Article

Systematic Review and Meta-analysis of Real-World Adherence to Drug Therapy for Osteoporosis

Cerner LifeSciences, 9100 Wilshire Blvd, Ste 655E, Beverly Hills, CA 90212, USA.
Mayo Clinic Proceedings (Impact Factor: 5.81). 01/2008; 82(12):1493-501. DOI: 10.1016/S0025-6196(11)61093-8
Source: PubMed

ABSTRACT To quantify the adherence of patients to drug therapy for osteoporosis in real-world settings via a systematic review and meta-analysis of observational studies.
The PubMed and Cochrane databases were searched for English-language observational studies published from January 1, 1990, to February 15, 2006, that assessed patient adherence to drug therapy for osteoporosis using the following medical subject headings and keywords: drug therapy, medication adherence, medication persistence, medication possession ratio, patient compliance, and osteoporosis. Studies were stratified into 3 groups: persistence (how long a patient continues therapy), compliance (how correctly, in terms of dose and frequency, a patient takes the medication), and adherence (a combination of persistence and compliance). A random-effects model was used to pool results from the selected studies.
Twenty-four studies were included in the meta-analysis. The pooled database-derived persistence rate was 52% (95% confidence interval [CI], 44%-59%) for treatment lasting 1 to 6 months, 50% (95% CI, 37%-63%) for treatment lasting 7 to 12 months, 42% (95% CI, 20%-68%) for treatment lasting 13 to 24 months, returning to 52% (95% CI, 45%-58%) for treatment lasting more than 24 months. Pooled adherence rates decreased from 53% (95% CI, 52%-54%) for treatment lasting 1 to 6 months to 43% for treatment lasting 7 to 12 months (95% CI, 38%-49%) or 13 to 24 months (43%; 95% CI, 32%-54%). The pooled refill compliance estimate was 68% (95% CI, 63%-72%) for treatment lasting 7 to 12 months and 68% (95% CI, 67%-69%) for treatment lasting 13 to 24 months. The pooled self-reported compliance rate was 62% (95% CI, 48%-75%) for treatment lasting 1 to 6 months and 66% (95% CI, 45%-81%) for treatment lasting 7 to 12 months.
One-third to half of patients do not take their medication as directed. Nonadherence occurs shortly after treatment initiation. Terms and definitions need to be standardized to permit comparability of technologies designed to improve patient adherence. Prospective trials are needed to assess the relationship between adherence and patient outcomes.

Download full-text

Full-text

Available from: Ronald Joel Halbert, Jul 02, 2015
0 Followers
 · 
162 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We examined prescription adherence rates by contraceptive method among women who used oral contraceptive pills (OCP), transdermal patch or vaginal ring. Women in the St. Louis area were provided their choice of OCP, patch or ring at no cost and followed for 18 months. Time between monthly refills was obtained from pharmacy data and analyzed as a marker of adherence. Risk factors for initial nonadherence were estimated using Cox proportional hazards; predictors for repeated nonadherence were analyzed using Poisson regression with robust error variance. Overall, 619 participants filled 6435 contraceptive prescriptions with a median of 10 refills per participant. Only 30% of women (n = 187) obtained all refills on time. In the time-to-failure analysis, use of vaginal ring and increased parity were predictors of early nonadherence (p < .05). In the multivariable analysis, use of the vaginal ring and history of abortion were risk factors for repeated nonadherence (p < .01). Even with financial barriers removed, pharmacy data show that many women inconsistently refill their contraception and may be at risk for unintended pregnancy.
    Contraception 04/2011; 83(4):340-5. DOI:10.1016/j.contraception.2010.08.003 · 2.93 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this study was to review the methods of prior studies that estimate the association between compliance to osteoporosis pharmacotherapy on fracture risk, and make recommendations to guide future research. We completed a systematic search of MEDLINE to identify all English language nonexperimental studies that examined the impact of adherence to osteoporosis pharmacotherapy on fracture risk. Studies that measured compliance were eligible and those that only examined persistence were excluded. We summarized the methodology of each study and make recommendations for future research. We identified 14 eligible articles: nine cohort and five nested case-control. Length of baseline (lookback) periods ranged between 3 months and 2 years, with nearly all studies (86%) restricting inclusion to treatment-naïve users. A threshold of 80% was most commonly used to define compliance (n = 10), with few studies providing a more thorough analysis through categorical (n = 3) or continuous (n = 1) measures. All nine cohort studies adjusted for age, sex, prior fracture, and at least one other comorbidity or drug; two cohort studies adjusted for a comorbidity score. Two of the five case-control studies clearly controlled for age, sex, drug exposure, event date and length of follow up. One study considered a theoretical sensitivity analysis to account for potential healthy adherer bias, yet all mentioned limitations related to possible residual confounding. We identify great variability in methods of prior studies that evaluate the impact of compliance to osteoporosis pharmacotherapy on fracture risk, and make recommendations to guide future research.
    11/2010; 1(4):149-162. DOI:10.1177/2040622310376137
  • [Show abstract] [Hide abstract]
    ABSTRACT: Contours of objects obtained from two dimensional image segmentation can be used to identify an object shape or define a projection or slice of a three dimensional object. When a contour is compared to reference contours or to adjacent slices or projections, it is necessary to extract the important features of the curves, reduce the effects of noise, and normalize the contours. The method of Fourier descriptors is compared with the method of B-splines for achieving these goals for three dimensional sampled boundary curves. The effective filters in both space and frequency domains are examined, and the results are demonstrated with simulations.
    Acoustics, Speech, and Signal Processing, IEEE International Conference on ICASSP '86.; 05/1986