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Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice
... The general psychometric properties of validity, reliability, sensitivity and specificity are defined in appendix Bl. All need to be considered when assessing a measure of adherence (Farmer 1999) as does the possibility of bias in the study design. ...
... Reviews of adherence research conclude that the quality of much work is poor due to shortcomings in the methodology, including the measurement of adherence (Nichol et al. 1999;Farmer 1999). Adherence can be measured 'directly', for example by biochemical assay of the drug, or 'indirectly' by self-report questionnaire. ...
... Direct measures are the only way to ensure a patient has actually swallowed prescribed medication. However no measure is perfect, making identification of a reference measure difficult (Farmer 1999). Measurement of adherence is also made difficult by problems defining adherence, particularly if nonadherence is partial or if a temporal component is considered. ...
p> The main objectives of this study were firstly, to compare candidate measures of adherence (cyclosporin levels, self-report, clinician and interviewer ratings) used in all subjects with the ‘gold standard’ of electronic monitoring used in a random sample of 60 subjects to find the most valid and feasible method for use in clinical practice, and estimate the prevalence of non-adherence; secondly, to investigate the major variables associated with non-adherence with the aim of identifying potentially modifiable factors.
One hundred and seventy two subjects were invited to take part. Nineteen refused to take part and complete data were available for 145 subjects. The sample was representative of the eligible population. Other measures of adherence performed poorly when tested against electronic monitoring. Therefore main analyses were confined to the 58 subjects with data available from electronic monitoring of adherence to prednisolone. Two patterns of non-adherence were identified: missing medication and erratic timing of doses. Seven (12%) subjects missed at least 20% days prednisolone and 26 (45%) took their medication outside a 12 hour period 32% of the time. Multivariate analyses showed that the factors most strongly associated with non-adherence were having a transplant from a live donor, having less belief in the need for prednisolone specifically or for immunosuppressants as a group, being prescribed prednisolone on alternate days and functional limitations due to emotional factors. Depression occurred in 30% subjects but was not significantly associated with non-adherence.
The results show that a significant proportion of transplant recipients are non-adherent to immunosuppressants and that beliefs about medication are a promising target for an intervention designed to improve adherence. Clinicians need to be aware that subjects with transplants from live donors may be at greater risk of non-adherence and that patients may hold beliefs about immunosuppressants that differ from medical opinion and that impair adherence in manner that is logical to the patient. </p
... Um die Adhärenz bei der Medikamenteneinnahme zu überprüfen, wurden verschiedene [30]. Kevin C. Farmer beschreibt einen hohen Cut-Off-Wert mit einer Erhöhung der Sensitivität der Messmethode bei gleichzeitiger Erniedrigung der Spezifität und umgekehrt [104]. Bei "Überadhärenz" (Patient nimmt mehr Tabletten ein als verschrieben) können auch Angaben >100% erreicht werden [30]. ...
... Um eine zuverlässigere Aussage über die Adhärenz treffen zu können, wird daher eine Kombination mehrerer Messmethoden empfohlen [104]. ...
... Bei der direkten Überwachung der Medikamenteneinnahme werden die Patienten durch den Arzt oder durch medizinisches Personal dabei beobachtet, wie sie die Tabletten einnehmen [105]. Diese quantitative Methode ist aus organisatorischen Gründen allerdings oft nur bei Einzeldosen sowie bei stationär aufgenommenen Patienten möglich [69,104]. Im Alltag lässt sich diese Beobachtungsmethode oft nicht umsetzen. ...
Laut Schätzungen des Robert Koch-Instituts erkranken jährlich fast 500.000 Personen an einer Krebserkrankung, mit steigender Tendenz. Durch stetige Fortschritte in der Forschung kam es durch die Entwicklung einer Chemotherapie in Tablettenform zu einem Paradigmenwechsel in der Krebstherapie. Für ein optimales Therapie-Outcome ist es von großer Bedeutung, dass die Patienten ein adhärentes Verhalten zeigen. Weiterhin zeigt sich in der bisherigen Literatur, dass psychische Komorbiditäten die Adhärenz und damit den Behandlungserfolg gleichermaßen beeinflussen können. Dies wurde in der vorliegenden Arbeit evaluiert. Die Studie umfasste insgesamt 69 Krebspatientinnen und -Patienten, die eine Chemotherapie mit Capecitabin erhielten. Untersucht wurden Gruppenunterschiede zwischen soziodemografischen und klinischen Variablen auf der einen Seite und Adhärenz auf der anderen Seite sowie die klinisch relevante Belastung durch Angstsymptome. Zur Datenerhebung wurden zum einen der MARS-Fragebogen zur Erfassung der Adhärenz und zum anderen der GAD-7 zur Erfassung der Angstsymptomatik verwendet. Adhärentes Verhalten in Bezug auf die Einnahme von Capecitabin zeigte sich bei 75.4% der Personen im untersuchten Studienkollektiv. Dieses Ergebnis steht in Einklang mit bisherigen Publikationen, die ebenfalls den Zusammenhang zwischen Adhärenz bei Capecitabin untersuchten. Die weitere Hypothese war, dass höhere Angstbelastungen unter Patienten signifikant mit einer verminderten Adhärenz in Zusammenhang stehen. Dies konnte in der vorliegenden Studie jedoch nicht festgestellt werden. Einerseits zeigte zwar nur ein geringer Anteil der untersuchten Patienten Hinweise einer Angststörung (7%), andererseits wurde festgestellt, dass nicht alle dieser Patienten eine psychotherapeutische Behandlung erhielten. Für zukünftige Forschungen wäre zu überlegen, weitere Messinstrumente zur Diagnostik einer niederschwelligen Angst einzusetzen. Weiterhin wären ein größeres Therapieangebot und umfassendere psychosoziale Unterstützung dringend erforderlich. Abschließend bleibt festzuhalten, dass in Zukunft weitere Studien, v.a. auch mit größeren Fallzahlen sowie Längsschnitt- oder Follow-up-Studien zu diesem Forschungsthema dringend indiziert sind.
... Thence, comparing physicians' prescription records and pharmacy dispensation records enables to identify the rate of primary nonadherence to prescribed medications with respect to the type of patients, physicians, their specialty, diagnosis, medications, their cost and co-payments as well as geographic location. Early detection of PNA can result in targeted communication with patients as well as can help to identify its causes and address them [5]. ...
... In Hungary [5], the PNA to medications prescribed by general practitioners for the time period 2012-2015 was 35.9%. The PNA was lower in the age group 65 + years than in the group 45-64 years (37.9%). ...
... The observed decrease in the PNA rate with age agrees well with the previous studies, e.g. from Poland [8] or Hungary [5]. The policyholder's social status category tends to correlate with their age, which is re ected in the PNA rates. ...
Background
ePrescription enables to investigate primary non-adherence (PNA) to pharmacotherapy by studying the percentage of prescriptions which have been issued (a prescription record present) but not dispensed in a pharmacy (a dispensation record missing) out of a total number of registered prescriptions. Identification of non-adherence enables to analyze its causes and target them efficiently.
Methods
This paper investigates PNA rate for prescriptions issued to patients with chronic diseases such as hypertension, diabetes mellitus and hypercholesterolemia (N=108 735), and its dependence on the following variables: geographic location, age, sex, social status, physicians specialty and the level of patient‘s co-payment for medications. The presented dataset comprises a private health insurance company’s prescription data collected over a period of 12 months (January 2018 – December 2018).
Results
The PNA rate for ePrescriptions issued to patients with the above-mentioned chronic diseases reached up to 4.0%. In general, the PNA rate showed decrease with increasing comorbidity as well as with age. Primary non-adherence rates were lowest for the prescriptions written by general practitioners (3.6%). Among health insurance premium defaulters who pay the full price of prescribed medications, the PNA rate showed decrease with their cost. Significantly higher PNA rate was observed among premium payers (40.4%) compared with premium defaulters (3.5%).
Conclusions
Interestingly, the very high rate of adherence among patients with chronic diseases exceeds the numbers previously reported in the literature, where adherence rate ≥80% is described as ‘good’ adherence. This could be partially explained by the fact that the present study included only chronic-disease patients undergoing a medical treatment – non-diagnosed patients or patients without a medical treatment were not considered.
... A study by MacEwan et al. demonstrated that assessment of adherence rates is generally not better than a random guess (53 vs. 50%) [4]. Precise measure or assessment of insulin adherence is acknowledged as an important prerequisite to improving insulin nonadherence [3] and interpreting the effects of an intervention [5]. Results and clinical outcomes from an intervention cannot be interpreted realistically without information regarding correct adherence, i.e., if therapy fails to achieve the desired outcome, there is a risk that the clinician or researcher assume that a drug failure has occurred if adherence is assessed incorrectly and nonadherence, therefore, is not discovered [5]. ...
... Precise measure or assessment of insulin adherence is acknowledged as an important prerequisite to improving insulin nonadherence [3] and interpreting the effects of an intervention [5]. Results and clinical outcomes from an intervention cannot be interpreted realistically without information regarding correct adherence, i.e., if therapy fails to achieve the desired outcome, there is a risk that the clinician or researcher assume that a drug failure has occurred if adherence is assessed incorrectly and nonadherence, therefore, is not discovered [5]. Yet, there is no gold-standard method to assess insulin adherence and no cut-off point or consensual standard for what constitutes adequate insulin adherence [2]. ...
A systematic review will be conducted to update the evidence base and provide an overview of insulin adherence quantification in adults with insulin-treated type 2 diabetes, i.e., the methods used to assess insulin adherence and the cut-off points that constitute adequate insulin adherence.
... Although self-report measures are frequently used in adherence research, there have been many investigations that question their validity (e.g. Farmer, 1999;Hanita, 2000;Vitolins et aI., 2000). As with any measurement tool, adherence measures must demonstrate validity and reliability. ...
