Sentiment analysis in medication adherence: using ruled-based and artificial intelligence-driven algorithms to understand patient medication experiences.

BACKGROUND: Studies are exploring ways to improve medication adherence, with sentiment analysis (SA) being an underutilized innovation in pharmacy. This technique uses artificial intelligence (AI) and natural language processing to assess text for underlying feelings and emotions. AIM: This study aimed to evaluate the use of two SA models, Valence Aware Dictionary for Sentiment Reasoning (VADER) and Emotion English DistilRoBERTa-base (DistilRoBERTa), for the identification of patients' sentiments and emotions towards their pharmacotherapy. METHOD: A dataset containing 320,095 anonymized patients' reports of experiences with their medication was used. VADER assessed sentiment polarity on a scale from - 1 (negative) to + 1 (positive). DistilRoBERTa classified emotions into seven categories: anger, disgust, fear, joy, neutral, sadness, and surprise. Performance metrics for the models were obtained using the sklearn.metrics module of scikit-learn in Python. RESULTS: VADER demonstrated an overall accuracy of 0.70. For negative sentiments, it achieved a precision of 0.68, recall of 0.80, and an F1-score of 0.73, while for positive sentiments, it had a precision of 0.73, recall of 0.59, and an F1-score of 0.65. The AUC for the ROC curve was 0.90. DistilRoBERTa analysis showed that higher ratings for medication effectiveness, ease of use, and satisfaction corresponded with more positive emotional responses. These results were consistent with VADER's sentiment analysis, confirming the reliability of both models. CONCLUSION: VADER and DistilRoBERTa effectively analyzed patients' sentiments towards pharmacotherapy, providing valuable information. These findings encourage studies of SA in clinical pharmacy practice, paving the way for more personalized and effective patient care strategies.

Medications Adherence and Associated Factors Among Patients with Stroke in Iraq.

Purpose: Stroke poses significant challenges to affected individuals, their families, and healthcare systems, with adherence to medications being a pivotal determinant of health outcomes. In this study, we aim to evaluate the medication adherence of stroke patients living in Iraq, and explore how patients' demographic and clinical details relate to their adherence levels. Furthermore, we seek to assess the self-care practices used by stroke patients and their adherence to them. Patients and Methods: We carried out a cross-sectional correlational study conducted from November 2022 to April 2023, stroke patients diagnosed in seven hospitals across Baghdad and Al-Mothanna governorate were recruited, with diagnoses confirmed by physicians and senior neurologists using MRI and/or CT scans. Patients' adherence to medications, demographic data, clinical characteristics, and self-care activities were analyzed using descriptive statistics and regression analyses. Results: Of the 200 participants, mean age was 58.27 years, with males constituting 53.5%. About 40.5% had a hemorrhagic stroke, and 59.5% an ischemic stroke. The mean adherence score was 13.36 (SD= 4.658) out of a possible 28. Factors significantly correlated with medication adherence included age, monthly income, time since having a stroke, and education level. Adherence was also significantly linked to having diabetes mellitus or high blood pressure. The assessment of participants' self-care activities and medication adherence revealed that responses to questions about healthcare habits varied, with "None" being the most common response for most items. Notably, we found no significant association between adherence and factors such as gender, marital status, living place, and smoking status. Conclusion: Medication adherence remains suboptimal among stroke patients in Iraq. Various demographic and clinical factors play a role in influencing adherence. The conformity to medication regimens and factors associated with it among individuals who have suffered a stroke in Iraq is vital.

Post-pandemic persistence of adverse health behaviors in patients with psychotic disorders: A follow-up study.

OBJECTIVE: The ramifications of the COVID-19 pandemic on patients with psychotic disorders have been previously documented by the authors of this study. The aim of study is to investigate whether the effects of the pandemic continued among the same cohort of patients with psychotic disorders who participated in the initial study. METHODS: 232 of the 255 participants in the initial study participated in this follow-up study. The assessment covered sociodemographic data, changes in physical and mental health since the pandemic, new diagnoses of physical illnesses, smoking, medication adherence, suicidal behavior. RESULTS: The body weight of the patients before, during, and after the pandemic was 77.6 ± 13.1,81.3 ± 14.1,and 83.1 ± 14.3, respectively and there was increase in BW in the post-pandemic compared to before the pandemc and the during the pandemic (Z: - 8.658, p < 0.001, r: -0.57; Z: -6.852, p < 0.001, r: -0.45 respectively). The mean number of cigarettes smoked daily by the patient's before the pandemic, during the pandemic, and after the pandemic was 11.1 ± 14.2,14.9 ± 16.2,and 12.9 ± 14.9, respectively. There was a decrease in the number of cigarettes smoked daily in the post-pandemic compared to the during the pandemic (Z: -4753, p < 0.001, r: -0.45). Both suicidal ideations and attempts were significantly higher during the pandemic compared to after the pandemic (p < 0.001,p < 0.001). Medication adherence in the post-pandemic period was not different compared to the pandemic levels (Z: -0.621, p:0.535). CONCLUSION: The study confirmed the continuation of adverse outcomes noted previously, such as increased body weight, increased daily cigarette consumption, and diminished medication adherence.

