ArticleLiterature Review

Medication Compliance and Persistence: Terminology and Definitions

January 2008
Value in Health 11(1):44 - 47

DOI:10.1111/j.1524-4733.2007.00213.x

Source
PubMed

Authors:

Joyce A Cramer

Yale University

Show all 13 authorsHide

Objective: The aim of the study is to provide guidance regarding the meaning and use of the terms "compliance" and "persistence" as they relate to the study of medication use. Methods: A literature review and debate on appropriate terminology and definitions were carried out. Results: Medication compliance and medication persistence are two different constructs. Medication compliance (synonym: adherence) refers to the degree or extent of conformity to the recommendations about day-to-day treatment by the provider with respect to the timing, dosage, and frequency. It may be defined as "the extent to which a patient acts in accordance with the prescribed interval, and dose of a dosing regimen." Medication persistence refers to the act of continuing the treatment for the prescribed duration. It may be defined as "the duration of time from initiation to discontinuation of therapy." No overarching term combines these two distinct constructs. Conclusions: Providing specific definitions for compliance and persistence is important for sound quantitative expressions of patients' drug dosing histories and their explanatory power for clinical and economic events. Adoption of these definitions by health outcomes researchers will provide a consistent framework and lexicon for research.

Designing a Real-Time Medication Intake and Adherence Dashboard: Features, Functionality, and Data Display to Meet the Needs of Patients, Care Partners and Healthcare Providers

Article

Full-text available

May 2025
J MED SYST

To determine the key features, utilities, and functionalities of an adherence dashboard so that patients, care partners, and healthcare providers can effectively use it to identify and improve medication nonadherence. A qualitative study was conducted in four stages. In Stage 1, semi-structured interviews and focus groups were conducted with patients, care partners, and healthcare providers after showing existing dashboards to gain feedback and determine their needs and preferences for the dashboard. In Stage 2, data gathered from Stage 1 were used to develop paper prototypes. In Stage 3, these prototypes were evaluated by participants to refine the design. Finally, in Stage 4, a framework for the key components of the adherence dashboard was developed based on user feedback. Some of the key features identified include individualized medication adherence, overall adherence summaries, customizable notifications, real-time data visualization, and integration with existing healthcare systems such as electronic health records (EHR). Participants also highlighted the importance of intuitive design, ease of navigation, secure data handling, and the ability to customize the dashboard according to user preferences. This study identifies key features and functionalities and provides a user-centered framework for designing a real-time medication adherence dashboard tailored to the needs of patients, caregivers, and healthcare providers. Future work will focus on developing a fully functional dashboard, integrating it into clinical practice, and evaluating its effectiveness in improving medication adherence.

Effectiveness of inbuilt cell phone reminders in chronic medication compliance

Article

Full-text available

Apr 2025
S Afr Fam Pract (2004)

Background: Adherence to chronic medication is crucial for managing chronic diseases and preventing complications. However, maintaining consistent adherence remains challenging, particularly in low- and middle-income countries where forgetfulness is a common barrier. The widespread use of mobile phones, even in resource-limited settings, offers a practical opportunity to leverage inbuilt reminder features to support medication adherence. This study evaluates the effectiveness of inbuilt cell phone reminders in enhancing chronic medication compliance among patients in the eThekwini health district of KwaZulu-Natal, South Africa.Methods: In this prospective, cross-sectional study, 400 patients on chronic medications were systematically selected from five healthcare centres. Participants were divided into two groups: those using mobile phone reminders (Group 1) and those who did not (Group 2). Medication adherence was assessed using a standardised questionnaire, and statistical analyses, including Chi-square tests and logistic regression, were conducted to identify differences in adherence rates.Results: Group 1 exhibited significantly higher adherence rates (87%) compared to Group 2 (67%, p 0.001). The use of cell phone reminders was associated with a 2.5-fold increase in the odds of adherence (odds ratio [OR] = 2.5, 95% confidence interval [CI]: 1.7–3.6, p 0.001).Conclusion: Inbuilt cell phone reminders are a cost-effective intervention that significantly enhances medication adherence, especially in resource-limited settings. Integrating mobile technologies into public health strategies could improve chronic disease management.Contribution: This study highlights the potential of mobile phone reminders as a practical tool for improving medication adherence, with significant implications for public health strategies in low-resource settings.

Assessment of antiseizure medication adherence based on postmortem toxicology and claimed prescriptions in cases of sudden unexpected death in epilepsy

Article

Full-text available

Apr 2025
EPILEPSIA

Objective Individuals with epilepsy are at a higher risk of dying suddenly and without explanation, known as sudden unexpected death in epilepsy (SUDEP). Seizures are a risk factor for SUDEP, and nonadherence to antiseizure medication (ASM) increases this risk. We aimed to assess adherence to ASMs at the time of death among young SUDEP cases by comparing prescription claims with postmortem toxicology at an individual level. Methods We identified all forensically autopsied SUDEP cases by assessing autopsy reports, toxicology reports, and Danish health registries from a previously identified nationwide population of sudden unexplained deaths in Denmark. We included cases aged 1–35 and 36–49 years between 2000–2019 and 2007–2019, respectively. We assessed adherence to ASMs by examining discrepancies or consistencies between any register‐based claimed prescriptions and postmortem toxicology findings, resulting in four possible outcomes: evidence of adherence, nonadherence, nontreatment or undertreatment, and nonprescribed medication. Results Of 477 sudden unexplained deaths, 84 (18%) were identified as SUDEP. Among the SUDEP cases, 73 (87%) claimed ASMs before death and 67 (80%) had ingested ASM according to postmortem findings. Evidence of nonadherence was found in 16 (19%) SUDEP cases, constituting 22% (n = 16/73) of SUDEP cases who claimed ASM before death. Adherence was observed in 53 SUDEP cases (63%), comprising 73% (n = 53/73) of SUDEP cases who claimed ASM before death. Nonadherent SUDEP cases tended toward a higher prevalence of psychiatric diseases when compared with the remaining SUDEP cases. Significance By uniquely matching register‐based prescription data with postmortem toxicology findings, we ascertained that 73% of SUDEP cases adhered to their claimed ASM, underscoring the necessity for continued vigilance in seizure management. However, improving medication adherence may possess preventive potential for SUDEP, as 22% exhibited nonadherence to their claimed ASM.

Identifying the attributes of adherence to tuberculosis treatment in Indonesia: A Delphi study

Article

Full-text available

Feb 2025

Adherence to tuberculosis (TB) treatment is essential for achieving successful health outcomes. Establishing a consensus among healthcare professionals regarding the definition and key attributes of adherence to TB treatment is essential. The aim of this study was to explore the perspectives of experts and patients on the attributes of adherence to TB treatment. A total of 20 TB specialists and 10 pulmonary TB patients from various regions in Indonesia participated in a three-round Delphi study designed to categorize and validate these attributes. In the first round, participants were interviewed to gather qualitative insights. In the second and third rounds, experts assessed the level of agreement on identified attributes using a five-point Likert scale. The strength of consensus was measured using the interquartile range (IQR), following the best practices outlined in the Conducting and REporting DElphi Studies (CREDES) guidelines. The experts achieved a substantial consensus, with over 85% agreement on the identified attributes. The findings indicated that adherence to TB treatment encompasses the ability of pulmonary TB patients to follow agreed-upon recommendations, including both medication adherence and lifestyle modifications. These lifestyle changes include improved nutritional care, smoking cessation, abstaining from alcohol, stress management, improved physical activity, better sleep, and rest quality, and preventive behaviors related to TB. In conclusion, the findings enhanced the understanding of adherence to TB treatment by highlighting its multifaceted nature. The consensus emphasized that adherence extends beyond medication-taking behaviors to include essential lifestyle changes, underscoring the comprehensive approach needed to support TB patients effectively.

Evaluation of Anti-Epileptic Drug Adherence and Contributing Factors Among Adults with Epilepsy at Yekatite 12 Hospital Medical College, 2024

Article

Apr 2025

Background: Epilepsy affects over 50 million individuals worldwide, making it one of the most prevalent neurological disorders. Anti-epileptic drugs (AEDs) serve as the primary treatment, enabling up to 70% of patients to achieve seizure freedom when adhering to an effective regimen. “Medication adherence” refers to the extent to which patients follow their prescribed medication schedules, including correct dosages and intervals. This concept emphasizes a patient-centered approach in healthcare, highlighting collaboration between patients and healthcare providers in developing treatment plans rather than a one-sided directive. Studies indicate that anti-epileptic drug (AED) non-adherence rates among adults with epilepsy range from 29% to 39%. This non-adherence undermines the effectiveness of AED regimens, leading to an increased risk of fractures, injuries, and automobile accidents. Additionally, retrospective research has shown that non-adherence contributes to higher healthcare utilization and Costs as evidenced by increased emergency department visits and inpatient admissions. Objective: To assess the prevalence of anti-epileptic medication adherence and associated factors among adult epileptic patients in Yekatite 12 Medical College, Addis Ababa, Ethiopia. Method: A cross-sectional study involving adult epileptic patients at Yekatite 12 Medical College in Addis Ababa, Ethiopia, was carried out from May 3, 2024, to August 13, 2024. Data will be gathered using a structured questionnaire, and descriptive statistics will be used to analyze and present the results. Result: Of 230 respondents, 130 (56.5%) were male, and 100 (43.5%) were female. Most of the patients, 160 (69.6%), were in the 20-45 age range, while only 11 (4.8%) were above 60. Most of the respondents, 155 (67.4%), identified as Orthodox, and nearly half, 109 (47.4%), were married. Additionally, 126 (54.8%) of the patients had access to primary education. Regarding employment, 104 (45.2%) were employed, and 9 (3.9%) were students. Lastly, 123 (53.5%) of the patients earned between 1000 and 5000. Conclusion: The findings of this study show a low adherence rate to anti-epileptic drug (AED) treatment compared to the standard adherence rate of over 95%, which is necessary to effectively prevent seizure recurrence. Missing one or more doses of the AED regimen each week can lead to treatment failure and trigger seizures. In conclusion, 60% of the study participants adhered to their AED treatment, with forgetfulness being the main reason for non-adherence, followed by a busy lifestyle.

Triggers of treatment interruption and resumption among individuals with type 2 diabetes: a narrative cross-sectional qualitative study

Article

Full-text available

Apr 2025

Purpose Treatment interruption and resumption are common among people with type 2 diabetes mellitus (T2D), but the triggers of resumption, according to the reasons for interruption, remain underexplored. This study examined patterns of treatment interruption and resumption. Methods Narratives from 13 T2D patients with a history of treatment interruption were analysed through semi-structured interviews. Results Four patterns were identified: 1) “Economic rationality”, where financial barriers caused interruptions, but resumption was facilitated by low-cost check-ups and updated patient mindsets to manage medical expenses within the constraints of a limited household budget; 2) “Proactive information seeking”, where doubts about treatment effectiveness led to interruptions, followed by resumption through active health risk reassessment by the patient’s self-directed efforts; 3) “Health professional-patient relationship”, where conflicts with healthcare providers prompted interruptions, but trustful encounters encouraged resumption; and 4) “Sustained partnerships with community health professionals”, where personal challenges caused interruptions, but non-coercive partnerships with community health professionals fostered resumption through strengthened patient commitment. Conclusion This study highlights the need for tailored medical support and local policy development for T2D patients, emphasizing subjective interpretations of their experiences on treatment interruption and resumption. Recognizing these patterns can guide resource allocation and the design of community-based diabetes care interventions.