... Others have suggested the use of different categories of adherence (e.g. Farmer, 1999). The major problem that arises from using categorical classification of adherence is that comparisons across studies that use different methods of classification is not possible. ...
p> The primary objective of the current programme of research was to determine the effects of cognitive variables (self-efficacy and outcome expectations) and other factors (affective state and aversive feedback) on adherence.
First, a laboratory based simulation study was used, as this enabled isolation of the influence that aversive feedback (simulating the effect of pain) had on adherence. Self-efficacy, outcome expectations and affective state were assessed at baseline and after early experience of the simulation. Adherence behaviour was recorded by the computer programme throughout the simulation. In a follow-up study, a longitudinal field study measured self-efficacy, outcome expectations, affective state and pain at baseline and after early experience of physiotherapy. Adherence was assessed 8 weeks after starting treatment. In both studies, self-efficacy, outcome expectations, affective state and aversive feedback served as the independent variables, and various aspects of adherence behaviour formed the dependent variables.
More positive cognitions predicted how long participants persisted with the simulated physiotherapy task and real world physiotherapy. Presence of aversive feedback in the laboratory study resulted in slower than instructed responding. Increased pain in the field study was also associated with poorer adherence during sessions. Simulated and perceived recovery, in the laboratory and field studies respectively, was related to both cognitions and aversive feedback.
The conclusions were that both cognitions and aversive feedback were important to adherence behaviour. In addition, it was evident that different factors were important to different aspects of adherence behaviour. </p
... Equally prescribers may be unaware of their patients' medication taking practices. Non-adherence with medication can be classified as intentional, often related to the need to avoid drug-related adverse effects (8,9) , or unintentional related to cognitive or visionary impairment, poor cognition (10) , or due to poor educational achievement or forgetfulness. Unlikely, few large studies of OCs adherence have been conducted in the general population. ...
... These factors include women's social and demographic characteristics, shown to be associated with contraceptive discontinuation for method related reasons in the United States (17,18) . Longitudinal studies should also explore the impact of women's changing life circumstances on the concurrent dynamics of contraceptive use (9) . In some study in this review, the decision-making process in choosing a contraceptive method, including the role of the health care provider (19,20) , should be better understood; the reasons for initiating use of a contraceptive method may affect the user's long-term experience and satisfaction with the method. ...
Objectives: The objective of this review the approaches for improving oral contraceptives (OCs) adherence.
Methods: The search strategy involved the use of the following data bases: Cochrane Library, Pubmed,
hinari, a Pop Line, Scopus, Science direct, the Cochrane register of Controlled Trials. Types of study are
original Research studies, RCTs, systematic reviews, full text articles.
Results: Adherence is a shared responsibility of patients, clinicians, and manufacturers; the patient and
clinician are the focal points for these efforts. Counseling must be individualized, which requires knowledge
of factors that predict adherence and understanding of the patient’s decision making process as it relates to
medications.
Conclusion: Improving adherence and preventing early discontinuations is a shared responsibility of OCs
users, health care providers, and OCs manufacturers. Manufacturers should recognize that the provision
of written materials that are both informative and easy to understand can improve patient compliance.
Continued improvements in OCs formulations are important in reducing unwanted side effects. However,
our findings suggest that providers are the focal point for helping women to become more successful OCs
users.
Key words: Oral contraceptives, Adherence, Discontinuations, Oral contraceptives and counseling
... Adherence to medication has long been recognised as a crucial factor in achieving good therapeutic outcomes while medication nonadherence has been linked to treatment failure (Farmer, 1999;Hassan, et al., 2019;Lam and Fresco, 2015). Sokol et al. in a study among patients with diabetes and hypercholesterolemia, showed that higher medication adherence was significantly associated with lower disease-related medical costs, despite medication cost increase. ...
... Biochemical measurements involve determining the concentration of a drug or its metabolites in biological fluids, particularly blood and urine. In some instances, biological markers are given together with the drugs to ascertain the presence of a drug in the blood (Farmer, 1999;Lam and Fresco, 2015). These provide evidence that patients have indeed ingested their medications. ...
... Adherence to medication has long been recognised as a crucial factor in achieving good therapeutic outcomes while medication nonadherence has been linked to treatment failure (Farmer, 1999;Hassan, et al., 2019;Lam and Fresco, 2015). Sokol et al. in a study among patients with diabetes and hypercholesterolemia, showed that higher medication adherence was significantly associated with lower disease-related medical costs, despite medication cost increase. ...
... Biochemical measurements involve determining the concentration of a drug or its metabolites in biological fluids, particularly blood and urine. In some instances, biological markers are given together with the drugs to ascertain the presence of a drug in the blood (Farmer, 1999;Lam and Fresco, 2015). These provide evidence that patients have indeed ingested their medications. ...
Objectives: The primary objective of this review is (1) to better understand the prevalence and impact of medication nonadherence, (2) to identify risk factors for medication nonadherence, (3) to understand the association between nonadherence and its implications on patient health outcomes in pharmacy practice, and (4) to study interventions designed to improve patient adherence to prescribed medications for medical conditions, considering its impact on both medication adherence and patient health outcomes. Methods: Published journal articles were manually sorted. Additional references were obtained from citations within the retrieved articles. This review surveyed the findings of the identified articles with data extracted to presents various strategies and resources on medication nonadherence related to patients and healthcare providers. English languages were considered inclusion criteria in reviewing published articles related to medication nonadherence. This review also surveyed identified articles to determine both subjective and objective medication adherence measures. Key findings: The research in this field needs advances, including improved design of feasible long‐term interventions, objective adherence measures, and sufficient study power to detect improvements in patient health outcomes. Conclusion: Current methods of improving medication adherence for chronic health problems are mostly complex and ineffective so full benefits of treatment cannot be realized. To date, monitoring of patient medication adherence and use of interventions to improve adherence are rare in routine clinical practice.
... Methods employed by these studies include patient interviews [10,11,21] and statistical analyses that estimated the association between certain patient factors (such as age, socioeconomic status, education level, depression, and polypharmacy) with medication nonadherence [4,12]. Patient interviews are generally considered an unreliable method for objectively assessing medication adherence [22][23][24][25]. In addition, accuracy and validity of patient interviews can be further affected by interviewer's skill and construction of questions [16,22]. ...
... Patient interviews are generally considered an unreliable method for objectively assessing medication adherence [22][23][24][25]. In addition, accuracy and validity of patient interviews can be further affected by interviewer's skill and construction of questions [16,22]. Only a small number of studies utilized a validated selfreport questionnaire to assess SLE patients' perceived barriers to adherence, namely the Beliefs About Medicines Questionnaire (BMQ) [7,26,27]. ...
To estimate the level of medication adherence and barriers to adherence among systemic lupus erythematosus (SLE) patients. Patients taking antimalarials, immunosuppressives, and/or steroids to treat SLE were included. Adherence was measured using the Medication Adherence Self Report Inventory (MASRI) and adherence rates < 80% were considered nonadherent while rates ≥ 80% sufficiently adherent. Pill counts were conducted in a proportion of participants. Barriers to adherence were identified using the Identification of Medication Adherence Barriers Questionnaire 30 (IMAB-Q 30). Associations between adherence and patient demographics and disease-specific characteristics were explored. A total of 94 patients were studied and 28 pill counts conducted. 10 patients were classified as nonadherent and 84 patients as sufficiently adherent. 46% of patients were taking steroids, 77.7% antimalarials, and 55.3% immunosuppressives. 88% of patients were taking ≥ 1 medication for non-SLE conditions. The mean medication adherence rate for the SLE patients was 90.7%. Important barriers to adherence reported by nonadherent patients were: concern about harmful side effects (50%), being easily distracted (50%), life getting in the way (50%), being unsure or disagreeing that their condition will worsen without medications (50%), and having personal reasons for not taking medications (50%). Non-adherent patients reported significantly more barriers than sufficiently adherent patients (p < 0.001). The adherence rate in our population was higher than expected, reaching 90%. Barriers to medication adherence were identified and should be addressed on a population and individualized basis to improve patient outcomes.
... The aims of this review were to provide a comprehensive examination of medication adherence and to deepen our understanding of the underlying mechanisms of non-adherence, recognizing it as a significant issue in clinical practice. It acknowledges that medication adherence, while being of vital importance, is also a complex issue influenced by numerous factors (27)(28)(29)(30)(31). To address this complexity, a multi-approach strategy may be necessary to gain deeper insights into adherence behavior (32). ...
The aims of this review are to explore the critical issue of medication adherence, which is essential for effective healthcare outcomes but remains a significant challenge. The review delves into the diverse aspects of non-adherence, including patient perceptions, economic challenges, and complex treatment regimens. It emphasizes the importance of accurate adherence assessments, particularly through self-report questionnaires and retrospective database analyses. The review also explores the historical evolution of adherence concepts and highlights the critical role of pharmacists in educating patients and managing medication regimens. The importance of recognizing and addressing medication non-adherence as a significant health policy issue is underscored, advocating for improved measurement methods and interventions such as multidrug punch cards and medication charts. The review advocates for a patient-centered approach and multidisciplinary collaboration in healthcare, aiming to enhance healthcare outcomes and medication adherence through systemic changes. It also underscores the need for empowering pharmacists with expanded roles and appropriate tools within healthcare systems to further improve patient outcomes. Adherencia k liečbe-cesta k pochopeniu pacienta Cieľom tohto prehľadového článku je problematika adherencie k liečbe, ktorá je kľúčová pre dosiahnutie výsledkov v oblasti zdravotnej starostlivosti. Článok skúma rôzne aspekty non-adherencie, ako napr. postoj pacienta k liečbe, ekonomické prekážky a zložitosť liečebných režimov. Súčasne je kladený dôraz na hodnotenie adherencie, predovšetkým pomocou seba-hodnotiacich dotazníkov a retrospektívnych analýz údajov z databáz. Identifikácia non-adherencie predstavuje prehliadanú oblasť zdravotnej politiky. Využívanie nových možností merania a intervencii, ako sú viacdávkové perforačné karty a liekové karty, môžu prispieť k zlepšeniu adherencie. Nevyhnutnosť systémových zmien, potreba multidisciplinárnej spolupráce zdravotníckych pracovníkov a orientácia na individuálne potreby pacienta predstavujú cestu k lepšej adherencii. Kľúčové slová: adherencia k liečbe, bariéry adherencie, adherencia pacientov, prie-skumy a dotazníky, sebahodnotiace dotazníky.