LDL-cholesterol goal achievement and self-reported medication adherence: insights from the JET-LDL registry.

In patients with recent acute coronary syndromes (ACS), current guidelines recommend a low-density lipoprotein cholesterol (LDL-C) level <55 mg/dl. Despite the widespread use of different potent lipid-lowering therapies (LLT), this goal is not always achieved, often due to poor medication adherence. In this prespecified subanalysis of the JET-LDL registry, we sought to evaluate the relationship between LDL-C targets achievement and LLT adherence in a cohort of patients hospitalized for ACS. Patients self-reported medication adherence was assessed using the Morisky Medication Adherence Scale (MMAS) at 3-months follow-up. Depending on the score obtained, the population was divided into two groups: high adherence (HA, MMAS≥6) vs low adherence (LA, MMAS<6). The occurrence of the primary-endpoint (LDL-C reduction >50% from baseline or level <55 mg/dl at 1-month) was compared between the two groups. 963 patients were included in the present analysis; in 277 cases (28.7%) a MMAS score <6 was reported (LA-group), while in the other 686 (71.3%) the score obtained was ≥6 (HA-group). No difference between the two groups was observed regarding LDL-C levels at admission and LLT prescribed at discharge. At 1-month, primary-endpoint occurred in 62.5% of cases, with a statistically significant difference between the two groups (LA 60% vs HA 65%, p-value 0.034). At multivariate logistic regression analysis, LA was identified as an independent predictor of not achieving the primary-endpoint (OR 0.48 [0.39-0.85], p-value 0.006). In conclusion, in a real-world cohort of patients with ACS, low medication adherence to LLT was a common event (28.7%), having a negative impact on LDL-C goal achievement.

Comparing the effectiveness of online individualized transdiagnostic treatment with acceptance and commitment therapy on medication adherence, gastrointestinal symptoms and perceived stress of patients with irritable bowel syndrome.

Aim: This study aimed to investigate whether transdiagnostic treatment as well as acceptance and commitment therapy (ACT) could improve treatment adherence and alleviate gastrointestinal symptoms plus perceived stress in patients suffering from irritable bowel syndrome. Background: Research has shown that people with chronic diseases often have negative attitudes toward medications, especially when they also have psychiatric disorders. This, along with the complex dosing requirements and inadequate knowledge about medication adherence among irritable bowel syndrome patients, can affect the treatment efficacy. Methods: A randomized clinical trial was conducted using a pre-test-post-test design. The statistical population included patients with irritable bowel syndrome referring to Taleghani Hospital in Tehran between winter 2021 and spring 2022. Convenience sampling was used to select 30 individuals, with 15 people assigned to each group. Two types of psychotherapy were provided online and individually to the participants. The desired treatments were given to the transdiagnostic treatment and ACT groups in eight weekly sessions of 45-60 minutes. Results: There was no significant difference between the transdiagnostic treatment pre-test and ACT regarding perceived stress, medication adherence, and gastrointestinal symptoms (P>0.05). There was no significant difference either between the transdiagnostic treatment and ACT post-test. However, there was a significant difference between the pre-test and post-test phases of ACT regarding adherence, gastrointestinal symptoms, plus perceived stress (P<0.05) and transdiagnostic treatment regarding gastrointestinal symptoms (P<0.05). Conclusion: Specialists may use transdiagnostic treatment and ACT as effective psychological treatments to alleviate gastrointestinal symptoms and perceived stress, thereby increasing treatment adherence in patients with irritable bowel syndrome.

Translation, transcultural adaptation, and validation of the Brazilian Portuguese version of the general medication adherence scale (GMAS) in patients with high blood pressure.

Objective: To validate the General Medication Adherence Scale (GMAS) in Brazilian Portuguese for hypertensive patients. Methods: The GMAS-English was translated into Brazilian Portuguese and adapted for cultural appropriateness by a translation process and expert panel. A cross-sectional study was conducted in northeast Brazilian cardiology divisions of public and private hospitals, interviewing hypertensive patients. Reliability was assessed using Cronbach's alpha, intraclass correlation, and Pearson's correlation. Convergent validity was tested against the BMQ using chi-square. Criterion validity was assessed by comparing GMAS with blood pressure control using chi-square. Results: The GMAS was translated and adapted according to standard procedures. In a validation study with 167 hypertensive patients, Cronbach's alpha was 0.79, and Pearson's correlation showed significant test-retest reliability (p < 0.001). Convergent validity with BMQ was significant (p < 0.001), with 89.4 % sensitivity for behaviors considered adherent (High adherence and good adherence), but between the strata that measure low adherence (Partial adherence, low adherence and very low adherence), the specificity rate was 50 %. Criterion validity between GMAS and blood pressure control was not observed. Conclusion: The Brazilian Portuguese version of the GMAS exhibited good consistency and reproducibility, modest agreement with BMQ scale and did not demonstrate acceptable criterion validity for hypertensive patients.

