Therapeutic Adherence In Patients Research Articles

Access to health services and its influence on adherence to treatment of arterial hypertension during the COVID-19 pandemic in a Hospital in Callao, Peru: A cross-sectional study

Background Access to health services compromises therapeutic adherence in patients with arterial hypertension (HTN), which is a risk factor for cardiovascular disease and premature death. The aim of the research is to determine the influence of access to health services on adherence to antihypertensive treatment during the COVID-19 pandemic. Methods We included a cross-sectional analytical study. A survey was applied to 241 hypertensive patients at the Daniel Alcides Carrión Hospital, Callao-Peru. Data were analyzed using SPSS software. Absolute and relative frequencies were reported and the chi-square test was applied with a statistical significance level of p<0.05. In addition, multiple logistic regression analysis was performed using the Stepwise method. Results Our results show that non-adherence to treatment is associated with health expenses (ORa: 1.9 CI 95% 1.7-2.2), considers the environment clean (ORa: 1.4 IC 95% 1.2-1.8), not receiving care due to lack of a doctor (ORa: 2.8 CI 95% 1.5-3.2), difficult with procedures (ORa: 2.8 IC 95% 1.2-2.8), having difficulty with schedules (ORa: 3.7 CI 95% 2. 3-5.5), fear of receiving care at the hospital (ORa: 4.5 CI 95 % 2.7-6.8), trust in health staff (ORa: 7.5 CI 95% 2.3-10.5) and considering that the physician does not have enough knowledge (ORa: 3.1 CI 95% 2.4-7.8). Conclusion Therapeutic adherence was associated with expenses in the consultation considers the environment clean, not receiving care due to lack of a doctor, difficult with procedures, having difficulty with schedules, fear of receiving care at the hospital, trust in health staff and considering that the physician does not have enough knowledge.

Peer support impact on therapeutic adherence in patients with multiple sclerosis: a mixed-methods pilot trial protocol

IntroductionPatient partnership is a key component of patient-centred care. One form of partnership is individual peer support, which can improve patients’ quality of life and adherence to treatment. Patient with...

Patient-Centered Prescription Model to improve therapeutic adherence in patients with multimorbidity

To date, interventions to improve medication adherence in patients with multimorbidity have shown modest and inconsistent efficacy among available studies. Thereby, we should define new approaches aimed at improving medication adherence tailored to effective prescribing, with a multidisciplinary approach and patient-centered.In this regard, the Patient-Centered Prescription Model has shown its usefulness on improving appropriateness of drug treatments in patients with clinical complexity. For that, this strategy addresses the following four steps: 1) Patient-Centered assessment; 2) Diagnosis-Centered assessment; 3) Medication-Centered assessment; and 4) Therapeutic Plan.We propose through a clinical case an adaptation of the Patient-Centered Prescription Model to enhance both appropriateness and medication adherence in patients with multimorbidity. To this end, we have included on its first step the Spanish version of a cross-culturally adapted scale for the multidimensional assessment of medication adherence. Furthermore, we suggest a set of interventions to be applied in the three remaining steps of the model. These interventions were firstly identified by an overview of systematic reviews and then selected by a panel of experts based on Delphi methodology.All of these elements have been considered appropriate in patients with multimorbidity according to three criteria: strength of their supporting evidence, usefulness in the target population and feasibility of implementation in clinical practice.The proposed approach intends to lay the foundations for an innovative way in tackling medication adherence in patients with multimorbidity.

Access to health services and its influence on adherence to treatment of arterial hypertension during the COVID-19 pandemic in a Hospital in Callao, Peru: A cross-sectional study.