... In defining compliance, direct and indirect methods are used, each with different advantages and disadvantages. Direct methods include the evaluation of blood pressure levels, urinary wastes and breakdown products, drug metabolites, and various other markers, whereas indirect methods include the review of treatment outcome, patient notification, records of the number of drug doses or compliance with appointments, prescription followup, and the physician's opinion (13,14). ...
... We conducted a cross-sectional, secondary analysis of baseline data from a clinical trial involving patients with breast cancer taking AET after their primary treatment. These patients participated in a pilot randomized controlled trial (STRIDE) [29,30] studying the feasibility and acceptability of a small-group telehealth intervention, compared with a usual care control condition that monitored their medication-taking with the Medication Event Monitoring System [31] (clinicaltrials.gov identifier: NCT03837496). ...
Purpose
Adjuvant endocrine therapy (AET) reduces breast cancer morbidity and mortality, yet women often report suboptimal adherence. Though correlates of AET adherence are well-documented, few studies examine the relative importance of multi-level factors associated with adherence. The aim of this study was to identify factors most strongly associated with AET adherence in women with breast cancer.
Methods
Between 10/2019 and 6/2021, women (N = 100) with non-metastatic, hormone receptor-positive breast cancer, taking AET who reported AET-related distress enrolled into a clinical trial. Participants completed baseline measures, including the Medication Adherence Rating Scale-5, sociodemographics, and validated measures of anxiety, depression, medication-taking self-efficacy, social support, and treatment satisfaction. We created a latent factor and tested associations between sociodemographic, medical, and psychosocial characteristics and adherence. Associated predictors (p < .10) were entered into a structural model, which was corroborated via multivariate regression modeling.
Results
A four-indicator latent adherence factor demonstrated good model fit. Participants (Mage = 56.1 years, 91% White) who were unemployed (B = 0.27, SE = 0.13, p = .046) and reported greater treatment convenience (B = 0.01, SE = 0.01, p = .046) reported greater adherence. Scores of participants who reported greater medication-taking self-efficacy (p = .097) and social support (p = .062) approached better adherence. Greater medication-taking self-efficacy (B = 0.08, SE = 0.02, p < .001) and being unemployed (B = 0.28, SE = .14, p = .042) were most strongly associated with greater adherence, independent of other predictors. Multivariate modeling confirmed similar findings.
Conclusions
Medication-taking self-efficacy and employment status were associated with AET adherence above other related factors.
Implications for Cancer Survivors
Enhancing patients’ confidence in their ability to take AET for breast cancer may represent an important intervention target to boost adherence.
... Trained study staff identified potentially eligible patients and received permission to approach the patient. Upon approach, if eligible, the patient provided informed consent, completed a psychosocial assessment, and received a Medication Event Monitoring System (MEMS Caps) pill cap and bottle [33]. Participants were instructed to place their AET medication in the MEMS Caps bottle, which automatically recorded the time/date the bottle was opened as a proxy of medication taken. ...
Adjuvant endocrine therapy (AET) reduces breast cancer morbidity and mortality; however, adherence is suboptimal. Interventions exist, yet few have improved adherence. Patient characteristics may alter uptake of an intervention to boost adherence. We examined moderators of the effect of a virtual intervention (STRIDE; #NCT03837496) on AET adherence after breast cancer.
At a large academic medical center, patients taking AET (N = 100; Mage = 56.1, 91% White) were randomized to receive STRIDE versus medication monitoring. All stored their medication in digital pill bottles (MEMS Caps) which captured objective adherence. Participants self-reported adherence (Medication Adherence Report Scale) at 12 weeks post-baseline. Moderators included age, anxiety, and depressive symptoms (Hospital Anxiety and Depression Scale), AET-related symptom distress (Breast Cancer Prevention Trial Symptom Scale), and AET-specific concerns (Beliefs about Medications Questionnaire). We used hierarchical linear modeling (time × condition × moderator) and multiple regression (condition × moderator) to test the interaction effects on adherence.
Age (B = 0.05, SE = 0.02, p = 0.003) and AET-related symptom distress (B = −0.04, SE = 0.02, p = 0.02) moderated condition effect on self-reported adherence while anxiety (B = −1.20, SE = 0.53, p = 0.03) and depressive symptoms (B = −1.65, SE = 0.65, p = 0.01) moderated objective adherence effects. AET-specific concerns approached significance (B = 0.91, SE = 0.57, p = 0.12). Participants who received STRIDE and were older or presented with lower anxiety and depressive symptoms or AET-related symptom distress exhibited improved adherence. Post hoc analyses revealed high correlations among most moderators.
A subgroup of patients who received STRIDE exhibited improvements in AET adherence. The interrelatedness of moderators suggests an underlying profile of patients with lower symptom burden who benefitted most from the intervention.
NCT03837496.
... The way to evaluate adherence was not the reference standard, i.e., electronic monitoring. 36,40 However, this approach is an indirect measure of treatment adherence and also has some limitations. 6,41 We have integrated objective and subjective approaches from various sources to evaluate adherence, as suggested. ...
Despite its potential impor- tance for adherence, knowledge of the treatment has been little studied in patients with psychosis. We performed this study to assess the possible association between knowledge of the treatment and nonadherence, unintentional nonad- herence (UNA) and intentional nonadherence (INA).
... Further, non-biological markers have increased importance recently due to COVID-19, which forced many clinical trials to adapt their protocols to be remote. There has been a heavy reliance on indirect subjective measures, such as self-report (e.g., medication diaries, ecological momentary assessment, text/email report), as well as indirect objective measures, such as pill count (not self-reported) and Medication Event Monitoring System (MEMS®), which tracks the time and date when medication bottles are opened (Farmer, 1999;Shi et al., 2010). ...
Background
Accurate assessment of medication adherence is important for understanding pharmacotherapy outcomes across all phases of adolescent substance use disorder (SUD) clinical trials. The objective of this study was to describe and assess the pairwise concordance between three commonly used non‐biological medication adherence assessment methods in adolescents who use alcohol to inform the selection of medication adherence measures for use in future youth SUD trials.
Methods
Participants (N = 32, 17–19‐years‐old) took N‐acetylcysteine and placebo, in a randomized cross‐over design, for 10 days each. Medication adherence was assessed (20 days total) via pill count, medication videos submitted twice daily, and the Medication Event Monitoring System (MEMS®). Lin's Concordance Correlation Coefficient (CCC) assessed concordance and Bland–Altman plots are reported. Linear mixed‐effects models with main effects of medication, treatment block (first medication, second medication), and sequence were also run.
Results
Medication videos yielded the lowest (64%) and pill count yielded the highest (89%) adherence estimates. CCC values indicated poor correspondence, except between pill count and MEMS. The Bland–Altman plots showed good pairwise agreement between all methods. Linear mixed‐effects models indicated a difference between the first and second cross‐over medication, with adherence estimates being lower for the second medication, regardless of whether it was N‐acetylcysteine or placebo.
Conclusions
The study yielded important and practical information. First, incorporating more than one method of adherence assessment may capture estimated floor and ceiling adherence in the absence of a biological marker. This is particularly relevant for remote or hybrid studies where bio‐marker collection is challenging. Selection of the assessment methods will depend on study goals. Second, the continuation of medication adherence research can benefit each phase of clinical trials and inform rigorous pharmacotherapy evaluation.
... Advances in behavioral medicine have been aided by new technology allowing intensive monitoring of biological parameters of outcomes such as ambulatory blood pressure (Vandermeiracker, 1995) as well as circumscribed behaviors such as pill taking (Farmer, 1999) or use of inhalers (Simmons, Nides, & Kleerup, 1998). However, there are still limits to our ability to assess and monitor more complex behaviors in natural environments. ...
Two distinct literatures have contributed to a tremendous growth of interest in coping. The 1st consists of descriptive studies that have used coping checklists. This literature is in crisis because of its failure to yield substantive findings concerning the role of coping in adaptation that cannot be dismissed as truisms, trivia, or the product of a confounding of stress, coping, and distress. The 2nd literature concerns interventions to improve adaptation by enhancing coping. It provides evidence of the efficacy of intervention but provides little understanding of crucial ingredients, mechanisms of change, or barriers to maintaining gains. Both literatures would benefit from cross-fertilization. Process studies of interventions designed to improve coping provide an alternative to fruitless and potentially misleading correlational studies using checklists. Such studies might also aid in understanding and refining intervention strategies.
... To improve the health outcomes of the patients, a uniform reminder of denosumab injection administration was initiated by the clinical pharmacist at the end of the study for all patients, including those in the control group. The willingness of patients to participate in CPAMS in the future rather than creating questionnaires or questions and answers was a better indicator of patient satisfaction with CPAMS, given the need to prevent patients from feeling oppressed or the difficulty of understanding in older patients [30]. Patients only needed to answer whether they were interested in participating subsequently; this avoids taking up too much time, which can cause impatience. ...
We established a clinical pharmacist adherence management system (CPAMS) led by clinical pharmacists to examine whether denosumab adherence could be improved. The results showed that CPAMS could effectively improve adherence to denosumab and the treatment of osteoporosis. However, this effect weakened during the spread of infectious diseases such as COVID-19.