Predicting Long-Term Engagement in mHealth Apps: Comparative Study of Engagement Indices.

BACKGROUND: Digital health care apps, including digital therapeutics, have the potential to increase accessibility and improve patient engagement by overcoming the limitations of traditional facility-based medical treatments. However, there are no established tools capable of quantitatively measuring long-term engagement at present. OBJECTIVE: This study aimed to evaluate an existing engagement index (EI) in a commercial health management app for long-term use and compare it with a newly developed EI. METHODS: Participants were recruited from cancer survivors enrolled in a randomized controlled trial that evaluated the impact of mobile health apps on recovery. Of these patients, 240 were included in the study and randomly assigned to the Noom app (Noom Inc). The newly developed EI was compared with the existing EI, and a long-term use analysis was conducted. Furthermore, the new EI was evaluated based on adapted measurements from the Web Matrix Visitor Index, focusing on click depth, recency, and loyalty indices. RESULTS: The newly developed EI model outperformed the existing EI model in terms of predicting EI of a 6- to 9-month period based on the EI of a 3- to 6-month period. The existing model had a mean squared error of 0.096, a root mean squared error of 0.310, and an R2 of 0.053. Meanwhile, the newly developed EI models showed improved performance, with the best one achieving a mean squared error of 0.025, root mean squared error of 0.157, and R2 of 0.610. The existing EI exhibited significant associations: the click depth index (hazard ratio [HR] 0.49, 95% CI 0.29-0.84; P<.001) and loyalty index (HR 0.17, 95% CI 0.09-0.31; P<.001) were significantly associated with improved survival, whereas the recency index exhibited no significant association (HR 1.30, 95% CI 1.70-2.42; P=.41). Among the new EI models, the EI with a menu combination of menus available in the app's free version yielded the most promising result. Furthermore, it exhibited significant associations with the loyalty index (HR 0.32, 95% CI 0.16-0.62; P<.001) and the recency index (HR 0.47, 95% CI 0.30-0.75; P<.001). CONCLUSIONS: The newly developed EI model outperformed the existing model in terms of the prediction of long-term user engagement and compliance in a mobile health app context. We emphasized the importance of log data and suggested avenues for future research to address the subjectivity of the EI and incorporate a broader range of indices for comprehensive evaluation.

Development and Delivery of an Integrated Digital Health Care Approach for Children With Juvenile Idiopathic Arthritis: Usability Study.

Background: Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disorder with no cure. Most children are prescribed several medications aimed at controlling disease activity, managing symptoms, and reducing pain. Physical activity is also encouraged to retain musculoskeletal function. The primary determinants of treatment success are maintaining long-term adherence, ongoing monitoring by a pediatric rheumatologist, and involvement of an interdisciplinary team. To support these goals, a new digital intervention was developed, InteractiveClinics, which aimed to prompt children to take their medications, report pain levels, and increase their physical activity. Objective: This study aims to evaluate the usability of InteractiveClinics among children with JIA. Methods: As part of this pediatric cross-sectional study, 12 children were asked to wear a smartwatch for 2 weeks, which was synchronized to the InteractiveClinics phone app and web-based platform. Personalized notifications were sent daily to the watch and phone, to prompt and record medication adherence and pain level assessment. Physical activity was automatically recorded by the watch. At the end of the study, all children and parents completed a postintervention survey. Written comments were also encouraged to gain further feedback. Descriptive statistics were used to summarize the survey results, and all qualitative data underwent thematic analysis. Results: Twelve children aged 10 to 18 years (mean 14.2, SD 3.1 years; female: n=8, 66.7%) and 1 parent for each child (n=12; female: n=8, 66.7%) were enrolled in the study. Based on the highest and lowest agreement areas of the survey, most children and parents liked the smartwatch and web-based platform; they found it easy to learn and simple to use. They were also satisfied with the pain and physical activity module. However, usability and acceptability barriers that hindered uptake were identified in the phone app and medication module. Children required a unique in-app experience, and their suggestive improvements included more personalization within the app; simplification by removing all links not relevant to antirheumatic medications; flexibility in response times; improved conferment through gamification; additional comment fields for the input of more data, such as medication side effects or pain-related symptoms; more detailed graphical illustrations of the physical activity module, including a breakdown of metrics; and importantly, interconnections between modules, because medication adherence, pain levels, and physical activity can each influence the other. They were, overall, improving usefulness for children and parents. Conclusions: The usability of InteractiveClinics was positive. Children and parents liked the watch and web-based platform and were satisfied with the pain and physical activity module. However, children wanted a unique in-app experience through more personalization, simplification, flexibility, conferment, comment fields, graphical illustrations, a breakdown of metrics, and interconnections. Certainly, inclusions are needed to promote user adoption and advancement of new validated digital health interventions in pediatric rheumatology, to support the delivery of integrated care.

