A systematic review of primary care-focused, self-reported medication adherence tools.

BACKGROUND: Clinician recognition of nonadherence is generally low. Tools that clinicians have used to assess medication adherence are self-reported adherence instruments that ask patients questions about their medication use experience. There is a need for more structured reviews that help clinicians comprehensively distinguish which tool might be most useful and valuable for their clinical setting and patient populations. OBJECTIVES: This systematic review aimed to (1) identify validated, self-reported medication adherence tools that are applicable to the primary care setting and (2) summarize selected features of the tools as an assessment of clinical feasibility and applicability. METHODS: The investigators systematically reviewed MEDLINE via Ovid, Embase via Ovid, International Pharmaceutical Abstracts, and CINAHL from inception to December 1, 2020. Investigators independently screened 3394 citations, identifying 43 articles describing validation parameters for 25 unique adherence tools. After screening each tool, 17 tools met the inclusion criteria and were qualitatively summarized. RESULTS: Findings highlight 25 various tool characteristics (i.e., descriptions, parameters and diseases, measures and validity comparators, and other information), which clinicians might consider when selecting a self-reported adherence tool with strong measurement validity that is practical to administer to patients. There was much variability about the nature and extent of adherence measurement. Considerable variation was noted in the objective measures used to correlate to the self-reported tools' measurements. There were wide ranges of correlation between self-reported and objective measures. Several included tools had relatively low to moderate criterion validities. Many manuscripts did not describe whether tools were associated with costs, had copyrights, and were available in other languages; how much time was required for patients to complete self-report tools; and whether patient input informed tool development. CONCLUSION: There is a critical need to ensure that adherence tool developers establish a key list of tool characteristics to report to help clinicians and researchers make practical comparisons among tools.

Development of a New Patient-Reported Medication Adherence Instrument: Concerns Influencing Medication Adherence.

PURPOSE: The purpose of this research was to conceptualize and develop a tool for identifying persons who are, or are likely to be, non-adherent to medications prescribed by their healthcare provider(s) by identifying concerns that patients have regarding their treatments. PATIENTS AND METHODS: The target populations were persons diagnosed with atrial fibrillation or osteoarthritis, who were prescribed anticoagulants or over-the-counter or prescription pain medications, respectively. In this two-stage, multi-year, qualitative research study, relevant concepts were explored, confirmed and refined. The focus was on non-adherence due to active (thus potentially modifiable) patient decisions to forego taking medications as prescribed. RESULTS: The most common concerns among participants with atrial fibrillation were medication-related side effects and fear of bleeding. Participants with osteoarthritis were most concerned about short-term stomach problems and long-term kidney and liver side effects. The Concerns Influencing Medication Adherence (CIMA) instrument was developed based on these concerns and those identified in the literature. It is comprised of 16 items: a core set of 11 items potentially applicable to multiple disease states, 3 items specific to atrial fibrillation, and 2 items unique to osteoarthritis. The instrument is intended to be completed electronically, and publicly available for use in direct patient care in the United States or in population health management. CONCLUSION: To our knowledge, this is the first instrument focused on medication adherence that includes documented details of patient input as recommended by the United States Food and Drug Administration guidance. Patient input is considered a key component of content validity. In this research, for example, the concerns that patients have regarding their treatments can be expected to have affected past medication adherence and can potentially impact future adherence. Although applicability outside atrial fibrillation or osteoarthritis was not assessed, the general items may be useful in assessing adherence in other chronic diseases.

Nurse telephone education for promoting a treat-to-target approach in recently diagnosed rheumatoid arthritis patients: A pilot project.

OBJECTIVE: The aim of the present study was to implement a nurse telephone education programme for patients with recently diagnosed rheumatoid arthritis (RA) that promotes shared decision-making and a treat-to-target approach. METHODS: This was a pilot project of newly diagnosed adult RA patients conducted between November 2015 and December 2016. A rheumatology clinic nurse telephoned patients to offer disease education. A toolkit was mailed to patients. Measures included call attempts, call time, a qualitative description of free-text notes and the proportion of patients who adhered to their next clinic visit. Data were analysed descriptively and qualitatively. RESULTS: Twenty-six patients participated in the nurse calls. Most patients were female (65%), with a median age of 54 years (range 22-78 years). Median call length was 14.5 min, with a range of 8-23 min. Qualitative notes indicated that patients overwhelmingly supported the nurse calls. Nineteen patients (73%) were adherent to their follow-up visit. CONCLUSION: This preliminary project successfully implemented an educational programme that included a nurse-facilitated, RA-specific, telephone call and toolkit. This educational programme could be a model for similar educational efforts by other clinics.

