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Medication non-adherence is recognized as a global problem associated with financial burden for patients and healthcare funds. At the European level, different Medication Adherence Technologies (MATech) are in use. The European Network to Advance Best practices and technoLogy on medication adherencE (ENABLE, COST Action 19132) was launched to: 1) identify current practices for Medication Adherence (MA) support by healthcare professionals; 2) create a structure for the repository of existing MATech that could be used by different stakeholders; and to 3) prepare guidance for sustainable implementation of MATech across European healthcare settings. ENABLE gathered different healthcare professionals and academics from 39 countries, to achieve the set of goals during a four-year period. Several cross-European studies were conducted employing stakeholder consultation (Delphi) and survey methods, including analysis of current practices for assessing and supporting MA in routine care, as well as barriers and facilitators to managing MA, work on medication management during COVID pandemic, reimbursement pathways of adherence interventions and protocols to identify the best practices and technologies. The MATech repository was designed by ENABLE members, and consultation of different stakeholders is currently in progress. The repository structure includes information about the MATech product and provider, goals and content related to managing MA, and information about the scientific evaluation and implementation. A cross-European expert survey identified a limited number of MA enhancing interventions that are currently subject to reimbursement. ENABLE identified the need for collaboration, infrastructure, and reimbursement to enhance the uptake of MATech in daily practice.
The purpose was to assess the knowledge of nursing students and academic staff regarding eHealth. The web-based cross-sectional study was conducted using the Google form platform. The sample was the students and academic staff of the Faculty of Health, University of Vlore in Albania. In the final analysis, 145 individuals were included; 128 were women and 17 were men. The average age of the participants was 25.17 years, namely students (77.93%) and academic staff (22.07%). 48.97% of the participants reported that they considered themselves a little informed about eHealth, p=0.001. The most often cited obstacles to the use of eHealth were health professionals' lack of familiarity with and confidence in eHealth tools, patients' lack of interest in and awareness of digital health, or limited access to eHealth resources. Developing a health education module for eHealth that may be incorporated into the nursing curriculum to tailor patient care regimens is recommended.
Introduction: CA19132—European Network to Advance Best practices & technoLogy on medication adherencE (ENABLE) project aims to raise awareness of medication adherence (MA) and digital technologies. ENABLE is composed of 40 European countries including members from various backgrounds. Communication and dissemination play an important role in this project.
Aim: To present communication and dissemination activities in the COST ENABLE project.
Methods: The outlined plan for communication including the selection and utilization of appropriate channels of dissemination and communication during the first two-year period is presented.
Results: A website and accounts on LinkedIn and Twitter were created to increase visibility by sharing all relevant events, publications, and congresses. A communication plan was prepared using an analysis of strengths, weaknesses, opportunities and threats to predetermine the activities to be held in the 4-year period. Newsletters were prepared in quarterly periods, and upcoming events were announced to all members and new participants. Promotional materials were designed to create a sense of belonging among the members and to promote the project. A press release was prepared using lay language to communicate with the general public.
Conclusion: To carry out a joint European project and effectively disseminate its results to stakeholders (scientific community, pharmaceutical industry, researchers, patients, patient associations and general public), effective communication and dissemination strategies are needed, and these strategies can be a driving force in policymaking at international level by raising awareness.
Introduction: In the European Cooperation In Science and Technology (COST) project CA19132—European Network to Advance Best practices & technology on medication adherencE (ENABLE), Work Group 1 examines how medication adherence is managed across Europe.
Aim: To gain knowledge on specific actions and initiatives to improve medication adherence during the COVID-19 pandemic.
Methods: A cross-sectional, online survey was carried out 4/21–6/30, 2021. COST members from 39 countries were asked to disseminate the survey to key-opinion leaders (i.e., medication adherence experts) from health, academic, and governmental institutions, and patient associations with the aim of 5 respondents per country. Answers to open-ended questions were analyzed using the Framework Method. This abstract presents the results on the question on actions to improve adherence during the pandemic.
Results: In total, 140 KOLs from 35 COST countries responded. Most of them (n = 74) represented a research/academic organization. 57 respondents from 27 countries answered that there were no specific actions in their country to improve adherence during the pandemic. In addition, 32 respondents were not aware of any actions. Telemedicine (n = 22) was the most often reported action. Other actions included, for example, easier access to medicines and public information and education.
Conclusion: Most of European countries seem not have had actions specifically aimed at improving medication adherence during the pandemic. Many actions are known to have been taken to maintain access to care and medication, but these were not seen as actions to improve adherence.
Background: Poor medication adherence remains to be the greatest challenge in drug therapy. There has been a rapid development of different digital technologies to support adherence to medication but there is limited knowledge about their effectiveness and safety.. Pharmacoepidemiological studies can contribute, but there are many methodological challenges.