Effects of pain, hospitalization, and medication on depressive symptom in Syrian patients with chronic diseases.

Chronic diseases and pain exacerbate depressive symptom in Syria. Limited research on hospital-induced depressive symptom among Syrian patients with chronic diseases warrants further study. A cross-sectional study in four Damascus hospitals revealed high rates of pain and depressive symptom. This study aims to investigate the prevalence and severity of chronic pain and hospital-induced depressive symptom in Syrian patients, as well as the relationship between pain, depressive symptom, and medication behavior. This study analyzes the impact of pain, hospitalization, and medication on patients with chronic diseases. The four Damascus hospitals included 453 patients from various departments. Data were collected through structured interviews and internationally recognized scales such as the PSEQ, HADS, and MMAS. These findings offer insights into pain management and psychological well-being, with implications for patient care and support strategies. The study involved 453 patients with chronic diseases, with gender distribution showing 46.6% females and 53.4% males. The age range was from 7 to 87 years, with an average of 46.87 years. Chi-square tests revealed a significant connection between gender and HADS-A scores, where 48.3% of females had abnormalities (χ2 (1, N = 453) = 7.125, p = 0.028). Marital status was significantly associated with anxiety and depressive symptom levels, particularly among widowed and divorced patients. Employment status, education, and comorbidity were linked to abnormal HADS-A scores, while education level showed a positive correlation with HADS-D scores. ANOVA tests showed significant differences in MMAS scores across income groups (F (3, 449) = 3.167, p = 0.024), with a notable difference between low-income and lower-middle-income groups (mean difference = 0.389, p = 0.031. Chronic pain and HID are prevalent among Syrian patients with chronic diseases and influenced by socio-demographic factors. Personalized interventions are needed to address psychological symptoms and medication behavior.

Using linked electronic medical record-pharmacy data to examine lupus medication adherence: A retrospective cohort study.

INTRODUCTION: Medication nonadherence is common in systemic lupus erythematosus (SLE) and associated with morbidity and mortality. We explored the reliability of pharmacy data within the electronic medical record (EMR) to examine factors associated with nonadherence to SLE medications. METHODS: We included patients with SLE who were prescribed ≥1 SLE medication for ≥90 days. We compared two datasets of pharmacy fill data, one within the EMR and another from the vendor who obtained this information from pharmacies and prescription benefit managers. Adherence was defined by medication possession ratio (MPR) ≥80%. In addition to MPR for each SLE medication, we evaluated the weighted-average MPR and the proportion of patients adherent to ≥1 SLE medication and to all SLE medications. We used logistic regression to examine factors associated with adherence. RESULTS: Among 181 patients (median age 36, 96% female, 58% Black), 98% were prescribed hydroxychloroquine, 34% azathioprine, 33% mycophenolate, 18% methotrexate, and 7% belimumab. Among 1276 pharmacy records, 74% overlapped between linked EMR-pharmacy data and data obtained directly from the vendor. Only 9% were available from the vendor but not through linked EMR-pharmacy data. The weighted-average MPR was 57%; 45% were adherent to hydroxychloroquine, 46% to ≥1 SLE medication, and 32% to all SLE medications. Older age was associated with adherence in univariable and multivariable analyses. DISCUSSION: Our study showed that obtaining linked EMR-pharmacy data is feasible with minimal missing data and can be leveraged in future adherence research. Younger patients were more likely to be nonadherent and may benefit from targeted intervention.

Sex Differences in Hypertension and Its Management Throughout Life.