Access to health services compromises therapeutic adherence in patients with arterial hypertension (HTN), which is a risk factor for cardiovascular disease and premature death. The aim of the research is to determine the influence of access to health services on adherence to antihypertensive treatment during the COVID-19 pandemic. We included a cross-sectional analytical study. A survey was applied to 241 hypertensive patients at the Daniel Alcides Carrión Hospital, Callao-Peru. Data were analyzed using SPSS software. Absolute and relative frequencies were reported and the chi-square test was applied with a statistical significance level of p<0.05. In addition, multiple logistic regression analysis was performed using the Stepwise method. Our results show that non-adherence to treatment is associated with health expenses (ORa: 1.9 CI 95% 1.7-2.2), considers the environment clean (ORa: 1.4 IC 95% 1.2-1.8), not receiving care due to lack of a doctor (ORa: 2.8 CI 95% 1.5-3.2), difficult with procedures (ORa: 2.8 IC 95% 1.2-2.8), having difficulty with schedules (ORa: 3.7 CI 95% 2. 3-5.5), fear of receiving care at the hospital (ORa: 4.5 CI 95 % 2.7-6.8), trust in health staff (ORa: 7.5 CI 95% 2.3-10.5) and considering that the physician does not have enough knowledge (ORa: 3.1 CI 95% 2.4-7.8). Therapeutic adherence was associated with expenses in the consultation considers the environment clean, not receiving care due to lack of a doctor, difficult with procedures, having difficulty with schedules, fear of receiving care at the hospital, trust in health staff and considering that the physician does not have enough knowledge.

Abstract 115: An Action Plan To Improve Biochemically Detected Non-adherence To Antihypertensive Treatment Results In A Short-term Reduction In Arterial Stiffness And A Long-term Reduction In Albuminuria (the ATHAN Clinical Trial)

We previously shown that a specific 3-months(m) intervention improved therapeutic adherence in patients with non-controlled hypertension (HT) decreases blood pressure (BP). We aim to evaluate if there is also a decrease in HT-mediated organ damage (HMOD) at short- and long-term. We conducted a prospective, randomized clinical trial in a HT Unit. Consecutively attended patients with 24h-BP &gt;or=130/80 mmHg despite receiving at least 2 antihypertensive drugs and with therapeutic non-adherence confirmed by determination of antihypertensives in urine (n=47) were randomized (1:1) to receive a specific 3m program to improve adherence (INT=intervention) or routine follow-up (C=control). Antihypertensive treatment was not changed. Prior to randomization, and at 3m and 12m, the presence of antihypertensives in urine and albuminuria were determined. BP and pulse wave velocity (PWV) were evaluated by 24h- ambulatory monitoring in all periods. After 3m, all patients received usual care. At 3m, the adjusted BP differences (mean; 95% CI) from baseline (INT vs. C) were -14.3 mmHg (-5.1 to -23.5), p=0.003, and -10, 0 mmHg (-4.0 to -16.0), p=0.002, for 24h-SBP and 24h-DBP, respectively. The INT group maintained the decrease in BP at 12m. vs baseline: mean change (95% CI) of 24h-SBP = -16.1 mmHg (-22.8 to -9.4), p &lt;0.001 and 24h-DBP change = -7.8 (-12, 8 to -2.7), p=0.002. In the INT group, the percentage of undetected antihypertensive drugs decreased from baseline (median [interquartile range]): 40% [20-100], 0% [0-25], and 18.3% [0-40] at baseline, 3m and 12m, respectively; Z= -3.426 (p&lt;0.001) and Z= -3.055 (p=0.002) for changes at 3m and 12m, respectively. PWV decreased at 3m only in the INT group: mean difference (95% CI) -0.402 m/sec (-0.054 to -0.749), p=0.025, but not at 12m. Albuminuria (median [IQR]) decreased in the INT group at 12m: 27.1 mg/g [11.1-116.2] and 22.4 mg/g [6.4-91.9] at baseline and 12 m, respectively (Z=-2.207, p=0.027). In conclusion, urine biochemical detection of therapeutic non-adherence and a specific 3m-intervention to improve adherence lead to better BP control, which maintains in the long term. In addition, there is a decrease in arterial stiffness in the short term and a regression of albuminuria in the long term, thus reducing the HMOD.

Impact of the Allergic Therapeutic Adherence in Children with Allergic Rhinitis and ADHD: A Pilot Study.