Factors driving persistence to first-line advanced therapies in inflammatory bowel disease: a real-world study from a tertiary referral centre

Article

Full-text available

Apr 2025
INTERN EMERG MED

Factors driving the persistence of advanced therapies—defined as the duration from therapy initiation to discontinuation—in inflammatory bowel disease (IBD) remain unclear. This study aimed to evaluate the persistence of biologics and oral small molecules in a real-word IBD cohort and to identify influencing factors. Data from IBD patients starting advanced therapy at a tertiary referral centre after 2010 were retrospectively collected, including persistence and discontinuation reasons. Differences in persistence probability among therapies were analysed, and factors influencing persistence versus discontinuation due to failure were assessed by univariate and multivariate analyses. Among 274 included patients [median age 42.5 years; F/M 119/155; 146 with Crohn’s disease (CD) and 128 with ulcerative colitis; median follow-up 38 months (IQR 14–75)], 141 (51.5%) remained persistent with first-line therapy, while 70 (26%) discontinued due to failure. No significant difference in persistence was observed among drugs ( p = 0.11). Univariate analysis identified CD phenotype ( p < 0.01), disease duration prior to therapy ( p = 0.01), concomitant mesalamine or steroids ( p < 0.01), and therapy optimisation ( p < 0.01) as factors influencing persistence. Multivariate analysis confirmed CD phenotype as associated with higher persistence, while therapy optimisation was linked to increased discontinuation risk. CD was associated with better drug persistence, while therapy optimisation correlated with a higher discontinuation rate. Targeting deep healing and enhancing timely, precise optimisation strategies is essential for improving treatment outcomes. Graphical abstract

Advanced Therapies in Elderly Patients With Inflammatory Bowel Disease: A Comparative Retrospective Cohort Study in Taiwan

Article

Full-text available

Apr 2025
Therapeut Clin Risk Manag

Purpose Inflammatory Bowel Disease (IBD) predominantly affects younger individuals, but emerging data indicates a shift toward older populations. Elderly-onset IBD (diagnosed at 60 years or older) differs from younger-onset IBD, presenting with atypical symptoms and higher risks of infections and malignancies. However, drug persistence is underexplored in the elderly IBD group, warranting further investigation to optimize treatment strategies for this demographic. Patients and Methods This retrospective cohort study included IBD patients receiving advanced therapies at the Chang Gung IBD Center from October 2017 to September 2023. Patients were stratified into two groups: elderly-onset (≥60 years) and control (<60 years). We compared one-year persistence of advanced therapies, opportunistic infections, IBD-related admissions, complications, surgeries, and acute flare-ups between the groups. Specifically, we analyzed the one-year persistence of various advanced therapies within the elderly-onset cohort. Results The study included 511 IBD patients, 107 of whom were elderly-onset. Elderly-onset patients had a higher body mass index, a higher proportion of ulcerative colitis, fewer smokers, and lower levels of white blood cells, hemoglobin, and albumin. Differences were noted in Montreal classifications and a higher use of Vedolizumab. Clinical outcomes, including steroid-free remission rates, one-year therapy persistence, infections, complications, surgeries, and flare-ups, were comparable between groups. In Crohn’s disease (CD), Infliximab and Ustekinumab exhibited higher one-year persistence. Predictors of one-year therapy persistence included Montreal L1 (OR: 6.722; 95% CI: 1.296–34.852; P=0.023), Ustekinumab use (OR: 5.672; 95% CI: 1.138–28.267; P=0.034), and hemoglobin level (OR: 1.612; 95% CI: 1.210–2.147; P=0.001) with an optimal cutoff of 11.65 g/dL. Conclusion Elderly-onset IBD patients display unique clinical characteristics and therapy persistence, particularly in CD, highlighting the necessity for customized therapeutic strategies.

Predictors of Adherence to Infertility Treatment among Women in Eastern Uttar Pradesh

Article

Full-text available

Apr 2025

Background: Infertility is a significant public health concern, impacting millions of couples globally. Adherence to treatment plays a vital role in the successful management of infertility; however, many women encounter barriers that impede their ability to follow prescribed treatments. This study seeks to explore the factors influencing treatment adherence among infertile women in Eastern Uttar Pradesh. Methods: A hospital-based study was conducted at the Department of Obstetrics & Gynaecology, Sir Sunderlal Hospital, Banaras Hindu University, from January 2024 to October 2024. A total of 106 infertile women were surveyed using a structured interview schedule. Data on socio-demographic characteristics, treatment adherence, and barriers were collected. Chi-square tests and logistic regression analyses were used to examine associations between treatment adherence and independent variables. Results: The majority of respondents (40.6%) were aged 25-29 years, and 60.4% resided in rural areas. Socioeconomic status, duration of marriage, husband's education, and type of infertility were significantly associated with adherence. Women from the highest socioeconomic class were 15.6 times more likely to adhere (OR: 15.60, 95% CI: 1.72-140.82, p = 0.014). Women married for ≤5 years had higher adherence (OR: 6.45, 95% CI: 1.96-21.21, p = 0.00). Education also played a role; women with graduate-level education (OR: 2.81, 95% CI: 1.08-7.33, p = 0.03) and those whose husbands had higher education (OR: 5.84, 95% CI: 2.17-15.71, p = 0.00) were more likely to adhere. Conclusion: Socioeconomic status, education, and marriage duration significantly influence adherence to infertility treatment. Strengthening financial support, improving healthcare access, and increasing awareness through education and counseling can enhance adherence. A multidimensional approach integrating financial, educational, and psychosocial support is essential to improving reproductive health outcomes. Key words: Infertility, Treatment Adherence, Socioeconomic Status, Education, Eastern Uttar Pradesh, Logistic Regression

Real-world adherence and persistence with medication among men with lower urinary tract symptoms owing to benign prostatic hyperplasia in Japan: a clinical prospective study

Preprint

Full-text available

Mar 2025

Purpose We investigated the persistence of medication for lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) and identified baseline factors associated with treatment discontinuation in a clinical cohort of Japanese men. Methods We included 2500 patients between April 1, 2014 and March 31, 2015. The final analysis included 2295 patients from 30 urological hospitals. We collected baseline characteristics, including age, prostate-specific antigen (PSA) level, prostate volume (PV), International Prostate Symptom Score (IPSS), and quality-of-life (QOL) score. The type of initial medication and reasons for treatment discontinuation were recorded. Results The median participant age was 72 years. The median PSA level was 2.4 ng/mL, the median PV was 33 mL, the median IPSS score was 15 points, and the median QOL score was 5 points. The median time to medication discontinuation was 154 days (95% confidence interval [CI]: 132–176). Persistence rates at 1, 2, 3, 4, and 5 years were 37.3%, 29.1%, 24.2%, 20.2%, and 17.8%, respectively. The most common reason for discontinuation was loss to follow-up (71.1%). Multivariate analysis showed that younger age (70–79 vs. ≥80 years and ≤ 69 vs. ≥80 years), higher PSA level (≥ 2.4 ng/mL vs. <2.4 ng/mL, greater PV (≥ 33 mL vs. <33 mL), and month of medication initiation were significantly associated with longer treatment persistence. Conclusion Persistence of treatment with medication for LUTS/BPH was relatively low in our cohort. Several baseline factors, including age, PSA level, PV, and the month of treatment initiation, were identified as predictors of treatment persistence.

Can 4 weeks of real-world active breaks improve glycaemic management in sedentary adults with type 1 diabetes? The EXTOD-Active randomised control trial protocol

Article

Full-text available

Apr 2025

Sedentary behaviour is associated with an increased risk of cardiovascular disease and all-cause mortality in individuals with type 1 diabetes (T1D). Recent laboratory-based research suggests that breaking up prolonged sedentary periods improves glycaemic markers in people with T1D. However, the effects of breaking up sedentary behaviour for prolonged periods in real-world settings remain unknown. This study aims to assess the effect of 4 weeks of active breaks on time spent within the target glycaemic range (time in range (TIR), 3.9–10.0 mmol/L) in adults with T1D Adults with T1D (n=118) who are sedentary for ≥8 hours per day will first complete a 7-day baseline assessment. Participants will then be randomised into either a control group (maintenance of habitual lifestyle) or an intervention group, where active breaks (3 min of self-paced walking every 30 min between 09:00 and 17:00, Monday through Friday) will be prescribed for 4 weeks. Activity levels (activPAL), TIR (via continuous glucose monitor), insulin dose and carbohydrate intake will be monitored throughout. The effect of active breaks on TIR will be compared between baseline and week 4, with data analysed using analysis of covariance (ANCOVA). The trial has been approved in the UK by the West Midlands-Solihull Ethics Committee (22/WM/0221). The findings from the study will be disseminated through peer-reviewed journals and presentations at national and international scientific conferences. Trial registration number NCT05706298 .

The Modification and Validation of the Medication Compliance Questionnaire (MCQ) for the Assessment of Adherence to Antiretroviral Therapy (ART)

Article

Mar 2025

INTRODUCTION: Anti-retroviral therapy (ART) significantly improves the prognosis of human immunodeficiency virus (HIV) infection. Yet long-term and complex regimens often lead to non-adherence. Maintaining at least 95% adherence is crucial for effective ART and thus preventing drug resistance. The Medication Compliance Questionnaire (MCQ) has been used for adherence assessment in antihypertensive treatment, with an 80% cut-off level. This study aimed to modify and validate the MCQ for assessing adherence to ART. MATERIALS AND METHODS: The MCQ underwent modification with the incorporation of a new rating scale and scoring method. A pilot study was conducted at the Infectious Disease Clinic, Hospital Raja Perempuan Zainab II, Kelantan. Inclusion criteria were adults living with HIV (PLHIV), on ART for at least two months and who can communicate in Malay. Fisher’s Exact test was used to determine validity, sensitivity, and specificity. Cronbach's alpha and intra-class correlation coefficients were used to evaluate reliability, with significance set at p <0.05. RESULTS: A total of 60 PLHIV adults participated in this pilot study. Viral load served as the validity criterion for the modified MCQ, showing a significant association with adherence (p=0.018). Sensitivity and specificity values were 100.0% and 79.5%, respectively. Cronbach’s alpha coefficients for drug-taking and drug-stopping behaviour domains were 0.65 and 0.90, respectively. CONCLUSION: The modified MCQ is a valid and reliable tool for assessing adherence to ART, demonstrating high sensitivity and adequate specificity. It is suitable for use in clinical practice to improve medication therapy management for PLHIV

The Relation between Endothelial Monocyte-activating Polypeptide II and Polymorphism of Endothelin-1 Gene (G8002A) and Their Effect on Renal Function in Adolescent Patients with Beta-thalassemia Major

Article

Full-text available

Mar 2025

BACKGROUND Iron overload, chronic anemia in addition to particular chelators of iron are considered the key factors in kidney impairment pathogenesis in beta-thalassemia major (β-TM). “Endothelin-1 (ET-1) is a very potent endogenous vasoconstrictor” that plays as a stimulator for reactive oxygen species production. “Endothelial monocyte-activating polypeptide-II (EMAP-II) is a multifunctional polypeptide, a pro-inflammatory cytokine with anti-angiogenic properties.” The aim of this study is the assessment of “ET-1 gene polymorphism (G8002A) in adolescents with β-TM as a probable genetic marker for vascular renal dysfunction and its potential connection to EMAP II.” PATIENTS AND METHODS β-TM patients ( n = 60) with no symptoms of renal disease were studied in comparison to 60 healthy controls. Serum EMAP-II, serum ferritin, hemolysis markers, and urinary albumin-to-creatinine ratio were measured. ET-1 gene polymorphism (G8002A) was evaluated by the polymerase chain reaction-restriction fragment length polymorphism. RESULTS EMAP II was higher in a significant value in β-TM patients in comparison to nonthalassemic group. “EMAP II was higher significantly in nephropathic patients.” A significant correlation was found between EMAP II and both delayed puberty and positive family history of anemia.” In β-TM, AA variant of the polymorphism of ET-1 gene (G8002A) was found of greater value than that found in controls.” “Patients with nephropathy were significantly higher among AA genotype in comparison to GG and GA genotypes.” Serum ferritin and “EMAP II were high significantly in AA genotype.” CONCLUSION EMAP-II and ET-1 gene polymorphism (G8002A) may serve as the potential indicators for predicting β-TM patients with high susceptibility to kidney problems.

Prediction of medication nonadherence in patients with lung cancer based on nomogram model construction

Article

Full-text available

Mar 2025
MEDICINE

Lung cancer is the leading cause of death among patients with cancer. Medication nonadherence affects survival time and remission of disease symptoms in patients with lung cancer. Therefore, this study analyzed the risk factors for medication nonadherence in patients with lung cancer and established a nomogram prediction model. The basic information and clinical characteristics of patients with lung cancer were collected from the Affiliated Hospital of Chengde Medical University from April 2020 to March 2023. The Chinese version of the Morisky Medication Adherence Questionnaire-8 was used to evaluate patients’ medication adherence. A least absolute shrinkage and selection operator regression model and multivariate logistic regression analysis were used to identify the risk factors for medication nonadherence and establish a nomogram prediction model. The predictive ability of the nomogram was evaluated using the concordance index (C-index) and the area under the operating characteristic curve. Decision curve analysis (DCA) and the clinical impact curve were used to assess the potential clinical value of the nomogram. A total of 161 patients with lung cancer were included in this study, with a medication nonadherence rate of 47.20%. Risk factors included age, surgery, education level, bone metastases, comorbidities, well-being, and constipation. The C-index and area under the operating characteristic curve were 0.946. The threshold probability for DCA ranged from 0.07 to 0.95. The nomogram can predict the risk of medication nonadherence in patients with lung cancer and help identify those at risk early in clinical settings, allowing for the development of intervention programs and improved clinical management.

Association of medication adherence with treatment preferences: incentivizing truthful self-reporting

Article

Full-text available

Feb 2025
EUR J HEALTH ECON

Objective Self-reported medication adherence may be influenced by socially desirable answers and untruthful reporting. Misreporting of adherence behavior can bias estimations of treatment (cost)effectiveness. This study investigated how to induce truthful self-reported medication adherence and evaluated how self-reported (truth-induced vs. regularly reported) medication adherence and treatment preferences were associated. Methods Medication adherence was measured after a discrete choice experiment eliciting stated preferences for Multiple Sclerosis (MS)-treatments. Data was collected among MS-patients in three Western countries. Half of the sample was randomized to ‘choice-matching’, a novel mechanism which induces truthfulness. It financially compensates respondents based on their self-reported adherence and guesses about other respondents’ adherence. To investigate the impact of truth-incentivized adherence reporting on preference heterogeneity, interaction effects between medication adherence and treatment preferences were tested separately within the choice-matching and the ‘standard’ group. Results The sample comprised 380 MS-patients (mean age 41y, 69% female). Respondents in the choice-matching group reported a lower medication adherence compared to the standard group (always adherent: 39.3% vs. 46.6%). Mixed logit models showed significant interaction effects: in the choice-matching group, higher medication adherence resulted in lower utility for pills twice/day compared to injections three times/week (p = 0.019), while in the standard group, respondents with higher medication adherence preferred pills once/day compared to injections three times/week (p = 0.005). Conclusion Choice-matching likely encouraged respondents to report their true medication adherence. Linking truthful behavior to patients’ preferences allows for a better understanding of preference heterogeneity and helping to make decisions that fit patients’ true preferences.

