Validez y fiabilidad del cuestionario ARMS-e en pacientes con Diabetes mellitus tipo 2 / Validity and reliability of the ARMS-e questionnaire in patients with type 2 Diabetes mellitus

Introducción: El cuestionario “Adherence to Refills and Medications Scale” (ARMS) se diseñó para medir adherencia al tratamiento. Fue traducido y adaptado al español, pero no se han evaluado sus propiedades psicométricas. El objetivo fue evaluar dichas propiedades en una población con diabetes mellitus tipo 2. Método: El estudio se llevó a cabo en farmacias comunitarias de Granada (España) mediante entrevista. Se realizó un análisis factorial de componentes principales (AFCP) con rotación Varimax (validez de constructo), un análisis de concordancia (validez de criterio concurrente y fiabilidad por estabilidad temporal) y alfa de Cronbach y correlación ítem-total (fiabilidad por homogeneidad). Resultados: 107 pacientes entraron en el estudio. El 54,2 % (58) fueron hombres y la edad media fue 70,5 años (D.E.: 9,7). El AFCP extrajo 4 factores que explicaron el 57,49 % de la varianza total. El alfa de Cronbach= 0,428 y el test-retest κ= 0,627 (p > 0,001). Conclusiones: El ARMS-e no puede ser considerado una herramienta útil para medir la adherencia al tratamiento antidiabético oral en esta muestra. (AU)

Introduction: The Adherence to Refills and Medications Scale questionnaire (ARMS) was designed to measure ad-herence to treatment. It was translated and adapted into Spanish, but its psychometric properties have not been evaluated. The aim was to evaluate these properties in a population with type 2 diabetes mellitus. Method: The study was carried out in community pharmacies in Granada (Spain) by interview. A principal compo-nent factor analysis (PCA) with Varimax rotation (construct validity), a concordance analysis (concurrent criterion validity and reliability by temporal stability) and Cronbach’s alpha and item-total correlation (reliability by homo-geneity) were performed. Results: 107 patients entered the study. 54.2 % (58) were male and the mean age was 70.5 (SD: 9.7). The PCA extract-ed 4 factors that explained 57.49 % of the total variance. Cronbach’s alpha= 0.428, and in the test-retest κ= 0.627 (p > 0.001). Conclusions: The ARMS-e cannot be considered a useful tool to measure adherence to oral antidiabetic treatment in this sample. (AU)

Role of Caregivers in Remote Management of Patients With Type 2 Diabetes Mellitus: Systematic Review of Literature.

BACKGROUND: With the growing use of remote monitoring technologies in the management of patients with type 2 diabetes mellitus (T2DM), caregivers are becoming important resources that can be tapped into to improve patient care. OBJECTIVE: This review aims to summarize the role of caregivers in the remote monitoring of patients with T2DM. METHODS: We performed a systematic review in MEDLINE, Embase, Scopus, PsycINFO, and Web of Science up to 2022. Studies that evaluated the role of caregivers in remote management of adult patients with T2DM were included. Outcomes such as diabetes control, adherence to medication, quality of life, frequency of home glucose monitoring, and health care use were evaluated. RESULTS: Of the 1198 identified citations, 11 articles were included. The majority of studies were conducted in North America (7/11, 64%) and South America (2/11, 18%). The main types of caregivers studied were family or friends (10/11, 91%), while the most common remote monitoring modalities evaluated were interactive voice response (5/11, 45%) and phone consultations (4/11, 36%). With regard to diabetes control, 3 of 6 studies showed improvement in diabetes-related laboratory parameters. A total of 2 studies showed improvements in patients' medication adherence rates and frequency of home glucose monitoring. Studies that evaluated patients' quality of life showed mixed evidence. In 1 study, increased hospitalization rates were noted in the intervention group. CONCLUSIONS: Caregivers may play a role in improving clinical outcomes among patients with T2DM under remote monitoring. Studies on mobile health technologies are lacking to understand their impact on Asian populations and long-term patient outcomes.

Efeitos dasMedidas restritivas de combate à covid-19 no cumprimento das rotinas de tratamento do hiv no centro de saúde de moamba / Effects of restrictive measures to combat covid-19 on compliance with hiv treatment routines at the moamba health center

