and higher prescription rates among patients with a history of cardiovascular disease, diabetes, and kidney disease (>80%), and those receiving antiretroviral therapy and with controlled HIV viral load (∼75%). Only 27% of VLWH with HTN had optimal BP control of systolic BP <130 mmHg and diastolic BP <80 mmHg, with a lower rate of control among Black vs White patients (24% v. 31%). In multivariate regression, Black patients had a higher likelihood of HTN medication prescription (OR 1.32, 95% CI: 1.22-1.42) but were less likely to have optimal BP control (OR 0.82; 0.76-0.88). Important positive correlates of antihypertensive prescription and optimal BP control included: number of outpatient visits in prior year, and histories of diabetes, coronary artery disease, and heart failure. There was about 10% variability in both antihypertensive prescription and BP control patterns between VHA facilities for patients with similar characteristics. There was increased inter-facility variation in antihypertensive prescription among those with a history of heart failure and those not receiving antiretroviral therapy. ConclusionIn a retrospective analysis of large VHA data, we found that VLWH with HTN have suboptimal antihypertensive medication prescription and BP control. Black VLWH had higher HTN medication prescription rates but lower optimal BP control.

The management of unused and expired medications in Thai households: Influencing factors and prevailing practices.

Although the improper disposal of unused and expired medications represents a global environmental concern, its significance is often underestimated. This research delves into the practices and factors related to the management of unused and expired medications. Data was collected through a comprehensive survey of Thai households, with 400 structured questionnaires. Multiple regression was then employed to analyze the data. Findings show an intriguing paradox. The participants in the survey demonstrated commendable knowledge regarding the appropriate management of unused or expired medications. Yet, this knowledge was not sufficiently put into practice. This study identifies the factors that have a positive influence on proper medication disposal practices, such as age, level of education, attitude, and perception. Surveyed participants exhibited a tendency to retain unused medications and discard expired ones with household waste. Most of them showed a low degree of medication management, pointing to the need for targeted interventions. This research provides tangible benefits for policymakers, healthcare practitioners, and researchers addressing waste management paradigms. In terms of policy, the study highlights the need for comprehensive interventions, including medication take-back systems, infrastructure development, and educational initiatives. Policymakers are urged to bridge the gap between knowledge and behavior by promoting access to collection points for proper medication disposal to avoid perpetuating the cycle of suboptimal medication management. This research informs strategies to encourage responsible medication management practices globally, addressing the adverse environmental and health impacts associated with the improper accumulation of medications.

Concordance between pharmacy dispensing and electronic monitoring data of direct oral anticoagulants - A secondary analysis of the MAAESTRO study

BackgroundDirect oral anticoagulants are the preferred treatment for stroke patients with atrial fibrillation. Pharmacy dispensing data represent a practical method to identify suboptimal medication adherence. ObjectiveThis study investigates whether pharmacy dispensing data are indicative of real-life adherence behavior, using data from 130 patients in the MAAESTRO study (2018–2022) in Basel, Switzerland. MethodsThis secondary data analysis of the MAAESTRO study (Dietrich, 2024) included patients with electronic monitoring (EM) and dispensing data for 12 months. Patients with at least two refills were included in the analysis.We categorized refill series into three adherence patterns using the Delta T method (Baumgartner, 2022): all refills on time, erratic refills, end-gaps ≥10 days. EM-adherence was assessed through “taking adherence” and “missing days” (24h without intake). We analyzed: i) all dispensing data (“all refills”); ii) all data independently of the MAAESTRO phase (“all phases”); iii) the last two dispensing data (“last”), and iv) EM data from the MAAESTRO phase that match the date of the last refill (“matched”). Associations between refill patterns and adherence were examined using Spearman correlation and Fisher's exact test. ResultsData analyzed from 50 patients (mean age 76.4 ± 9.1 years, 56.0 % male) included 252 refills with a median of 4 refills per patient. Refill patterns were: all refills on time (40.0 %), erratic refills (36.0 %), and end-gaps >10 days (24.0 %). Mean taking adherence was 89.3 ± 13.7 %. EM data revealed missing days in 82.0 % of patients, with 61.0 % having irregular refill patterns. Matched taking adherence was moderately associated with Delta T over all refills (p = 0.034) and the last refill (p = 0.013). ConclusionsDispensing data processed with the Delta T method correlate moderately with EM data. The Delta T value for the last two refills shows promise for estimating irregular adherence, suggesting potential for targeted interventions in pharmacy practice.

