I was reading Todd Defren's PR Squared blog post today about Wikipedia, and if a company should or should not create an entry for themselves. It got me thinking more about Wikipedia, and using it as a go to source for information.
I do not use Wikipedia regularly, however I find increasingly useful for trivial information, such as who is Lonelygirl15, since I missed all the YouTube ballyhoo.
I think UGC (user generated content) is fantastic, however I do not think it is always an authoritative source. With that in mind, I looked up the my favorite terms: medication adherence, medication non-adherence, medication compliance and medication non-compliance. The only listing was Compliance (Medicine).
From the Wikipedia entry:
"Compliance (or Adherence) is a medical term that is used to indicate a patient's correct following of medical advice. Most commonly it is a patient taking medication (drug compliance), but may also apply to use of surgical appliances such as compression stockings, chronic wound care, self-directed physiotherapy exercises, or attending counselling or other courses of therapy.
Patients may not accurately report back to healthcare workers because fear of possible embarrassment, being chastised, or seeming to be ungrateful for a doctor's care.
Causes for poor compliance include:
• Forgetfulness
• Prescription not collected or not dispensed
• Purpose of treatment not clear
• Perceived lack of effect
• Real or perceived side-effects
• Instructions for administration not clear
• Physical difficulty in complying (e.g. opening medicine containers, handling small tablets, swallowing difficulties, travel to place of treatment)
• Unattractive formulation, such as unpleasant taste
• Complicated regimen
• Cost of drugs"
The listing goes on to discuss "Adherence: An estimated half of those for whom medicines are prescribed do not take them in the recommended way. Until recently this was termed "non-compliance", and was sometimes regarded as a manifestation of irrational behavior or willful failure to observe instructions, although forgetfulness is probably a more common reason. But today health care professionals prefer to talk about "adherence" to a regimen rather than "compliance"...."
And "Drug Compliance: It is estimated that only 50% of patients suffering from chronic diseases in developed countries follow treatment recommendations...."
And "Concordance: Concordance is a current UK NHS initiative to involve the patient in the treatment process and so improve compliance...."
Overall it is a great listing. Wikipedia (rather the authors & editors) address the causes, the percentage of patients who are non-adherent, and the differences between adherence and compliance and concordance.
I guess I will have to live the listing title: Compliance (Medicine).
Showing posts with label Medication Non-adherence. Show all posts
Showing posts with label Medication Non-adherence. Show all posts
Wednesday, November 12, 2008
Monday, October 27, 2008
Medication Adherence and Asthma Symptoms Abstract
Today's Medication Adherence related abstract comes from The HighWire Press. My comments are at the end.
Brief-interval telephone surveys of medication adherence and asthma symptoms in the Childhood Asthma Management Program Continuation Study. BG Bender, A Rankin, ZV Tran, and FS Wamboldt
BACKGROUND: Although it is known that most patients do not consistently take controller medications every day, the impact of non-adherence on asthma control is not well documented.
OBJECTIVE: To establish the relationship between medication adherence and symptom control in adolescents and young adults with asthma.
METHODS: A total of 756 adolescents and young adults diagnosed as having mild to moderate asthma on entry into the original study underwent 6 monthly telephone interviews as an ancillary project to the Childhood Asthma Management Program Continuation Study. Participants were queried about medication use and symptom control within each 1-month interview window. Strategies adopted to improve self-report accuracy included use of repeated interviews, confidential reporting to staff unknown to the participants, and use of questions focused on recent behavior.
RESULTS: Only participants who were consistently on inhaled corticosteroids (ICSs) for the entire 6-month study interval were included. Three groups of patients were contrasted: those not on ICSs (n = 420), those on ICSs with high adherence (> or = 75% of medication taken, n = 90), and those on ICSs with low/medium adherence (< 75% of medication taken, n = 148). Participants in the low/medium adherence group reported, on average, less symptom control and more variability in wheezing, awakening at night, missed activities, and beta2-agonist use during the 6-month period, although most in this group perceived their asthma to be under good control.
CONCLUSION: Despite extensive patient education and support, diminished ICS adherence was frequent and undermined symptom control in this group of adolescents and young adults with mild to moderate asthma.
MY COMMENTS
This is another one of these, uh really? abstracts relating to poor medication adherence and lack of symptom control, but supports the fact that if you do not take your controller medications, you will not be able to control your symptoms.
My feelings about adolescents and asthma medication is that they will not take their ICS unless they are having an attack. Forgetfulness and stigma, I believe, are the two drivers of this non-adherence. It would have been nice if the researchers had added the question: "Why didn't you take your ICS"?, but they will probably have to do another study to get this question answered.