National and Northern New England Opioid Prescribing Patterns, 2013-2014.

OBJECTIVE: To evaluate current opioid prescribing patterns nationally and regionally across several northern New England states and compare with prescription data on an institutional level over a two-year period, between 2013 and 2014. DESIGN, SETTING, AND SUBJECTS: The IMS Health National Prescription Audit (NPA) database was used to obtain prescription data from US retail pharmacies between 2013 and 2014. METHODS: Our study compared noninjectable opioid dispensing between two time periods: January-June 2013 and July-December 2014. Opioid prescription data were obtained nationally and in New Hampshire, Vermont, Maine, and Massachusetts. Institutional prescription data were supplied by Dartmouth Hitchcock Medical Center (DHMC) and University of Vermont Medical Center (UVMC) pharmacies. RESULTS: There was a 3.4% ( P = 0.81) decrease in opioid prescriptions filled nationally. Among New England states, opioid prescribing decreased in Maine (-5.20%, P = 0.72), Massachusetts (-4.4%, P = 0.78), and Vermont (-2.2%, P = 0.89) but increased in New Hampshire by 1.3% ( P = 0.94). Examination of local institutional opioid utilization revealed a 13.6% decline in prescriptions filled at UVMC, and only a 0.4% decrease at DHMC. CONCLUSIONS: The review of opioid prescriptions filled in 2013-14 suggests that national opioid utilization may be reaching a plateau. Initiatives such as prescription monitoring programs, prescriber opioid education, addiction treatment programs, public addiction awareness, and availability of medical cannabis may play a role in interstate variability of opioid use. National and regional data served as a benchmark for local institutional comparison, laying groundwork for efforts to explore areas where opioids can be prescribed more judiciously.

Awareness and perceptions of Vermont's prescribed product gift ban and disclosure law by prescribers and pharmacists.

PURPOSE: Vermont law strictly regulates the interactions between pharmaceutical manufacturers and health care providers, including gifts, meals, and medication samples. The purpose of this study was to describe providers' awareness and perceptions of current requirements. METHODS: An online survey was completed by Vermont providers, including prescribers and pharmacists. The survey asked providers about their awareness of 15 different legal requirements and about their level of agreement with these requirements. RESULTS: Four hundred and eleven providers completed the survey (61% male, mean age 52 years, and 71% physicians). Awareness of the 15 requirements ranged from 28.4% to 93.8%. Most providers agreed or had no strong opinions. Responses at significance levels of P < .001 were noted in 8 of 15 requirements when perceptions were stratified by providers who had any interactions with pharmaceutical representatives in the past year (N = 227, 55.4%) versus providers who reported no interactions (N = 183; 44.6%). CONCLUSIONS: A high proportion of Vermont providers are unaware of the current law. Most agreed or had no strong opinions about the requirements; however, at least a quarter disagreed with banning small gifts and meals. Having any interaction with pharmaceutical representatives changed how providers perceived the requirements. These data may be useful for other states considering similar laws.

A survey of treatment practices in diabetic peripheral neuropathy.

OBJECTIVE: To evaluate provider practices for identification and treatment of painful diabetic peripheral neuropathy (DPN). METHODS: A questionnaire was distributed to healthcare providers attending educational programs in New England. RESULTS: The survey was completed by 357 providers. Although generally ineffective in neuropathic pain, non-steroidal anti-inflammatory drugs were prescribed by 31% of providers. Only 57% providers used a quantitative pain scale to evaluate pain. The effectiveness of medications was assessed at least frequently by 70% of providers and at every visit by 22% providers. CONCLUSION: The results reiterate the need for routinely monitoring patients with painful DPN and using appropriate pain scales.