Denosumab is currently one of the drugs that can effectively reduce the risk of clinical fracture. However, as a drug requiring long-term subcutaneous injection, patient adherence to denosumab is the most important factor affecting its therapeutic efficacy. Therefore, we established a clinical pharmacist adherence management system (CPAMS) led by clinical pharmacists and examined whether denosumab adherence could be improved.
Data were collected from patients receiving denosumab in our hospital between March 2021 and May 2022. The patients who participated in the CPAMS were in the intervention group, and the rest were in the control group. We analysed the proportion of days covered (PDC) value of denosumab, distribution of subsequent visits, and proportion of patients who continued participating during the normal and coronavirus (COVID-19) periods.
Eighty-five patients were enrolled in this retrospective study: 32 in the intervention group and 53 in the control group. The PDC values were significantly higher in the intervention group (0.9875, 0.9025–1) than in the control group (0.5, 0.5–0.5) after 1 year. The subsequent visit rate in the intervention group was 93.80%. However, none of the patients in the control group returned. In the intervention group, the ratio of timely to delayed subsequent visits was 11:19. After the COVID-19 pandemic, the PDC value of the intervention group (0.957, 0.5–1) was lower than that before COVID-19, and the ratio of timely to delayed subsequent visits was 9:13.
Clinical pharmacist-led CPAMS could effectively improve adherence to denosumab and the treatment of osteoporosis.
... Various methods have been devised to determine compliance when unobserved (e.g., self-reports), but most all depend on subjective or indirect information, and as such are unreliable. 16,17 In some trials, participants' biomarkers may systematically change in response to the treatment or any alternatives to provide objective information about noncompliance. Consider three recently published regulatory tobacco clinical trials studying the effect of VLNC cigarettes versus NNC cigarettes on smoking behavior. ...
Participant noncompliance, in which participants do not follow their assigned treatment protocol, often obscures the causal relationship between treatment and treatment effect in randomized trials. In the longitudinal setting, the G-computation algorithm can adjust for confounding to estimate causal effects. Typically, G-computation assumes that both 1) compliance is observed; and 2) the densities of the confounders can be correctly specified. We aim to develop a G-computation estimator in the setting where both assumptions are violated. For 1), in place of unobserved compliance, we substitute in probability weights derived from modeling a biomarker associated with compliance. For 2), we fit semiparametric models using predictive mean matching. Specifically, we parametrically specify only the conditional mean of the confounders, and then use predictive mean matching to randomly generate confounder data for G-computation. In both the simulation and application, we compare multiple causal estimators already established in the literature with those derived from our method. For the simulation, we generated data across different sample sizes and levels of confounding. For the application, we apply our method to a trial that sought to evaluate the effect of cigarettes with low nicotine on cigarette consumption (Center for the Evaluation of Nicotine in Cigarettes Project 2 - CENIC-P2).
... The indirect measures include various forms of self-reporting by the patient, medication measurement (pill count), use of electronic monitoring devices and review of prescription records and claims. 8 Each method has its advantages and disadvantages but no method is regarded as the gold standard. Self-reports using questionnaires are simple, fast, inexpensive and able to detect MA barriers. ...
Hypertension is a chronic medical condition which remains inadequately managed everywhere. Medication adherence (MA) is a critical parameter for achieving strict blood pressure (BP) control in patients undergoing antihypertensive therapy (AHT). Good MA is also a key factor determining the success of preventive measures for cardiovascular (CV) risk reduction. So, the objective of this research was to study the medication adherence and blood pressure control among hypertensive patients of Pokhara Valley. A randomized community-based prospective study was conducted in different places of Pokhara. In the study, a structured questionnaire i.e. Brief medication questionnaire (BMQ) with a high sensitivity and specificity was used. Out of 79 respondents enrolled, most of the respondents (n=51, 64.6%) were shown to be non-adherent and only 28 (35.4%) were adherent to the prescribed AHT. The study showed that among adherers, 75% were undergoing monotherapy and 64.3% (n=18) had their BP under control. The comparison between BP control and the different occupation showed that the highest percentage of BP control was achieved in housewives. Most of the respondents were non-adherent to the prescribed AHT which requires special attention of the healthcare providers. Key words: Hypertension, medication adherence, brief medication questionnaire, anti-hypertensive therapy
... However, for some medications, measuring these levels is a good, commonly used method to evaluate adherence. The indirect methods for measuring adherence include asking the patient about the ease with which s/he takes the prescribed medications, evaluation of clinical response, tablet counting, collecting questionnaires from patients, using electronic drug monitors, measuring physiological markers, having the patient keep a medication diary, and evaluation of the children's adherence by asking for the help of a caregiver [14,15]. This last technique was used during an independent monitoring survey conducted during SMC to evaluate adherence in children in the Dosso region. ...
Background
Seasonal malaria chemoprevention (SMC) consists of the intermittent administration of a 3 day course of anti-malarial medications during the months of highest malaria risk in the Sahel region, where malaria transmission is highly seasonal. SMC is an effective intervention to reduce episodes of uncomplicated and severe malaria in children. However, morbidity cannot be lowered without adherence to medications. The objective of this study was to examine SMC medication adherence and to identify the attitudes and practices of caregivers during the 2020 SMC campaign in the Dosso region.
Methods
This study was conducted based on data from independent monitoring using random cluster sampling. Adherence levels and the attitudes and practices of caregivers were evaluated using data from caregivers’ self-reports and analysed according to Bernard Vrijens’ taxonomy .
Results
At the initiation of treatment phase, 99% of children (N = 2296) received their first administration of medication, with 90% of caregivers (N = 1436) knowing that the medications help prevent malaria. However, only 56% of caregivers (N = 1856) reported that treatment initiation took place under direct observation by the distributor. At the implementation of treatment phase, 90% of children (N = 2132) took their medication on the second day and 84% (N = 1068) took it the third day. “Forgetting,” “not having time,” and “the mother’s absence” were the main reasons caregivers gave to explain discontinuation of the 3 day course of medication.
Conclusion
This simple, low-cost survey demonstrated that coverage of SMC and adherence by caregivers to completing the full 3 day medication course was high. The survey also showed that knowledge, attitudes, and practices of some caregivers regarding adherence to medications during the SMC campaign could be improved. Expanding distributors’ training, developing and providing them with tools for interpersonal communication, and strengthening supervision could lead to even higher adherence.
... Resolving such comorbidities is essential if patients' adherence to treatment can be enhanced (WHO, 2003). Economic poverty is one of the main factors influential in neglected treatment adherence, especially in leishmaniasis (Farmer, 1999;Robinson, 1997;Timmreck et al., 1993). ...
Leishmaniasis is an overlooked, poverty-stricken, and complex disease with growing social and public health problems. In general, leishmaniasis is a curable disease; however, there is an expansion of unresponsive cases to treatment in cutaneous leishmaniasis (CL). One of the effective and ignored determinants in the treatment outcome of CL is poor treatment adherence (PTA). PTA is an overlooked and widespread phenomenon to proper Leishmania treatment. This study aimed to explore the effect of poor adherence in unresponsiveness to treatment in patients with anthroponotic CL (ACL) by comparing conventional statistical modalities and machine learning analyses in Iran. Overall, 190 cases consisting of 50 unresponsive patients (case group), and 140 responsive patients (control group) with ACL were randomly selected. The data collecting form that included 25 queries (Q) was recorded for each case and analyzed by R software and genetic algorithm (GA) approaches. Complex treatment regimens (Q11), cultural and lay views about the disease and therapy (Q8), life stress, hopelessness and negative feelings (Q22), adverse effects of treatment (Q13), and long duration of the lesion (Q12) were the most prevalent significant variables that inhibited effective treatment adherence by the two methods, in decreasing order of significance. In the inherent algorithm approach, similar to the statistical approach, the most significant feature was complex treatment regimens (Q11). Providing essential knowledge about ACL and treatment of patients with chronic diseases and patients with misconceptions about chemical drugs are important issues directly related to the disease's unresponsiveness. Furthermore, early detection of patients to prevent the long duration of the disease and the process of treatment, efforts to minimize side effects of treatment, induction of positive thinking, and giving hope to patients with stress and anxiety by medical staff, and family can help patients adhere to the treatment.
... A Systematic Review by Cramer et al. has shown that patients use less medication for diabetes than prescribed (9). However, several tools are available to assess treatment adherence, including blood tests, electronic monitoring of medicine containers , 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 counting pills, and self-reported methods (10). But there has been no "gold standard" criteria for adherence to the medications (11). ...
Background:
Diabetes mellitus (DM) is a common serious health problem. Medication adherence is a crucial determinant of therapeutic success in patients with diabetes mellitus. This study aims to examine the 8-item Morisky Medication Adherence Scale (MMAS-8) psychometric properties among diabetic patients.
Methods:
This study was carried out at the Internal Medicine clinic of Firooz Abadi Hospital in Tehran, Iran, from 2018 to 2020. The English version of the MMAS-8 was translated into Persian and administered to patients with diabetes mellitus. A total of 150 patients who had diabetes were included. Cronbach's alpha was calculated to assess the reliability.
Results:
According to the recommended scoring method, the Mean ± SD of MMAS-8 scores was 4.97 ± 1.92. Good internal consistency was found in our study (Cronbach's α = 0.70). Not any significant relationship between MMAS-8 categories and occurrence of complications was found.
Conclusions:
The findings of this validation study indicate that the Persian version of the MMAS-8 is a reliable measure of medication adherence, but it has not acceptable validity. Further studies are needed to reach a good validity.
... The most common options are surveys, pill counts, plasma drug concentration sampling, and electronic monitoring. 9,12,13 To illustrate these tradeoffs, we use two contrasting cases: participant self-report surveys (low cost, low accuracy) and biosensor-enabled electronic monitoring (high cost, high accuracy). 14 Surveys 15 are inexpensive and easy to administer. ...