Objectives: To provide insight in key methodological challenges in observational studies on the effectiveness and safety of digital technologies to support medication adherence.
Description: The workshop will begin with an introduction to the theme of digital technologies in medication adherence. Such technologies include, e.g., smart pill-boxes/packaging, digital inhalers, audio and vibration-based tracking devices, pill-tracers and e-injection pens, e-Health self-management applications and big data. Short presentations and interactive discussions will follow around different types of methodological challenges that needs to be addressed when designing studies to assess the effectiveness and safety of digital technologies to support medication adherence. A template for a research protocol will be developed during the workshop. This will be organized as group discussions including 8-10 people in each group, led by a facilitator. All facilitators are active members of the European COST Action "European Network to Advance Best practices & technoLogy on medication adherencE" (ENABLE) project.
https://www.eventscribe.net/2022/ICPE/agenda.asp?pfp=FullSchedule
Background: Medication non-adherence jeopardises the effectiveness of chronic therapies and negatively affects financial sustainability of healthcare systems. Available medication adherence-enhancing interventions (MAEIs) are utilised infrequently, and even more rarely reimbursed. The aim of this paper was to review reimbursed MAEIs across selected European countries.
Methods: Data on reimbursed MAEIs were collected from European countries at the ENABLE Cost Action expert meeting in September 2021. The identified MAEIs were analysed and clustered according to their characteristics, direct vs. indirect relation to adherence, and the targeted adherence phase.
Results: Out of 12 contributing countries, 10 reported reimbursed MAEIs, 28 in total, of which 20 were identified as MAEIs targeting adherence directly. Reimbursed MAEIs were most often performed by either doctors ( n = 6), nurses ( n = 6), or pharmacists ( n = 3). The most common types of MAEIs were education ( n = 6), medication regimen management ( n = 5), and adherence monitoring feedback ( n = 4). Only seven reimbursed MAEIs were technology-mediated, whereas 11 addressed two interlinked phases of medication adherence, i.e. , implementation and persistence.
Conclusion: Our review highlights the scarcity of reimbursed MAEIs across the selected European countries, and calls for their more frequent use and reimbursement.
Medication adherence is a key factor impacting efficacy and safety of medicines, yet how it is dealt with in European registration trials is unknown. A cross‐sectional analysis of European Medicines Agency (EMA) marketing authorisation dossiers for new medicines approved through centralised procedures in the European Union between 2010‐2020 was performed. Data was extracted from European Public Assessment Reports and Clinical Study Reports. Clinical trials covering five therapeutic areas were included: diabetes, respiratory conditions, cardiovascular diseases, infectious diseases, and oncology. Outcomes included adherence assessment, measurement methods, and rates. Overall, 102 medicines studied in 253 clinical trials were reviewed. All but one study reported measuring adherence. 220 trials (87%) measured adherence using quantitative methods, while 32 (13%) trials monitored adherence but did not further quantify. Reported adherence rates were high (>90%) across trials yet marked disparities in measurement methods and definitions were found. The most frequently used adherence measurement method was pill/dose count (single method: 52.7%; in combination: 37.7%; with patient diary/report: 17.3%; electronic methods: 1.4%; bioanalytical methods: 4.1%). Patient diary/report (6.4%) and electronic methods (2.7%) were also used as single methods. Electronic methods were more often used in respiratory and anti‐infective trials, while bioanalytical methods were more frequently used in diabetes. Overall, adherence is measured in EMA registration trials, yet the methods used and the way in which adherence rates are presented vary widely between trials and therapeutic areas. To better understand and compare efficacy of medicines, standardization of adherence definitions and measurement methods is needed.
Introduction: Current literature lacks detailed understanding of the reimbursement framework of medication adherence enhancing interventions (MAEIs). As part of the ENABLE COST Action, the EUREcA (“EUropen REimbursement strategies for interventions targeting medication Adherence”) study aimed to provide an in-depth overview of reimbursed MAEIs currently available in European countries at national and regional levels and to pave the way for further MAEIs to be implemented in the future.
Methods: A web-based, cross-sectional survey was performed across 38 European countries and Israel. The survey questionnaire was developed as a result of an iterative process of discussion informed by a desk review. The survey was performed among invited ENABLE collaborators from June to July 2021. Besides descriptive analysis, association between country income and health care expenditure, and the availability of reimbursed MAEIs were also assessed.
Results: The survey identified 13 reimbursed MAEIs in nine countries: multi-dose drug dispensing ( n = 5), medication review ( n = 4), smart device ( n = 2), mobile application ( n = 1), and patient education ( n = 1). The median GDP per capita of countries having ≥1 reimbursed MAEI was significantly higher compared to countries having no reimbursed adherence intervention (33,888 EUR vs 16,620 EUR, respectively; p = 0.05).