Long-term adherence to anti-osteoporosis medication and determinants of adherence in the population-based screening trial ROSE

Article

Full-text available

Feb 2025
OSTEOPOROSIS INT

Screening initiatives for osteoporosis must facilitate treatment of those at elevated fracture risk. In a randomized controlled trial of 24,229 women, those in the screening group with FRAX ≥ 15% were invited for DXA with AOM treatment offered as per national guidelines. Treatment initiation in the following year was 9.5 times higher compared with controls. To determine if screened individuals have lower adherence to anti-osteoporotic medication (AOM) than unscreened and to examine determinants for low treatment adherence. In 2010/2011, women aged 65–80 (N = 34,229) in the Region of Southern Denmark were invited to the risk-stratified osteoporosis strategy evaluation (ROSE) randomized study. Women in the screening group with moderate to high 10-year fracture risk (FRAX® ≥ 15%) were invited for dual-energy x-ray absorptiometry with AOM treatment as per national guidelines. Screened, controls, and an age-matched general population sample were compared for adherence to AOM using 10-year follow-up data on prescription and hospital records. Among ROSE participants with FRAX ≥ 15%, 5864 screened and 5790 controls were eligible for analysis, along with an equal number from the general population. AOM initiation in the first year was 9.5 times higher in screened compared to controls (HR 9.50, 7.16; 12.61). There was no difference in implementation assessed as medication possession ratio. The 5-year persistence rates were similar in screened and controls (51–52%), but lower in the general population (44%). FRAX risk factors partly influenced AOM initiation in the screened, with different patterns in other groups. Immobilization, comorbidities, and co-medications were key determinants of discontinuation in both the short and long term. The ROSE screening programme significantly increased treatment initiation in postmenopausal women. Screened women showed similar treatment adherence levels to non-screened once they started medication. However, frail women were more prone to treatment discontinuation, highlighting the need for targeted support in this subgroup. The original ROSE trial is registered at ClinicalTrials.gov (NCT01388244). The study protocol has been published in Rubin et al. The risk-stratified osteoporosis strategy evaluation study (ROSE): a randomized prospective population-based study. Design and baseline characteristics. Calcif Tissue Int. 2015;96(2):167–79.

Medication adherence of patients with peripheral arterial disease to antithrombotic therapy: a systematic review

Article

Full-text available

Feb 2025

Objectives Antithrombotic therapy (ATT) prevents atherothrombotic events (AE) in patients with peripheral arterial disease (PAD). However, the benefit may be compromised by poor medication adherence (MA). Therefore, our primary objective was the proportion of patients with PAD with poor MA in literature following patient-reported, pharmacy-reported or laboratory-reported outcome measurements. Poor MA is a combined outcome of primary non-adherence (inability to initiate a prescription), secondary non-adherence (incorrect daily intake) and non-persistence (discontinuation of daily intake). Design Systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data sources PubMed, EMBASE and Cochrane Library were searched from 2000 to June 2023. Eligibility criteria Publications with a (sub)cohort of patients with PAD that reported on patients’ MA to ATT were included. Data extraction and synthesis All articles were reviewed on eligibility and methodological quality by two independent researchers. The data were retrieved and collected in Review Manager Web and the percentages were calculated per subgroup. The risk of bias was assessed by using the Cochrane risk-of-bias tool for randomised controlled trials (RCT) and the methodological index for non-randomised studies score for non-RCTs. Results We identified 274 potential records of which 10 studies (32 628 patients) were included. Six studies were RCTs and two prospective and two retrospective studies. Most studies scored a moderate risk of bias and had heterogeneous study designs. Poor MA rates ranged between 2% and 45%. Higher rates of poor MA were found in studies with longer follow-ups, pharmacy-reported outcome measurements and registry-based cohorts. Conclusion Heterogeneous study designs create a wide dispersion in the proportions. However, poor MA to ATT was found in approximately one-third of the patients with PAD and seemed to increase with longer therapy duration, which highlights the magnitude of this societal challenge. Enhancing patients’ MA to ATT might be a key element in reducing the risk of AE, and therefore, more attention to MA in clinical and research settings is warranted. PROSPERO registration number CRD42023431803.

Real-World Analysis of Adherence to Abemaciclib and Endocrine Therapy in Women with HR+/HER2− Breast Cancer

Article

Full-text available

Feb 2025

Background: Adherence to oral anticancer therapies among breast cancer patients is an often-overlooked issue. A lack of patient compliance can be caused by several factors, and may hinder the efficacy of prescribed medication, leading to a shorter than expected survival. In this context, few data about adherence to CDK4/6 inhibitors in real-world practice are available. We report here the results of a retrospective analysis of adherence to abemaciclib plus endocrine therapy in a cohort of women with hormone receptor-positive (HR+), epidermal growth factor 2 negative (HER2−) breast cancer. Methods: Abemaciclib adherence was computed as the ratio between the total number of cycles/months that medication was supplied and the months between the first and the last prescription. The proportion of Days Covered (PDC) ranged from 0 to 1. A score of 0.8 (i.e., 80% adherence rate) was the cutoff used to classify the patients as adherent (0.8 ≤ PDC ≤ 1) or non-adherent (0 ≤ PDC < 0.8). The received dose intensity was also calculated. Results: The abemaciclib pharmacy claims of 100 women with HR+/HER2− breast cancer were retrieved. Most patients (91%) were treated in the advanced setting. Abemaciclib was more frequently taken with an aromatase inhibitor (63%) than with fulvestrant (27%). In this population, the adherence rate was high (92.25% + 1.939 SD). The proportion of non-adherent patients taking abemaciclib with PDC <0.8 was 12%. There was a significative correlation between the occurrence of side effects and the use of <5 drugs for non-oncological illnesses, probably reflecting concomitant non-oncological diseases. Conclusions: Adherence to abemaciclib-based therapy is high in a real-life setting, pending the adequate and proactive management of patients. The careful evaluation of patients and detailed information about expected adverse events are essential to ensure adherence to this antineoplastic agent.

Adherence Definitions, Measurement Modalities, and Psychometric Properties in HIV, Diabetes, and Nutritional Supplementation Studies: A Scoping Review

Article

Full-text available

Feb 2025

Measuring adherence has been a priority for researchers to help inform effective care for patients regularly consuming medications for chronic conditions. As a widely accepted “gold standard” adherence measure or operational definition does not exist, studies measure adherence using different modalities, which may lead to different conclusions about adherence patterns. The purpose of the scoping review was to identify modalities used to measure adherence to HIV medication, diabetes medication, and nutritional supplementation and explore the variation in adherence definitions, measurement modalities, and psychometric properties being reported across studies. Comprehensive searches were performed in PubMed, Scopus, and PsycINFO from January 2012 to January 2022. We included studies reporting psychometric properties of adherence/compliance to HIV medication, diabetes medication, or nutritional supplements. In total, we included 88 studies in the review. The 8-item Morisky Medication Adherence Scale (MMAS-8) was the most frequently used self-reported measure. We found almost no relationship between country income level and triangulation levels. The operational definition of adherence fell into four categories: numerical, dichotomous, ranked ordinal, and undefined. The amount of variation in an adherence definition category within a modality depended on whether the measures within the modality could be assessed numerically and whether widely accepted cutoffs existed for the measure. Across studies, 46 (52%) reported both validity and reliability, 28 (31%) reported validity only, and 14 (16%) reported reliability only. Fourteen types of validity and six types of reliability were identified across the studies. Measuring adherence accurately and reliably continues to be a challenge for research in HIV, diabetes, and nutritional supplementations. When reporting adherence measurements, we suggest including adherence results from multiple measures and modalities, presenting adherence results numerically, and reporting multiple types of validity and reliability.

Methodology for calculating the "proportion of days covered" to determine adherence to pharmacotherapy using data from the accounting of implemented electronic prescriptions of the EMIAS

Article

Full-text available

Jan 2025

Adherence is one of the crucial determinants of high-quality and effective pharmacotherapy. Along with the search for optimal methods to improve adherence and with the study of factors influencing it, it remains an equally urgent task to choose the optimal method to evaluate it. In the context of the digitalization of healthcare systems that is actively taking place in many countries, including Russia, the approach based on the analysis of prescription data is of the greatest interest among all known methods of measuring adherence. The calculation of the «proportion of days covered» (PDC) has become the most widespread among the variants of this approach. However, the local adoption of foreign experience of assessing adherence by PDC turned out to be hampered by the presence of significant problems associated with insufficient standardization of the calculation methodology and interpreting the results obtained. The purpose of this work was to develop the standard PDC calculation method based on the EMIAS prescription claims data to increase compliance with the requirements for qualitative studies of medication adherence. The analysis of the literature made it possible to identify and describe the following most significant elements of PDC calculation methodology: (1) minimum fill criterion; (2) evaluation period; (3) method for identifying fill date; (4) calculation of the total number of days in the evaluation period; (5) calculation of the number of days covered with prescriptions; (6) interpretation of PDC calculation results; (7) assessment of multiple adherences. Based on the results of the literature analysis and on the experience of conducted pilot study, in the summary of this paper, an optimal list of recommendations was presented that allows for a qualitative assessment of adherence by PDC methodology.

Facilitators and Barriers of Treatment Compliance among Type 2 Diabetes Mellitus Patients Attending the Diabetes Clinic of a Tertiary Care Hospital, Kolkata: A Mixed-Methods Study

Article

Full-text available

Dec 2024

Introduction: Type 2 diabetes mellitus is a disease of epidemic proportions and has emerged as a major healthcare problem. Compliance to medication plays a crucial role in achieving success in medical treatment and preventing complications. Objectives: The objective of this study was to assess the treatment compliance among the study participants and explore its perceived barriers and facilitators. Method: A descriptive cross-sectional study was carried out using Morisky's Medication Adherence Scale (MMAS) among 308 type2 diabetes mellitus patients who were selected through systematic random sampling. Qualitative data was collected though in-depth interviews and were analysed by manual content analysis. Results: Out of the 308 study participants 47% were found to have high treatment compliance and 20% and 35% were found to have medium and low compliance, respectively. On binomial logistic regression, age, duration since diagnosis, family support and current treatment regimen were found to be significantly associated with treatment compliance. Multiple facilitators of compliance could be identified of which, self-awareness of disease, fear of complications and family support were most pronounced. Where asinability to purchase the medicines, forgetfulness, and lack of satisfaction with health services, were among the identified barriers of treatment compliance. Conclusion: High Compliance to diabetes medication was found among 47% of the study participants. Tailored interventions against the perceived barriers are necessary to promote compliance and improve glycaemic control.

Why Do They Persist? Understanding Living Kidney Donors and Persistence

Article

Full-text available

Jan 2025
TRANSPL P

Efficacy of an intervention to increase therapeutic adherence in patients with secondary prevention for cardiovascular disease: a study protocol for a randomized controlled trial

Article

Full-text available

Jan 2025

Introduction Cardiovascular diseases represent the leading cause of mortality worldwide. This category includes cerebrovascular disease, ischemic heart disease, and peripheral vascular disease. Secondary prevention is effective for patients with a history of cardiovascular events, with antihypertensives, statins, and acetylsalicylic acid being the most prescribed drugs. Therapeutic adherence is crucial, as the lack of it increases morbidity, mortality, reduces quality of life, and raises healthcare costs. However, less than half of patients adhere to all three drugs within the first year post-event. Furthermore, non-adherence is more pronounced in primary care. Objective Based on our hypothesis that in patients undergoing cardiovascular secondary prevention, an intervention grounded in the application of the Chronic Care Model improves adherence to the three preventive drugs, this study aims to evaluate the efficacy of a health education intervention, which implements this model, to increase adherence in patients with cardiovascular disease. Methods An open-label randomized controlled trial will be conducted, selecting patients who meet inclusion criteria through consecutive non-probability sampling. Random assignment will be performed using the random number table method. Based on a therapeutic adherence rate of 50% in the control group and 80% in the intervention group, with a type I error of 5% (95% confidence interval), a type II error of 20% (80% power), and accounting for a 15% loss to follow-up, the final sample size will be of 45 patients per group. Follow-up will last for 1 year. Following data collection, univariate, bivariate, and multivariate analyses will be performed to isolate confounding factors and assess the intervention’s impact on adherence. Discussion If the results obtained in this study are favorable and the intervention is successful in enhancing therapeutic adherence, its applicability would be substantial, representing a feasible intervention for implementation in primary care. This approach addresses a significant public health issue, namely the lack of therapeutic adherence and its associated consequences. Moreover, this is particularly pertinent for high-risk patients, such as those in secondary prevention, given that cardiovascular disease remains the leading cause of mortality in developed countries. This trial has been registered at clinicalTrials.gov, https://clinicaltrials.gov/study/NCT06510946.