Comprehensive real time remote monitoring for Parkinson’s disease using Quantitative DigitoGraphy

People with Parkinson’s disease (PWP) face critical challenges, including lack of access to neurological care, inadequate measurement and communication of motor symptoms, and suboptimal medication management and compliance. We have developed QDG-Care: a comprehensive connected care platform for Parkinson’s disease (PD) that delivers validated, quantitative metrics of all motor signs in PD in real time, monitors the effects of adjusting therapy and medication adherence and is accessible in the electronic health record. In this article, we describe the design and engineering of all components of QDG-Care, including the development and utility of the QDG Mobility and Tremor Severity Scores. We present the preliminary results and insights from an at-home trial using QDG-Care. QDG technology has enormous potential to improve access to, equity of, and quality of care for PWP, and improve compliance with complex time-critical medication regimens. It will enable rapid “Go-NoGo” decisions for new therapeutics by providing high-resolution data that require fewer participants at lower cost and allow more diverse recruitment.

A need to integrate pharmacological management for multimorbidity into dementia guidelines in Australia.

Pharmacological management is a vital aspect of dementia care. Suboptimal medication prescribing and adverse drug reactions are major causes for ongoing concerns for the quality of care. This review aims to investigate the existence and comprehensiveness of Australian guidelines dedicated to supporting dementia care in the context of pharmacological management. Guideline registries and databases (EMBASE and CINAHL) were searched to identify Australian guidelines addressing pharmacological management in dementia care and to uncover barriers and considerations associated with guideline implementation. Seven Australian guidelines were identified. Barriers to effective implementation were identified at individual, provider, and system levels. None of the identified guidelines provided comprehensive guidance on management of multimorbidity and polypharmacy. Although Australian guidelines are available to guide pharmacological management in dementia, several barriers impede their effective implementation. There is an urgent need for updated guidelines that address the management of multimorbidity and polypharmacy in people living with dementia.

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.

Assessing multilevel barriers to hydroxyurea adherence in youth with sickle cell disease using pharmacy-based refill records.

Suboptimal medication adherence is common across youth with chronic health conditions and may contribute to health disparities and adverse health outcomes, especially in underserved communities. Using pharmacy prescription records and guided by the World Health Organization Multidimensional Adherence Model, we examined patient-, treatment-, and health system-related factors that may affect hydroxyurea adherence in 72 youth with sickle cell disease (SCD), 10-18 years who had participated in the multisite "Hydroxyurea Adherence for Personal Best in SCD" (HABIT) feasibility (6 months) and efficacy (12 months) trials. Pharmacy data were collected from the year prior to study entry through the duration of each trial. We also examined hydroxyurea dose at baseline, prescribing patterns (hydroxyurea formulation and dose prescribed), quantity of hydroxyurea dispensed, and number of daily capsules/tablets prescribed. Data were analyzed using descriptive statistics. On average, youth were prescribed 1095±402mg hydroxyurea per day, requiring ingestion of 3 or more capsules for 39.4% of youth. Frequently identified potential barriers were complex medication regimens in which dose of hydroxyurea differed by day of week (47.2%); receipt of an inadequate (<30 days) supply of hydroxyurea from the pharmacy≥3 times during record collection period (29.2%); and prescription of hydroxyurea suspension suggesting problems swallowing capsules (22.2%). In this sample, most youth were exclusively prescribed 500mg capsules (62.5%), which was associated with complex medication regimens (RR 3.0, 95% CI 1.4-6.7). Potential barriers were common, occurred at all levels and are potentially modifiable with targeted interventions at the treatment- and health system-related levels.