Conclusions: Our findings highlight that to date only a small number of MAEIs have been reimbursed in European countries. Comprehensive health technology assessment recommendations and multi-stakeholder collaboration could help removing barriers related to the implementation and reimbursement of MAEIs.
Trainer in "The Training School on Working with Patients on Medication Adherence-Practical Solutions" organized by the COST Action CA19132 European Network to Advance Best practices & technoLogy on medication adherencE (ENABLE)
Introduction: Medication adherence is a common problem among elderly adults and the literature on nonadherence is considerable for this age group but there is a gap of publications in young adults.
Aim: The aim was to assess the level of medication adherence among young adults in Albania.
Methods: A cross-sectional web-based study was conducted in May 2021. The Rief adherence index (RAI) questionnaire was used for the data collection through the Google forms platform using the snowballing method. The call for participation was posted in the authors' social networks with different reminders. Only adult people aged ≥ 18 were eligible to participate. A checklist for Reporting Results of Internet E-Surveys (CHERRIES) was taken into account while conducting the study. The participants had the possibility to complete the questionnaire once.
Results: The study included a total of 440 people. The mean age was 29.8 ± SD 14.8. 77.3% of participants were female with higher education. 23.6% of participants suffered from a chronic illness. Regularity was reported in initiating the use of medications prescribed. Changing medication doses and discontinuing treatment earlier without consulting a doctor was the most common phenomenon found.
Discussion: In this study, we found that medication non-adherence is common among young adults although with high educational levels.
Conclusion: Health professionals should provide sufficient information and counseling on medication adherence to doses and taking medications as prescribed to young adults that often are underestimated in relation to medication adherence.
OBJECTIVES: The European Cooperation in Science and Technology (COST) project “European Network to Advance Best practices & technoLogy on medication adherencE” (ENABLE) aims at raising awareness and broadening knowledge on medication adherence (MA). First task of ENABLE Work Group 1 is to collect information on the management of MA across Europe.
METHODS: A cross-sectional study with a pilot study and two-part online survey was planned. A pilot study was conducted among 3 key opinion leaders (KOLs) from 5 countries to assess viability of the first survey. The first survey was targeted to 5 KOLs from health, academic, governmental institutions and patient associations from each 39 COST-ENABLE countries. It was designed to identify barriers and facilitators, management strategies, and available interventions enhancing MA. The second-part survey will contain closed-questions based on the results of the first survey and will be targeted to healthcare professionals. A quantitative analysis will be applied to measure how different methods and interventions are implemented in different countries and areas of Europe. Online informed consent is obtained along with ethical approval for both surveys at country-level where necessary.
RESULTS: The pilot study was conducted in April 2021 and collected answers from 12 KOLs. The online survey including 10 open questions for KOLs was available from April 21 to the end of June. Answers to the open questions are being analysed qualitatively by a group of researchers with an analytical matrix of codes developed based on pilot study outputs. The second online survey will be available for healthcare professionals in the autumn of 2021.
CONCLUSIONS: The two-part survey will provide a broad insight of management of MA across Europe including unmet needs, and barriers and facilitators of MA. It will be the basis for scientific collaboration and foster multidisciplinary knowledge on MA to improve patients’ health outcomes.
https://www.ispor.org/heor-resources/presentations-database/presentation/euro2021-3407/113640
Introduction: The European Cooperation In Science and Technology (COST) project “CA19132 - European Network to Advance Best practices & technoLogy on medication adherencE” (ENABLE) Work Group 1 examines how countries manage medication adherence and the personal, healthcare professional (HCP), and health system barriers and facilitators of medication adherence.
Aim: To get knowledge on adherence-related practices and unmet needs perceived by different European HCPs.
Methods: Qualitative study with online survey sent to 3 key opinion leaders (KOLs) in 5 countries (Bulgaria, Croatia, Spain, Sweden, Turkey) involved in the ENABLE action. KOLs selected were HCPs and adherence experts from academia, hospital, and professional associations. Survey contained responders’ background information and twelve open questions. Answers were analysed in 3 levels (patient, HCP, national/healthcare system) with Framework method through a coding process to establish thematic groupings.
Results: 12 KOLs responded. Most crucial patient-related barriers are absence of awareness, and need for training/education. The issues among HCPs are lack of awareness, data accessibility, need for training and guidelines, and insufficient collaboration between professionals. The most significant barriers related to healthcare systems are lack of legal basis, policies, national programs, accessible medication adherence technology, and digital solutions.
Conclusion: Lack of awareness and resources regarding medication adherence could be identified as the main barrier/unmet need in all 3 levels analysed in this pilot study. These findings will be confirmed in a survey to all 39 COST ENABLE countries.