Background/Aims
The quality of the evidence used to evaluate a drug’s safety and efficacy depends, in part, on how well participants adhere to the prescribed drug-taking regime. There are multiple approaches to measure adherence in clinical trials, varying in their cost and accuracy. We demonstrate a method for evaluating the cost-effectiveness of common adherence monitoring methods, considering the costs and data quality for drugs that differ in how forgiving they are of nonadherence.
Methods
We propose a simulation approach to estimate the value of evidence about adherence, considering both costs of collection and potential errors in interpreting clinical trial results. We demonstrate the approach with a simulated clinical trial of nitrendipine, a common calcium channel blocker. We consider two trial designs, one using pretrial adherence to “enrich” the trial sample and one without an enrichment strategy. We use scenarios combining high and low values of two key properties of a clinical trial: participant adherence and drug forgiveness.
Results
Under the conditions of these simulations, the most cost-effective adherence monitoring approach depends on both trial participant adherence and drug forgiveness. For example, the enrichment strategy is not cost-effective for the base scenario (high forgiveness and high adherence), but is for other scenarios. We also estimate the effects of evaluable patient analysis, a controversial procedure that excludes nonadherent participants from the analyses, after a trial is completed.
Conclusions
Our proposed approach can guide drug regulators and developers in designing efficient clinical trials and assessing the impact of nonadherence on trial results. It can identify cost-effective adherence-monitoring methods, given available knowledge about the methods, drug, and patients’ expected adherence.
... Adherence to the test drug was monitored on monthly phone calls and during their follow-up visits. [25,26] All study participants were advised to follow physical activity, which included at least 4 km walk in 25 min. Test drug preference was observed by predefined questionnaire at regular intervals. ...
Objective: The prevalence of diabetes mellitus in India is increasing day by day. This study was conducted to assess the impact of fenugreek with controlled diet in prediabetic patients of with fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c). Study Design: Interventional parallel randomized control trial. Materials and Methods: A total of 280 prediabetics were included in the study. Patients were randomized and one group of patients received 10 g of fenugreek powder in hot water every day, whereas the second group did not receive it. Strict dietary controls were followed as per the guidelines of American Diabetic Association (ADA) protocols. The parameters were assessed on the first visit and every 3 months for 24 months. Results: Dietary addition of fenugreek leads to a reduction in blood glucose levels. Statistical analysis shows that there was a significant reduction in FBGlevels in the 24 months in the study group (P < 0.001), whereas a significant reduction in HbA1c in the 24th month (P = 0.001). Half of the study participants (52.9%, 59.2%, and 57.1% at 6, 12, and 24 months, respectively) reported acceptable compliance about fenugreek treatment. Conclusion: Dietary addition of fenugreek can have a synergistic effect along with diet control on FBG and HbA1c.
... [11c] Strategies to improve adherence Adherence with study treatment is assessed at each titration assessment and at the 26 and 52-week follow-up assessments by asking participants to estimate their adherence. 32 Participant's preferences are incorporated into the titration process, so for example, if they do not wish to increase dose at any time, their preference is accommodated. ...
Background: Chronic Obstructive Pulmonary Disease (COPD) is associated with significant morbidity, mortality and healthcare costs. Beta-blockers are well-established drugs widely used to treat cardiovascular conditions. Observational studies consistently report that beta-blocker use in people with COPD is associated with a reduced risk of COPD exacerbations. The bisoprolol in COPD study (BICS) investigates whether adding bisoprolol to routine COPD treatment has clinical and cost-effective benefits. A sub-study will risk stratify participants for heart failure to investigate whether any beneficial effect of bisoprolol is restricted to those with unrecognised heart disease.
Methods: BICS is a pragmatic randomised parallel group double-blind placebo-controlled trial conducted in UK primary and secondary care sites. The major inclusion criteria are an established predominant respiratory diagnosis of COPD (post-bronchodilator FEV1<80% predicted, FEV1/FVC<0.7), a self-reported history of ≥2 exacerbations requiring treatment with antibiotics and/or oral corticosteroids in a 12-month period since March 2019, age ≥40 years and a smoking history ≥10 pack years. A computerised randomisation system will allocate 1574 participants with equal probability to intervention or control groups, stratified by centre, and recruitment in primary/secondary care. The intervention is bisoprolol (1.25 mg tablets) or identical placebo. The dose of bisoprolol/placebo is titrated up to a maximum of 4 tablets a day (5mg bisoprolol) over four-seven weeks depending on tolerance to up-dosing of bisoprolol/placebo – these titration assessments are completed by telephone or video call. Participants complete the remainder of the 52-week treatment period on the final titrated dose (1,2,3,4 tablets) and during that time are followed up at 26 and 52 weeks by telephone or video call. The primary outcome is the total number of participant reported COPD exacerbations requiring oral corticosteroids and/or antibiotics during the 52-week treatment period. A sub-study will risk stratify participants for heart failure by echocardiography and measurement of blood biomarkers.
Discussion: The demonstration that bisoprolol reduces the incidence of exacerbations would be relevant not only to patients and clinicians but also to healthcare providers, in the UK and globally.
Trial registration: Current controlled trials ISRCTN10497306 (registered 16 August 2018)
... Certain number of HIV patients though aware of their HIV positive status are reluctant for treatment or are stigmatized to present to ART clinics. 5,6 Opportunistic Infections (OIs) are common in HIV/AIDS due to their frail immune system. These are major causes of death in AIDS patients with low CD4 counts. ...
... Certain number of HIV patients though aware of their HIV positive status are reluctant for treatment or are stigmatized to present to ART clinics. 5,6 Opportunistic Infections (OIs) are common in HIV/AIDS due to their frail immune system. These are major causes of death in AIDS patients with low CD4 counts. ...
Currently, there is no cure for Human immunodeficiency virus /Acquired immunodeficiency syndrome (HIV/AIDS) but, there are medications to control HIV and prevent opportunistic infections. Clinicians must be vigilant enough to extract history and send relevant laboratory investigations to diagnose the disease in early stage. Patient may not have known his /her diagnosis or intentionally avoided to reveal the disease status which further complicates the diagnosis and treatment. This is case of a 51 years male, where social stigma forces the patient to hide his diagnosis and reluctant to seek medical treatment ultimately reaps the life. Hence, government and concerned authority must work up for wide availability of HIV/AIDS medications and motivate people to seek medical advices as soon as possible. Concerned authority must motivate people to consider it as any other treatable disease.
... Such approaches can minimize the limitations of other self-reported methods by standardizing the measurement and increasing the validation consistency. These questionnaires are often validated with statistical tests and combined with other subjective or objective measures, thus improving the consistency of the results (55). The MASRI questionnaire was adopted in five papers (20,25,30,33,47) and all studies explored the adherence rate in SLE. ...
Lack of medication adherence is frequent in chronic connective tissue diseases and is associated with poorer health outcomes, low quality of life and economic loss. This research is based on a systematic literature search and aims to identify the surveys and tools used for the assessment of medication adherence in patients with connective tissue diseases (CTDs) and in particular the tools co-designed with patients. A systematic literature review was performed in PubMed and Embase databases searching for studies concerning the application of surveys or tools designed for medication adherence assessment. A specific analysis was also performed to identify which of these existing tools were developed in co-design with patients affected by CTDs. 1958 references were identified, and 31 studies were finally included. Systemic lupus erythematosus was the most investigated disease, followed by the Behçet’s disease. The tools used to assess adherence in CTDs were, in most cases, valid and useful. However, the results showed a certain degree of heterogeneity among the studies and the medication adherence assessment and measurement tools adopted, which were mostly based on selfreported questionnaire. No co-designed tools with patients were found. Low- and non-adherence were explored in some CTDs with valid and useful tools, while other CTDs still need to be assessed. Therefore, more efforts should be made to better understand the specific reasons for the low- and non-adherence in CTDs patients.
... 11,19 There is no ideal threshold for measuring adherence to prescribed medications and the selection of arbitrary cut-off value/threshold is of great concern to researchers since there is lack of pharmacological basis underlying decision to choose cut-off values. 11,20 In addition, several studies have proposed and used disease-specific measures to assess adherence to medications among patients with various conditions including asthma. 19,21 Thus, it remains unclear which adherence measure would be appropriate to assess adherence to asthma medications in patient population already known to have high non-adherence rates. ...
Background:
Limited studies have systematically reviewed the literature to identify and compare the various database methods and optimal thresholds for measuring medication adherence specific to adolescents and adults with asthma. In the present study, we aim to identify the methods and optimal thresholds for measuring medication adherence in population-based pharmacy databases.
Methods:
We searched PubMed, Embase, International Pharmaceutical Abstracts (IPA), Web of Science, Google Scholar, and grey literature from January 1, 1998, to March 16, 2021. Two independent reviewers screened the studies, extracted the data, and assessed the quality of the studies. A quantitative knowledge synthesis was employed.
Results:
Thirty-eight (38) retrospective cohort studies were eligible. This review identified 20 methods for measuring medication adherence in adolescent and adult asthma administrative health records. Two measures namely the medication possession ratio (MPR) and proportion of days covered (PDC) were commonly reported in 87% of the literature included in this study. From the meta-analysis, asthma patients who achieved adherence threshold of "0.75-1.00" [OR: 0.56, 95% CI: 0.41 to 0.77] and ">0.5" [OR: 0.71, 95% CI: 0.54 to 0.94] were less likely to experience asthma exacerbation.
Conclusion:
Despite their limitations, the PDC and the MPR still remain the most common measures for assessing adherence in asthma pharmacy claim databases. The evidence synthesis showed that an adherence threshold of at least 0.75 is optimal for classifying adherent and non-adherent asthma patients.