Traditional Methods Hold Their Ground Against Machine Learning in Predicting Potentially Inappropriate Medication Use in Older Adults

ObjectivesMachine learning methods have gained much attention in health sciences for predicting various health outcomes but are scarcely used in pharmacoepidemiology. The ability to identify predictors of suboptimal medication use is essential for conducting interventions aimed at improving medication outcomes. It remains uncertain whether machine learning methods could enhance the identification of potentially inappropriate medication use among older adults compared with traditional methods. This study aimed to (1) to compare the performances of machine learning models in predicting use of potentially inappropriate medications and (2) to quantify and compare the relative importance of predictors in a population of community-dwelling older adults (>65 years) in the province of Québec, Canada. MethodsWe used the Québec Integrated Chronic Disease Surveillance System and selected a cohort of 1 105 295 older adults of whom 533 719 were potentially inappropriate medication users. Potentially inappropriate medications were defined according to the Beers list. We compared performances between 5 popular machine learning models (gradient boosting machines, logistic regression, naive Bayes, neural networks, and random forests) based on receiver operating characteristic curves and other performance criteria, using a set of sociodemographic and medical predictors. ResultsNo model clearly outperformed the others. All models except neural networks were in agreement regarding the top predictors (sex and anxiety-depressive disorders and schizophrenia) and the bottom predictors (rurality and social and material deprivation indices). ConclusionsIncluding other types of predictors (eg, unstructured data) may be more useful for increasing performance in prediction of potentially inappropriate medication use.

Effectiveness of pharmacist intervention on antidepressant medication knowledge, necessity, and concerns beliefs in patients with depression

Abstract Background Sub-optimal patient medication knowledge, negative beliefs, and concerns about the potential of medications to cause harm are important contributory factors to non-adherence in patients with depression. Objectives To assess the effectiveness of a pharmacist intervention on antidepressant medication knowledge, necessity, and concerns beliefs in patients with depression. Methods A prospective interventional study (approval number: ABUCUHSR/2020/018) was carried out between April 2019 and March 2020 at the Federal Neuro-Psychiatric Hospital, Maiduguri, Nigeria. Patients were randomized into the usual care or intervention group. The intervention consisted of an educational programme, and data were collected at baseline, 3 months, and 6 months. Patient knowledge about medicines and beliefs about medicines questionnaires were used to assess patient knowledge and beliefs. Key findings A total of 49 (81.6%) and 52 (86.6%) participants completed the 6-month follow-up in the usual care and intervention groups, respectively. Significant improvements in mean medication knowledge scores of participants in the intervention group were observed at 3 months (P &amp;lt; .001) and 6 months (P &amp;lt; .001), respectively. Significant improvements in mean medication necessity and concerns belief scores of participants in the intervention group were also observed at 3 months (P &amp;lt; .001) and 6 months (P &amp;lt; .001), respectively. Medication knowledge (P &amp;lt; .001, partial η2 = 0.203), medication necessity (P &amp;lt; .001, partial η2 = 0.329), and medication concerns (P &amp;lt; .001, partial η2 = 0.163) positively changed with time. Conclusion Pharmacist intervention significantly improved antidepressant medication knowledge, necessity, and concerns beliefs in patients with major depressive disorder.

Determinants of medication adherence among elderly with high blood pressure living in deprived areas.

The current study was conducted to determine the impact of health literacy and factors related to adherence to drug treatment, using the model proposed by the World Health Organization, in older adults with hypertension residing in informal settlements in Hamadan. This cross-sectional study was conducted on 405 patients in Hamadan city, located in the western part of Iran. Data were collected using an interviewer-administered questionnaire that included the 5-dimensional model proposed by the World Health Organization, Health Literacy for Iranian Adults, and Morisky Medication Adherence Scale-8. A two-stage sampling procedure was used to select patients from 14 comprehensive health service centers and health bases. The data were analyzed using SPSS v.24. The study found that medication adherence was suboptimal in 63% of the participants. Additionally, 87.5% of patients had inadequate or insufficient health literacy. Factors related to medication adherence included age (odds ratio (OR) = 1.07), annual income (OR = 0.17), duration of hypertension (OR = 7.33), health literacy (OR = 1.03), self-reported health status (P < 0.05), and regular medication use (P < 0.008). The results of this study indicate that more than half of the older adults in the study had suboptimal medication adherence and insufficient health literacy. The study also found that various factors, such as socioeconomic status, disease and treatment-related factors, and patient-related factors, influence medication adherence among older adults.