Evaluation of Real-World Evidence to Assess Effectiveness Outcomes of Janus Kinase Inhibitors for Rheumatoid Arthritis: A Systematic Review of US Studies

Article

Full-text available

Jan 2025

Objective This review summarized the real-world effectiveness outcomes of Janus kinase inhibitors (JAKi) for rheumatoid arthritis (RA) based on observational studies. Methods A systematic review followed PRISMA guidelines, with searches conducted in PubMed, Embase, and CINAHL from each database’s inception to June 2, 2023. Studies were included if they evaluated real-world effectiveness outcomes of JAKi for US RA patients. Search terms included “RA”, “JAKi”, and “real-world”. All citations were imported into COVIDENCE platform. Two reviewers independently performed title/abstract screening and full-text eligibility. For each article, study characteristics and effectiveness measures focusing on treatment pattern, clinical response, and patient-reported outcomes (PROs) of JAKi were extracted. Newcastle-Ottawa Scale (NOS) was utilized to assess the quality of the included articles. Results In total, 35 studies representing 252–30,556 patients were included. A majority used the administrative claims datasets (n=23, 65.71%), followed by 9 studies using electronic medical record (EMR) data and 3 studies using patient registry databases. Across claims-based studies, adherence, persistence, and effectiveness of JAKi were common outcomes. Adherence rates varied, with a proportion of days covered (PDC) ranging from 0.53 to 0.83 across 11 studies. Persistence of JAKi in RA patients was reported in 14 studies, where the median persistence time in treatment was reported to be between 121–516 days. Six studies applied effectiveness algorithms, with 14.8–26% of patients meeting effective treatment criteria. In addition, the most common measure of clinical response throughout the studies was Clinical Disease Activity Index (CDAI), with 10 articles reporting mean CDAI changes between −4.7 and 5.1. Across 12 studies that measured the PROs, the most prevalent PRO was pain, with the mean change in pain ranging from −9.3 to 8.9 across these studies. Conclusion Real-world studies on JAKi for RA reflect a range of effectiveness measures, illustrating the expanding role of JAKi in clinical practice.

Untangling areas of improvement in secondary prevention of ischemic stroke in patients with atrial fibrillation

Article

Full-text available

Dec 2024

Improvement of post-stroke outcomes relies on patient adherence and appropriate therapy maintenance by physicians. However, comprehensive evaluation of these factors is often overlooked. This study assesses secondary stroke prevention by differentiating patient adherence to antithrombotic treatments (ATT) from physician-initiated interruptions or switches. We analyzed a population-based retrospective cohort (n = 10,343) of post-stroke patients with atrial fibrillation using the VID database (2010–2017). Secondary prevention was evaluated based on patients’ primary and secondary adherence to ATT at two years (percentage of days covered—PDC—and persistence/discontinuation) and physician prescription patterns (initiation, interruption, switching, restart). E-prescription and dispensing data were linked. Three ATT strategies were identified: oral anticoagulants (OAC), antiplatelets (APT), or combination therapy (OAC + APT), prescribed to 54%, 23%, and 17% of patients, respectively. Primary adherence was high for all ATTs (≈90%). OAC discontinuation was highest (16%), but frequently restarted (73.4%). APT treatment was interrupted the most (14%) and restarted the least (38.5%) by physicians, followed by OAC (interrupted in 11%, restarted in 65%). Overall, 17% of patients switched treatments, with OAC + APT being switched the most (76%), mainly to OAC (53.8%). Identifying areas for improvement in secondary stroke prevention requires considering both patient adherence and physician prescription patterns (initiation, interruptions, and restarts).

Persistence of newly prescribed 5-aminosalicylic acid in patients with ulcerative colitis: A nationwide comprehensive database study

Article

Full-text available

Dec 2024
PLOS ONE

The 5-aminosalicylic acid (5-ASA) agents are first-line drugs for ulcerative colitis (UC). However, intolerance as well as other issues have been reported for these drugs, making it difficult to sustain this treatment; accordingly, the persistence of 5-ASA is an important indicator of UC treatment strategy. We aimed to analyze the persistence of 5-ASA in patients with UC in Japan. This was a 1-year, nationwide, population-based cohort study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. We identified patients who were assigned UC-related disease codes and newly prescribed 5-ASA between April 2015 and September 2019 and specified the number of days until 5-ASA prescriptions were interrupted during a follow-up of up to 365 days. Among the 137 million patients who were covered by the universal health insurance in Japan during the study period, 68,234 eligible patients were identified. The 5-ASA persistence in these patients were 87.2%, 65.6%, and 56.4% after 30, 180, and 365 days, respectively. The 5-ASA persistence by subtype at 365 days was 54.4%, 56.4%, and 57.6% for time-dependent, pH-dependent, and multi-matrix system types, respectively. The 5-ASA persistence rate after 365 days was 65.0% for those under 20 years of age, 51.0% for those 20–39 years old, 57.5% for those 40–64 years old, and 65.5% for those over 64 years of age. This study revealed the 1-year persistence of newly prescribed 5-ASA in patients with UC newly prescribed 5-ASA in Japan, based on a national claims database of more than 100 million individuals.

Assessment of Potential Factors Influencing Attention-Deficit/Hyperactivity Disorder Drug Adherence: A Database Study

Article

May 2025
Int J Environ Res Publ Health

First-line treatment for Attention-Deficit/Hyperactivity Disorder (ADHD) is pharmacological but is associated with poor success rates in adults. The potential to discontinuously use stimulants may confound adherence assessment. Approximately 30–50% of adults with ADHD will experience depressive episodes, and associated treatment with antidepressants is generally recommended. It can therefore be expected that patients with a formal F90 diagnosis would show higher medication adherence than patients without a diagnosis and that the simultaneous use of antidepressants would increase adherence to ADHD medication. The primary aim was to explore the influence of factors of ADHD diagnosis and comorbid antidepressant use on stimulant adherence. A retrospective, longitudinal pharmacoepidemiological study was conducted on South African community pharmacy dispensing records for 2012–2016 for all patients aged between 18 and 40 years with any record of receiving a drug classified as “Central nervous system other” by the MIMS in 2015. Patients endorsed with an ADHD-linked diagnostic code (F90) were identified and contrasted with those receiving ADHD-indicated medication in the absence of a confirmatory diagnostic code. Two methods were applied to assess adherence to ADHD and/or depression treatment drugs: monthly medicine plotting and Proportion of Days Covered (PDC). Patients were classified as being more or less adherent based on monthly medicine plotting criteria. A study population of 89 patients was identified: 50 had F90 diagnostic codes and 39 were classified as “Non F90”. Adherence as measured based on PDC was generally higher for antidepressant use than for methylphenidate for patients classified as being more adherent. A trend towards higher consumption of antidepressants was shown for the treatment-adherent group. Diagnostic code distinction revealed significantly higher adherence rates to methylphenidate for F90 code patients. Adherence rates to antidepressants appeared to be generally higher for non-F90 patients. Many factors may influence adherence to ADHD-indicated drugs; however, the impact of a confirmed diagnosis may be a strong determinant of motivation to be adherent to ADHD pharmacotherapy.

Immunotherapy for neuromyelitis optica spectrum disorder: a comparative analysis of efficacy and safety of azathioprine, mycophenolate mofetil, tacrolimus, and rituximab

Article

Full-text available

Apr 2025

Background and purpose Biologic therapies are anticipated to dominate the treatment landscape for neuromyelitis optica spectrum disorders (NMOSD) in the future. Despite this, many patients in China continue to use off-label medications due to economic and other constraints. A multicenter NMOSD cohort study was conducted to compare the efficacy and safety of tacrolimus (TAC), mycophenolate mofetil (MMF), azathioprine (AZA), and rituximab (RTX). The objective of this study is to provide a clinical evidence-based reference for patients who still require the use of these off-label medications. Methods This retrospective study included NMOSD patients treated with TAC (n = 24), MMF (n = 74), AZA (n = 34), and RTX (n = 81). Of these, 81 underwent magnetic resonance imaging (MRI) activity analysis during follow-up. The observation period commenced with the treatment initiation and extended until August 31, 2023. The primary efficacy outcome was the time to the first relapse post-immunotherapy initiation, The hazard ratio (HR) was analyzed using the Cox proportional hazards model to compare the relative risk of the first relapse between different treatment groups (e.g., RTX, MMF, TAC, and AZA). Secondary outcomes encompassed annualized relapse rate (ARR), MRI activity, drug persistence, and relapse rate (RR). The safety outcome was the occurrence of severe adverse drug reaction events. Results A total of 213 patients were included in the study. During the first year of immunotherapy, patients treated with RTX (HR = 18.41, 95% CI: 4.039–83.87; p < 0.05) and MMF (HR = 22.72, 95% CI: 4.783–108.0; p < 0.0001) experienced a significantly lower risk of relapse compared to those treated with tacrolimus (TAC). The risk of first relapse in the AZA group was higher compared to the RTX group (HR = 2.786, 95% CI: 0.4771–16.27; p = 0.2551) and the MMF group (HR = 4.005, 95% CI: 0.5973–26.86; p = 0.1529), although the differences were not statistically significant. In the second year, this trend continued with RTX (HR = 6.200, 95% CI: 1.825–21.06; p = 0.0034) and MMF (HR = 6.017, 95% CI: 1.782–20.32; p = 0.0039) demonstrating a lower relapse risk compared to oral TAC. Similarly, RTX and MMF were more effective than oral AZA in reducing relapse risk (RTX: HR = 3.510, 95% CI: 1.202–10.25; p = 0.0216; MMF: HR = 3.909, 95% CI: 1.318–11.59; p = 0.0140). The difference in the risk of the first relapse between the MMF and RTX groups was not statistically significant (HR = 0.7217, p = 0.7156 in the first year; HR = 0.9351, p = 0.9003 in the second year) although the difference was not statistically significant. The risk of first relapse was higher in the group treated with oral conventional immunosuppressants (ISTs) compared to the RTX group, (HR = 2.170, p = 0.1449 in the first year; HR = 1.820, p = 0.1091 in the second year). The annual relapse rate (ARR) significantly decreased after treatment with all four drugs. RTX and MMF were more effective in controlling disease relapse compared to TAC and AZA, though these differences were not statistically significant (RTX: ARR = 0.12, 95% CI: 0.03–0.21; MMF: ARR = 0.15, 95% CI: 0.07–0.23; TAC: ARR = 0.21, 95% CI: 0.03–0.39; AZA: ARR = 0.19, 95% CI: 0.08–0.3; p = 0.81). When combining clinical and relapse-independent MRI activity analyses in 81 NMOSD patients, RTX demonstrated superior control of disease activity, with a statistically significant difference (p = 0.036). No hospitalization events related to severe drug adverse effects were reported in either the IST or RTX groups. Conclusion The study provides data comparing the efficacy of various off-label treatments in a Chinese NMOSD cohort, illustrating that RTX is more effective than traditional immunosuppressants in controlling NMOSD relapses and disease activity but no superiority in the time to the first relapse post-immunotherapy initiation. RTX and MMF may offer superior treatment alternatives for NMOSD patients compared to TAC and AZA.

Turkish translation and cultural adaptation of the Ascertaining Barriers to Compliance taxonomy for medication adherence

Article

Full-text available

Apr 2025
BRIT J CLIN PHARMACO

Aims The aim of this study was to create a Turkish version of the Ascertaining Barriers to Compliance (ABC) taxonomy for medication adherence. Methods A systematic literature search was conducted, followed by a national Delphi study using suggested methods of the International Society for Medication Adherence for translation of the ABC taxonomy for medication adherence. Three scientific databases (PubMed, TRDizin and ProQuest) were used in the systematic literature search to detect the terms and definitions and to identify a panel of Turkish‐speaking experts in medication adherence. Three consecutive Delphi rounds were performed through online surveys. The consensus levels were categorized into moderate consensus (50–75%), consensus (>75–95%) and strong consensus (>95%). Results Among 698 Turkish articles, adherence‐related terms and definitions were derived from 20 studies, and a Delphi survey was created accordingly. The Delphi survey was sent to a total of 187 panellists. The response rates were 20.9, 71.8 and 92.9% in the rounds, subsequently. Most of the panellists were pharmacists (56.4%) and held a PhD degree (76.9%). In the 3 consecutive Delphi rounds, all ABC taxonomy terms reached at least moderate consensus, while most of the definitions reached at least moderate consensus except the definition of initiation. Conclusion This study provided the Turkish ABC taxonomy for medication adherence and a minimum moderate level of consensus was reached for all the terms and most of the definitions. The Turkish ABC taxonomy should be used in education, research and clinical practice to promote and enable medication adherence in patients.