Brief-interval telephone surveys of medication adherence and asthma symptoms in the Childhood Asthma Management Program Continuation Study. BG Bender, A Rankin, ZV Tran, and FS Wamboldt
BACKGROUND: Although it is known that most patients do not consistently take controller medications every day, the impact of non-adherence on asthma control is not well documented.
OBJECTIVE: To establish the relationship between medication adherence and symptom control in adolescents and young adults with asthma.
METHODS: A total of 756 adolescents and young adults diagnosed as having mild to moderate asthma on entry into the original study underwent 6 monthly telephone interviews as an ancillary project to the Childhood Asthma Management Program Continuation Study. Participants were queried about medication use and symptom control within each 1-month interview window. Strategies adopted to improve self-report accuracy included use of repeated interviews, confidential reporting to staff unknown to the participants, and use of questions focused on recent behavior.
RESULTS: Only participants who were consistently on inhaled corticosteroids (ICSs) for the entire 6-month study interval were included. Three groups of patients were contrasted: those not on ICSs (n = 420), those on ICSs with high adherence (> or = 75% of medication taken, n = 90), and those on ICSs with low/medium adherence (< 75% of medication taken, n = 148). Participants in the low/medium adherence group reported, on average, less symptom control and more variability in wheezing, awakening at night, missed activities, and beta2-agonist use during the 6-month period, although most in this group perceived their asthma to be under good control.
CONCLUSION: Despite extensive patient education and support, diminished ICS adherence was frequent and undermined symptom control in this group of adolescents and young adults with mild to moderate asthma.
MY COMMENTS
This is another one of these, uh really? abstracts relating to poor medication adherence and lack of symptom control, but supports the fact that if you do not take your controller medications, you will not be able to control your symptoms.
My feelings about adolescents and asthma medication is that they will not take their ICS unless they are having an attack. Forgetfulness and stigma, I believe, are the two drivers of this non-adherence. It would have been nice if the researchers had added the question: "Why didn't you take your ICS"?, but they will probably have to do another study to get this question answered.
Tuesday, September 30, 2008
Found Around the Web Today
It has been awhile since I have posted a "What I am Reading" or "What I have Found" post, so here you go. Some interesting stuff out there that sparked my interest.
From Reuter's Health, a report on Sex Bias in Control of Cancer Pain:
"How well pain is managed in people with cancer apparently differs between men and women, new research hints. Dr. Kristine A. Donovan, of the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida, and colleagues examined pain severity and the adequacy of pain management in 131 cancer patients newly referred to a multidisciplinary cancer pain clinic." Full Story
From LifeScript, a study that shows 1 in 5 Diabetics do not take their medication as prescribed. "Too many diabetics are neglecting to take life-saving prescription medicines regularly, one study warned. Published in the Archives of Internal Medicine, the study estimated that 21% of diabetics fail to adhere to their prescription schedule." Full Story
Allan Showalter, MD from AlignMap discusses the Implications Of The Redundant Patient Compliance Review. I like to post abstracts and some compliance reviews, but his blog posts are always more insightful, biting and from an MD's perspective. Full Story
And lastly, from the International Journal of STD and AIDS: Factors associated with lack of antiretroviral adherence among adolescents in a reference centre in Rio de Janeiro, Brazil. Full Story.
From Reuter's Health, a report on Sex Bias in Control of Cancer Pain:
"How well pain is managed in people with cancer apparently differs between men and women, new research hints. Dr. Kristine A. Donovan, of the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida, and colleagues examined pain severity and the adequacy of pain management in 131 cancer patients newly referred to a multidisciplinary cancer pain clinic." Full Story
From LifeScript, a study that shows 1 in 5 Diabetics do not take their medication as prescribed. "Too many diabetics are neglecting to take life-saving prescription medicines regularly, one study warned. Published in the Archives of Internal Medicine, the study estimated that 21% of diabetics fail to adhere to their prescription schedule." Full Story
Allan Showalter, MD from AlignMap discusses the Implications Of The Redundant Patient Compliance Review. I like to post abstracts and some compliance reviews, but his blog posts are always more insightful, biting and from an MD's perspective. Full Story
And lastly, from the International Journal of STD and AIDS: Factors associated with lack of antiretroviral adherence among adolescents in a reference centre in Rio de Janeiro, Brazil. Full Story.
Personal Voice and other Medication Adherence "Scams"
I subscribe to a number of Google Alerts regarding medication non/ adherence /compliance. For the most part they are pretty spot on regarding articles with my chosen keywords, new research, blog posts etc... At least once a day is a link to a faux blog that simply lists keywords with advertising and links to other spam sites.
Once such site came up today, but also revealed some useful information - ie. NCPIE is promoting October as Talk About Prescriptions Month (more on this in another post) but they have a broken link to the site.