Em países economicamente fragilizados, com alta prevalência de infecções por vírus de imunodeficiência humana, as medidas de saúde pública e administrativas adoptadas para prevenir, controlar e conter a propagação da pandemia da COVID-19 representaram ameaça às actividades de controlo e manejo do HIV. Objectivo: analisar os efeitos das medidas de prevenção, controlo e contenção da propagação da COVID-19 na adesão às rotinas de tratamento anti-retroviral entre pacientes atendidos no Centro de Saúde de Moamba. Métodos: Foi adoptada uma metodologia mista, de orientação quantitativa, para uma abordagem retrospectiva dos efeitos das medidas de controlo e contenção do coronavírus, entre 1 de Outubro de 2019 e 31 de Março de 2021. Para o efeito, foram escrutinados 20 processos clínicos (Fichas Resumo) de pacientes seguidos nos cuidados de HIV entre Outubro e Dezembro de 2018. Os titulares destas Fichas Resumo foram submetidos a entrevistas semiestruturadas (auto-relato) para identificar os factores que durante o período de vigência das Medidas restritivas de combate à COVID-19 afectaram o cumprimento das rotinas de tratamento anti-retroviral (comparecimento às consultas e adesão às datas de colecta de medicamentos). Os dados obtidos dos processos clínicos foram submetidos à análise estatística descritiva. O teste paramétrico do qui-quadrado (X2 ) foi utilizado para investigar associações e correlações entre as variáveis socioeconómica e biomédica. A informação obtida, por meio de entrevistas semiestruturadas (auto-relato), foi submetida à análise temática de Braun e Clark Resultados: Os achados do estudo mostram uma tendência de variação para o período anterior (aos 6meses) e posterior (12 e 18 meses) a introdução das medidas vigilância activa da COVID 19. Em relação à taxa de adesão estimada, a média achada para os 18meses estudados, foi de 96,22% (±3,38) e a mediana de adesão foi de 97,55% (IQR: 93.73% ­ 99,35%). Porém, aos 6meses de avaliação, foi de 97% (±2,04, intervalo de 92% a 100%), aos 12 meses atingiu 94,39% (±3,43%, intervalo 86%-98.9%) e estabilizou-se nos 96,6% (±2,72), aos 18 meses de avaliação. Quanto à média de dias de atraso no levantamento de medicamentos, a média achada para o período estudado foi de 3,3 dias (±1,72, IQR 2 ­ 4,75). Aos 6 meses de avaliação, a média de dia de atrasos foi de 0,5 dias (±0,61 IQR 0-1), aos 12 meses regrediu para 1,6 dias (±1,1 IQR: 1-3) e atingiu 1,2 dias (±0,89 IQR: 1-3) aos 18 meses de avaliação. A média de células CD4 achada nos pacientes foi de 455,12 células/mm³ (± 135,78, IQR: 345,3 células/mm³ ­ 585,03 células/mm³) para o período em estudo. Neste período, 40% (8/20) dos pacientes apresentaram CD4 inferior a 350 células/mm³; 60% (12/20) tinham CD4 superior a 350 células/mm³. A média de células CD4 por 1 mm³ de sangue foi de 72,8 células/mm³ (±156,27 células/mm³, IQR 342 células/mm³ e 594 células/mm³) aos 6 meses de estudo; 496,18 células/mm³ (± 133,48 células/mm³, IQR 367 células/mm³ e 596,5 células/mm³) aos 12 meses e 463,16 células/mm³ (±160,04 IQR 352 células/mm³) aos 18 meses de avaliação, respectivamente. Foi observada uma associação estatisticamente significativa entre os resultados da contagem de células CD4 (valor-p=0,009); tempo do paciente em tratamento anti-retroviral (valor-p=0,045); nível de adesão ao tratamento do MRC-19 e Cumprimento das Rotinas de Tratamento do HIV no Centro de Saúde de Moamba xii HIV (valor-p=0,01) e partilha ou sobras de medicamentos (valor-p=0.05) e o número de dias de atraso no levantamento de medicamentos. O medo de ser infectado pelo coronavírus (valor p=0,095) não influenciou os dias de atraso no levantamento de medicamentos. Outrossim, não foi encontrada nenhuma correlação entre atrasos no pagamento de medicamentos rendimento médio mensal (valor-p=0,85), apesar dos auto-relatos sobre a falta de dinheiro como condição para cumprir as rotinas de tratamento anti-retroviral. Conclusão: Os factores socioeconómicos e comportamentais foram mais importantes nas medidas tomadas para combater a COVID-19. No entanto, após a implementação das medidas de combate à COVID-19, o Centro de Saúde de Moamba melhorou a capacidades de tratamento de HIV com essas variações. Assim, o estudo recomenda a realização de estudos para explorar factores que promovam a cumprimento das rotinas de tratamento.