Probiotic Supplementation Improves Glucose Homeostasis and Modulates Interleukin (IL)-21 and IL-22 Levels in Pediatric Patients with Type 1 Diabetes: A Randomized Placebo-Controlled Trial

Article

Apr 2025

Background: Probiotics alter gut microbiota and have beneficial effects on immune homeostasis. The role of probiotics in diabetes has been shown in some studies. Interleukin (IL)-21 and IL-22 have been implicated in the pathogenesis of type 1 diabetes mellitus (T1DM). Objectives: This study aimed to assess the effect of oral supplementation with probiotics on glycemic control and IL-21 and IL-22 levels in pediatric patients with T1DM. Methods: This randomized controlled trial was registered in ClinicalTrials (NCT04579341) and included 70 children and adolescents with T1DM. They were randomly assigned into two groups to receive either an oral probiotic tablet containing 0.5 mg Lactobacillus acidophilus once daily or a matching placebo. Both groups were followed up for 6 months with assessment of fasting blood glucose (FBG), lipids, hemoglobin A1c (HbA1c), and IL-21 and IL-22 levels. Results: Baseline clinical characteristics and laboratory parameters were similar between both groups (p > 0.05). After six months, probiotic supplementation for the intervention group resulted in significant decreases in FBG, HbA1c, total cholesterol, and IL-21 levels, while IL-22 was increased compared with baseline levels (p < 0.001) and compared with the placebo group (p < 0.001). No adverse reactions were reported. Baseline IL-21 was positively correlated to FBG, HbA1c, and total cholesterol while there were negative correlations between these variables and IL-22 levels. Conclusions: Probiotic supplementation improved glucose homeostasis and glycemic control, possibly through their immunomodulatory effects on cytokines IL-21 and IL-22. Thus, probiotics could be a safe adjuvant therapy to intensive insulin in pediatric patients with T1DM.

Inequities in statin adherence for primary prevention of cardiovascular disease: a historical cohort study in English primary care

Article

Apr 2025

Background Cardiovascular disease (CVD) is a leading global health concern. . Statins are effective in reducing CVD risk, but suboptimal adherence limits their potential, yet recent data on this issue is limited, particularly regarding its association with socioeconomic deprivation and ethnicity. Methods We analysed English primary care data from the CPRD Aurum database for individuals aged 25 and older who started statin therapy between 1st January 2015 and 31st December 2019, with no prior CVD. Prescription-refill data were used to calculate the proportion of days covered (PDC) within one year. We used logistic regression to examine the relationship between socioeconomic deprivation or ethnicity and suboptimal statin adherence (defined as a PDC<80%) adjusted for age, sex, year of statin prescription, deprivation or ethnicity, comorbidities, smoking and BMI status. We also assessed whether sex might modify these associations. Results Among the 337,990 individuals included, 32.9% had suboptimal statin adherence. Deprivation was associated with an 11% increase in odds of suboptimal adherence (OR 1.11, 95% CI 1.08-1.13). All ethnic minorities had higher odds of suboptimal adherence compared to the White group (Black: OR 2.00, 1.92-2.08; Mixed: OR 1.49, 1.41-1.56; South-Asian: OR 1.35, 1.31-1.39). Men in deprived areas and of South-Asian ethnicity background had higher odds of suboptimal adherence. Conclusion Suboptimal statins adherence remains a significant issue and a missed opportunity to reduce CVD burden. Adherence inequities exist, and targeted interventions are necessary to address these disparities.

Desafíos en la adherencia a STRIDE-II: perspectivas de gastroenterólogos y pacientes con enfermedad inflamatoria intestinal

Article

Apr 2025

Prevalence and factors associated with medication adherence among diabetes patients in rural sub-district health facilities in Bangladesh

Article

Full-text available

Mar 2025
Discov Public Health

Introduction Medication adherence is critical for improving chronic disease outcomes, particularly diabetes mellitus. The prevalence of medication adherence among people with diabetes in rural communities is largely unknown. This study aimed to identify the prevalence and associated factors of medication adherence across sub-district healthcare facilities in Bangladesh. Research design and methods This cross-sectional study included 389 diabetic patients from non-communicable disease corners (NCDsC) of four health facilities in Bangladesh, between September and December 2023. Participants were ≥ 18 years old and diagnosed as DM by a registered physician and/or receiving anti-diabetic medication for at least six months. Independent variables included socio-demographic characteristics, behavioural characteristics, clinical history, and treatment status. Medication adherence was identified using the Morisky medication adherence scale (MMAS-8) (© 2006 Donald E. Morisky), and logistic regression analysis was performed to establish associated factors of medication adherence. Results The prevalence of high medication adherence was 40.4% (95% CI 35.6–45.3), and low medication adherence was 33.2% (95% CI 28.6–38). High medication adherence was significantly associated with recommended exercise (aOR: 1.78, 95% CI 1.12–2.83; p = 0.015), frequent (at least three within preceding three months) NCDsC visits (aOR: 1.86, 95% CI 1.20–2.86; p = 0.005), and blood glucose levels (aOR: 1.84, 95% CI 1.18–2.86; p = 0.005) after adjusting relevant confounders. Conclusion Maintaining a controlled glycaemic status, frequent visits within the preceding three months, and engaging in recommended physical activity are strongly associated with high medication adherence. These findings will help government, and policymakers design strategies for higher medication adherence, mitigating risks, and managing NCDs in rural communities, thus improving health outcomes.

Types of Usual Source of Care and Medication Adherence in Patients with Diabetes Mellitus

Article

Mar 2025

UNIVERSIDADE DE BRASÍLIA FACULDADE DE CIÊNCIAS DA SAÚDE DEPARTAMENTO DE FARMÁCIA REAÇÕES ADVERSAS DOS MEDICAMENTOS ADJUVANTES NO TRATAMENTO DE CÂNCER: SISTEMA CARDIOVASCULAR Brasília -DF 2023

Research

Full-text available

Mar 2025

SUMMARY: Chemotherapy regimens commonly induce cardiotoxicity as an adverse effect of treatment. Manifestations such as hypertension, heart failure, and arrhythmia are frequent developments requiring pharmacological treatment both for symptom resolution and progression control. Children and adolescents are particularly susceptible to heart disease as a consequence of cancer treatment; however, therapeutic options have limited evidence regarding their application in pediatric patients. Differences in ADME parameters, as well as greater susceptibility to adverse effects from drugs and their excipients, require extra caution in the selection of therapeutic agents, monitoring of adverse reaction incidence, and therapy adjustment to align with the patient’s physiology while effectively treating the condition. This review highlights potential adverse reactions to three drugs commonly used in the treatment of hypertension, heart failure, and arrhythmia in children, neonates, and adolescents: propranolol, hydralazine, and amlodipine. Potential adverse reactions were listed and categorized according to severity and incidence rarity. Medications available in the Brazilian market were analyzed regarding their formulation composition; specific excipients known to cause adverse reactions in children and neonates were described. Products were listed based on their use of such excipients. The three drugs demonstrated a favorable safety profile for use in pediatric patients. Most described adverse effects can be considered extensions of their pharmacological actions and can be managed through dose adjustment; severe adverse reactions are mostly idiosyncratic. Certain excipients pose a significant risk of adverse reactions, but these predominantly affect specific populations, and several alternative formulations are available. This information may be valuable for prescribers and caregivers; cancer treatment often requires adjuvant medications, and knowledge of potential adverse reactions of drugs affecting the cardiovascular system in the management of cardiotoxicity will allow for responsible use and greater therapeutic safety and efficacy. Keywords: Adjuvant Chemotherapy, Cardiotoxicity, Cardiovascular System, Cardiovascular Drugs, Drug-Related Side Effects and Adverse Reactions, Excipients

Factors associated with perceived medication safety during transitions of care in patients with cancer: A secondary data analysis of a cross-sectional survey

Article

Mar 2025
EUR J ONCOL NURS

A Nomogram-based Analysis on Medication Adherence of Hypertensive Patients in China

Article

Feb 2025
Asian Nurs Res

Interventions to improve medication adherence in persons with mental disorders

Article

Jan 2025
CURR OPIN PSYCHIATR

Purpose of review Nonadherence to medication is prevalent in patients with mental illness. Various factors responsible for it. As a result, there are more hospitalizations, increased risk of suicide and increased cost of care. Thus, there is a need for effective interventions to improve adherence in mentally ill patients. Recent findings Adherence to medication includes participation of patient in decision making. Interventions in the recent years help patients through techniques like psychoeducation, motivational interviewing and cognitive behaviour therapy. Interventions involve both patients and caregivers. There is a growing body of research about use of technology -based interventions using smart phones, various applications, digital platforms and artificial intelligence. Recent findings of research indicate that a combination of methods of intervention may be more useful in improving adherence. Some conventional interventions yield good results. Robust research is needed in the field of technology- based interventions. Summary Non adherence to medication leads to poorer health outcomes and hampers integration of the patient in the society. A collaborative effort of the team of healthcare providers, the patient and caregivers is the way ahead for better adherence and good quality of life.

THE EVALUATION AND OPTIMISATION OF PACIENTS’ ADHERENCE TO PULMONARY REHABILITATION PROGRAMS

Article

Feb 2025

Rehabilitation programs for patients with chronic lung diseases are well-establiched as a means of enhancing standard therapy in order to control and alleviate symptoms and optimize functional capacity. Pulmonary rehabilitation is appropriate for any stable patient with a chronic lung diasease who is disabled by respiratory symptoms. Patient adherence in respiratory rehabilitation programs is crucial for the success of therapeutic interventions. Recent reports suggest that non-adherence can negatively affect clinical outcomes and patients' quality of life. This paper aims to analyze methods of evaluating adherence, identify factors influencing patient behavior, and propose effective strategies to enhance adherence. By adopting a multidisciplinary approach, the goal is to make a significant contribution to improving the conditions of patients requiring respiratory rehabilitation.

Pharmaceutical marketing best practices to acquire market share through profitable Patient Adherence programs

Article

Jan 2025

Tawfik Hussien Eweda

Examining the relationship between healthcare practitioner's communication and patient adherence to treatment: A protocol for systematic review

Preprint

Jan 2025

Objective: This study aims to explore the relationship between patient-practitioner communication and subsequent patient adherence to healthcare intervention.Data sources: Ovid MEDLINE, CINAHL, APA PsycInfo, CENTRAL and Scopus will be searched from 2014 to January 2025. Manual searching of reference lists of eligible articles will be also completed.Study selection: Studies published in any language that quantified the effects of patient-practitioner communication on patient adherence to healthcare intervention. Data extraction and analysis: Screening, data extraction and risk of bias assessment will be conducted by two independent reviewers. Disagreements will be resolved through consensus. Risk of bias will be assessed using the Joanna-Briggs Institute (JBI) checklists for non-randomised studies, and the Cochrane Risk of Bias v2 (RoB2) for randomised controlled trials. If appropriate, results will be pooled with summary estimates and confidence intervals; otherwise, we will conduct a narrative synthesis. We will organise our findings by healthcare discipline, modalities of communication (e.g., face-to-face, video and phone calls), and the study location.PROSPERO registration number: CRD42025616150

Adherence to Oral Anticancer Agents Among Adults With Gastrointestinal Tract Cancer: A Scoping Review

Article

Jan 2025
CANCER NURS

Background Patients with gastrointestinal tract cancer reported suboptimal adherence to oral anticancer agents (OAAs), reducing their therapeutic benefit and increasing mortality risk. A scoping review can comprehensively map available evidence on adherence to OAAs and inform appropriate support to improve treatment outcomes. Objective The aim of this study was to comprehensively map studies on adherence to OAAs among adults with gastrointestinal tract cancer, including the adherence rate, nonadherence reasons, influential factors, management strategies, and theories that guide these studies. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews Checklist and the 5-stage methodological framework of scoping review were followed. According to the 5 research questions, 7 databases were systematically searched for peer-reviewed original studies, and a narrative synthesis was performed. Results Fifty-two studies were included. Adherence ranged from 16.7% to 100%, giving a median rate of 68% by self-report. Seven categories of nonadherence reasons were identified, with adverse effects, cancer progression, patient refusal, and forgetfulness being most frequently reported. Furthermore, more than 40 influential factors were identified. They are related to patient, disease condition, therapy, socioeconomic, and healthcare-system dimensions. Education and follow-up care were the main components of management strategies, but the effectiveness was inconsistent. Currently, only 3 of 52 studies adopted theoretical frameworks. Conclusion Adherence to OAAs among adults with gastrointestinal tract cancer is suboptimal. Future studies with rigorous designs and theoretical frameworks are needed to develop adherence-enhancing strategies and explain theoretical mechanisms. Implications for Practice Routine assessments and preventive actions are suggested to delay modifiable nonadherence.

Éducation et observance thérapeutique dans l’hypertension artérielle

Article

Feb 2017

A retrospective service evaluation of patient awareness and engagement, and medication compliance and adherence, in patients with opportunistically identified vertebral fragility fractures in a local fracture liaison service

Article

Jan 2025
Radiography

Long-term Effects of Attention Deficit Hyperactivity Disorder (ADHD) on Social Functioning and Health Care Outcomes

Article

Feb 2025
J PSYCHIATR RES

Issue 1 www.ijrar.org (E-ISSN 2348-1269, P-ISSN 2349-5138) IJRAR25A1040

Article

Full-text available

Jan 2025

Issue 1 www.ijrar.org (E-ISSN 2348-1269, P-ISSN 2349-5138) IJRAR25A1040

Article

Jan 2025

Medication Adherence And Its Impact On Chronic Disease Outcomes: A Comprehensive Review 1Diksha Srivastava, 2Riya Shukla, 3Sufiyan khan, 4Prashant Saxena, 5Fahad Tanveer 1Doctor of pharmacy , 2Doctor of pharmacy, 3Doctor of pharmacy , 4Doctor of pharmacy , 5Doctor of pharmacy

Article

Full-text available

Jan 2025

One important factor influencing health outcomes in the treatment of chronic illnesses is medication adherence. Poor disease control, greater death rates, and increased healthcare utilisation are all consequences of poor adherence. The vocabulary, definitions, classifications, and significance of medication adherence in the management of chronic diseases are examined in this paper. Also included are adherence improvement techniques, the effect of particular chronic illnesses, and patient obstacles. Promoting adherence requires both a patient-centered strategy and the participation of healthcare providers. The analysis emphasizes the necessity of integrated approaches to remove obstacles and improve adherence, which will eventually improve patient outcomes and lower medical expenses. 1 Introduction Long-term pharmacological treatment is required for chronic conditions such diabetes, hypertension, cardiovascular disease, and asthma in order to avoid complications and improve the quality of life. A crucial aspect in accomplishing treatment objectives is medication adherence, which is the degree to which patients take their prescriptions as directed. However, adherence rates are still low; in affluent nations, about 50% of patients do not follow their prescribed regimens. The purpose of this review is to present a thorough analysis of how medication adherence affects health outcomes, improvement tactics, and the role of healthcare professionals.