... An affirmative answer to any of these questions qualifies a recipient as nonadherent. This scoring is intentional strict due to the assumption that recipients under-report nonadherence with a self-report questionnaire [19]. If the answer is 'yes' to any of the items, recipients are asked how often they were nonadherent. ...
After kidney transplantation, a strict immunosuppressive medication regimen is necessary for graft survival. However, nonadherence to medication has been shown to occur early after transplantation and to increase over time. Weaning the recipient off dual therapy onto monotherapy in order to reduce immunosuppressive burden may also be a way to promote adherence, although little is known about the impact of such a regimen on fear of rejection. We performed a cohort study on medication adherence and fear of rejection in a randomized, investigator‐driven, open‐label, single‐centre pilot study. Recipients were randomized at 6‐months post‐transplant to either continue Tacrolimus and Mycophenolate mofetil (TAC/MMF) or to taper MMF at 6 months and discontinue MMF at 9 months (TAC monotherapy). Recipients completed questionnaires about medication adherence and fear of rejection at 6 and 12‐months post‐transplantation. Medication adherence was significantly higher in the TAC monotherapy group compared to dual TAC/MMF therapy group (χ2 (1) = 4.582; P = 0.032). We found no difference in fear of rejection between the two groups of recipients (P = 0.887). Simplification of the medication regimen is a potential tool for increasing adherence in clinical practice (Netherlands Trial Register – NL4672). Simplification of the immunosuppressive medication regime, if considered safe by the physician, is a way to promote medication adherence among kidney transplant recipients. In this study, a randomized controlled trial was conducted among KTR's with Tacrolimus once‐daily and with or without Mycophenolate Mofetil.
... This variation may attributable to different study designs, type of the target medications and heterogeneity in study populations. There is no standard method to measure medication adherence, and accordingly definition of nonadherence are varied across studies 124 . Medication adherence can be assessed either directly or indirectly. ...
OBJECTIVES Chronic kidney disease (CKD) patients with uncontrolled blood pressure are at high risk of cardiovascular events, hospitalization, and mortality. There is limited research evaluating utilization patterns of anti-hypertensives in hypertensive CKD patients. This study aims to assess anti-hypertensives use, particularly, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) in the United States, and explore contextual and individual risk factors of treatment compliance. METHODS Hypertensive CKD patients were selected using Medicare 5% sample claims data from the United States Renal Data System (USRDS) databases (2006-2013). We included patients who diagnosed with hypertension and CKD, and followed them from Jan 1, 2008 to Dec 31, 2013. We first investigated medication treatment patterns among incident CKD patients. We then performed time-dependent survival analyses to evaluate long-term benefits of being adherence to ACEIs/ARBs. Medication adherence in this study was measured by proportion days covered (PDC). Lastly, we used geographically weighted regression model (GWR) to explore risk factors of medication adherence. RESULTS Approximately 50% of incident hypertensive CKD patients received guideline-recommended ACEIs/ARBs after their first diagnosis of CKD. Anti-hypertensive regimens including ACEIs/ARBs and statins yielded better CKD outcomes than regimens without these drugs. Additionally, continuously being adherent to ACEIs and ARBs was associated a significant decline in risk of end-stage renal disease (ESRD) and mortality in long run. However, only 61% of hypertensive CKD who used ACEIs/ARBs had good medication compliance (PDC ≥80%). Patients residing in the Northeast region and the Midwest region demonstrated better adherence than those residing in the Southern United States. Availability of primary resources, neighborhood deprivation status, and coverage of Part D Low-income Subsidy (LIS) were factors related with medication adherence. Geographically varied association between contextual characteristics and adherence were displayed by maps. CONCLUSIONS Utilization of guideline-recommended ACEIs/ARBs is suboptimal in elderly patients with hypertension and CKD in the United States, although they had significant long-term benefits on CKD outcomes. Adherence to ACEIs/ARBs is geographically differentiated across the United States. Contextual and individuals risk factors identified in this study are helpful to design population-based strategies in a local area to promote medication compliance, from a population perspective.
... Adherence to statin treatment has been estimated 6 months before the index date using the proportion of days covered (PDC) method [20], i.e., the ratio between the number of days of medication supplied (according to pharmacy-claim) and days of observation before the index date, multiplied by 100. Patients were considered adherent to statin treatment if they had a PDC of ≥ 80%. ...
Abstract Background This cross-sectional study aimed to identify actionable factors to improve LDL-cholesterol target achievement and overcome underuse of lipid-lowering treatments in high- or very-high-cardiovascular risk patients. Methods We evaluated healthcare records of 934,332 subjects from North-Italy, including subjects with available lipid profile and being on statin treatments up to December 2018. A 6-month-period defined adherence with proportion-of-days-covered ≥ 80%. Treatment was classified as high-intensity-statin (HIS) + ezetimibe, HIS-alone, non-HIS (NHIS) + ezetimibe or NHIS alone. Results We included 27,374 subjects without and 10,459 with diabetes. Among these, 30% and 36% were on secondary prevention, respectively. Adherence was high (78–100%) and increased with treatment intensity and in secondary prevention. Treatment intensity increased in secondary prevention, but only 42% were on HIS. 2019-guidelines LDL-cholesterol targets were achieved in few patients and more often among those with diabetes (7.4% vs. 10.7%, p
... 33 Traditional methods for monitoring medication adherence in clinical trials include direct measures (e.g., drug assays of blood or urine, direct observation of the patient receiving the medication) and indirect measures, such as self-reported pill count, electronic monitoring devices, and review of prescription records and claims. 34 Because pill counting and electronic monitoring devices are difficult to implement in the setting of an observational study such as ours, we used both a direct measure (urine metabolite levels) and an indirect measure (self-reported, prescription record-validated medication use) to evaluate adherence. High sensitivity for drugs commonly prescribed to reduce cardiovascular risk in patients with CKD, such as several angiotensin II receptor blockers, indicated excellent adherence for these medications. ...
Background Polypharamacy is common among patients with chronic kidney disease (CKD), but little is known about urinary excretion of many drugs and their metabolites among CKD patients.
Methods To evaluate self-reported medication use in relation to urine drug metabolite levels in a large cohort of CKD patients, the Germany Chronic Kidney Disease study, we ascertained self-reported use of 158 substances and 41 medication groups and coded active ingredients according to the Anatomical Therapeutic Chemical classification system. We used a nontargeted mass spectrometry-based approach to quantify metabolites in urine; calculated specificity, sensitivity, and accuracy of medication use and corresponding metabolite measurements; and used multivariable regression models to evaluate associations and prescription patterns.
Results Among 4885 participants, there were 108 medication-drug metabolite pairs based on reported medication use and 78 drug metabolites. Accuracy was excellent for measurements of 36 individual substances in which the unchanged drug was measured in urine (median, 98.5%; range 61.1%-100%). For 66 pairs of substances and their related drug metabolites, median measurement-based specificity and sensitivity were 99.2% (range 84.0%-100%) and 71.7% (range 1.2%-100%), respectively. Commonly prescribed medications for hypertension and cardiovascular risk reduction—including angiotensin-II receptor blockers, calcium channel blockers, and metoprolol—showed high sensitivity and specificity. Although self-reported use of prescribed analgesics (acetaminophen, ibuprofen) was <3% each, drug metabolite levels indicated higher usage (acetaminophen, 10%-26%; ibuprofen, 10%-18%).
Conclusions This comprehensive screen of associations between urine drug metabolite levels and self-reported medication use supports the use of pharmacometabolomics to assess medication adherence and prescription patterns in persons with CKD, and indicates underreported use of medications available over the counter, such as analgesics.
... Previous adherence studies of patients with T2DM have described this indirect measurement as a study limitation [8][9][10][11]14]. Pill counting or medication event monitoring system (MEMS) has higher accuracy as compared to other methods [15]. However, pill count or MEMS performed to measure adherence is likely to result in psychological bias among patients. ...
IntroductionFor medication adherence, pill counting has higher accuracy in objective assessment. However, previous reports have shown that factors such as psychological bias and other people’s involvement in managing and helping patients take their medications may influence the outcomes. In Japan, all prescription medicines of patients are checked by medical reconciliation, and a pill count is performed during hospitalization. This study investigated factors affecting the medication adherence of patients with type 2 diabetes mellitus (T2DM), including patient- and medication-related factors, by pill counting using medical reconciliation in a situation where the patient’s psychological bias is low.Methods
This study included 103 patients with T2DM who had been treated with oral hypoglycemic agents (OHAs) for at least 24 weeks. Patients whose OHAs were managed by another person were excluded. We calculated medication adherence values (MAVs) according to the following formula: MAV = (total prescription days − prescription days of OHAs brought when admitted)/(days from the start of OHAs to hospitalization). The relationship between MAVs and patient- and medication-related factors was analyzed.ResultsOn multiple linear regression analysis of patient-related factors with P < 0.10 in the univariate analysis as explanatory variables, a lower number of chronic diseases (β = 0.017; P < 0.001) and higher number of OHAs (β = − 0.021; P = 0.04) were independent factors for lower MAV. Medication-related factors were not found to be independent factors.Conclusions
Our findings suggest that poor adherence was independently associated with lower number of chronic diseases and higher number of OHAs in patients with T2DM.
Background:
This new clinical practice guideline concerns the psychosocial diagnosis and treatment of patients before and after organ transplantation. Its objective is to establish standards and to issue evidence-based recommendations that will help to optimize decision making in psychosocial diagnosis and treatment.
Methods:
For each key question, the literature was systematically searched in at least two databases (Medline, Ovid, Cochrane Library, and CENTRAL). The end date of each search was between August 2018 and November 2019, depending on the question. The literature search was also updated to capture recent publications, by using a selective approach.