The Economically dependent countries with high HIV prevalence have been threatened by public health and administrative measures to control and contain the CVID/19 pandemic. Objective: The study investigates the impact of COVID-19-fighting restrictions on compliance with antiretroviral treatment routines among HIV-positive patients at Moamba Health Centre. Methods and Procedures: This is a quantitative and qualitative study with a retrospective descriptive component carried out through the analysis of clinical records of 20 participants in HIV care. It adopted semi-structured interviews to gather information (self-report) on factors affecting participants' compliance with ART routines (presence at consultations, compliance with the medication collection schedule) after the introduction of restrictive measures to fight COVID 19 in 20 patients followed on ART from October 2019 to March 2021.Statistical inference, in the form of parametric chi-square tests (X2), was used to assess associations and correlations between socioeconomic and biomedical variables extracted from clinical records (Summary Sheet). A reflective analysis of Braun and Clark was conducted using the information obtained from semi structured questionnaires (self-report). Results: Means of estimated adherence to HIV care ranged from 97% (±2.04, range of 92% and 100%) before the introduction of restrictive measures to fight COVID-19 to 94.39% (±3, 43% ranging between 86% and 98.9%) at the 12-month evaluation from April to September 2020. From October 2019 to March 2021, the average adherence rate was 96.6% (±2.72). The estimated average adherence during the study period was 96.22% (±3.38) and a median of 97.55% (IQR: 93.73% - 99.35%). During the study period, the average number of days late in collecting ARVs was 3.3 days (±1.72, IQR 2 ­ 4.75). It occurred between 6 months before and 12 months after COVID-19 combat measures (6 months before and 12 months after COVID-19 combat measures). From April to September 2020, the average of delays in collecting ARVs reached 1.6 days (±1.1 ± 1.1 IQR: 1-3) and decreased to 1.2 days (±0.89 IQR 1-3) during the third semester of evaluation from October 2020 to March 2021 showing that the measures to fight COVID-19 had a negative influence on the fulfilment of ART routines among the participants. The mean CD4 count during the study was 455.12 cells/mm3 (± 135.78, IQR: 345.3 cells/mm3 ­ 585.03 cells/mm3); 40% (8/20) of patients had CD4 ≤ 350 ≤ 350 cells/mm3 and 60% (12/20) had CD4 > 350 cells/mm3. CD4 averages varied from 72.8 cells/mm3 (± cells/mm3, IQR 342 cells/mm3 and 594 cells/mm3) after 6 months of study; 496.18 cells/mm3 (± 133.48 IQR 367 cells/mm3 ­ 596.5 cells/mm3) at 12 months of study and 463.16 cells/mm3 (±160.04 IQR 352 cells/mm3 ­ 555 cells/ mm3) at 18 months of the study, revealing that some of the measures to fight the COVID-19 strengthened the capacity for HIV/care provision at the Moamba Health Centre. Delays in fetching ARVs at the pharmacy influence CD4 results (p-value=0.009); time on ART (p-value=0.045); level of adherence to HIV care (p-value = 0.01) and sharing of ARV leftovers (p-value = 0.05). Fear of infection by Coronavirus (p-value=0.095) did not influence ARV retrieval delays. Self-reported about lack of money, as a condition for complying with ART routines, but not delays in collecting ARVs and mean monthly income (p-value=0.848). MRC-19 e Cumprimento das Rotinas de Tratamento do HIV no Centro de Saúde de Moamba xiv Conclusion: The results suggest that delays in fetching ARVs are not necessarily caused by financial constraints. It may be attributed to factors such as fear of infection by Coronavirus (although this did not influence significantly). However, fear of Coronavirus did affect people's willingness to access ARV services, even if it was not statistically significant. CD4 results, time on ART, the adherence level on HIV care, and sharing of ARV leftovers influenced the delays on ARVs collection. The study concludes that measures to fight COVID-19 increased the weight of socioeconomic and behavioural factors that affect adherence to HIV care and treatment routines, increasing delays in ARV collection. The effects of measures to fight COVID-19 highlighted the need to improve indicators, instruments, and procedures for recording, measuring, and evaluating factors affecting compliance with antiretroviral treatment routines, regarded as indicators of HIV care.

Trends in Buprenorphine Initiation and Retention in the United States, 2016-2022.

This study uses data from an all-payer database of prescriptions dispensed in US retail pharmacies to assess trends in buprenorphine initiation and retention during 2016-2022.

Food Security and Medication Adherence in Young and Middle-Aged Adults with Diabetes.

Medication nonadherence in individuals with diabetes can lead to adverse health outcomes. Young and middle-aged adults are more likely to have low food security than other age groups. However, little research has focused on the relationship between food security and medication adherence in this population. The objective of this study was to examine the relationship between food security and medication adherence among young and middle-aged adults with diabetes. This study used 2019 National Health Interview Survey data. Persons were included if they were aged less than 50 and had a diabetes diagnosis. Individuals were categorized as nonadherent to medication if they answered "yes" to one question indicating nonadherence. Food security status was categorized as food secure, low food security, and very low food security. Among adults under age 50 with diabetes, nearly a fifth were categorized as having low or very low food security. Approximately a quarter of the participants were not adherent. Respondents with low food security and very low food security were significantly more likely to be nonadherent to medication than those who were food secure. People with diabetes under the age of 50 who have low or very low food security are at an increased risk for nonadherence to medication.

Assessment of adherence to at-home oral anti-infective therapy among paediatric patients discharged from a Quebec hospital.