Effective engagement in computerized cognitive training for older adults

Article

Jan 2025
AGEING RES REV

Assessment of Compliance to Oral Iron and Folic Acid Supplementation among Pregnant Women in Wardha District: A Protocol for Community-based Mixed Method Study

Article

Dec 2024

Background Anemia is a significant public healthcare challenge. It is prevalent, particularly among pregnant women, and leads to many complications among mothers and newborn children. According to NFHS 5, compliance with consumption of oral iron and folic acid supplementation (IFAS) in Wardha is 50%, hence, there is a need for in-depth exploration of sociocultural factors impacting pregnant women’s adherence to oral iron and folic acid supplementation (IFAS). The proposed research will investigate pregnant women’s oral iron and folic acid supplementation (IFAS) compliance and identify factors affecting the availability, compliance, and intake of oral iron and folic acid supplementation (IFAS) and iron-rich foods. Subject and Methods The study design will be a community-based mixed-method study conducted in randomly selected primary health centers in the Wardha district. Inferential statistics and regression analysis will be used for quantitative and qualitative data through thematic analysis. R Studio version 4.1.2 shall be used for statistical data analysis. Frequency and proportions of quantitative data must be recorded; thematic analysis of qualitative data must be completed; and inferential statistics such as logistic regression analysis must be performed for conformity evaluation. Results The expected outcome of the study is the compliance rate of oral iron and folic acid (IFAS) and various determinants affecting the adherence rate and availability and compliance of oral iron and folic acid supplementations. Conclusions The study will assess compliance in regards to oral iron and folic acid supplementation among pregnant women and participants and stakeholder perceptions of oral iron and folic acid (IFAS) and determinants of compliance through qualitative inquiry, the findings shall help to inform stakeholders for corrective measures and improved MCH outcomes.

How Often Is Medication Taken as Prescribed? A Novel Assessment Technique

Article

Full-text available

Jul 1989

The evaluation of the efficacy of medication is confounded when patients do not adhere to prescribed regimens. Overdosing, underdosing, and erratic dosing intervals can diminish drug action or cause adverse effects. Using a new method with epilepsy as a model, we assessed compliance with long-term medications among newly treated and long-term patients. Medication Event Monitor Systems (Aprex Corporation, Fremont, Calif) are standard pill bottles with micro-processors in the cap to record every bottle opening as a presumptive dose. Compliance rates averaged 76% during 3428 days observed: 87% of the once daily, 81% of the twice daily, 77% of the three times a day, and 39% of the four times a day dosages were taken as prescribed. Coefficients of variation of drug serum concentrations had no significant relationship to compliance rates. Pill counts overestimated compliance increasingly as compliance with the prescribed regimen declined. Neither drug serum concentrations nor pill counts would have identified the frequency of missed doses that were revealed with continuous dose observations.

Tracking Trends in Secondary Stroke Prevention Strategies

Article

Full-text available

Mar 2004

Stroke is defined as a rapid onset of isolated neurologic dysfunction and is the leading cause of disability in adults, as well as the third-leading cause of death in the US. Nearly 600,000 cases of stroke are reported annually. To quantify the impact of emerging evidence on the use of secondary stroke prevention strategies in patients discharged from a specialized stroke center in 2002 compared with those discharged in 2000. Using a retrospective approach, data were collected on the first 100 patients cared for by the stroke service from July 1, 2000, to December 31, 2000. Using a prospective approach, the goal was to enroll 100 patients with a diagnosis of ischemic stroke and telephone the patients 1 and 3 months after discharge to determine patient adherence and persistence rate of medications. This is an interim report of the first 20 patients enrolled. Both studies resulted in populations of 55% women and 45% men. The most common risk factor was hypertension, with 59% on admission in 2000 and 75% in 2002. Use of antithrombotics (98% in 2000 to 100% in 2002) and antihypertensives (67% in 2000 to 90% in 2002) was high in both studies and not significantly different. The 2 most significant changes in prescribing were increased use of statins (13% in 2000 to 50% in 2002, p = 0.0007) and combination clopidogrel and aspirin use (0% in 2000 to 20% in 2002, p = 0.001). At 3 months, 66.7% of patients were on the same antithrombotic medication as at discharge. The dedicated stroke service was able to effectively translate emerging evidence and guidelines into practice and significantly change the use of prescribed medications for secondary stroke prevention.

Drug Persistency Patterns for Patients Treated With Rivastigmine or Donepezil in Usual Care Settings

Article

Full-text available

Apr 2005

To compare levels of persistency with 2 cholinesterase (ChE) inhibitors--rivastigmine and donepezil--for the treatment of Alzheimer's disease (AD) through the use of administrative claims data. This retrospective cohort study identified treatment-naive, community-based AD patients having an initial prescription (index event) for rivastigmine or donepezil between June and December 2000, in the United States, from pharmacy claims in a proprietary administrative claims database. Patients were excluded if they received either drug during the 180 days prior to their index prescription or if they did not have continuous plan enrollment during this period and for at least 90 days following the index date. The probability of treatment discontinuation within the first 60 days of treatment was estimated. Time to treatment discontinuation was analyzed for the cohort of patients that remained on therapy > or =60 days as well as for subgroups of the cohort reaching either approved or maximum recommended doses of donepezil or rivastigmine. Treatment discontinuation was defined as either a stop of therapy (no prescription refill within 60 days of estimated completion of prior prescription) or a switch to an alternative AD drug. Kaplan-Meier survival and proportional hazard model analyses were performed. Proportion of days covered (PDC) by an AD therapy was also evaluated in each quarter during the first year of follow-up. Of the newly treated AD study population, 30.4% (171/563) of rivastigmine patients and 31.2% (583/1,871) of donepezil patients discontinued treatment within 60 days of starting therapy (P = 0.72). For the cohort of patients that remained on therapy > or =60 days, the mean time to treatment discontinuation was 331 days (95% confidence interval [CI], 307-355) for rivastigmine patients (n = 392) versus 337 days (95% CI, 322-352) for donepezil patients (n = 1288). The proportion of patients with a PDC > or =80% after 12 months of follow-up was 23% for the donepezil group and 19% for the rivastigmine group (P = 0.34). For the cohort subgroup that reached an approved dose, the mean time to treatment discontinuation was 346 days (95% CI, 318-374) for rivastigmine patients (n = 282) versus 338 days (95% CI, 323-353) for donepezil patients (n = 1,283). For the cohort subgroup that reached the maximum recommended dose, the mean time to treatment discontinuation was 396 days (95% CI, 343-449) for rivastigmine patients (n = 61) versus 364 days (95% CI, 344-384) for donepezil patients (n = 712). Newly treated AD patients in a usual care setting who initiate therapy with either rivastigmine or donepezil have similar levels of persistency with treatment.

Predictors of Long-term Persistence on Statins in a Subsidized Clinical Population

Article

Full-text available

Nov 2000

The use of statins in primary prevention of cardiovascular disease is currently under debate. This study characterizes and identifies predictors of the persistence of use of statins in a clinical cohort of subsidized new users of similar age to the WOSCOPS trial subjects. Medical, pharmaceutical, and demographic records for the period January 1, 1987 through December 31, 1994 were extracted from the databases of Québec's provincial health plan for a 10% random sample of social assistance recipients. Patients remained eligible for inclusion if they had received a first dispensation of a statin between January 1, 1987 and July 31, 1994. Persistence was defined as the number of days on treatment with a statin while continuing to renew dispensations within a defined time limit. New users of statins included 983 social assistance recipients who were observed for a total of 2,439,153 person-days. Median persistence on statin treatment was 173 (95% CI = 155, 204) days. Only 13% of patients persisted for 5 years of treatment. A higher index of chronic morbidity, pre-existing cardiovascular disease, and previous use of nicotinic acid were predictive of longer persistence on statin medication. Those patients whose first statin dispensation was for lovastatin discontinued treatment earlier than those whose first dispensation was for pravastatin or simvastatin. New users showed low persistence on statins in a cohort of socially assisted persons aged 45-64, in spite of the minimal financial cost of the drug for such beneficiaries of Québec's provincial health plan.

The impact of compliance with osteoporosis treatment on fracture rates in actual practice.

Conference Paper

Sep 2002

Patient Adherence with HMG Reductase Inhibitor Therapy among Users of Two Types of Prescription Services

Article

May 2002

T. Jeffery White

OBJECTIVE: The primary objective of this study was to compare patient adherence with HMG reductase inhibitor drug therapy (HMG) between two types of prescription service: mail-service pharmacy and community pharmacies. METHODS: This study was a retrospective database analysis of pharmacy and medical claims for 14,826 commercial (40.9%) and Medicare+Choice (59.1%) members of a large HMO in California who were newly started on HMG therapy during the identification period, continuously enrolled during the review period (defined as each member's 6-month pre-index period through 360 days of follow-up), and between 18 and 75 years of age. Members who exclusively used only the mail-service pharmacy for HMG prescriptions were compared to members who used only community pharmacies for HMG prescriptions. The main outcome measures were adherence, medication possession ratio (MPR), persistence, prescription count, and duration of therapy. RESULTS: All outcome measures were significantly greater for the mail-service cohort than for the community pharmacy cohort (pless than0.0001). CONCLUSION: This analysis suggests that patients who use mail-service systems to fill prescriptions exhibit a higher degree of adherence with HMG therapy compared to those who use community pharmacies.

Compliance with statins in primary care

Article

Jan 2004

Aim. To investigate patient compliance with statin therapy and its effect on health outcomes. Design. A retrospective cohort study. Subjects and settings. All patients prescribed a statin, in a large Liverpool GP practice, from 31 December 1991 to 26 January 2003. Outcome measures. Compliance on cardiovascular mortality indices. Results. 25 per cent of the patients were non-compliant. The incidence of all cause mortality was significantly reduced in the compliant sub-group (P=0.0043, relative risk reduction [RRR] 44%). Compliance with therapy was associated with a significant reduction in CHD mortality (P=0.0088, RRR 56%), and non-cardiovascular mortality (P=0.0055, RRR=63%). Cholesterol monitoring was found to be a statistically significant predictor (P<0.001) of patient compliance. Diabetes patients were the most likely to be receiving this service (P<0.001). Conclusion. Non-compliance means that the maximal benefits of statin therapy are not being attained in this patient population. Prescribing of statins to patients in whom no benefit is being realised represents a significant cost to the practice. This emphasises the need to implement compliance-enhancing initiatives, such as regular cholesterol monitoring.

Partial medication compliance: The enigma in poor medical outcomes

Article

Jan 1995

Joyce A Cramer

The Effect of Prescribed Daily Dose Frequency on Patient Medication Compliance

Article

Sep 1990
ARCH INTERN MED

Seth A. Eisen

• The objective of this study was to determine the relationship between prescribed daily dose frequency and patient medication compliance. The medication compliance of 105 patients receiving antihypertensive medications was monitored by analyzing data obtained from special pill containers that electronically record the date and time of medication removal. Inaccurate compliance estimates derived using the simple pill count method were thereby avoided. Compliance was defined as the percent of days during which the prescribed number of doses were removed. Compliance improved from 59.0% on a three-time daily regimen to 83.6% on a once-daily regimen. Thus, compliance improves dramatically as prescribed dose frequency decreases. Probably the single most important action that health care providers can take to improve compliance Is to select medications that permit the lowest daily prescribed dose frequency.(Arch Intern Med. 1990;150:1881-1884)

How Often Is Medication Taken as Prescribed?