Treatment adherence across different psychiatric disorders: findings from a large patient cohort

IntroductionMedication adherence was defined by the WHO as “the extent to which a person’s behavior coincides with the medical advice given” (WHO, 2003). Existing literature indicates that approximately 49% of patients with major psychiatric disorders do not fully adhere to their prescribed psychopharmacological therapy (Colom et al, 2002). Non-adherence can lead to partial therapeutic responses or treatment resistance, increased risk of relapse, re-hospitalization, elevated suicide risk, and overall poorer functioning, thereby compromising the patient-doctor therapeutic relationship (Garcìa et al, 2016).ObjectivesThe aim of the present study was to assess potential differences in terms of clinical features related to adherence to treatment in a large cohort of psychiatric patients of an Italian psychiatric department.MethodsThe study included 307 psychiatric patients, of any gender or age, diagnosed with unipolar depression (UD), bipolar depression (BD), anxiety disorders (AD), schizophrenic spectrum disorders (SS) or a primary diagnosis of personality disorders (PD), based on DSM-5 criteria. Patients were consecutively recruited from the Department of Psychiatry at Luigi Sacco University Hospital, in Milan. The patient’s adherence to treatment was evaluated using the Clinician Rating Scale (CRS), with a cut-off of ≥ 5 defining adherence subgroups (A+: score ≥ 5; A-: score &lt; 5). Comparative and predictive analysis were performed for the whole sample and the two adherence subgroups.ResultsOverall, nearly one-third of the whole sample reported suboptimal medication adherence. Specifically, rates were approximately 35.3% and 32.7% for BD and SS, respectively, followed by 30.8% for PD, 28% for AD and, 20.3% for UD (see Figure 1). Patients with A- showed significantly higher current substance abuse (17.8% vs 4.5%, p&lt;.001), along with a higher rate of lifetime substance abuse, although with a trend towards significance (31.5% vs 20.5%; p=.057). Moreover, the A- group had a significantly higher number of lifetime hospitalizations (1.35 ± 1.8 vs 0.73 ± 1.11; p&lt;.001) and higher rate of previous psychotropic treatment dropouts compared to the A+ group (90% vs. 36.2%; p&lt;.001, see Figure 2).Image:Image 2:ConclusionsApproximately one-third of the whole sample reported a suboptimal medication adherence, with varying rates across different diagnoses. Current and lifetime substance abuse appears to be an unfavorable transdiagnostic factor. Additionally, severe outcomes such as increased hospitalizations and a more acute disease presentation are linked to poorer adherence. Recognizing the characteristics of adherence patterns within specific diagnostic categories is crucial for designing precise interventions to enhance patient outcomes and optimize the overall effectiveness of treatment.Disclosure of InterestN. Girone: None Declared, B. Benatti Speakers bureau of: Angelini, Lundbeck, Janssen, Rovi., M. Cocchi: None Declared, F. Achilli: None Declared, C. Viganò: None Declared, M. Vismara: None Declared, B. Dell’Osso Grant / Research support from: Angelini, Lundbeck, Janssen, Pfizer, Otzuka, Neuraxpharm, and Livanova, Speakers bureau of: Angelini, Lundbeck, Janssen, Pfizer, Otzuka, Neuraxpharm, and Livanova

Abstract P321: Clinical Correlates of Medication Adherence to Antihypertensives and Bipolar Medications in Individuals With Hypertension and Bipolar Disorder

Introduction: Individuals with bipolar disorder (BD) have high rates of suboptimal medication adherence, medical illness, and premature mortality largely from cardiovascular causes. In the current analysis, we examined screening and baseline data from an ongoing randomized controlled trial and assessed clinical correlates of adherence to antihypertensives and BD medications in 55 patients with bipolar disorder and hypertension. Hypothesis: We assessed the hypothesis that adherence to antihypertensives would correlate with systolic blood pressure (SBP) and adherence to BD medication would correlate with psychiatric symptoms. Method: Inclusion criteria were a BD Type 1 or 2 diagnosis, being prescribed antihypertensives, and uncontrolled hypertension (SBP ≥130mmHg). Adherence was measured for the prior week with 1) self-reported Tablets Routine Questionnaire for antihypertensives (TRQ-HTN) and BD (TRQ-BD) with higher percentage reflecting worse adherence and 2) objective electronic monitoring using an eCAP © for one antihypertensive medication. Average SBP was calculated from 12 readings over one week. Symptoms of BD were measured with the Montgomery-Asberg Depression Rating Scale (MADRS) and the Brief Psychiatric Rating Scale (BPRS). Results: Mean age of the sample (N=55) was 53.91±9.97, a majority female (61.8%), 49.1% Black and 45.5% White. Mean years of education was 14.09 ±2.83 and 95% had Bipolar Type I. At screen, TRQ-HTN was 35.80% ± 21.78 (N=55); at baseline, mean TRQ-HTN was 12.94 ± 16.88%. At screen, TRQ-BD was 29.61% ±28.02 (N=55); at baseline, TRQ-BD was 19.43% ±28.54 (N=50). At baseline, eCAP (N=43) was 39.53 ± 35.11%. There was a significant improvement in TRQ-HTN from screen to baseline (t(52) = -6.75 r &lt;0.001) and a trend for TRQ-HTN (t(49) = 1.80, p = 0.078). There was a significant correlation between TRQ-HTN and eCAP at baseline (rs=0.307, p&lt;.05, N= 43) yet eCAP reported more missed days than TRQ-HTN (Mean = -25.581 t(42) = -4.903 p&lt;0.001). TRQ-BD was significantly correlated with BPRS ( r = 0.313, p &lt;.05, N = 50) but not with MADRS. Neither TRQ-HTN nor eCAP were correlated with SBP. SBP significantly decreased from screen to baseline (t(53) = 2.357 p&lt;.05). Conclusion: In conclusion, adherence levels vary widely and objective measurement identified rates of missed medications that were approximately 26% higher than self-report. Self-reported BD adherence was related to global psychiatric symptoms but not depression while antihypertensive adherence did not relate to SBP. Greater BD symptom severity may be a clinical indicator to assess for adherence problems and medication and BP monitoring alone may improve adherence and SBP.