OBJECTIVES: Non-adherence to anti-infective therapy contributes to treatment failure and the emergence of bacterial resistance. This study aimed to assess at-home adherence, by paediatric patients, to oral anti-infective (OAI) therapy prescribed for treatment of acute infections and to explore the factors contributing to non-adherence. METHODS: This prospective descriptive study involved French-speaking patients under 16 years of age who were discharged with one or more OAIs prescribed for home administration for a maximum of 30 days. Telephone surveys were used to assess overall adherence, which consisted of primary adherence (patient's ability to procure the medication) and secondary adherence (patient's ability to take the treatment as prescribed). RESULTS: Overall, 51.7% (30/58) of patients were adherent to OAI therapy, with 100% primary adherence (n=69/69) and 51.7% secondary adherence (n=30/58). On average, patients took 98% of the total number of doses prescribed, and non-adherence was related mostly to not following medication administration schedules (63.3% of patients followed the exact schedule). Indeed, the adherence rate for patients taking one or two doses per day was twice the rate for patients taking more than two doses per day (81.8% vs 44.7%, p=0.043). CONCLUSIONS: Half of the paediatric patients treated for acute infections were non-adherent to OAI therapy at home. Interventions are needed to improve this situation.

Exploring the Impact of Experiences with Everyday and Major Discrimination and HIV-Related Stigma on Engagement in HIV Care Among Older African Americans Living with HIV.

OBJECTIVES: The purpose of this pilot study was to explore the effect of HIV-related stigma and everyday major experiences of discrimination on medication and clinic visit adherence among older African Americans living with HIV in Ohio. METHODS: We collected data from 53 individuals who were living with HIV in Ohio, ≥ 50 years of age, and who identified as Black or African American. We conducted logistic regression models to examine the impact of HIV-related stigma and experiences of discrimination on medication and visit adherence. Each model controlled for age, time since diagnosis, and sexual orientation. RESULTS: The average age was 53.6 ± 2.1 years and 94.3% were men. Almost half (49.1%) of the participants reported poor medication adherence and almost a third (31.4%) reported poor visit adherence. HIV-related stigma (adjusted odds ratio (aOR) = 1.39; 95% confidence interval (CI) = 1.02-1.89) and major experiences of discrimination (aOR = 1.70; 95% CI = 1.11-2.60) were associated with a greater odds of poor medication adherence. Additionally, major experiences of discrimination were associated with a threefold increase in the odds of poor visit adherence (aOR = 3.24; 95% CI = 1.38-7.64). CONCLUSIONS: HIV-related stigma and major experiences of discrimination impede optimal medication and HIV clinic visit adherence for older African Americans living with HIV. To reduce the impact of stigma and discrimination on HIV care engagement, our first step must be in understanding how intersecting forms of stigma and discrimination impact engagement among older African Americans living with HIV.

Adherence and persistence to pharmacotherapy in patients with heart failure: a nationwide cohort study, 2014-2020.

AIMS: We aimed to study initiation, adherence, and long-term persistence to beta-blockers (BB), renin-angiotensin system inhibitors (RASi), and mineralocorticoid receptor antagonists (MRA) in a nationwide cohort of patients with heart failure (HF). METHODS: Patients aged 18-80 years in Norway with a first diagnosis of HF from 2014 until 2020 that survived ≥30 days were identified from the Norwegian Patient Registry and linked to the Norwegian Prescription Database. We collected information about BB, RASi [angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARB), and angiotensin receptor-neprilysin inhibitors (ARNI)], and MRA. Dual HF therapy was defined as taking at least two out of three drug classes, whereas triple HF therapy was defined as taking all three. Initiation (time to initiation) and persistence (time to discontinuation using a grace period of 30 days) of HF drugs was calculated by the Kaplan-Meier method, followed to outcome of interest, death, or December 2020. One-year adherence was measured as proportion of days covered (PDC) using a cut-off at 80%. For adherence and persistence measurements, we allowed for maximum 60 days of stockpiling and switching within drug groups. We performed sensitivity analyses to test the robustness of our findings. RESULTS: Out of 54 899 patients included in the cohort, 75%, 69%, and 21% initiated a BB, RASi, and MRA, respectively, whereas 13% did not receive any. Dual and triple HF therapy was prescribed to 61% and 16%, respectively. The proportion of adherent patients during the first year following initiation was 83%, 81%, 84%, and 61% for BB, RASi, ARNI, and MRA, whereas 42% and 5% were adherent to dual and triple HF therapy, respectively. From 2 to 5 years following initiation, persistence decreased from 58% to 38%, 57% to 37%, and 31% to 15% for BB, RASi, and MRA, respectively. Within the RASi group, persistence was higher for ARNI than for ACEI and ARB. There were no major changes in either initiation or adherence of the drug classes from 2014 to 2019, except for an increase in initiation and adherence of MRA. CONCLUSIONS: We found low adherence to dual and triple HF therapies in this nationwide cohort study of newly diagnosed HF patients. Efforts are needed to increase adherence and persistence to HF therapies into clinical practice, emphasizing maintenance of multiple drug therapies in patients with such an indication.

