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 01/2016; 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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    • "Medication non-adherence is a widespread problem in the United States, increasing safety risks for patients and placing a significant financial burden on the healthcare industry [1]. Poor adherence to medication often results in substantial worsening of a disease, increased mortality, and unnecessary healthcare costs [2] [3]. For the purposes of this paper, we limit the definition of adherence to the medication regimen a physician prescribes, and a patient's commitment to taking those medications as prescribed. "
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    ABSTRACT: Medication non-adherence is a major concern in the healthcare industry and has led to increases in health risks and medical costs. For many neurological diseases, adherence to medication regimens can be assessed by observing movement patterns. However, physician observations are typically assessed based on visual inspection of movement and are limited to clinical testing procedures. Consequently, medication adherence is difficult to measure when patients are away from the clinical setting. The authors propose a data mining driven methodology that uses low cost, non-wearable multimodal sensors to model and predict patients' adherence to medication protocols, based on variations in their gait. The authors conduct a study involving Parkinson's disease patients that are "on" and "off" their medication in order to determine the statistical validity of the methodology. The data acquired can then be used to quantify patients' adherence while away from the clinic. Accordingly, this data-driven system may allow for early warnings regarding patient safety. Using whole-body movement data readings from the patients, the authors were able to discriminate between PD patients on and off medication, with accuracies greater than 97% for some patients using an individually customized model and accuracies of 78% for a generalized model containing multiple patient gait data. The proposed methodology and study demonstrate the potential and effectiveness of using low cost, non-wearable hardware and data mining models to monitor medication adherence outside of the traditional healthcare facility. These innovations may allow for cost effective, remote monitoring of treatment of neurological diseases.
    Computers in Biology and Medicine 09/2015; 66:120-134. DOI:10.1016/j.compbiomed.2015.08.012 · 1.24 Impact Factor
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133 Reads