The Utah Pharmacy Summit: Collaborating to Optimize Patient Care

Pharmacy has evolved significantly over the past 20 years, despite advances in pharmacotherapy and the expanding scope of pharmacy practice, pharmacists have struggled to collaborate across disciplines to create improved processes that enable the best outcomes from these innovations. A lack of innovation at any part of the healthcare system could inhibit the progress of practice innovations thereby leading to suboptimal patient medication and health outcomes. The Utah Pharmacy Summit was held in late 2022 with the goal of promoting pharmacist collaboration and a unified pharmacist voice within the state. The success of the Summit leads us to encourage collaborative forums across the Globe.

Abstract 15092: Projected Cost Saving With Optimal Medication Adherence in Cardiovascular Disease Patients Requiring Lipid Lowering Agents in Mexico and Thailand

Background: Adherence to chronic cardiovascular treatments is less than 50% in developing countries, which impedes achieving targeted clinical outcomes. This study aims to estimate potential benefits of improving adherence in CVD patients requiring secondary prevention. Methods: We performed state-transition Markov model simulation for secondary CVD prevention in Mexico and Thailand. Stakeholders were engaged based on CHEERS II guideline. The analyses were performed upon a healthcare system perspective for a lifetime horizon. Two scenarios were compared: (1)optimal adherence (which is simulated based on mean adherence from a meta-analysis of 51 RCTs), and (2) status quo. The association of adherence and CVD outcomes (MI and stroke) is based on a dose-response meta-analysis of observational studies of 4,051,338 patients. Direct medical costs are obtained from literature review. Outcomes are accumulated number of CVD events and associated costs in 2022 USD, life-year, and quality-adjusted life years (QALYs). Sensitivity analyses were performed to assess the robustness of our findings. Results: Status quo in both countries were expected to have a higher risk of CVD than optimal adherence (Mexico: RR 1.22, 95% CI 1.17-1.28; Thailand: RR 1.21, 95% CI 1.16-1.26). The number needed to treat to prevent one additional CV event was 25.02 and 29.37, respectively. Consequently, achieving optimal adherence can increase life-year by 0.60, 0.84 and QALYs by 0.59 and 0.68 in Mexico and Thailand, respectively. Moreover, this could avert CV event-related medical costs of $614 and $313. When lipid lowering therapy costs are included, the optimal adherence scenario results in cost saving with $418 in Mexico and $293 in Thailand. Cost saving findings are robust across all sensitivity analyses. Conclusion: In developing countries, patients requiring lipid lowering agents for secondary CVD prevention suffer from preventable outcomes due to their suboptimal medication adherence. It is recommended to consider various methods of improving adherence that could result in cost savings and achieving therapeutic goals.