Article

Jun 1989

Joyce A Cramer

The evaluation of the efficacy of medication is confounded when patients do not adhere to prescribed regimens. Overdosing, underdosing, and erratic dosing intervals can diminish drug action or cause adverse effects. Using a new method with epilepsy as a model, we assessed compliance with long-term medications among newly treated and long-term patients. Medication Event Monitor Systems (Aprex Corporation, Fremont, Calif) are standard pill bottles with microprocessors in the cap to record every bottle opening as a presumptive dose. Compliance rates averaged 76% during 3428 days observed: 87% of the once daily, 81% of the twice daily, 77% of the three times a day, and 39% of the four times a day dosages were taken as prescribed. Coefficients of variation of drug serum concentrations had no significant relationship to compliance rates. Pill counts overestimated compliance increasingly as compliance with the prescribed regimen declined. Neither drug serum concentrations nor pill counts would have identified the frequency of missed doses that were revealed with continuous dose observations.(JAMA. 1989;261:3273-3277)

Impact of concurrent medication use on statin adherence and refill persistence

Article

Mar 2005

Background: Effective therapy for chronic illness requires daily medication adherence (DMA) for prolonged periods. Overall medical regimen complexity may represent one barrier to successful adherence. Methods: To assess the relationship between the number of concurrently prescribed medicines and adherence to 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins), we analyzed a cohort of 5488 patients in a single health insurance plan who began statin therapy between July 1, 1999, and June 30, 2002. We assessed 2 parameters of statin adherence: (1) DMA ([total number of pills dispensed/total number of days between first and last prescription] X 100) and (2) refill persistence (RP) (consecutive months of refills after initial prescription). Results: The cohort was 61.6% male, with a mean ± SD age of 52.7 ± 9.3 years. Patients were prescribed a mean ± SD of 2.9 ± 2 total medicines (range, 1-13), with a mean ± SD statin DMA of 82.1% ± 26.5%. By 12 months, only 68% of patients continued filling statin prescriptions. After controlling for age, income level, and treatment for hypertension or ischemic heart disease, a greater number of concurrently prescribed medicines was significantly associated with better DMA (P = .005) and longer RP (P = .03). Conclusions: In this cohort, statin DMA was generally adequate, but RP was suboptimal. Patients with more concurrently prescribed medicines had higher DMA and better RP, even after adjusting for demographic factors and cardiovascular comorbidity. Physicians should not be deterred from initiating statin therapy by a patient's medical regimen complexity but should be alert for lack of therapy persistence, particularly in younger and healthier patients.

The impact of varying degrees of compliance with osteoporosis medication on fracture rates in actual practice

Article

Nov 2002
VALUE HEALTH

·P-48 Biometric issues in measuring and analyzing compliance in clinical trials

Article

Aug 1990
Contr Clin Trials

Joerg Hasford

Defining compliance/adherence and persistence: ISPOR Special Interest Working Group

Article

Nov 2005
VALUE HEALTH

Hypertension and current issues in compliance and patient outcomes

Article

Apr 2012

Economic and human costs associated with untreated or inadequately controlled hypertension and its complications continue to be an issue in the United States despite the availability of numerous antihypertensive agents. Knowledge of hypertension, product profiles, tolerability concerns, convenience of dosing, health-related quality of life effects, and cost of therapy are some of the factors that may influence the compliance of patients to their medication regimens. Recent reports on patient noncompliance have focused on patient-provider relationships, psychosocial barriers, home blood pressure monitoring, and electronic monitoring systems to improve blood pressure control. The use of health-related quality of life assessment in antihypertensive studies and in routine clinical practice provides another opportunity to optimize a patient‘s regimen for short-and long-term hypertension control in a cost-effective manner.

Different aspects of adherence to antihypertensive treatments

Article

Jun 2004

This review collects together data concerning the measurement of patient behavior towards antihypertensives, considering all its aspects - adherence, persistence and switching. The wide heterogeneity of terms, outcome definitions and methods of assessment (the multiplicity of approaches did not allow a full meta-analysis, but a qualitative description of the results) are demonstrated. The percentages of adherence/compliance from the studies discussed in this review range from 15 to 99% across different study designs, populations and methods. Large, observational studies are suggested as a reliable method to measure patient behavior. An emerging issue is the relevance of patient motivation and education, which could provide a higher level of compliance to treatment, thus allowing achievement of better clinical outcomes and improved use of resources for the healthcare system.

The effect of prescribed daily dose frequency on patient medication compliance

Article

Oct 1990
ARCH INTERN MED

The objective of this study was to determine the relationship between prescribed daily dose frequency and patient medication compliance. The medication compliance of 105 patients receiving antihypertensive medications was monitored by analyzing data obtained from special pill containers that electronically record the date and time of medication removal. Inaccurate compliance estimates derived using the simple pill count method were thereby avoided. Compliance was defined as the percent of days during which the prescribed number of doses were removed. Compliance improved from 59.0% on a three-time daily regimen to 83.6% on a once-daily regimen. Thus, compliance improves dramatically as prescribed dose frequency decreases. Probably the single most important action that health care providers can take to improve compliance is to select medications that permit the lowest daily prescribed dose frequency.

On White-Coat Effects and the Electronic Monitoring of Compliance

Article

Aug 1990
ARCH INTERN MED

ALVAN R. FEINSTEIN

Compliance with therapeutic regimens

Article

May 1984
J Adolesc Health Care

PIP Focusing on the issue of adolescent compliance with medical regimens, the discussion defines compliance; reports on the incidence of noncompliance; discussed direct and indirect methods of measuring compliance; considers noncompliance as a diagnostic issue; reviews theoretical approaches to compliance research -- individualistic models, the health-belief model, and the provider-patient relationship; and examines adolescent compliance with oral contraceptives (OCs) and improving adolescent compliance with therapeutic regimens. Compliance has been defined as the extent to which an individual's behavior -- in terms of taking medications, following diets, or executing lifestyle changes -- coincides with medical or health advice. It has been reported that there is more noncompliance associated with longterm prescriptions than with those of shorter durations. The most common approach to the study of nonconforming health behavior has been to identify individual factors that are associated with various forms of noncompliance. Study finding suggest that despite the characteristics of the patient, the behavior of the health care provider can largely determine whether the adult patient will comply or not with medical advice. Further study will determine if adolescents behave similarly. Confirming previous reports, the findings suggest that the nature of the interaction between the health care provider and the patient, combined with the adolescent's sexual behavior and social psychological status, may influence how compliant she will be with her regimen. More ongoing research that will allow physicians to identify adolescents at risk of noncompliance so that appropriate intervention strategies may be employed is needed in this area. Strategies to increase the likelihood that adolescent patients will follow prescribed treatment regimens include: reminding the patient about the importance of compliance at each and every visit; improving the physician-patient relationship; and rewarding and reinforcing compliance.

Improving patients' compliance with therapeutic regimens

Article

Feb 1983
J Indiana State Med Assoc

S J Cohen

Relation between medication compliance and medical outcomes

Article

Aug 1995

Joyce A Cramer

The Assessment of Refill Compliance Using Pharmacy Records

Article

Feb 1997
J CLIN EPIDEMIOL

The refill records of computerized pharmacy systems are used increasingly as a source of compliance information. We reviewed the English-language literature to develop a typology of methods for assessing refill compliance (RC), to describe the epidemiology of compliance in obtaining medications, to identify studies that attempted to validate RC measures, to describe clinical features that predicted RC, and to describe the uses of RC measures in epidemiologic and health services research. In most of the 41 studies reviewed, patients obtained less medication than prescribed; gaps in treatment were common. Of the studies that assessed the validity of RC measures, most found significant associations between RC and other compliance measures, as well as measures of drug presence (e.g., serum drug levels) or physiologic drug effects. Refill compliance was generally not correlated with demographic characteristics of study populations, was higher among drugs with fewer daily doses, and was inconsistently associated with the total number of drugs prescribed. We conclude that, though some methodologic problems require further study, RC measures can be a useful source of compliance information in population-based studies when direct measurement of medication consumption is not feasible.

Persistence of Use of Lipid-Lowering Medications: A Cross-National Study

Article

Jun 1998

Although clinical trials have demonstrated the benefits of lipid-lowering therapy, little is known about how these drugs are prescribed or used in the general population. To estimate predictors of persistence with therapy for lipid-lowering drug regimens in typical populations of patients in the United States and Canada. A cohort study defining all prescriptions filled for lipid-lowering drugs during 1 year, as well as patients' demographic and clinical characteristics. New Jersey's Medicaid and Pharmacy Assistance for the Aged and Disabled programs and Quebec's provincial medical care program. All continuously enrolled patients older than 65 years who filled 1 or more prescriptions for lipid-lowering drugs (N = 5611 in the US programs, and N = 1676 drawn from a 10% sample in Quebec). Proportion of days during the study year for which patients had filled prescriptions for lipid-lowering drugs; predictors of good vs poor persistence with therapy. In both populations, patients failed to fill prescriptions for lipid-lowering drugs for about 40% of the study year. Persistence rates with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors were significantly higher than those seen with cholestyramine (64.3% vs 36.6% of days with drug available, respectively). Patients with hypertension, diabetes, or coronary artery disease had significantly higher rates of persistence with lipid-lowering regimens. In New Jersey, multivariable analysis indicated that the poorest patients (those enrolled in Medicaid) had lower rates of drug use than less indigent patients (those enrolled in Pharmacy Assistance for the Aged and Disabled) after adjusting for possible confounders, despite virtually complete drug coverage in both programs. When rates of use were measured in the US population for the 5 years following the study year, only 52% of surviving patients who were initially prescribed lipid-lowering drugs were still filling prescriptions for this drug class. In all populations studied, patients who were prescribed lipid-lowering drug regimens remained without filled prescriptions for over a third of the study year on average. Rates of persistence varied substantially with choice of agent prescribed, comorbidity, and socioeconomic status, despite universal coverage of prescription drug costs. After 5 years, about half of the surviving original cohort in the United States had stopped using lipid-lowering therapy altogether.

Effectiveness of Interventions to Improve Patient Compliance: A Meta-Analysis

Article

Sep 1998
MED CARE

This article summarizes the results of 153 studies published between 1977 and 1994 that evaluated the effectiveness of interventions to improve patient compliance with medical regimens. The compliance interventions were classified by theoretical focus into educational, behavioral, and affective categories within which specific intervention strategies were further distinguished. The compliance indicators broadly represent five classes of compliance-related assessments: (1) health outcomes (eg, blood pressure and hospitalization), (2) direct indicators (eg, urine and blood tracers and weight change), (3) indirect indicators (eg, pill count and refill records), (4) subjective report (eg, patients' or others' reports), and (5) utilization (appointment making and keeping and use of preventive services). An effect size (ES) r, defined as Fisher's Z transformation of the Pearson correlation coefficient, representing the association between each intervention (intervention versus control) and compliance measure was calculated. Both an unweighted and weighted r were calculated because of large sample size variation, and a combined probability across studies was calculated. The interventions produced significant effects for all the compliance indicators (combined Z values more than 5 and less than 32), with the magnitude of effects ranging from small to large. The largest effects (unweighted) were evident for refill records and pill counts and in blood/urine and weight change studies. Although smaller in magnitude, compliance effects were evident for improved health outcomes and utilization. Chronic disease patients, including those with diabetes and hypertension, as well as cancer patients and those with mental health problems especially benefited from interventions. No single strategy or programmatic focus showed any clear advantage compared with another. Comprehensive interventions combining cognitive, behavioral, and affective components were more effective than single-focus interventions.

Defining the margins for errors in patient compliance with prescribed drug regimens

Article

Dec 2000

John Urquhart

A systematic review of the associations between dose regimens and medication compliance

Article

Aug 2001
CLIN THER

Previous reviews of the literature on medication compliance have confirmed the inverse relationship between number of daily doses and rate of compliance. However, compliance in most of these studies was based on patient self-report, blood-level monitoring, prescription refills, or pill count data, none of which are as accurate as electronic monitoring (EM). In this paper, we review studies in which compliance was measured with an EM device to determine the associations between dose frequency and medication compliance. Articles included in this review were identified through literature searches of MEDLINE, PsychInfo, HealthStar, Health & Psychosocial Instruments, and the Cochrane Library using the search terms patient compliance, patient adherence, electronic monitoring, and MEMS (medication event monitoring systems). The review was limited to studies reporting compliance measured by EM devices, the most accurate compliance assessment method to date. Because EM was introduced only in 1986, the literature search was restricted to the years 1986 to 2000. In the identified studies, data were pooled to calculate mean compliance with once-daily, twice-daily, 3-times-daily, and 4-times-daily dosing regimens. Because of heterogeneity in definitions of compliance, 2 major categories of compliance rates were defined: dose-taking (taking the prescribed number of pills each day) and dose-timing (taking pills within the prescribed time frame). A total of 76 studies were identified. Mean dose-taking compliance was 71% +/- 17% (range, 34%-97%) and declined as the number of daily doses increased: 1 dose = 79% +/- 14%, 2 doses = 69% +/- 15%, 3 doses = 65% +/- 16%, 4 doses = 51% +/- 20% (P < 0.001 among dose schedules). Compliance was significantly higher for once-daily versus 3-times-daily (P = 0.008), once-daily versus 4-times-daily (P < 0.001), and twice-daily versus 4-times-daily regimens (P = 0.001); however, there were no significant differences in compliance between once-daily and twice-daily regimens or between twice-daily and 3-times-daily regimens. In the subset of 14 studies that reported dose-timing results, mean dose-timing compliance was 59% +/- 24%; more frequent dosing was associated with lower compliance rates. A review of studies that measured compliance using EM confirmed that the prescribed number of doses per day is inversely related to compliance. Simpler, less frequent dosing regimens resulted in better compliance across a variety of therapeutic classes.