Results:
Lack of adherence to immunosuppressant drugs can be expected in 25-30% of patients and increases the odds of organ loss after kidney transplantation (odds ratio 7.1). Psychosocial interventions can significantly improve adherence. Meta-analyses have shown that adherence was achieved 10-20% more frequently in the intervention group than in the control group. 13- 40% of patients suffer from depression after transplantation; mortality in this group is 65% higher. The guideline group therefore recommends that experts in psychosomatic medicine, psychiatry, and psychology (mental health professionals) should be involved in patient care throughout the transplantation process.
Conclusion:
The care of patients before and after organ transplantation should be multidisciplinary. Nonadherence rates and comorbid mental disorders are common and associated with poorer outcomes after transplantation. Interventions to improve adherence are effective, although the pertinent studies display marked heterogeneity and a high risk of bias. *All of the issuing bodies, authors, and editors of the guideline are listed in eTables 1 and 2.
Background: The model medication adherence questionnaire (MMA) measures oral medication adherence among patients with type 2 diabetes (DM). The validity of the questionnaire needs to be objectively demonstrated. Methods: A descriptive cross-sectional study was carried out among adult patients with type 2 DM who attended clinics in District General Hospital (DGH) Gampaha. A sample of 150 patients was recruited consecutively to establish the criterion and construct validity. The criterion was the composite index of pill count, recital dosage and regular clinic attendance. Sensitivity and specificity with 95% confidence-intervals (CI) were established. Construct validity: convergent and discriminative, was assessed. Results were analyzed by Spearmen correlation and Man-Whitney-U test with p values. Results: The accuracy of the test was denoted by the area under the curve which is 0.87 (95% CI 0.81–0.93) with p<0.0001. The best cut-off point was 70. Patients who score >70 have good adherence to the medication while ≤70 have average adherence. This has a sensitivity of 92.9% (95% CI 85.5–96.9%), a specificity of 72.5% (95% CI 58–83.7%) with a misclassification rate of 14%. The positive likelihood ratio (LR) is 10.2. High positive LR (>10) represents that adherence is very likely in a person with a score >70. The negative likelihood ratio is 0.3 and is in the intermediate range. It suggests that a score <70 is suggestive but insufficient to rule out the non-adherence. The ideal cutoff to predict the optimum HbA1C of MMA is 67. Conclusions: MMA is a valid questionnaire to measure medication adherence.
Estima-se que a não-adesão atinja quase a metade dos usuários crônicos de medicamento. Objetivo: considerando a importância da identificação da não-adesão à farmacoterapia, tem-se o objetivo de mapear a literatura existente no que diz respeito aos métodos de aferi-la. Método: esta revisão narrativa foi conduzida sem limitação temporal, por meio de buscas realizadas nas bases de dados MEDLINE/PubMed, Scielo e Google Acadêmico. Para isso, utilizaram-se os descritos em Ciências da Saúde (DeCS) (Medication Adherence e Adesão à Medicação; Patient Compliance e Cooperação do Paciente; Surveys and Questionnaires e Inquéritos e Questionários); os termos MESH (medication adherence, patient compliance, surveys and questionnaires); e outros termos gerais. Resultados: os métodos para aferir adesão são categorizados em medidas diretas e indiretas. Não há um padrão ouro para aferir a adesão, pois sempre há vantagens e desvantagens em cada método. A medida indireta de autorrelato parece ser o método mais indicado para monitorar a adesão e avaliar o comportamento da não-adesão e para ser utilizado na prática clínica. Conclusão: apesar da riqueza de informações encontradas nesta área, não há consenso entre os pesquisadores. Deve-se verificar qual dimensão se quer medir quanto à adesão e então escolher o instrumento adequado ou então associar instrumentos para realizar a medida pretendida.
Drug review websites such as Drugs.com provide users' textual reviews and numeric ratings of drugs. These reviews along with the ratings are used for the consumers for choosing a drug. However, the numeric ratings may not always be consistent with text reviews and purely relying on the rating score for finding positive/negative reviews may not be reliable. Automatic classification of user ratings based on textual review can create a more reliable rating for drugs. In this project, we built classification models to classify drug review ratings using textual reviews with traditional machine learning and deep learning models. Traditional machine learning models including Random Forest and Naive Bayesian classifiers were built using TF-IDF features as input. Also, transformer-based neural network models including BERT, Bio_ClinicalBERT, RoBERTa, XLNet, ELECTRA, and ALBERT were built using the raw text as input. Overall, Bio_ClinicalBERT model outperformed the other models with an overall accuracy of 87%. We further identified concepts of the Unified Medical Language System (UMLS) from the postings and analyzed their semantic types stratified by class types. This research demonstrated that transformer-based models can be used to classify drug reviews based solely on textual reviews.
Background:
Unhealthy alcohol use is associated with increased progression to tuberculosis (TB) disease, but its effect on adherence to isoniazid (INH) preventive therapy (IPT) is not known.
Methods:
This was a prospective study of persons with HIV (PWH) with latent TB in Southwestern Uganda reporting any current (prior 3 months) alcohol use or no alcohol consumption in prior year (2:1 ratio). All received INH. We defined sub-optimal adherence as <90% of days with at least one Medication Event Monitoring System (MEMS) cap opening, over the prior 90 days. Alcohol use was categorized as: none: no self-report, and phosphatidylethanol (PEth) <8 ng/mL; moderate: Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) 1-2 (women) or 1-3 (men), and/or PEth 8-<50 ng/mL; unhealthy: AUDIT-C ≥3 (women) or ≥4 (men), and/or PEth ≥50 ng/mL. We used generalized estimating equations logistic regression analyses to assess the association between the level of alcohol use and sub-optimal INH adherence.
Results:
Three hundred and two persons were enrolled; 279 were on INH for three or more months. The prevalence of sub-optimal INH adherence was 31.3% at 3 months and 43.9% at 6 months. The odds of sub-optimal INH adherence were higher for unhealthy (adjusted odds ratio [aOR] 2.78 (95% CI: 1.62-4.76) and moderate [aOR] 1.59 (95% CI: 0.94-2.71) compared to no alcohol consumption.
Conclusions:
Sub-optimal adherence to INH at 3- and 6-months was high among PWH and associated with unhealthy alcohol use. Adherence support and/or alcohol reduction strategies are needed for this group at high risk for active TB.
This proceeding presents the papers presented at the 18th Scandinavian Conference on Health Informatics - SHI 2022 in Tromsø, Norway on August 22-24, 2022.
The SHI conference is an annual scientific event attended by scientist and practitioners working in the field of Health Informatics. The area of Health informatics is driven by development in technologies and informatics research that are advancing in parallel and for the integration of information and communication of health and social care. The area includes issues related to EHR, eHealth services and systems, intelligent systems, mobile health applications, telemedicine, assistive technology, artificial intelligence, and Internet of Things.
The field of Health Informatics in this conference is examined from a very broad perspective with participants presenting research outcomes and with focus on eHealth, informatics, Assistive technologies, machine learning, gaming, Internet of the Things, Implementation of eHealth services, EHR, Artificial Intelligence, management and organizational aspects, legal and social issues. More than 40 manuscripts were received with a total of 32 accepted as full papers and 11 as extended abstracts after peer-review. The Editorial Board selected publications with relevance and quality of the field to provide a state-of-the-art of the area. Authors of these communications are researchers of 35 different affiliations, and 13 countries (in alphabetic order: Czech Republic, Denmark, Finland, Germany, India, Italy, Luxembourg, Netherlands, Norway, Pakistan, Sweden, Switzerland, and USA).
All contributions are peer reviewed. The Editorial board expect this proceeding will be of interest for researchers and practitioners working in the field of Health Informatics.
Among many other things, 2022 made us aware of the value of networking. The past years , due to the Covid pandemic, demonstrated the necessity for access to information to improve health and healthcare, and the need for professionals to use and apply that information to transform healthcare. At the same time, the past years made us aware of different approaches and of the importance of Health informatics for renew and innovation of health and social care to improve the delivery of health and social care services to benefit citizens and patients, as we were forces to adapt to a “new normal” in many areas.
The Editors would like to thank the members of the Scientific Program Committee, the Organizing Committee, and all reviewers, who carried out the very professional, through and objective refereeing of the scientific work in order to achieve a high-quality publishing achievement for this scientific event.
The Editors would like to thank Linköpings University press, Sweden for the publication of the processing as an Open access Book. We expect the SHI 2022 provides a forum for research and researchers in Health Informatics, as well as to facilitate scientific discussion, share experiences, and promote collaboration and networking between researchers and practitioners across all countries.
In addition to the delegates presentations, SHI 2022 had the following keynote speakers: Prof. Sabine Koch from Karolinska Institutet (Sweden), Dr. Morten Hasselstrøm Jensen from Aalborg University (Denmark), Prof. and chief physician Audny Anke from the University Hospital of North-Norway (Norway), and research scholar & psychologist Henriette Michalsen, University Hospital of North-Norway (Norway).
Background
Patients taking adjuvant endocrine therapy (AET) after breast cancer face adherence challenges and symptom‐related distress. We conducted a randomized trial to evaluate the feasibility, acceptability, and preliminary efficacy of a telehealth intervention (Symptom‐Targeted Randomized Intervention for Distress and Adherence to Adjuvant Endocrine Therapy [STRIDE]) for patients taking AET.
Methods
From October 2019 to June 2021, 100 patients reporting difficulty with AET were randomly assigned to either STRIDE or a medication monitoring (MedMon) control group. STRIDE included six weekly small‐group videoconferencing sessions and two individual calls. We defined feasibility as having >50% of eligible patients enroll, >70% complete the 12‐week assessment, and > 70% of STRIDE patients complete ≥4/6 sessions. We monitored adherence with the Medication Event Monitoring System Caps (MEMS Caps). At baseline and 12‐ and 24‐weeks after baseline, patients self‐reported adherence (Medication Adherence Report Scale), AET satisfaction (Cancer Therapy Satisfaction Questionnaire), symptom distress (Breast Cancer Prevention Trial‐Symptom Checklist), self‐management of symptoms (Self‐efficacy for Symptom Management‐AET), coping (Measure of Current Status), quality of life (QOL; Functional Assessment of Cancer Therapy‐Breast), and mood (Hospital Anxiety and Depression Scale). We used linear mixed effects models to assess the effect of STRIDE on longitudinal outcomes.