Allergic rhinitis (AR) is the most common chronic allergic disease in children. Several studies have shown an association between attention deficit hyperactivity disorder (ADHD) and allergies, especially AR. Patients with ADHD usually have poor therapeutic adherence, and untreated AR symptoms may worsen the quality of life of patients. The aim of our study was to analyse therapeutic adherence in patients with ADHD and AR and estimate the impact of the adherence on ADHD symptoms. Total Nasal Symptoms Score (TNSS), Paediatric or Adolescent Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ 6-12 years; ARQLQ 13-17 years), Swanson, Nolan, and Pelham version IV scale (SNAP-IV), and Medication Assessment Questionnaire (MGL MAQ) were recorded. In the AR-ADHD group, a positive correlation between TNSS and SNAP-IV subscales was found: worse AR symptoms were related to a negative effect on ADHD scores. AR-ADHD patients with better ADHD therapeutic adherence showed higher AR symptoms and higher oppositional defiant disorder scores in the SNAP-IV questionnaire. Our results suggest that better adherence to AR therapy (oral antihistamines and/or intranasal corticosteroids, INCS) is associated with a reduction in inattention symptoms in children with ADHD. This data could prove to be fundamental for the psychic outcome of these patients.

Adherencia terapéutica de pacientes con riesgo cardiovascular en atención primaria. Proyecto REAAP

ObjectiveTo describe the perceptions and daily experiences of primary care (PC) physicians in dealing with the lack of therapeutic adherence in patients with cardiovascular risk, as well as their expectations and possible areas for improvement. Material and methodsA qualitative study (within the framework of the REAAP project: Network of Experts in Adherence in Primary Care) carried out in several autonomous communities in Spain using an open-ended questionnaire completed by PC physicians and analyzed using the framework analysis method to guide the coding of the topics. ResultsEighteen physicians participated, and three main themes were identified from their responses: an approach to adherence during clinical practice, barriers that hinder the appropriate adherence, and interventions to improve it. The strategies most frequently mentioned to facilitate patients’ therapeutic adherence were improving physician-patient communication and continuity of care, involving community pharmacies, and simplifying treatment by prescribing drugs in fixed combinations. ConclusionsThere is no single ideal strategy to facilitate therapeutic adherence, and it is necessary to combine several interventions to optimize it. The first step is to understand the problems and the tools available. Initiatives such as the REAAP project are an important means to improve patient adherence, and for healthcare personnel to recognize the importance that this issue deserves.

A SPECIFIC 3 MONTHS-PROGRAM TO IMPROVE NON-ADHERENCE IN UNCONTROLLED HYPERTENSION IMPROVES BLOOD PRESSURE CONTROL AND ASSOCIATED ORGAN DAMAGE (ATHAN CLINICAL TRIAL)

Objective: To evaluate whether a specific 3-month(m) action plan to improve therapeutic adherence in patients with uncontrolled hypertension on ◊ 2 drugs results in a decrease in BP and whether this is maintained at 12m. Secondly, to assess if this correlates with an improvement in subclinical organ damage. Design and Method: Prospective, randomized clinical trial where patients attended consecutively in a Hypertension Unit with ambulatory 24h-BP ◊130/80 mmHg despite receiving at least 2 antihypertensive drugs and with therapeutic non-compliance confirmed by the determination of antihypertensive drugs in the urine, were randomized (1:1) to receive a specific 3-month program to improve adherence (INT = intervention) or routine follow-up (C = control). Antihypertensive treatment was not modified, but beyond 3m all patients received usual care. Before randomization, and at 3m and 12m, urinary screening for antihypertensive drugs and albuminuria, and 24h-ambulatory BP monitoring were determined. Results: Forty-six patients were randomized. At 3m, mean (95%CI) baseline-adjusted BP differences (INT vs. C) were -14.7 mmHg (-5.4 to -24.1), p = 0.001 and -10.0 mmHg (-3.9 to -16.2), p&lt;0.001 for 24h-SBP and 24h-DBP, respectively. The INT group maintained the BP decrease at 12m. vs. baseline: mean(95%CI) variation of 24h-SBP = -16.1 mmHg (-22.8 to -9.4), p&lt;0.001 and variation of 24h-DBP = -7.8 (-12.8 to -2.7), p = 0.002. In the INT group, the percentage of non-detected antihypertensive drugs decreased compared to baseline: median [IQR]: 40% [20-85.7], 0% [0-25], and 18.3 % [0-40] at baseline, 3m and 12m respectively; Z = -3.295 (p&lt;0.001) and Z = -3.055 (p = 0.002) for changes at 3m and 12m, respectively. Albuminuria (median [IQR]) decreased in the INT group: 27.1 mg/g [11.2-116.2] and 22.4 mg/g [6.4-91.9] at baseline and 12m, respectively (Z = -2.207, p = 0.027). At 12m, variation of albuminuria correlated with variation of 24h-BP but not with variation of percentage of non-detected antihypertensive drugs. Conclusions: a 3-month specific nursing intervention to improve therapeutic adherence results in improved BP control in patients with inadequate therapeutic compliance. This improvement continues beyond the completion of this program. Decreased BP correlates with a regression of albuminuria.