Abstract 13892: Enhancing Guideline-Directed Medical Therapy in Post-Discharge Heart Failure Patients Through Comprehensive Medication Management Visits With Virtual Clinical Pharmacists

Introduction: According to national registries, the adoption and effective titration of GDMT for patients with HFrEF remains notably inadequate. Utilizing virtual clinical pharmacists (VCPs) to identify deficiencies in medication therapy presents a flexible and efficient approach for thorough and immediate interventions following discharge. Methods: A single-center retrospective analysis from May 2022-April 2023 examined post-discharge HF patients who participated in a comprehensive medication management (CMM) visit conducted by a VCP within 72 hours of their discharge. Results: Of 116 participants, 108 (93%) had a discharge diagnosis of HFrEF, and 8 (6.8%) with HFimpEF. During the VCP visit, 27 (23.3%) presented with active HF exacerbation symptoms including SOB (33%), fatigue (22%), weakness (19%), lower extremity swelling (11%), weight gain (11%), and tachycardia (4%). The percentages of the total population currently prescribed GDMT for HRrEF and HFimpEF classes are as follows: Beta Blocker (89.7%), ARNI (47.4%), MRA (33.6%), SGLT2i (25.9%), and ACEI/ARB (22.4%). Up-titrating of dosage was recommended for 75% of patients currently prescribed ARNI, 64% for Beta Blockers, and 51% for MRAs. Additionally, VCPs recommended adding the following drug classes to those not prescribed, despite being indicated: SGLT2i (45%), ARNI (30%), MRA (29%), Beta Blocker (25%), and ACEI/ARB (24%). Comprehensive counseling on HF self-care practices was delivered to the entire cohort (100%). Furthermore, support was extended to facilitate the management of comorbid conditions for 105 patients (91%), and social assistance was provided to 7 patients (6%). Conclusions: The utilization of VCPs played a crucial role in identifying care gaps, including but not limited to patient symptoms, suboptimal medication therapy, insufficient disease education, social assistance, and comorbidity management, which collectively contributed to initiating and up-titrating GDMT.

Improving Patient-Reported Outcomes in Stroke Care using Remote Blood Pressure Monitoring and Telehealth

Abstract Background Inequities in health care access leads to suboptimal medication adherence and blood pressure (BP) control. Informatics-based approaches may deliver equitable care and enhance self-management. Patient-reported outcomes (PROs) complement clinical measures to assess the impact of illness on patients' well-being in poststroke care. Objectives The aim of this study was to determine the feasibility of incorporating PROs into Telehealth After Stroke Care (TASC) and to explore the effect of this team-based remote BP monitoring program on psychological distress and quality of life in an underserved urban setting. Methods Patients discharged home from a Comprehensive Stroke Center were randomized to TASC or usual care for 3 months. They were provided with a BP monitor and a tablet that wirelessly transmitted data to a cloud-based platform, which were integrated with the electronic health record. Participants who did not complete the tablet surveys were contacted via telephone or e-mail. We collected the Patient-Reported Outcomes Measurement Information System Managing Medications and Treatment (PROMIS-MMT), Patient Activation Measure (PAM), Neuro-QOL (Quality of Life in Neurological Disorders) Cognitive Function, Neuro-QOL Depression, and Patient Health Questionnaire-9 (PHQ-9). T-tests and linear regression were used to evaluate the differences in PRO change between the arms. Results Of the 50 participants, two-thirds were Hispanic or non-Hispanic Black individuals. Mechanisms of PRO submission for the arms included tablet (62 vs. 47%), phone (24 vs. 37%), tablet with phone coaching (10 vs. 16%), and e-mail (4 vs. 0%). PHQ-9 depressive scores were nominally lower in TASC at 3 months compared with usual care (2.7 ± 3.6 vs. 4.0 ± 4.1; p = 0.06). No significant differences were observed in PROMIS-MMT, PAM, or Neuro-QoL measures. Conclusion Findings suggest the feasibility of collecting PROs through an interactive web-based platform. The team-based remote BP monitoring demonstrated a favorable impact on patients' well-being. Patients equipped with appropriate resources can engage in poststroke self-care to mitigate inequities in health outcomes.

Secular Trends in Central Nervous System-Active Polypharmacy Among Serial Cross-Sections of US Adults, 2009-2020.

