Adherence to medication. N Engl J Med

Stanford University, Palo Alto, California, United States
New England Journal of Medicine (Impact Factor: 55.87). 09/2005; 353(5):487-97. DOI: 10.1056/NEJMra050100
Source: PubMed
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    • "For example, the opportunity for delivery via systemic approaches (e.g., oral formulations or parenteral injections) is largely precluded by lack of specificity, which results in undesirable side effects and systemic toxicity [3]. Topical delivery (e.g., via eye drops) allows for better targeting and, as such, is used widely for many indications [4]. However, this approach is highly inefficient (i.e., drug bioavailability <3% in many cases), and it is also subject to poor patient compliance, due in part to the required frequency of application [5]. "
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    ABSTRACT: The development of a safe, simple, and efficacious means for ocular drug delivery remains a critical unmet need. Solid microneedles (MNs) show significant promise in this regard. However, the limited drug carrying capacity of devices demonstrated to date may limit potential for clinical translation, due to the prohibitively large array sizes that may be required for delivery of therapeutically-relevant dosages. In this study, titanium deep reactive ion etching (Ti DRIE) is used to address this limitation via fabrication of MNs with complex through-thickness fenestrations (i.e., windows), which serve as reservoirs for passive delivery. Using finite element analyses, mechanical testing, and ex vivo rabbit cornea preparations, we show that these devices possess sufficient stiffness for reliable insertion. Furthermore, using spectrophotometry and fluorescence microscopy, we show that these devices can increase carrying capacity up to five-fold relative to solid MNs of comparable size, as well as enhance sub-surface deposition in ex vivo rabbit cornea. Collectively, these results begin to demonstrate the potential embodied in fenestrated Ti MNs for eventual realization of ocular drug delivery devices with more clinically-relevant form factors.
    Sensors and Actuators B Chemical 02/2016; 223:15-23. DOI:10.1016/j.snb.2015.09.071 · 4.10 Impact Factor
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    • "Despite the ability to effectively manage chronic conditions with prescription drugs, an estimated one third to one half of all patients fails to take medications as prescribed by their providers. This often results in preventable worsening of disease and, in turn, excess hospitalizations (Osterberg and Blaschke, 2005). 4 The treatment of many chronic conditions requires compliance with a drug regimen prescribed by a physician—in the form of daily intake, for example (Encinosa, Bernard and Dor, 2010; Dezii, 2000). "
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    ABSTRACT: This paper analyzes how prices in the retail pharmaceutical market affect health care utilization. Specifically, I study the impact of Walmart’s $4 Prescription Drug Program on utilization of antihypertensive drugs and on hospitalizations for conditions amenable to drug therapy. Identification relies on the change in the availability of cheap drugs introduced by Walmart’s program, exploiting variation in the distance to the nearest Walmart across ZIP codes in a difference-in-differences framework. I find that living close to a source of cheap drugs increases utilization of antihypertensive medications by 7 percent and decreases the probability of an avoidable hospitalization by 6.2 percent.
    Journal of Health Economics 12/2015; DOI:10.1016/j.jhealeco.2015.07.005 · 2.58 Impact Factor
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    • "fears of addiction), and may reduce or stop their medication unilaterally (Pound et al., 2005). Research has also indicated that patient self-regulation leads to conflicts with health professionals, previously captured under the lop-sided rubrics of " compliance " and " adherence " e concepts which favored professional perspectives (Osterberg and Blaschke, 2005; O'Connor, 2006). Today, social research focuses on how medication-taking is negotiated and becomes meaningful to patients (Shoemaker and Ramalho de Oliveira, 2008). "
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    ABSTRACT: Discontents surrounding depression are many, and include concerns about a creeping appropriation of everyday kinds of misery; divergent opinions on the diagnostic category(ies); and debates about causes and appropriate treatments. The somewhat mixed fortunes of antidepressants - including concerns about their efficacy, overuse and impacts on personhood - have contributed to a moral ambivalence around antidepressant use for people with mental health issues. Given this, we set out to critically examine how antidepressant users engage in the moral underpinnings of their use, especially how they ascribe legitimacy (or otherwise) to this usage. Using a modified constant comparative approach, we analyzed 107 narrative interviews (32 in UKa, 36 in UKb, 39 in Australia) collected in three research studies of experiences of depression in the UK (2003-4 UKa, and 2012 UKb) and in Australia (2010-11). We contend that with the precariousness of the legitimacy of the pharmaceutical treatment of depression, participants embark on their own legitimization work, often alone and while distressed. We posit that here, individuals with depression may be particularly susceptible to moral uncertainty about their illness and pharmaceutical interventions, including concerns about shameful antidepressant use and deviance (e.g. conceiving medication as pseudo-illicit). We conclude that while people's experiences of antidepressants (including successful treatments) involve challenges to illegitimacy narratives, it is difficult for participants to escape the influence of underlying moral concerns, and the legitimacy quandary powerfully shapes antidepressant use.
    Social Science [?] Medicine 10/2015; 146:53-61. DOI:10.1016/j.socscimed.2015.10.012 · 2.89 Impact Factor
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