Targeting the gut-brain axis for therapeutic adherence in patients with inflammatory bowel disease: a review on the role of psychotherapy

Purpose Inflammatory Bowel Diseases (IBD) are disorders intensively studied in the literature as a model of gut-brain interactions within the so-called gut-brain axis. A non-negligible proportion of patients with IBD have psychological and psychiatric comorbidities and show non-low levels of depressive and anxiety symptoms. The remitting-recurrent course of IBD poses the need for therapeutic intervention that not only serves to induce clinical remission of the disease but also has an impact on maintenance. Therefore, therapeutic adherence is undoubtedly a cornerstone of managing these patients.Material and methods A literature search was conducted to identify studies with psychotherapy as an intervention and therapeutic adherence to IBD-specific therapy as one of the outcomes.Results Not many studies in the literature have specifically explored the role of psychotherapy in improving therapeutic adherence in patients with IBD. Most of the available trials have focused on cognitive-behavioral psychotherapeutic interventions and are directed toward basically oral therapies. Other studies focused on interventions delivered under telemedicine or mindfulness or hypnotherapy techniques.Conclusions This narrative review leans toward a probable beneficial effect of psychotherapy in therapeutic adherence although new and more organic studies need to be conducted to generate stronger evidence.

Barriers and Facilitating Factors of Adherence to Antidepressant Treatments: An Exploratory Qualitative Study with Patients and Psychiatrists.

This study examines the experiences and expectations of patients with depressive disorders regarding the disease and different antidepressants, as well as examining the barriers and facilitating factors that could affect their adherence to medications. An exploratory qualitative study was carried out. The study involved two focus groups made up of patients and caregivers and six semi-structured interviews with psychiatrists. In both cases, the participants were selected by intentional theoretical sampling, seeking maximum significance variation of social types. Prejudice about the side effects of medication was relevant. The importance of patients being well informed about the disease/treatments was noteworthy. The stigmatization of antidepressants by patients was identified as a barrier to medication adherence. The involvement of family members and the motivation of patients to be actively involved in the process to recover from the disease were identified as facilitating factors. The work carried out suggests the need for patients to have rigorous information about the disease/treatment to reduce the possible prejudices generated by beliefs. Maintaining greater contact and monitoring of patients/caregivers to help therapeutic adherence in patients with depressive disorders was also identified as being of great importance.

Third-generation antipsychotics in patients with schizophrenia and non-responsivity or intolerance to clozapine regimen: What is the evidence?

Clozapine is considered « the golden standard » for the management of treatment-resistant schizophrenia, but many patients do not present adequate responsivity even to this antipsychotic. If we add the need to strictly monitor the hematologic and cardiometabolic adverse events during each clozapine trial and the difficulty of preserving therapeutic adherence in patients with low insight, residual negative/positive symptoms, or economic challenges, then the necessity of exploring alternative interventions for these patients becomes obvious. Also, in case of intolerance to clozapine or where clozapine did not induce remission, clinicians have to find new ways to help their patients. Switching to other antipsychotics or using these agents as add-ons to clozapine are the main interventions explored in this review, for patients with schizophrenia resistant to clozapine (ultra-resistant schizophrenia, URS). When clozapine intolerance is detected, conversion to another antipsychotic with distinct pharmacologic properties or formulation (e.g., long-acting intramuscular injectable agents, LAI) may be a useful option. Third-generation antipsychotics (TGA) have been selected for their distinct pharmacodynamically profile, which allows, at a theoretical level, their use in combination with clozapine. This narrative review is based on searching four electronic databases, that retrieved 19 primary and secondary reports on aripiprazole (seven case reports or case series presenting 24 patients; nine clinical trials, and three systematic reviews/meta-analyses), two primary reports on brexpiprazole (case report and case series, N = 3 patients), and six primary reports on cariprazine (case reports and case series, N = 14 patients). Based on the information collected from these reports, which included oral and LAI formulations, the TGA most supported by evidence for the augmentation of clozapine is aripiprazole (high-and medium-quality data), followed by cariprazine (low-quality data). Brexpiprazole has not yet been systematically explored for this indication, and in the case of lumateperone, no report could be found. The efficacy of aripiprazole and cariprazine was supported in the domains of positive, negative, and general symptoms, and aripiprazole may positively impact the metabolic profile in patients with URS. Also, adding TGA may lead to a decrease in the dose of clozapine concomitantly administered. More data derived from good quality research are needed in order to confirm the circumstances of TGAs recommendation in patients with URS, either as monotherapy, or added to clozapine.