Patient Adherence and Medical Treatment Outcomes: A Meta-Analysis

Article

Oct 2002
MED CARE

Adherence is a factor in the outcome of medical treatment, but the strength and moderators of the adherence-outcome association have not been systematically assessed. A quantitative review using meta-analysis of three decades of empirical research correlating adherence with objective measures of treatment outcomes. Sixty-three studies assessing patient adherence and outcomes of medical treatment were found involving medical regimens recommended by a nonpsychiatrist physician, and measuring patient adherence and health outcomes. Studies were analyzed according to disease (acute/chronic, severity), population (adult/child), type of regimen (preventive/treatment, use of medication), and type and sensitivity of adherence and outcomes measurements. Overall, the outcome difference between high and low adherence is 26%. According to a stringent random effects model, adherence is most strongly related to outcomes in studies of nonmedication regimens, where measures of adherence are continuous, and where the disease is chronic (particularly hypertension, hypercholesterolemia, intestinal disease, and sleep apnea). A less stringent fixed effects model shows a trend for higher adherence-outcome correlations in studies of less serious conditions, of pediatric patients, and in those studies using self-reports of adherence, multiple measures of adherence, and less specific measures of outcomes. Intercorrelations among moderator variables in multiple regression show that the best predictor of the adherence-outcome relationship is methodological-the sensitivity/quality of the adherence assessment.

Pharmacist Intervention Enhances Adherence to Orlistat Therapy

Article

Nov 2003

Pharmacists, especially those in community practice, should increase their level of intervention in dealing with the nationwide epidemic of obesity since they interact with large numbers of the public on a regular basis. We hypothesized that patients who receive medication for weight loss may have an improved therapeutic outcome if they received additional support from their community pharmacist. To evaluate the impact of pharmacist support on patient persistence with orlistat. Pharmacists were trained in basic obesity management skills. Patients who were prescribed orlistat and attending an outpatient nutrition program were invited to participate in the study. All patients agreed to receive pharmaceutical care. Those who lived where the service was available were assigned to the intervention (I) group and those who did not were assigned to the control (C) group. All patients received usual care provided by the outpatient clinic. Thirty patients, 15 in the I group and 15 in the C group, were recruited. Both groups were predominantly women (87%) with a mean +/- SD age of 43.8 +/- 9.7 years. Patients in the I group had significantly greater persistence with orlistat therapy as assessed by duration of therapy (p = 0.006) and number of patients completing the 26-week study (7 I, 2 C; p = 0.046). There was no significant difference in percent of weight loss between groups (p > 0.05). In this pilot study, patients receiving pharmaceutical care took orlistat longer than the controls and had improved outcome with orlistat therapy.

The impact of compliance with osteoporosis therapy on fracture rates in actual practice

Article

Jan 2005

Clinical trials have demonstrated that drug therapy can reduce osteoporosis-related fracture risk in women over 50 years of age. Noncompliance could considerably limit the effectiveness observed in actual practice, however. The objective of this study was therefore to estimate fracture risk in relation to compliance with osteoporosis medication in actual practice. Demographic, prescription drug use, physician services, and hospitalization information for women with osteoporosis who were dispensed an osteoporosis medication between 1996 and 2001 was obtained from the Saskatchewan health data files. Compliance to treatment was defined as drug available to cover 80% of the time. Subsequent fractures were identified via hospitalizations or physician contacts with a relevant diagnostic or procedure code. The risk of fractures in relation to compliance was examined using a Cox proportional hazards model with time-dependent covariates. The impact of other patient characteristics, including age, having suffered a prior fracture, and prior use of osteoporosis medication and steroids, was also examined. 11,249 women suffering from osteoporosis were identified with a mean age at the time of the index prescription of 68.4 years and average follow-up of 2 years. The overall fracture rate was 4.5% per year. Patients who complied experienced a 16% lower fracture rate. This association was maintained within subgroups and after controlling for other patient characteristics that independently predict the fracture rate. These results indicate that improving compliance in actual practice may significantly decrease osteoporosis-related fracture risk.

Results of a naturalistic study of treatment options: Switching atypical antipsychotic drugs or augmenting with valproate

Article

Jul 2004
CLIN THER

Combination therapy with atypical antipsychotic agents has not been well studied. Duration of persistence with a prescribed treatment regimen can be used to estimate overall treatment success. The aim of this study was to determine whether valproate augmentation improved treatment efficacy (ie, persistence with the prescribed regimen) and efficacy (ie, reduction of antipsychotic dose) with atypical antipsychotic drugs for older and younger patients, using a retrospective database analysis. Prescription refill data for atypical antipsychotics during calendar-year 2001 from a national pharmacy chain was used for longitudinal analyses. The database was used to identify patients aged 15 to 64 years and > or =65 years taking risperidone, quetiapine, or olanzapine (but not valproate). Patients who switched to another atypical antipsychotic (group A) or added valproate (group B) were followed after the index prescription to determine the duration of persistence with the treatment regimen and dose changes. We identified 10,262 patients who were prescribed an atypical antipsychotic, of whom 1022 patients switched to an alternative atypical and 1651 added valproate to the index atypical. The addition of valproate provided significantly longer duration of treatment regimen (mean, 155-159 days) than switching from any atypical antipsychotic drug (mean, 127-130 days) for patients aged 15 to 64 years or > or =65 years (all P<0.001). Atypical antipsychotic doses did not change significantly from baseline to final prescription in groups A or B. The final mean (SD) dose of valproate added to risperidone (389.1 [130.7] mg/d) was significantly lower than valproate added to quetiapine (424.6 [117.1] mg/d; P=0.002) or olanzapine (411.6 [122.8] mg/d; P=0.007). In this naturalistic study, the addition of valproate to an atypical antipsychotic increased the duration of treatment compared with switching among atypical antipsychotics. Valproate augmentation may be a good treatment strategy for patients whose atypical antipsychotic monotherapy is inadequate.

Impact of Concurrent Medication Use on Statin Adherence and Refill Persistence

Article

Dec 2004
ARCH INTERN MED

Effective therapy for chronic illness requires daily medication adherence (DMA) for prolonged periods. Overall medical regimen complexity may represent one barrier to successful adherence. To assess the relationship between the number of concurrently prescribed medicines and adherence to 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins), we analyzed a cohort of 5488 patients in a single health insurance plan who began statin therapy between July 1, 1999, and June 30, 2002. We assessed 2 parameters of statin adherence: (1) DMA ([total number of pills dispensed/total number of days between first and last prescription] x100) and (2) refill persistence (RP) (consecutive months of refills after initial prescription). The cohort was 61.6% male, with a mean +/- SD age of 52.7 +/- 9.3 years. Patients were prescribed a mean +/- SD of 2.9 +/- 2 total medicines (range, 1-13), with a mean +/- SD statin DMA of 82.1% +/- 26.5%. By 12 months, only 68% of patients continued filling statin prescriptions. After controlling for age, income level, and treatment for hypertension or ischemic heart disease, a greater number of concurrently prescribed medicines was significantly associated with better DMA (P = .005) and longer RP (P = .03). In this cohort, statin DMA was generally adequate, but RP was suboptimal. Patients with more concurrently prescribed medicines had higher DMA and better RP, even after adjusting for demographic factors and cardiovascular comorbidity. Physicians should not be deterred from initiating statin therapy by a patient's medical regimen complexity but should be alert for lack of therapy persistence, particularly in younger and healthier patients.

Estimating Medication Persistency Using Administrative Claims Data

Article

Aug 2005

To review the definitions and methods for measuring medication persistency, and to propose a uniform definition of and calculation for persistency using pharmacy claims data. Literature review. A MEDLINE search (1966 to present) was performed to identify articles detailing a definition or method of persistency measurement based on automated pharmacy data. Articles were screened for relevance by title and abstract. References from identified articles were used to expand the search results. The concept behind medication persistency measurement is to capture the amount of time that an individual remains on chronic drug therapy. The methods to calculate medication persistency can be classified into 1 of 3 categories: (1) Persistency as a function of the medication possession ratio; (2) persistency as a function of medication availability at a fixed point in time; and (3) persistency as a function of the gaps between refills. The common goal of all persistency measures should be to reflect the continuity of medication usage and to capture the timeliness and the frequency of refilling. The measurement of persistency as a function of the gaps between refills provides the best assessment of refill compliance across a variety of medication and disease states and lends itself to the well-established measurements of survival analysis.

Persistence and Adherence of Medications for Chronic Overactive Bladder/Urinary Incontinence in the California Medicaid Program

Article

Jul 2005

To investigate persistence and adherence of medication treatment in chronic overactive bladder/urinary incontinence (OAB/UI) patients, and to evaluate OAB/UI-related comorbidity events associated with persistence. Pharmaceutical outcomes research with a health-care provider perspective was conducted on a California Medicaid (Medi-Cal) chronic OAB/UI population. The primary end point was medication possession ratio (MPR), which was used to measure refill adherence. Secondary end points measuring persistence patterns included discontinuation of OAB drug therapy (medication-uncovered interval > 30 days) and time to discontinuation (period from the index date until the first discontinuation date). Significant factors on nonpersistence were found by using a Cox Proportional Hazards model. Factors contributing to nonadherence (MPR < 0.8) and the relationship between OAB/UI comorbidity events and persistence were examined by logistic regressions. Of 2496 eligible patients, 36.9% had only one OAB/UI prescription. The mean MPR was 0.34 (SD 0.21) and the median was 0.3, indicating that on average only about one-third of period of time since medication initiation was covered by the therapy. Only 122 patients exhibited > 80% adherence during the 6-month follow-up-period. Significant predictors of higher persistence included: white ethnicity, previous hospitalization length, starting with tolterodine or oxybutynin extended-release, and previous use of topical drugs or antipsychotics. Nevertheless, previous depression or urinary tract infection (UTI) diagnosis, polypharmacy, significantly increased the odds of early discontinuation. Treatment discontinuation increased the risk of UTI diagnosis by 37% in the post-treatment period (P = 0.03; OR 1.37; 95% CI 1.03-1.84), but had no significant effect on other OAB/UI-related comorbidities. For chronic OAB/UI patients identified in this study, both persistence and adherence with medication treatment were suboptimal. These results suggest that persistence and treatment discontinuation remains problematic for the OAB/UI population.

Compliance and persistence with bisphosphonate dosing regimens among women with postmenopausal osteoporosis*

Article

Sep 2005

Poor compliance and persistence with bisphosphonates is a concern in postmenopausal osteoporosis due to its negative impact on fracture risk and healthcare costs as well as quality of life. Reducing oral bisphosphonate dosing frequency is one measure available to increase therapy convenience and practicality, with the hope of improving compliance and persistence. This study compared compliance and persistence with weekly and daily bisphosphonate regimens for postmenopausal osteoporosis. Administrative claims data (1997-2002) from 30 health plans were used to identify postmenopausal women (> 45 years) with osteoporosis, who had been newly prescribed a once-weekly (QW alendronate 35 mg or 70 mg) or once-daily (QD alendronate 5 mg or 10 mg or risedronate 5 mg) bisphosphonate. QW and QD cohorts were followed for 12 months from initial prescription. Medication possession ratios (MPRs) measured refill compliance during follow-up. Persistence was calculated as the number of days from the initial prescription to a lapse of > 30 days after completion of the previous refill. Data were available for 2741 women (QW, N = 731, QD, N = 2010). QW users had significantly higher medication compliance than QD users (69.2% vs. 57.6% MPR, p < or = 0.0001). QW users persisted with therapy significantly longer than QD users (p < 0.0001) and had higher rates of retention on treatment at 12 months than QD users (44.2% QW; 31.7% QD). Dosing frequency was the strongest predictor of time to discontinuation (p < 0.0001). Postmenopausal women prescribed a weekly bisphosphonate had significantly better compliance and persistence than those taking more frequent, daily bisphosphonate doses. However, compliance and persistence rates for both regimens were suboptimal, suggesting that less frequent dosing intervals may provide an opportunity to further improve the consistent use of bisphosphonate therapy.

A Checklist for Medication Compliance and Persistence Studies Using Retrospective Databases

Article

Feb 2007

The increasing number of retrospective database studies related to medication compliance and persistence (C&P), and the inherent variability within each, has created a need for improvement in the quality and consistency of medication C&P research. This article stems from the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) efforts to develop a checklist of items that should be either included, or at least considered, when a retrospective database analysis of medication compliance or persistence is undertaken. This consensus document outlines a systematic approach to designing or reviewing retrospective database studies of medication C&P. Included in this article are discussions on data sources, measures of C&P, results reporting, and even conflict of interests. If followed, this checklist should improve the consistency and quality of C&P analyses, which in turn will help providers and payers understand the impact of C&P on health outcomes.

Medication compliance: the importance of the dosing regimen

Jan 2001
CLIN THER
1296-310

Aj Claxton
Ja Cramer
C Pierce

17 Claxton AJ, Cramer JA, Pierce C. Medication compliance: the importance of the dosing regimen. Clin Ther 2001;23:1296-310.

in compliance and patient outcomes

Jan 2000
510-524

in compliance and patient outcomes. Curr Hypertens Rep 2000;2:510–14.

Adherence to Long-Term Therapies: Evidence for Action. Geneva: World Health Organization Available from

Jul 2003

E Sabate

Sabate E. Adherence to Long-Term Therapies: Evidence for Action. Geneva: World Health Organization, 2003. Available from: http://www.who.int/ chronic_conditions/en/adherence_report.pdf [Accessed July 2, 2006].

Patient adherence and medical treatment outcomes: a meta-analysis