Cost-Effectiveness of Medication Therapy Management Program Across Racial and Ethnic Groups Among Medicare Beneficiaries.

OBJECTIVES: Equity and effectiveness of the medication therapy management (MTM) program in Medicare has been a policy focus since its inception. The objective of this study was to evaluate the cost-effectiveness of the Medicare MTM program in improving medication utilization quality across racial and ethnic groups. METHODS: This study analyzed 2017 Medicare data linked to the Area Health Recourses File. A propensity score was used to match MTM enrollees and nonenrollees, and an incremental cost-effectiveness ratio between the 2 groups was calculated. Effectiveness was measured as the proportion of appropriate medication utilization based on medication utilization measures developed by Pharmacy Quality Alliance. Net monetary benefits were compared across racial and ethnic groups at various societal willingness-to-pay (WTP) thresholds. The 95% confidence intervals were obtained by nonparametric bootstrapping. RESULTS: MTM dominated non-MTM among the total sample (N = 699 992), as MTM enrollees had lower healthcare costs ($31 135.89 vs $32 696.69) and higher proportions of appropriate medication utilization (87.47% vs 85.31%) than nonenrollees. MTM enrollees had both lower medication costs ($10 681.21 vs $11 003.08) and medical costs ($20 454.68 vs $21 693.61) compared with nonenrollees. The cost-effectiveness of MTM was higher among Black patients than White patients across the WTP thresholds. For instance, at a WTP of $3006 per percentage point increase in effectiveness, the net monetary benefit for Black patients was greater than White patients by $2334.57 (95% confidence interval $1606.53-$3028.85). CONCLUSIONS: MTM is cost-effective in improving medication utilization quality among Medicare beneficiaries and can potentially reduce disparities between Black and White patients. Expansion of the current MTM program could maximize these benefits.

Medication nonadherence: health impact, prevalence, correlates and interventions.

Nonadherence to medicines is a global problem compromising health and economic outcomes for individuals and society. This article outlines how adherence is defined and measured, and examines the impact, prevalence and determinants of nonadherence. It also discusses how a psychosocial perspective can inform the development of interventions to optimise adherence and presents a series of recommendations for future research to overcome common limitations associated with the medication nonadherence literature. Nonadherence is best understood in terms of the interactions between an individual and a specific disease/treatment, within a social and environmental context. Adherence is a product of motivation and ability. Motivation comprises conscious decision-making processes but also from more 'instinctive', intuitive and habitual processes. Ability comprises the physical and psychological skills needed to adhere. Both motivation and ability are influenced by environmental and social factors which influence the opportunity to adhere as well as triggers or cues to actions which may be internal (e.g. experiencing symptoms) or external (e.g. receiving a reminder). Systematic reviews of adherence interventions show that effective solutions are elusive, partly because few have a strong theoretical basis. Adherence support targeted at the level of individuals will be more effective if it is tailored to address the specific perceptions (e.g. beliefs about illness and treatment) and practicalities (e.g. capability and resources) influencing individuals' motivation and ability to adhere.

Non-adherence to anti-tubercular treatment during COVID-19 pandemic in Raipur district Central India.

BACKGROUND: Non-adherence is major factor in failure of any drug regimen. The significance of non-adherence is so much that WHO states that increasing the effectiveness of Adherence Interventions may have far greater impact on health of population than any improvement in specific medical treatments. Incidence of non-adherence to Anti Tubercular Treatment (ATT) usually ranges from 8.4% to 55.8%. This study aims to find out the reasons of Non-adherence to ATT in patients receiving anti-tubercular treatment at DIRECTLY OBSERVED TREATMENT SHORTCOURSE (DOTS) Centre at District Tuberculosis Centre (DTC), Kalibadi, Raipur during COVID-19 pandemic. METHODS: A cross sectional study was conducted at Department of Pharmacology, Pt. JNM Medical College and DTC Kalibadi Raipur. 55 Patients taking ATT fulfilling inclusion and exclusion criteria were interviewed using structured questionnaire. The data obtained was analysed to know causes of non-adherence. RESULTS: Study was carried out between March & April 2020. In our study, 80% subjects were male and 20% were female. The main reasons for Non-adherence were Side-effects of drug in 36% cases, missing medication intentionally in 34% cases, lack of encouragement by family members in 32% cases, patient's unawareness of consequences of skipping medication in 25% cases, unaware of treatment duration in 22%, not feeling any change, forgetting to take medication, and burden of concomitant medication besides ATT, each in 20% cases, 13% cases had difficulty in procuring medication due to lockdown, 5% cases did not go to collect their medicine due to fear of contracting COVID-19 infection. CONCLUSIONS: Our study shows reasons for Non-adherence are multi-factorial with drug side -effects & intentionally skipping medication being major factors.