BACKGROUND: The prevalence of hypertension and uncontrolled hypertension may differ by age and sex. METHODS: We included participants in the Atherosclerosis Risk in Communities study at seven study visits over 33 years (visit 1: 15 636 participants; mean age, 54 years; 55% women), estimating sex differences in prevalence of hypertension (systolic blood pressure ≥130 mm Hg; diastolic blood pressure ≥80 mm Hg; or self-reported antihypertension medication use) and uncontrolled hypertension (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg) using unadjusted and comorbidity-adjusted models. RESULTS: The prevalence of hypertension increased from 40% (ages, 43-46 years) to 93% (ages, 91-94 years). Within hypertensive individuals, the prevalence of uncontrolled hypertension was higher in men (33%) than women (23%) at ages 43 to 46 years but became higher in women than men starting at ages 61 to 64, with 56% of women and 40% men having uncontrolled hypertension at ages 91 to 94. This sex difference was not explained by differences in coronary heart disease, diabetes, body mass index, estimated glomerular filtration rate, number of antihypertension medications, classes of medications, or adherence to medications. In both sexes, uncontrolled hypertension was associated with a higher risk for chronic kidney disease progression (hazard ratio, 1.5 [1.2-1.9]; P=4.5×10-4), heart failure (hazard ratio, 1.6 [1.4-2.0]; P=8.1×10-7), stroke (hazard ratio, 2.1 [1.6-2.8]; P=1.8×10-8), and mortality (hazard ratio, 1.5 [1.3-1.6]; P=6.2×10-19). CONCLUSIONS: Sex differences in the prevalence of hypertension and uncontrolled hypertension vary by age, with the latter having implications for health throughout the life course.

Medication-related burden and its association with medication adherence among elderly tuberculosis patients in Guizhou, China: a cross-sectional study.

Introduction: Tuberculosis (TB) morbidity and mortality are significantly increasing in the elderly worldwide. Their optimal health outcomes are hampered by medication related burden (MRB) and poor treatment adherence. Understanding th e MRB status from patients' perspectives and its association with adherence among elderly TB patients will help achieve the End TB targets. Thus, we aimed to identify the incidence of MRB and nonadherence among elderly TB patients in Guizhou, and determine their association. Methods: A cross-sectional study was conducted in three prefectures with high TB notifications in Guizhou in 2022. The data were collected via face-to-face structured interviews. MRB was measured using the Living with Medicines Questionnaire version 3 (LMQ-3), which consists of eight domains. Nonadherence was assessed by treatment interruption, which was defined as any interruption lasting at least 1 day at any time within the last 3 months. A binary unconditional logistic regression model was used to determine the association between variables. Results: Of the 405 elderly TB patients enrolled, 49.4% and 42.7% of the respondents perceived suffering from moderate and high MRB, respectively. The incidence of nonadherence among patients was 33.6%. Patients with higher scores in domain 2 (practical difficulties) [OR adj = 1.19; 95% CI (1.11-1.28)] and domain 4 (side effects burden of prescribed medications) [OR adj = 1.16; 95% CI (1.06-1.27)] were more likely to experience nonadherence. But, patients with higher scores in domain 8 (control/autonomy of medicine use) [OR adj = 0.70; 95% CI (0.61, 0.81)] were more likely to occur adherence. Patients with a high education level [OR adj = 0.29; 95% CI (0.08, 0.92)] had a decreased risk of nonadherence, but those with a living expense from a retirement salary [OR adj = 2.55; 95% CI (1.16, 5.71)] had an increased risk of nonadherence. Discussion: The incidence of MRB and medication nonadherence is high among elderly TB patients in Guizhou. The significant associations between the three domains of MRB and nonadherence highlight that measuring MRB in multiple dimensions using the LMQ-3 in elderly TB patients could assist clinicians in providing patient-centered care, and multifaceted interventions targeting the identified problems should be implemented to reduce MRB and nonadherence among elderly TB patients in Guizhou.

The effects of multifactorial pharmacist-led intervention protocol on medication optimisation and adherence among patients with type 2 diabetes: A randomised control trial.

Background: Patient-related factors and limited medication adherence in patients with chronic diseases, are associated with poor clinical outcomes, long-term complications, and increased overall disease costs. Many methods have been tested with mixed results, and innovative approaches are needed to encourage patients to adhere to their prescribed drug regimens. Methods: This randomised controlled trial examined a new multifactorial pharmacist-led intervention protocol (MPIP), including a medication therapy management (MTM) program with face-to-face counselling, patient-specific medication booklets, and a mobile application, from July 2021 to September 2022 in the Oud Al Touba diagnostic and screening ambulatory centre in 192 patients with type 2 diabetes in the United Arab Emirates. Medication adherence was assessed using the fixed medication possession ratio of medication refills and the medication adherence questionnaire. Results: At 12 months follow-up, participants in the MPIP showed significant improvement in overall medication adherence with total (composite) medication possession ratio (MPRt) of mean (±SD) 0.95 (±0.09) compared to 0.92 (± 0.09) in the control group with mean difference of 0.03 (95%, CI 0.01-0.06), P =0.02. In addition, improvement trend was evident in the MPIP group for all medication regimens with P value <0.01. Comparable results were noticeable in adherence questionnaire scores at the end of the study, with 66 participants in the intervention group scored zero on the questionnaire, suggesting high adherence to medication compared to the control group (48 participants only). The MTM program performed 41 clinical interventions on drug-related problems, compared to six interventions in the control group, and the use of mobile application and medication booklet have increased to 45.7% compared to 21.4% before study exit. Conclusions: The pharmacy intervention protocol effectively improved medication adherence and optimised medication regimens in diabetic patients with chronic medication regimens in an ambulatory healthcare centre.