Modifications in self-care, quality of life and therapeutic adherence in patients with rheumatoid arthritis during the SARS-CoV-2 pandemic treated by telehealth

IntroductionRheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation, causing pain and stiffness in the joints. SARS-CoV-2 increases the clinical vulnerability of the population with RA and has led to the implementation and/or development of telemedicine. ObjectiveTo describe changes in level of therapeutic adherence, quality of life and capacity for self-care agency, during the follow-up period of a group of patients linked to a non-face-to-face multidisciplinary consultation model during the SARS-CoV-2 pandemic. MethodologyDescriptive cohort study (July to October 2020). Description of the level of therapeutic adherence (Morisky Green Test), quality of life (EuroQOL-5-Dimensions-3-Level-version) and self-care capacity (ASA-R Scale) in the context of a telehealth model. A univariate and bivariate analysis was performed (Stata Software, Considered p-value <0.05). ResultsOf 71 patients treated under the telehealth model, 85.9% were women, the age range was between 33 and 86 years with a median of 63. The most prevalent comorbidity was arterial hypertension (35.2%). Quality of life did not change during follow-up nor did adherence to treatment, apart from in one item [the patients did not stop taking the medication when they were well (p = 0.029)]. In self-care capacity, there were significant improvements in five dimensions (p < 0.05), without significant differences in the global score. ConclusionPatients with RA evaluated in the context of telehealth in a period of pandemic did not present significant changes in quality of life, adherence to treatment, or capacity for self-care, and remained close to baseline values when they attended a traditional face-to-face assessment.

Development and Implementation of an Interprofessional Digital Platform to Increase Therapeutic Adherence: Protocol for a Mixed Design Study.

BackgroundAdherence to care plans is a major issue in health care systems. Improved adherence has several potential benefits such as ensuring treatment effectiveness and control of chronic diseases. There is currently a lack of tools to maximize treatment adherence in an integrated manner, that is, covering multiple aspects of patients’ health continuously throughout their medical care. To ensure better adherence, such tools must meet the needs of patients with chronic conditions as well as those of health care professionals. Acknowledging the health issues associated with nonadherence to treatment, an industry-research-clinical partnership aims to adapt a digital platform—facilitating patient-health care professional interactions—to improve therapeutic adherence in patients with chronic illnesses. The platform allows for exchanges between patients and health care professionals to facilitate the timing of medication use or chronic disease management and maximize patient adherence.ObjectiveThis study aims to (1) identify the needs of patients living with a chronic condition and their health professionals concerning their interactions regarding treatment; (2) codevelop an adaptation of an interactive patient-professional platform that meets the needs identified; and (3) then test the platform and document its effects and acceptability in a clinical setting.MethodsThe study will use a creative design thinking process based on the needs expressed by users (patients and health professionals) concerning treatment adherence for chronic diseases (eg, diabetes, asthma, high blood pressure, depression and anxiety, chronic obstructive pulmonary disease). A mixed method evaluation research design will be used to develop and evaluate the platform. Qualitative data will be used to assess user needs and acceptability of the platform, and quantitative data will provide the necessary insights to document its effects.ResultsTechnological development of the platform has been completed. Recruitment for the first part of Phase 1 started in May 2022. The results of this project to codevelop an interprofessional digital platform to increase therapeutic adherence will be relevant to clinicians and managers seeking contemporary solutions that support patient adherence to treatment for chronic diseases. These results will enable optimal use of the platform and identify areas for improvement in interactive patient-health care professional apps.ConclusionsThe adoption of an interactive digital platform to facilitate effective exchanges between patients and health care professionals in primary care settings could improve adherence to treatment. The platform tested in this project takes a first step in this direction by ensuring that the technological product is developed according to the needs of patients as well as the health professionals who are likely to use it.International Registered Report Identifier (IRRID)DERR1-10.2196/34463

Barriers and Solutions to Improve Therapeutic Adherence from the Perspective of Primary Care and Hospital-Based Physicians.