Effectiveness of eHealth interventions targeted to improve medication adherence among older adults with mild cognitive impairment: a protocol for a systematic review and meta-analysis.

INTRODUCTION: Medication adherence is a vital component of successful healthcare, yet poor adherence exists, especially in older adults with mild cognitive impairment. Therefore, this study seeks to conduct a systematic review of eHealth-based interventions aimed at improving medication adherence among older adults with mild cognitive impairment. METHODS AND ANALYSIS: An open electronic database search will be conducted in PubMed, CINAHL, PsycINFO, EMBASE and Cochrane library to identify potential studies till 2022. Two authors will independently screen the titles and abstracts, after which studies that will be eligible for full-text review will be independently assessed by two reviewers for inclusion. Studies will be selected if they evaluate eHealth interventions aiming to improve medication adherence among older adults with mild cognitive impairment. Data will be analysed by using the Comprehensive Meta-Analysis software V.3 and Review Manager (RevMan) software V.5. The authors will separately analyse each outcome measure, compute intervention effects and present them as relative risks with 95% CIs for dichotomous data. Continuous data will be presented as mean differences and standardised mean differences (if required) with 95% CIs. If substantive statistical heterogeneity is identified, we will consider the use of random-effects models that can be incorporated into the statistical analysis. We envisage that this review will adduce evidence on eHealth interventions that will improve medication adherence among older adults with mild cognitive impairment. The findings can also inform health professionals and other relevant stakeholders on current eHealth-based interventions that are used to improve medication adherence among older adults with mild cognitive impairment. ETHICS AND DISSEMINATION: Ethical approval is not required for systematic reviews. Findings will be disseminated widely through peer-reviewed publication and at conferences. PROSPERO REGISTRATION NUMBER: CRD42021268665.

Group based trajectory modeling to assess adherence to oral anticoagulants among atrial fibrillation patients with comorbidities: a retrospective study.

BACKGROUND: Poor adherence to oral anticoagulants is a significant problem in atrial fibrillation (AF) patients with comorbidities as it increases the risk for cardiac and thromboembolic events. AIM: The primary objective was to evaluate adherence to direct oral anticoagulants (DOACs) or warfarin using group-based trajectory modeling (GBTM). The secondary objective was to identify the predictors of adherence to oral anticoagulants. Finally, to report the drug interactions with DOACs/warfarin. METHOD: This retrospective study was conducted among continuously enrolled Medicare Advantage Plan members from January 2016-December 2019. AF patients with comorbid hypertension, diabetes and hyperlipidemia using warfarin/DOACs were included. Monthly adherence to DOAC/warfarin was measured using proportion of days covered (PDC) and then modeled in a logistic GBTM to identify the distinct patterns of adherence. Logistic regression model was conducted to identify the predictors of adherence to oral anticoagulants adjusting for all baseline characteristics. Concomitant use of DOACs/warfarin with CYP3A4,P-gp inhibitors were measured. RESULTS: Among 317 patients, 137 (43.2%) and 79 (24.9%) were DOAC, and warfarin users, respectively. The adherence trajectory model for DOACs included gradual decline (40.4%), adherent (38.8%), and rapid decline (20.8%). The adherence trajectories for warfarin adherence included gradual decline (8.9%), adherent (59.4%), and gaps in adherence (21.7%). Predictors of adherence included type of oral anticoagulant, stroke risk score, low-income subsidy, and baseline PDC. CYP3A4,P-gp drugs were co-administered with DOACs /warfarin resulting in adverse events. CONCLUSION: Adherence to oral anticoagulants is suboptimal. Interventions tailored according to past adherence trajectories may be effective in improving patient's adherence.

Development of a Predictive Nomogram for Estimating Medication Nonadherence in Hemodialysis Patients.

BACKGROUND Medication compliance in hemodialysis patients affects the therapeutic effect of treatment and patient survival. Therefore, we aimed to explore the influencing factors of medication adherence in hemodialysis patients and develop a nomogram model to predict medication adherence. MATERIAL AND METHODS Data from questionnaires on medication adherence in hemodialysis patients were collected in Chengde from May 2020 to December 2020. The least absolute selection operator (LASSO) regression model and multivariable logistic regression analysis were used to analyze the risk factors for medication adherence in hemodialysis patients, and then a nomogram model was established. The bootstrap method was applied for internal validation. The concordance index (C-index), area under the receiver operating characteristic (ROC) curve (AUC), decision curve analysis (DCA), calibration curve, net reclassification improvement (NRI) index, and integrated discrimination improvement (IDI) index were used to evaluate the degree of differentiation and accuracy of the nomogram model, and clinical impact was used to investigate the potential clinical value of the nomogram model. RESULTS In total, 206 patients were included in this study, with a rate of medication nonadherence of 41.75%. Eight predictors were identified to build the nomogram model. The C-index, AUC, DCA, calibration curve, NRI, and IDI showed that the model had good discrimination and accuracy. The clinical impact plot showed that the nomogram of medication adherence in hemodialysis patients had clinical application value. CONCLUSIONS We developed and validated a nomogram model that is intuitive to apply for predicting medication adherence in hemodialysis patients.