Data comprehensively examining trends in central nervous system (CNS)-active polypharmacy are limited. The objective of this cross-sectional study was to characterize the composition of and trends in CNS-active medication use in US adults. We included all participants ≥ 18 years old in the National Health and Nutrition Examination Study (NHANES), 2009-2020. The primary outcome was the percent of adults with CNS-active polypharmacy. This was defined as ≥ 3 medications among antidepressants [tricyclic, selective and serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs), opioids, antiepileptics, antipsychotics, benzodiazepines, and nonbenzodiazepine receptor agonists ("Z-drugs")]. Secondary outcomes included prevalence of any CNS-active medication and specific medications and classes over time, and their indications. Percentages were weighted according to NHANES's nationally representative sampling frame. log binomial regressions evaluated the relative risk (RR) for each outcome, comparing the last (2017-2020) versus the first (2010-2011) survey cycle. We included 34,189 adults (18.8% at least 65 years old) from five serial cross-sections (survey cycles). The prevalence of CNS-active polypharmacy was 2.1% in 2009-2010 and 2.6% in 2017-2020 [RR 1.18, 95% confidence interval (CI) 0.94-1.47]. The prevalence of CNS-active polypharmacy did not significantly change within any specific age group (e.g., age at least 65 years: RR 1.29, CI 0.74-2.24). The prevalence of any CNS-active medication was 21.0% in 2009 and 24.6% in 2017-2020 (RR] 1.12, 95% CI 1.02-1.25). A substantial increase occurred for antiepileptics (5.1-8.3%), specifically among participants aged 65 years and older (8.3-13.7%). This was largely driven by increasing gabapentin prevalence (1.4-3.6% overall; 3.3-7.9% age 65 years and older). Anticholinergic, SSRIs/SNRIs, antiepileptics, and benzodiazepines were elevated in most cycles for participants at least 65 years old compared with participants less than 65 years, and opioid use was increased in several cycles for older participants as well. Alprazolam was the most common benzodiazepine and third most common medication for anxiety/depression. Gabapentin was the most common CNS-active medication (3.6% of all participants in 2017-2020), followed by sertraline, citalopram, and acetaminophen-hydrocodone (each ~2%). The most common categories were antidepressants (13.7% in 2017-2020), followed by opioids (5.1% in 2017-2020). CNS-active medications are increasingly common, particularly gabapentin, and use of any CNS-active medication increased by 12%. Numerous CNS-active classes also increased in older adults throughout the years. Increasing suboptimal medication use highlight the need for further investigation into causes for potentially inappropriate prescribing, particularly for older adults.

Impact of a Standardized, Pharmacist-Initiated "Test-Claim" Workflow for Anticipating Barriers to Accessing Discharge Antimicrobials.

Background: Inability to access and afford discharge oral antimicrobials may delay discharges or result in therapeutic failure. "Test-claims" have the potential to identify such barriers. Objective: This study evaluated discharge antimicrobial access and patient outcomes after implementation of a standardized, inpatient pharmacist-initiated antimicrobial discharge medication cost inquiry (aDMCI) process. Methods: This was an Institutional Review Board (IRB)-approved, pilot retrospective cohort study that included adults admitted for ≥72 hours from November 1, 2018, to February 28, 2019, and discharged on oral antimicrobials. Patients with a cost inquiry (aDMCI group) were compared with those without (standard-of-care, SOC, group). Primary endpoint was discharge delay. Secondary endpoints included percentage of patients discharged on suboptimal antimicrobials and medication errors from aDMCI. Results: 84 patients were included: 43 in SOC and 41 in aDMCI. Seventy-five antimicrobial cost inquiries were evaluated among 41 patients. There were no discharge delays or medication errors associated with the standardized "test-claim" (aDMCI) workflow. Patients in the SOC group had a greater Charlson Comorbidity Index (4 [2-6] vs 2 [1-4], P =0.004), were more likely to be immunosuppressed (24, 56% vs 12, 29%; P =0.014), and had longer hospitalization (8 [5-15] vs 6 [5-9] days, P =0.026). Primary access barriers were prior-authorization (8, 11%) and associated with linezolid and moxifloxacin cost inquiries. Most aDMCIs results were available in <24 hours (66, 88%). Conclusions: The aDMCI process is safe and offers an actionable transition of care tool that can identify barriers to accessing discharge medications while insulating patients from surprise out-of-pocket cost.

Cross-sectional analysis of factors associated with medication adherence in western Kenya

ObjectivesPoor medication adherence in low-income and middle-income countries is a major cause of suboptimal hypertension and diabetes control. We aimed to identify key factors associated with medication adherence in western...