A quasi-experimental study about shared decision-making and motivational interviewing on patients with a recent fracture attending a fracture liaison services.

Shared decision making (SDM) aims to improve patients' experiences with care, treatment adherence and health outcomes. However, the effectiveness of SDM in patients with a recent fracture who require anti-osteoporosis medication (AOM) is unclear. The objective of this study was to assess the effectiveness of a multi-component adherence intervention (MCAI) including a patient decision aid (PDA) and motivational interviewing at fracture liaison services (FLS) on multiple outcomes compared to usual care (UC). This pre-post superiority study included patients with a recent fracture attending the FLS and with AOM treatment indication. The primary outcome was one-year AOM persistence measured by pharmacy records. Secondary outcomes included treatment initiation, AOM adherence (measured by medication possession ratio, MPR), decision quality (SDM process (0-100; best) and decisional conflict (0-100, highest conflict), subsequent fractures, and mortality. Outcomes were tested in MCAI and UC groups at the first FLS visit and 4- and 12-months after. Multiple imputation, uni- and multi-variable analyses were performed. Post-hoc analyses assessed the role of health literacy level. In total, 245 patients (MCAI: n = 136, UC: n = 109) were included. AOM persistence was 80.4% in the MCAI and 76.7% in the UC group (P=.626). SDM process scores were significantly better in MCAI (60.4 vs 55.1, P=.003). AOM initiation (97.8% vs 97.5%), MPR (90.9% vs 88.3%, P=.582), and decisional conflict (21.7 vs 23.0, P=.314) did not differ between groups. Results did not change importantly after adjustment. Stratified analyses by health literacy showed a better effect on MPR and SDM in those with adequate health literacy. This study showed no significant effect on AOM persistence however demonstrated a significant positive effect of MCAI on SDM process in FLS attenders.

When patients participate in the decision-making process (called shared decision-making), we may be able to improve the way they take medication and the way they experience care. We wanted to study how shared decision-making works in people who recently broke a bone and therefore needed anti-osteoporosis medication. We looked at two approaches that specialized nurses could use at the clinic. During the first visit, the nurses used a decision aid to discuss different medication options with the patient. During the second visit, nurses used "motivational interviewing" to better understand and support patients with taking their medication in the long term. We compared 109 patients who participated in this study to 126 patients who received normal care without the approaches. We found that the two approaches did not change the way people take their medication a year after the visits. However, patients who experienced the new approaches felt more involved in all phases of the decision to start and continue medication compared to patients receiving usual care. One year after the visits, people with higher health literacy were more likely to feel like they had been involved in the decision-making process, and more likely to still take their medication as prescribed.

Risk of Adverse Health Outcomes in Patients with Poor Adherence to Cardiovascular Medication Treatment: a Systematic Review / Risco de Desfechos Adversos à Saúde em Pacientes com Baixa Adesão ao Tratamento Medicamentoso Cardiovascular: uma Revisão Sistemática

Background: Cardiovascular diseases (CVD) remain the leading cause of mortality worldwide. Medication adherence is an important issue in managing chronic CVD, directly influencing outcomes and healthcare costs. Objectives: This systematic review, supported by the Brazilian Society of Cardiology, evaluates the impact of poor adherence to cardiovascular medications on critical clinical outcomes such as death and cardiovascular events. Methods: A comprehensive search was conducted across four databases, including Medline, Embase, Lilacs, and the Cochrane Library. The review included systematic reviews with meta-analyses that reported risk estimates for adherence to cardiovascular medications. Four systematic reviews, each incorporating observational studies, were selected. Results: The principal findings indicate that an increase in adherence to medications significantly reduces the risk of cardiovascular events, stroke, and all-cause death. Specifically, a 20% improvement in adherence to antihypertensive, lipid-lowering, and other cardiovascular medications correlated with reductions in cardiovascular events by 7%, 10%, and 9%, respectively; stroke by 17%, 13%, and 18%; and death by 12%, 9%, and 10%. The certainty of the evidence was moderate, suggesting that these effects are likely present. These findings emphasize the importance of enhancing medication adherence to improve clinical outcomes in CVD management. Conclusions: Evidence has demonstrated reductions in hard endpoints in both primary and secondary prevention through the control of conditions such as hypertension and elevated LDL cholesterol concentrations, as well as the benefits of antiplatelet therapy in atherosclerotic disease. However, additional studies are needed to better elucidate the relationship between adherence to cardiovascular medications and the improvement of critical clinical outcomes.