Persistence on oral pre-exposure prophylaxis (PrEP) among female sex workers in eThekwini, South Africa, 2016-2020.

BACKGROUND: Despite the established efficacy of PrEP to prevent HIV and the advantages of a user-controlled method, PrEP uptake and persistence by women in both trials and demonstration projects has been suboptimal. We utilized real-world data from an HIV service provider to describe persistence on oral PrEP among female sex workers (FSW) in eThekwini, South Africa. METHODS: We examined time from PrEP initiation to discontinuation among all FSW initiating PrEP at TB HIV Care in eThekwini between 2016-2020. We used a discrete time-to-event data setup and stacked cumulative incidence function plots, displaying the competing risks of 1) not returning for PrEP, 2) client discontinuation, and 3) provider discontinuation. We calculated hazard ratios using complementary log-log regression and sub-hazard ratios using competing risks regression. RESULTS: The number of initiations increased each year from 155 (9.3%, n = 155/1659) in 2016 to 1224 (27.5%, n = 1224/4446) in 2020. Persistence 1-month after initiation was 53% (95% CI: 51%-55%). Younger women were more likely to discontinue PrEP by not returning compared with those 25 years and older. Risk of discontinuation through non-return declined for those initiating in later years. Despite the COVID-19 pandemic, a greater number of initiations and sustained persistence were observed in 2020. CONCLUSIONS: Low levels of PrEP persistence were observed, consistent with data among underserved women elsewhere. Encouragingly, the proportion of women persisting increased over time, even as the number of women newly initiating PrEP and staff workload increased. Further research is needed to understand which implementation strategies the program may have enacted to facilitate these improvements and what further changes may be necessary.

Lipid-lowering drug adherence and combination therapy effects on gastrointestinal cancer in patients with dyslipidemia without diabetes: a retrospective cohort study in South Korea.

BACKGROUND: In aging populations, the number of people with high cholesterol levels is increasing. Appropriate management of high cholesterol levels with drugs such as statins may prevent secondary diseases. Despite many studies on the effects of statins on various types of cancer, the effectiveness of lipid-lowering therapy in preventing cancer remains controversial. This study aimed to evaluate its long-term effect on developing gastrointestinal (GI) cancer in patients with dyslipidemia. METHODS: This study used the National Health Insurance Sampling (NHIS) cohort data (2002-2015), which included patients with dyslipidemia without diabetes, and measured patients' adherence to lipid-lowering therapy using the medication possession ratio. We used the Cox proportional hazard ratio (HR) to identify the association between the continuity of lipid-lowering therapy and the risk of GI cancer. We also evaluated the association between a combination of lipid-lowering drugs and a reduced risk of GI cancer. RESULTS: A total of 49,351 patients were diagnosed with dyslipidemia, of which 579 were diagnosed with GI cancer. Patients with higher adherence to lipid-lowering therapy had a significantly reduced risk of GI cancer compared to patients without drugs, and high adherence was associated with a reduced incidence of all types of GI cancer. Specifically, the combination of statins and ezetimibe or fibrates appears to reduce GI cancer risk effectively. Overall, the continuity of lipid-lowering therapy had a protective effect on GI cancer in middle-aged and elderly patients with dyslipidemia compared to non-users. CONCLUSIONS: Our findings suggest that the continuity of lipid-lowering therapy is vital in patients with dyslipidemia. In addition, for individuals vulnerable to GI cancer, combination therapy may be associated with more effective protection against GI cancer. Healthcare providers need patient education and monitoring to improve drug adherence in patients with dyslipidemia.

Antiepileptic drug adherence in children in southern Ethiopia: A cross sectional study.