PurposeTo identify the barriers affecting treatment adherence in patients with chronic disease and to determine solutions through the physician’s opinion of primary care and hospital settings.MethodsAn observational study using the nominal group technique was performed to reach a consensus from experts. A structured face-to-face group discussion was carried out with physicians with more than 10 years of experience in the subject of treatment adherence/compliance in either the primary care setting or the hospital setting. The experts individually rated a list of questions using the Likert scale and prioritized the top 10 questions to identify barriers and seek solutions afterward. The top 10 questions that obtained the maximum score for both groups of experts were prioritized. During the final discussion group, participating experts analyzed the prioritized items and debated on each problem to reach consensual solutions for improvement.ResultsA total of 17 professionals experts participated in the study, nine of them were from a primary care setting. In the expert group from the primary care setting, the proposed solution for the barrier identified as the highest priority was to simplify treatments, measure adherence and review medication. In the expert group from the hospital setting, the proposed solution for the barrier identified as the highest priority was training on motivational clinical interviews for healthcare workers undergraduate and postgraduate education. Finally, the expert participants proposed implementing an improvement plan with eight key ideas.ConclusionA consensual improvement plan to facilitate the control of therapeutic adherence in patients with chronic disease was developed, taking into account expert physicians’ opinions from primary care and hospital settings about barriers and solutions to address therapeutic adherence in patients with chronic disease.

Predictors of therapeutic adherence in patients with severe mental illness

Introduction. This study aims to deepen our understanding of therapeutic adherence in patients with severe mental illnesses, an issue that holds significant public health and economic implications. Worldwide, one in eight individuals is affected by a mental disorder, leading to a substantial cost both direct and indirect, including extended hospital stays and lost productivity. Non-adherence to medication treatments remains a complex issue influenced by various demographic, socioeconomic, and disease-specific factors. The paper seeks to identify variables that contribute to decreased adherence in this population and compare them with existing literature. Method. This study, conducted from September 2022 to December 2022 at the Clinical Hospital of Psychiatry ‘Professor Doctor Alexandru Obregia’ in Bucharest, Romania, involved 177 participants. Data was collected through interviews, patient records, and verified with attending physicians and family members as needed. Exclusions were made for patients not fluent in Romanian or diagnosed with a major neurocognitive disorder per DSM-5. Assessments included the Clinical Global Impression Severity Scale (CGI-S) for disease severity and the modified Overt Aggression Scale (mOAS) for aggressive behavior. Treatment adherence was defined as taking 80-120% of the prescribed psychiatric treatment dose in the 4 weeks prior to current admission and was corroborated by at least two external sources. Statistical analysis employed logistic regression and post hoc Tukey tests to identify significant differences in patient data. Results. In our study, no statistically significant correlation was found between treatment adherence and various sociodemographic or personal factors. However, patients living alone had an Odds Ratio of 4.92, suggesting almost five times higher likelihood of treatment non-adherence. No significant correlations were identified concerning diagnosis, illness duration, or number of hospitalizations. Patients brought in by police had an 11-fold higher risk of non-compliance (OR 11.05), while those brought by ambulance had a 4-fold increased risk (OR 3.923). Non-compliant patients were more likely to experience prolonged involuntary hospitalization (p=0.007) and had a 4-fold greater risk of involuntary admission (OR 3.96). High scores on the Clinical Global Impression Scale (CGI), Admission Experience Survey (AES), and Modified Overt Aggression Scale (mOAS) were statistically significant predictors of patient non-compliance. Conclusion. In our study, we found no significant correlation between sociodemographic factors and medication adherence. However, living alone significantly raised the odds of non-adherence, suggesting the role of social support in treatment compliance. Manner of admission to the emergency room emerged as a key predictor, with involuntarily admitted patients showing heightened risks of non-compliance. Our data supports the linkage between lower adherence and more days of hospitalization, in alignment with the specialty literature. Patients admitted involuntarily were notably four times more likely to be non-adherent (OR 3.96, p=0.001). Additionally, the severity of illness at the time of admission was higher among nonadherent patients, as assessed by CGI, AES, and mOAS scales.