Introdução: As doenças cardiovasculares (DCV) continuam a ser a principal causa de mortalidade em todo o mundo. A adesão ao tratamento medicamentoso é uma questão importante no manejo das DCV crônicas, influenciando diretamente os resultados e os custos com saúde. Objetivos: Esta revisão sistemática, apoiada pela Sociedade Brasileira de Cardiologia, avalia o impacto da baixa adesão aos medicamentos cardiovasculares em desfechos clínicos críticos, como morte e eventos cardiovasculares. Métodos: Foi realizada uma busca abrangente em quatro bases de dados, incluindo Medline, Embase, Lilacs e Cochrane Library. A revisão incluiu revisões sistemáticas com meta-análises que relataram estimativas de risco para a adesão aos medicamentos cardiovasculares. Foram selecionadas quatro revisões sistemáticas, cada uma incorporando estudos observacionais. Resultados: Os principais achados indicam que um aumento na adesão aos medicamentos reduz significativamente o risco de eventos cardiovasculares, acidente vascular cerebral (AVC) e morte por todas as causas. Especificamente, uma melhoria de 20% na adesão a medicamentos antihipertensivos, hipolipemiantes e outros medicamentos cardiovasculares correlacionou-se com reduções nos eventos cardiovasculares de 7%, 10% e 9%, respectivamente; AVC de 17%, 13% e 18%; e morte de 12%, 9% e 10%. A certeza das evidências foi moderada, sugerindo que esses efeitos provavelmente estão presentes. Esses achados enfatizam a importância de melhorar a adesão ao tratamento medicamentoso para aprimorar os resultados clínicos no manejo das DCV. Conclusões: As evidências demonstraram reduções em desfechos duros tanto na prevenção primária quanto secundária através do controle de condições como hipertensão e concentrações elevadas de colesterol LDL, bem como os benefícios da terapia antiplaquetária em doenças ateroscleróticas. No entanto, são necessários estudos adicionais para elucidar melhor a relação entre a adesão aos medicamentos cardiovasculares e a melhoria dos desfechos clínicos críticos.

Using Games to Simulate Medication Adherence and Nonadherence: Laboratory Experiment in Gamified Behavioral Simulation.

Background: Medical nonadherence is a significant problem associated with worse clinical outcomes, higher downstream rehospitalization rates, and a higher use of resources. To improve medication adherence, it is vital for researchers and practitioners to have a solid theoretical understanding of what interventions are likely to work. To achieve this understanding, we propose that researchers should focus on creating small-scale laboratory analogs to the larger real-world setting and determine what interventions, such as nudges or incentives, work to change behavior in the laboratory. To do this, we took inspiration from the literature on serious games and gamification and experimental economics. We call our approach "gamified behavioral simulation." In this paper, we modeled everyday life as the state of being engaged in a simple but addictive game, illness as being interruptions to the functionality of that game, treatment as being a series of actions that can be taken to prevent or mitigate those interruptions, and adherence as sticking to a prescribed rule for the application of those actions. Objective: This study carries out a behavioral diagnosis of the medication adherence problem through a theoretically informed framework and then develops the gamified behavioral modeling approach to simulate medication nonadherence. Methods: A laboratory experiment was conducted using a modified popular and addictive open-source video game called "2048," which created an abstract model for the medication adherence behavior observed in real life. In total, 509 participants were assigned to the control and 4 intervention groups ("incentive" group, "reminder" group, "commitment device" group, and "elongated duration for symptoms" group). Results: The results of the modeling experiment showed that having theoretically informed interventions can increase the likelihood for them to be successful. In particular, there is evidence that the use of reminders improves the medication adherence rates for patients, and the same result was found in the modeling experiment, as they improved adherence significantly by 23% (95% CI -33.97% to -11.72%; P<.001). However, providing an incentive did not improve the adherence rate. We also tested the use of commitment devices, which, in line with real-world evidence, did not improve adherence rates. The fourth treatment tested elongated duration for symptoms, which attempted to show the power of modeling experiments where we test a what-if scenario that is extremely difficult to test in a real setting. The results indicated that if symptoms last longer, people did not adhere more to their medication regimen. Conclusions: Gamified behavioral simulation is a useful tool to explain real health behaviors and help in identifying which interventions are most likely to work in a randomized trial.

Implementing a Standardized Educational Tool for Patients With Brain Tumors Undergoing Concurrent Temozolomide and Radiation Therapy.

BACKGROUND: Patients diagnosed with glioblastoma multiforme (GBM) often undergo concurrent temozolomide and radiation therapy. Antineoplastic medication nonadherence continues to be an issue for patients with cancer. OBJECTIVES: This quality improvement project aimed to institute an evidence-based standardized educational tool for patients with GBM undergoing concurrent temozolomide and radiation therapy. METHODS: To assess medication adherence, patients completed the Brief Adherence Rating Scale at the end of the last radiation therapy visit. Patients and providers completed satisfaction surveys. FINDINGS: Data analysis from the administered Brief Adherence Rating Scale demonstrated a mean of 99.3% (N = 13) medication adherence among participants. Median medication adherence was demonstrated to be 100%, with scores ranging from 93% to 100%.