BACKGROUND: Epilepsy is one of the commonest chronic neurological disorders with serious health consequences. Treatment adherence is one of the determinants of seizure control. This study was designed to determine factors affecting antiepileptic drug adherence among children with epilepsy. METHODS: A cross sectional study was conducted on 192 children with epilepsy (≤14 years of age) on follow-up at a pediatric neurology clinic in Southern Ethiopia from January 1st to August 30th, 2019. Medication Adherence was measured using the eight-item Morisky's medication adherence scale. Logistic regression analysis was done to determine factors associated with antiepileptic drug adherence. RESULT: One hundred twenty-five (65%) of the study subjects were adherent to their medication. On multivariable analysis, factors predictive of good adherence included family size of ≤5 [AOR = 2.34, (95% CI: 1.07, 5.10); P = 0.03] and duration of epilepsy (<1year [AOR = 5.83, (95% CI: 1.48, 22.92); P = 0.012] and 1-2year [AOR = 4.58, (95% CI: 1.12, 18.77); P = 0.035]). Monthly family income of <1000 Ethiopian Birr [AOR = 0.18, (95% CI: 0.06, 0.61); P = 0.005] and presence of seizure attack in the past 3months [AOR = 0.23, 95% (CI: 0.10, 0.55); P = 0.001] predicted poor antiepileptic drug adherence. CONCLUSION: Adherence to antiepileptic drugs in children is low in our setting; low family income and occurrence of seizures while on treatment predicted poor adherence. Supplying free antiepileptic drugs to poor children and regular provision of information about expected treatment response to children with epilepsy and their caretakers may help improve adherence.

Hepatitis vaccination adherence and completion rates and factors associated with low compliance: A claims-based analysis of U.S. adults.

Poor compliance with multi-dose vaccine schedules by adults for whom hepatitis (Hep) A and B vaccines are recommended contributes to major Hep A and B disease burdens among high-risk U.S. adults. Evidence on hepatitis vaccine series adherence, completion, timeliness of completion, and factors associated with these outcomes, is limited and not readily generalizable for U.S. adults. This retrospective, observational study examined adherence, completion, its timeliness, and the impact of sociodemographic and clinical factors on these outcomes among a large, geographically representative sample of U.S. adults. We analyzed the Optum Clinformatics SES administrative claims database (1/1/2010-6/30/2020) for recipients of 2-dose (HepA, HepB2) or 3-dose (HepB3, HepAB) hepatitis vaccines. Adherence was defined as receipt of booster doses within specified assessment periods, per label-recommended schedules. Completion (receipt of all doses) was assessed at 6, 12, 18, and 24 months.The study included 356,828 adults ≥19 years old who were continuously enrolled in a medical benefit plan for one (HepB2), six (HepB3; HepAB), or 18 months (HepA) prior to and following the index date (first observed vaccine dose). Adherence and 24-month completion rates were: HepA (27.0%, 28.4%), HepB2 (32.2%, 44.8%), HepB3 (14.3%, 37.3%), HepAB, (15.3%, 33.8%). Kaplan-Meier completion curves plateaued after about 6 months for HepB2 and about 12 months for HepA, HepB3, and HepAB vaccines. Logistic regression analyses showed risk for low adherence/completion was generally associated with male gender, younger age, Black or Hispanic race/ethnicity, lower educational or household income attainment, and more comorbidities. Adherence and completion rates for all hepatitis vaccine series are low, especially for males, younger adults, those with lower socio-economic status and more comorbidities. To our knowledge, this is the largest claims-based analysis of adherence and completion rates for U.S. adults initiating all currently available HepA and HepB vaccines. Findings may inform hepatitis vaccination programming.

Self-reported non-adherence to P2Y12 inhibitors in patients undergoing percutaneous coronary intervention: Application of the medication non-adherence academic research consortium classification.

AIMS: The Non-adherence Academic Research Consortium (NARC) has recently developed a consensus-based standardized classification for medication non-adherence in cardiovascular clinical trials. We aimed to assess the prevalence of NARC-defined self-reported non-adherence to P2Y12 inhibitors and its impact on clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS: Using a standardized questionnaire administered at 1 year after PCI, we assessed the 4 NARC-defined non-adherence levels including type, decision-maker, reasons, and timing within the Bern PCI registry. The primary endpoint was the patient-oriented composite endpoint (POCE) defined as a composite of death, myocardial infarction, stroke, and any revascularization at 1 year. The recommended P2Y12 inhibitor duration was 12 months. Among 3,896 patients, P2Y12 inhibitor non-adherence was observed in 647 (17%) patients. Discontinuation was permanent in the majority of patients (84%). The decision was mainly driven by a physician (94%), and rarely by patients (6%). The most frequent reason was risk profile change (43%), followed by unlisted reasons (25%), surgery (17%), and adverse events (14%). Non-adherence occurred early (<30 days) in 21%, late (30-180 days) in 45%, and very late (>180 days) in 33%. The majority of POCE events (n = 421/502, 84%) occurred during adherence to the prescribed P2Y12 inhibitor. Permanent discontinuation, doctor-driven non-adherence, and risk profile change emerged as independent predictors for POCE. CONCLUSIONS: In real-world PCI population treated with 1-year DAPT, non-adherence was observed in nearly one-fifth of patients. Non-adherence to P2Y12 inhibitors was associated with worse clinical outcomes, while the risk was related to underlying contexts. CLINICALTRIALS.GOV IDENTIFIER: NCT02241291.