Medication non-adherence is associated with almost 200,000 deaths annually and €80-125 billion in the European Union. Novel technological advances (smart pill bottles, digital inhalers, and spacers, electronic pill blisters, e-injection pens, e-Health applications, big data) could help managing non-adherence. Healthcare professionals seem however inadequately informed about non-adherence, availability of technological solutions in daily practice is limited, and collaborative efforts to push forward their implementation are scarce. The European Network to Advance Best practices and technoLogy on medication adherencE (ENABLE, COST Action 19132) aims to 1) raise awareness of adherence enhancing solutions, 2) foster knowledge on medication adherence, 3) accelerate the clinical application of novel technologies, and 4) work collaboratively towards economically viable policy, and implementation of adherence enhancing technology across healthcare systems.
Introduction. Medication adherence is a common problem among elderly adults and the literature on nonadherence is considerable for this age group but there is a gap of publications in young adults.
Aim. The aim was to assess the level of medication adherence among young adults in Albania. Methods. A cross-sectional web-based study was conducted in May 2021. The Rief Adherence Index (RAI) questionnaire was used for the data collection through the Google forms platform using the snowballing method. The call for participation was posted in the authors' social networks with different reminders. Only adult people age ≥ 18 were eligible to participate. A checklist for Reporting Results of Internet E-Surveys (CHERRIES) was taken into account while conducting the study. The participants had the possibility to complete the questionnaire once.
Results. The study included a total of 440 people. The mean age was 29.8±SD14.8. 77.3% of participants were female with higher education. 23.6% of participants suffered from a chronic illness. Regularity was reported in initiating the use of medications prescribed. Changing medication doses and discontinuing treatment earlier without consulting a doctor was the most common phenomenon found.
Discussion. In this study, we found that medication non-adherence is common among young adults although with high educational levels.
Conclusion. Health professionals should provide sufficient information and counseling on medication adherence to doses and taking medications as prescribed to young adults that often are underestimated in relation to medication adherence.
Keywords: Medication adherence, young adults, non-EU country, web-based study.
Introduction. Medication adherence is a common problem among elderly adults and the literature on nonadherence is considerable for this age group but there is a gap of publications in young adults.
Aim. The aim was to assess medication adherence among randomly Albanian adults and to identify the most used drugs.
Methods. A cross-sectional web-based study was conducted in May 2021. The validated and reconciled into Albanian language Rief Adherence Index (RAI) questionnaire was used for the data collection. The administration of the questionnaire was made using the Google forms platform. The call for participation was posted at different times in the social media tools of the authors until a considerable number of participants was reached. Participation in the study was voluntary.
Results. The study included in total respectively 340 and 100 female and male participants. Most of the participants were single and lived alone. The most-reported chronic diseases were allergies, diabetes, hypertension, arrhythmias, and rheumatic diseases. The most commonly used drugs reported were antihistamines, antiarrhythmics, insulin, antihypertensives, and aspirin.
Discussion. Non-compliance with medication doses and discontinuation of treatment without consulting a physician was the most frequently reported phenomena.
Conclusion. Raising awareness among the adult population with chronic illness to take medication correctly in order to prevent related complications and costs should be the focus of health personnel.
Keywords: Medication adherence, young adults, non-EU country, web-based study.
Maintaining healthcare for noncommunicable diseases (NCDs) is particularly important during the COVID-19 pandemic; however, diversion of resources to acute care, and physical distancing restrictions markedly affected management of NCDs. We aimed to assess the medication management practices in place for NCDs during the second wave of the COVID-19 pandemic across European countries. In December 2020, the European Network to Advance Best practices & technoLogy on medication adherencE (ENABLE) conducted a cross-sectional, web-based survey in 38 European and one non-European countries. Besides descriptive statistics of responses, nonparametric tests and generalized linear models were used to evaluate the impact on available NCD services of the number of COVID-19 cases and deaths per 100,000 inhabitants, and gross domestic product (GDP) per capita. Fifty-three collaborators from 39 countries completed the survey. In 35 (90%) countries face-to-face primary-care, and out-patient consultations were reduced during the COVID-19 pandemic. The mean ± SD number of available forms of teleconsultation services in the public healthcare system was 3 ± 1.3. Electronic prescriptions were available in 36 (92%) countries. Online ordering and home delivery of prescription medication (avoiding pharmacy visits) were available in 18 (46%) and 26 (67%) countries, respectively. In 20 (51%) countries our respondents were unaware of any national guidelines regarding maintaining medication availability for NCDs, nor advice for patients on how to ensure access to medication and adherence during the pandemic. Our results point to an urgent need for a paradigm shift in NCD-related healthcare services to assure the maintenance of chronic pharmacological treatments during COVID-19 outbreaks, as well as possible future disasters.