Improving Therapeutic Adherence of Oral Antidiabetics in Insulin-Dependent Patients with Type 2 Diabetes Mellitus: the Combination of a Fixed-Dose

Objective: To assess whether the combination of fixed-dose Oral Antidiabetic drugs (OA) in a single tablet compared to OA separated into 2 or more tablets is an effective strategy to improve adherence in insulin-dependent patients with Type 2 Diabetes Mellitus (DM2). Methods: This was a prospective, longitudinal, multi-center study, carried out in 3 primary care centers in Spain. One hundred and twenty patients treated with OA and insulin prescribed for insulin-dependent DM2 were included. A cluster randomization was performed based on two groups: (1) Control Group (CG): Sixty patients treated with two OA prescribed separately in different tablets, and (2) an Intervention Group (IG): Sixty patients treated with OA were with 2 drugs in combination at a fixed dose, in a single tablet. Three visits took place. AO Adherence was measured by using electronic monitors (MEMS). Average adherence percentage (%; Average AP) and daily compliance (%; Daily AP) was calculated. A patient was considered adherent when AP was 80–100%. Insulin adherence was measured by counting. Results: One hundred and ten patients completed the study (79 in the IG and 31 in the CG). Global adherence was 92,59% and 79,62% in IG and 82,85% and 48,21% in CG at 6 and 12 months, respectively (p&lt;0.05 by groups). Daily adherence was 79,62% and 62,96% in IG and 17,85% and 10,71% in CG at 6 and 12 months, respectively (p&lt;0.05). Global adherence with insulin by count was 77,78% and 70,37% in IG and 57,14% and 60,71% in CG at 6 and 12 months, respectively with significant differences. In the non-adherent group, the number of concomitant medications and glucemia and haemoglobin A glycosylate levels at 6 and 12 months, were significantly higher than in the adherent population. The NNT was 4,42 patients to prevent one non-adherence. Conclusions: The combination of fixed-dose OA in a single tablet compared to OA separated into 2 or more tablets is an effective strategy to improve AO therapeutic adherence in patients with insulin-dependent DM2.

Therapeutic adherence of patients with breast and prostate cancers

Objective: to analyze the treatment compliance of patients with breast and prostate cancers. Methods: cross-sectional study with 303 patients with breast and prostate cancers. A semi-structured instrument and the Adherence Determinants Questionnaire Scale Brazilian version were used, and the data were analyzed using descriptive and inferential statistics. Results: mean adherence was found among all participants (100.0%). In patients with prostate cancer, we observed weak correlations between age and interpersonal aspects of care (r=0.198; p=0.048); and between treatment time and intentions (r=-0.295; p=0.049). In breast cancer patients, there was a positive correlation between age and perceived support/severity (r=0.174; p=0.013); and between years of study and interpersonal aspects of care (r=0.145; p=0.038) and intentions (r=0.156; p=0.026). Conclusion: patients with breast and prostate cancers showed moderate adherence to treatment, with higher means in the Support/Severity domain and lower in the Perceived Susceptibility domain.

The influence of reminder book to adherence of heart failure patients in Malang city.