Results
We enrolled 70.9% (100/141) of eligible patients; 92% completed the 12‐week assessment, and 86% completed ≥4/6 STRIDE sessions. Compared with MedMon, STRIDE patients reported less symptom distress (B[difference] = −1.91; 95% CI, −3.29 to −0.52; p = .007) and better self‐management of AET symptoms, coping, QOL, and mood. We did not observe significant differences in AET satisfaction or adherence.
Conclusions
STRIDE is feasible and acceptable, showing promise for improving outcomes in patients taking AET after breast cancer.
Lay summary
Patients taking adjuvant endocrine therapy (AET) after breast cancer may face challenges while following their treatment regimen.
In this randomized controlled trial of 100 patients taking AET, a brief, small‐group virtual intervention (STRIDE) was well‐received by patients and led to improvements in how upset patients were due to symptoms, how confident they were in managing symptoms, and how well they could cope with stress. Thus, STRIDE is a promising intervention and should be tested in future multi‐site trials.
We developed a three-step matching algorithm to enhance the between-group comparability for comparative drug effect studies involving prevalent new-users of the newer study drug versus older comparator drug(s). The three-step matching scheme is to match on: (1) index date of initiating the newer study drug to align the cohort entry time between study groups, (2) medication possession ratio measures that consider prior exposure to all older comparator drugs, and (3) propensity scores estimated from potential confounders. Our approach is illustrated with a comparative cardiovascular safety study of glucagon-like peptide-1 receptor agonist (GLP-1ra) versus sulfonylurea (SU) in type 2 diabetes patients using Taiwan’s National Health Insurance Research Database 2003–2015. 66% of 3195 GLP-1ra users had previously exposed to SU. The between-group comparability was well-achieved after implementing the matching algorithm (i.e., standardized mean difference < 0.2 for all baseline patient characteristics). Compared to SU, the use of GLP-1ra yielded a significantly reduced risk of the primary composite cardiovascular events (hazard ratio [95% confidence interval]: 0.71 [0.54–0.95], p = 0.022). Our matching scheme can enhance the between-group comparability in prevalent new-user cohort designs to minimize time-related bias, improve confounder adjustment, and ensure the reliability and validity of study findings.
Hydroxyurea (hydroxycarbamide) (HU) for sickle cell anaemia (SCA) is underutilised. Case management is an evidence‐based health management strategy and in this regard patient navigators (PNs) may provide case management for SCA. We hypothesised that HU‐eligible patients exposed to PNs would have improved indicators of starting HU and HU adherence. We randomised 224 HU‐eligible SCA adults into the Start Healing in Patients with Hydroxyurea (SHIP‐HU) Trial. All patients received care from trained physicians using standardised HU prescribing protocols. Patients in the Experimental arm received case management and education from PNs through multiple contacts. All other patients were regarded as the Control arm and received specialty care alone. Study physicians were blinded to the study arms and did not interact with PNs. At baseline, 6 and 12 months we assessed and compared laboratory parameters and HU adherence indicators. Experimental patients had higher 6‐month mean fetal haemoglobin (HbF) levels than controls. But at 12 months, mean HbF was similar, as were white blood cell count, absolute neutrophil count, total haemoglobin, platelet count and mean corpuscular volume. At 12 months there were fewer experimental patients missing HU doses than controls (mean 1·8 vs. 4·5, P = 0·0098), and more recent HU prescriptions filled than for controls (mean 53·8 vs. 92 days, median 27·5 vs. 62 days, P = 0·0082). Mean HU doses were largely similar. We detected behavioural improvements in HU adherence but no haematological improvements by adding PNs to specialty care.
Patients are not always aware of the inconveniences associated with renal transplantation, which they compare with a « rebirth », and from which they expect complete recovery. Therapeutic education is proposed to prepare patients for their life after transplantation. This study evaluated the impact of pre-transplant therapeutic education on patient-reported outcomes and rejection-free survival over the first year.
We collected data from 383 renal transplant patients followed-up in 7 centers. Patients who benefited from therapeutic education before transplantation (N=182) were compared to patients who did not (N=139) for quality-of-life, adherence and adverse events using the Pearson chi-square test, one-way ANOVA or t-test. The association between therapeutic education and time to acute rejection was investigated using Cox models.
The patients who benefited from therapeutic education reported adverse events less frequently (e.g., tremor: 9% vs. 32.4%, p=0.01) and better quality-of-life (MCS-QOL: 50.7±8.1 vs. 47.7±9.5, p=0.02; PCS-QOL: 49.1±7.1 vs. 46.0±9.2, p=0.013). No difference was found on adherence. Rejection-free survival was slightly better in the therapeutic education group (HR=0.44, 95%CI=[0.19-1.01]).
This multicenter retrospective cohort study suggests that integrating therapeutic education to care pathways entails clinical benefit, in terms of quality-of-life, self-reported adverse events and rejection-free survival. Randomized clinical trials are necessary to confirm this.
L’observance au traitement antirétroviral (ARV) est une issue prometteuse dans la lutte contre le VIH actuellement. Cependant l’atteinte de celle-ci est complexe dans des contextes ruraux des pays en développement comme celui de la République Démocratique du Congo (RDC). En effet, dans ce contexte, la transculturalité et le caractère « tabou » entourent les soins de l’infection par le VIH. Le fait que dans le contexte rural de la RDC, les infirmiers assurent la quasi-totalité des soins par délégation des tâches, l’approche des soins infirmiers transculturels pourrait être une solution dans le cadre de l’amélioration de l’observance. C’est au regard de l’influence de la transculturalité et du rôle primordial des infirmiers dans la prise en charge du VIH que le programme de recherche Kothara été conçu. Il propose une approche multimodale, transculturelle en sciences infirmières qui soutient l’utilisation du théâtre traditionnel comme stratégie d’éducation thérapeutique pour améliorer l’observance au traitement antirétroviral. Ainsi, trois grandes études ont été réalisées. L’étude Kothar 1 (descriptive-transversale multicentrique) a mesuré l’observance et a déterminé les facteurs qui en sont associés. L’étude kothar 2 (qualitative phénoménologique) a été menée pour comprendre les freins à l’observance. L’étude Kothar 3 était une revue systématique, qui a permis de comprendre les effets du théâtre dans le changement de comportement. A l’issue des résultats obtenus, une stratégie d’intervention (étude kothar 4) orientée vers l’axe éducationnel, la sécurité alimentaire et l’harmonisation de la qualité d’alliance thérapeutique Infirmier-patient dans leparcours de soins a été proposée.
Over 50% of HIV-positive adults globally are women (WHO. 2011. The global health sector strategy on HIV/AIDS 2011–2015 [Online]. World Health Organization. Available: http://www.who.int/hiv/pub/hiv_strategy/en/. Accessed Sept 2015) and if pregnant may be at risk of transmitting the virus to their baby during pregnancy, childbirth and breastfeeding. While HIV antiretroviral medications are available to treat the mother and prevent vertical transmission to the baby, high levels of adherence to ART are required to achieve optimal results for both.
Como es bien sabido, entre las principales características de las enfermedades crónicas están su progresión y permanencia (Larsen, 2009). Por lo tanto, los tratamientos se orientan, esencialmente, al control de síntomas y a la prevención de consecuencias adversas (Barley & Lawson, 2016; Bravo-González, 2014; Grau-Abalo, 2016; Leventhal, Weinman, Leventhal, & Phillips, 2008) a través de la toma de fármacos y la modificación del estilo de vida acordes a las necesidades de cada enfermo, de manera permanente y consistente en el tiempo. Esto implica el desarrollo de patrones de comportamiento complejos (Fernández & Merino, 2015), lo que puede dificultar la iniciación de un nuevo régimen de tratamiento, que se lleve a cabo de manera incorrecta o inconsistente, o que se suspenda parcial o totalmente, aumentando los riesgos para la salud y limitando los resultados esperados (Dunbar-Jacob, Schlenk, & McCall, 2012).
De manera general, se ha reportado que al menos el 50% de los enfermos crónicos tiene problemas de adhesión1 al tratamiento (Dunbar-Jacob et al., 2012; Fernández & Merino, 2015; Organización Mundial de la Salud [OMS], 20O3; Vilaplana, González, & Ordoñana, 2012), lo que se traducirá en un número elevado de ingresos a urgencias y otros servicios hospitalarios, impactando en su economía y calidad de vida y aumentando el riesgo de muerte (Dunbar-Jacob et al., 2012; Ebmeier et al., 2017; Engelkes, Janssens, de Jongste, Sturkenboom, & Verhamme 2015; Lam & Fresco, 2015; Walsh et al., 2019). Por el contrario, un nivel de adhesión elevado reducirá estos riesgos (Rosen, Fridman, Rosen, Shane, & Pevnick, 2017; Sokol, McGuigan, Verbrugge, & Epstein, 2005; Walsh et al., 2019).
Medicina Conductual: Avances y Perspectivas ofrece una visión con la que se pretende proporcionar al lector herramientas que permitan la adecuada evaluación e intervención sobre comportamientos desadaptativos en diversos padecimientos crónico-degenerativos y en distintas etapas del desarrollo del ser humano. Se resalta la importancia del trabajo del psicólogo, particularmente en personas con enfermedad crónica, empleando un modelo de atención multidisciplinaria y ofreciendo distintas estrategias de evaluación e intervención para su uso en el contexto hospitalario y más allá.
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