Mediating role of inner strength in the relationship between medication literacy and medication adherence among kidney transplant patients. / å† åœ¨åŠ›é‡åœ¨è‚¾ç§»æ¤æ‚£è€ è¯ç‰©ç´ å »ä¸Žæœè¯ä¾ä»Žæ€§å ³ç³»ä¸­çš„ä¸­ä»‹ä½œç”¨ï¼ˆè‹±æ–‡ï¼‰.

OBJECTIVES: Compared with long-term renal replacement therapy, kidney transplantation is the ideal treatment for end-stage renal disease (ESRD), significantly extending patient life and improving quality of life. Kidney transplant patients need to adhere to lifelong immunosuppressive medication regimens, but their medication adherence is generally poor compared with other organ transplant recipients. Medication adherence is closely related to medication literacy and psychological status, yet related studies are limited. This study aims to investigate the current status of medication adherence, inner strength, and medication literacy in kidney transplant patients, analyze the relationships among these 3 factors, and explore the mediating role of inner strength in the relationship between medication literacy and medication adherence. METHODS: A cross-sectional survey was conducted from March to October 2023 involving 421 patients aged≥18 years who visited kidney transplantation outpatient clinics at 4 tertiary hospitals in Hunan Province. The inner strength, medication literacy, and medication adherence of kidney transplant patients were investigated using the Inner Strength Scale (ISS), the Chinese version of the Medication Literacy Assessment in Spanish and English (MedLitRxSE), and the Chinese version of the Morisky Medication Adherence Scale-8 (C-MMAS-8), respectively. Univariate analysis was performed to examine the effects of demographic and clinical data on medication adherence. Correlation analysis was conducted to explore the relationships among medication literacy, medication adherence, and inner strength. Significant variables from univariate and correlation analyses were further analyzed using multiple linear regression, and the mediating effect of inner strength was explored. RESULTS: Among the 421 questionnaires collected, 408 were valid, with an effective rate of 96.91%. The scores of C-MMAS-8, MedLitRxSE, and ISS were 6.64±1.16, 100.63±14.67, and 8.47±4.03, respectively. Among the 408 patients, only 86 (21.08%) patients had a high level of medication adherence, whereas 230 (56.37%) patients had a medium level of medication adherence, and 92 (22.55%) patients had poor medication adherence. Univariate analysis indicated that the kidney transplant patients' age, marital status, education levels, years since their kidney transplant operation, number of hospitalizations after the kidney transplant, and adverse drug reactions showed significant differences in medication adherence (all P<0.05). Correlation analysis showed that inner strength positively correlated with both medication literacy (r=0.183, P<0.001) and medication adherence (r=0.201, P<0.001). Additionally, there was a positive correlation between medication adherence and medication literacy (r=0.236, P<0.001). Inner strength accounted for 13.22% of the total effect in the mediating role between medication literacy and medication adherence. CONCLUSIONS: The level of medication adherence among kidney transplant patients needs improvement, and targeted intervention measures are essential. Inner strength mediates the relationship between medication literacy and medication adherence in these patients. Healthcare professionals should focus on enhancing medication literacy and supporting patients' inner strength to improve medication adherence.

Efficacy of a Combination of Functional Exercise and Psychological Interventions in Improving Postoperative Rehabilitation and Intervention Compliance in Patients With Breast Cancer.

OBJECTIVE: This study aimed to investigate the effect of a combination of functional exercise and psychological interventions on postoperative rehabilitation and intervention compliance in patients with breast cancer (BC). METHODS: This study involved 100 patients with BC who underwent a radical mastectomy in our hospital between April 2020 and April 2021. We assigned patients to a control group (with a functional exercise intervention for patients) and an observation group (where patients received psychological interventions based on functional exercise) using a random number table. We observed and recorded the general data, intervention compliance, range of motion (ROM) of the shoulder joint pre and postintervention, pre and postintervention quality of life scores, and anxiety and depression scores before and after the interventions. RESULTS: There were no significant differences in general data between the 2 groups (P > .05). Repeated measures analysis showed no preintervention differences in compliance, shoulder ROM, quality of life, or anxiety and depression scores (P > .05). Postintervention, compliance and shoulder ROM improved in both groups, with the observation group significantly outperforming the control group (P < .05). Quality of life scores improved significantly in both groups, with higher scores in the observation group at 1 and 3 months (P < .05). Anxiety and depression scores decreased in both groups, with the observation group showing lower scores than the control group (P < .05). CONCLUSION: Combining functional exercise with psychological interventions improves treatment compliance, psychological status, postoperative shoulder ROM, and quality of life in breast cancer patients.