Background: Non-adherence to the recommended therapy causes patients with heart failure to experience recurrence of the disease. Reminder book on therapy adherence is very useful, because it assists in monitoring adherence to therapy carried out by patients while at home. Therefore, this study aims to determine the effect of the existence of a reminder book on adherence to therapy among patients with heart failure in a private hospital in Malang.Design and Methods: A pre-experiment design with one-group pre and posttest was used. The respondents were 18 patients that received counseling on the management of heart failure therapy while at home and were given a reminder book. Furthermore, the modified MMAS-8 scale was the study instrument used to measure adherence.Result: The results showed that most respondents were above the age of 65 with a treatment duration of 1 to 5 years. It was discovered that most of the respondents had never received information about heart failure therapy. Data analysis which was carried out using the Wilcoxon test with a p-value of 0.001, showed that there was a significant difference between respondents’ compliance before and after being given a reminder book.Conclusions: From this study, it was concluded that providing a reminder book has an effect on therapeutic adherence in patients with heart failure. Researchers recommend that hospitals should make use of this reminder as a tool to control or supervise outpatient therapy.Significance for public healthThe number of patients diagnosed with heart failure is increasing yearly, including rehospitalization rates. Adherence to therapy among patients with heart failure is important in preventing recurrence. One of the ways in improving adherence is the use of self-management techniques, such as independent monitor therapy. An example of this therapy is the use of a reminder book which helps to improve adherence and self-efficacy in patients with heart failure.

An observational study evaluating effectiveness and therapeutic adherence in patients with Type 2 Diabetes initiating dulaglutide vs. subcutaneous semaglutide in Spain

AimsTo evaluate in a real-world setting the effectiveness and adherence of weekly Dulaglutide and subcutaneous (sc) Semaglutide in patients with Type 2 Diabetes Mellitus (T2DM). MethodsSingle-centre retrospective observational study comparing glucose reduction (change from baseline of Fasting Plasma Glucose – FPG, and HbA1c) and weight reduction (absolute change in weight from baseline and % weight reduction) in patients initiating Dulaglutide (n=183) or sc Semaglutide (n=115) during an index period of 18 months. Safety, adherence to and persistence on index drug were also evaluated. ResultsPatients initiating Dulaglutide were older, had a longer diabetes duration and higher baseline FPG (180 vs. 165 mg/dl) and HbA1c (8.2 vs 7.84%) and were prescribed more insulin and sulfonylurea and less SGLT-2 inhibitors vs. patients on sc Semaglutide. After a median follow-up period of 9.37 months, both drugs reduced FPG by 43.18 mg/dl (Dulaglutide) and 48.36 mg/dl (sc Semaglutide); and HbA1c by 1.03% and 1.36%, respectively. Both drugs were associated to a weight loss of 5.63 kg (5.83% baseline weight) (Dulaglutide) and 7.6 kg (7.56%) (sc Semaglutide). Baseline age, duration of diabetes, BMI and HbA1c significantly influenced outcomes. Therapeutic adherence and persistence were similar for both drugs. Up to 95% of patients on Dulaglutide used 1.5 mg dose and 72% of patients on sc Semaglutide used 1.0 mg dose. ConclusionsIn a pragmatic setting and acknowledging important differences in baseline characteristics and background antidiabetic therapy that might drive specific drug prescription, both Dulaglutide and sc Semaglutide confirm a robust effect on glucose and weight reduction with a similar therapeutic adherence.

Efectos de la integración de grupos de ayuda mutua sobre la adherencia al programa de continuidad en el cuidado a pacientes con dependencia del alcohol realizado en Atención Primaria

ObjectivesTo demonstrate the effects of including mutual aid associations into a continuing care programme for patients with alcohol dependence carried out by Primary Care teams. SitePrimary Care Teams belonging to the attendance area of the University Hospital 12 de Octubre at Madrid. Participants207 participants with alcohol dependence treated in an intensive hospital outpatient-setting programme were included in a continuing care programme carried out by a Primary Care team for a four-year period. InterventionsPatients were randomised into two intervention modalities. The first group was followed up while receiving a treatment modality known as «monitoring recovery» (Group A, n = 97). The other group, in addition to the above-mentioned intervention, attended to a mutual aid association included in the Federation of Alcoholics of the Community of Madrid (FACOMA) in which the programme «Help Yourself-Help Us» was carried out (Group B, n = 112). Main OutcomesDropout rates on the sessions designed to monitor their recovery from their alcohol dependence and other comorbid medical conditions. ResultsPatients in Group B reached higher rates of therapeutic adherence to the programme (47.9% vs. 14.7%, p < 0.01), as well as for the comorbid medical issues when compared to Group A. ConclusionsIncluding mutual aid associations that carried out the «Help yourself-Help Us» programme for a four-year period improves outcomes related to therapeutic adherence in patients with alcohol dependence attending Primary Care teams.