The text isn't well written, but they do promote the importance of medication adherence and the role of the caregiver. It mentions a service called Personal Voice with a link to the website Family Focus Working Caregivers that has broken links and some healthcare information. Overall a horribly designed site, but offers the Personal Voice service which will call your loved ones for you in case you do not have the time to make sure they are taking their medications.
I called the number provided to get an information package. The voicemail thanked me for calling and asked me to dial the extension I wanted. I dialed "0" and got a voicemail that simply stated "Personal Voice". I did a Google Search for "Personal Voice Inc." and here is what I got:
At first I thought it was just a problem with them managing their online reputation - since the first four results are negative. I then read the posts and they all describe the service as a scam. They deduct money from one's checking account monthly, yet do not provide a service. They are tied to another company which is a debit-for-credit-card scam as well.
This just makes me mad. A company using medication non-adherence rates to scare caregivers into signing up for a service that is simply a scam to make money. Luckily they are now being investigated by the FBI. I have encountered a number of email phishing scams this year, and other online attempts to get information, but this is the first I have seen involving medication non-adherence.
Caregivers out there, be careful with the services you sign up for. Make sure they are legitimate and will provide a beneficial service for your loved ones. Check with the better business bureau and do a Google Search to check the company's reputation.
I have not included any links from this post on purpose.
Once such site came up today, but also revealed some useful information - ie. NCPIE is promoting October as Talk About Prescriptions Month (more on this in another post) but they have a broken link to the site.
The text isn't well written, but they do promote the importance of medication adherence and the role of the caregiver. It mentions a service called Personal Voice with a link to the website Family Focus Working Caregivers that has broken links and some healthcare information. Overall a horribly designed site, but offers the Personal Voice service which will call your loved ones for you in case you do not have the time to make sure they are taking their medications.
I called the number provided to get an information package. The voicemail thanked me for calling and asked me to dial the extension I wanted. I dialed "0" and got a voicemail that simply stated "Personal Voice". I did a Google Search for "Personal Voice Inc." and here is what I got:
At first I thought it was just a problem with them managing their online reputation - since the first four results are negative. I then read the posts and they all describe the service as a scam. They deduct money from one's checking account monthly, yet do not provide a service. They are tied to another company which is a debit-for-credit-card scam as well.
This just makes me mad. A company using medication non-adherence rates to scare caregivers into signing up for a service that is simply a scam to make money. Luckily they are now being investigated by the FBI. I have encountered a number of email phishing scams this year, and other online attempts to get information, but this is the first I have seen involving medication non-adherence.
Caregivers out there, be careful with the services you sign up for. Make sure they are legitimate and will provide a beneficial service for your loved ones. Check with the better business bureau and do a Google Search to check the company's reputation.
I have not included any links from this post on purpose.
Friday, September 26, 2008
Adheris Study Finds First 30 Days on Antidepressants Critical for Medication Adherence
I had a call a few months back where I was pitching Intelecare's Services. The prospect asked "who are your competitors". I gave the answer, "well, no one". I know it is not the proper VC answer, however, at the time (March) there wasn't anyone in our space doing what we do.
No one has a robust, web-based proprietary medical messaging platform that sends patient and caregiver created reminders via email, text and voice messaging. No one offers our hosted and enterprise solutions to industry. No one has 3.2M users and sends out 4M reminders daily. No one has a pro bono program that gives away their technology. No one is developing the next generation in Adherence 2.0 applications like we are.
Since that call, a handful of competitors have emerged offering similar products. In fact, one such competitor even used the same phrasing we have used on our website for two years to describe the services they offer and the industries they serve.
Competitors aside, Intelecare is still the gold standard - no matter how many other companies come into the space.
Even though our competitors charge for their reminders, we still offer a free service to patients and caregivers to ensure that they are helped with the #1 cause of medical non-adherence, forgetfulness. We still integrate our reminder platform into any existing web portal - both as an out of the box hosted solution and as a fully customized enterprise solution. We still offer our hosted email reminder platform pro-bono to non-profits that specialize in chronic disease states.
That being said, I found a press release from Adheris today announcing a study which results "showed that patients new to antidepressant treatment and those who had restarted therapy after a lapse of 6 or more months were twice as likely to discontinue therapy in the first 30 days of treatment versus patients previously dispensed an antidepressant."
This is significant because the first 30 days of therapy are integral to a patient continuing their therapy. "The practical implications of this study are that while all patients lapsed at an alarming rate over time, increased patient follow-up and education within the first 30 days of therapy in newly treated and lapsed patients restarting therapy are critical to help improve adherence and patient outcomes."
Adheris is a fantastic company that has been in the space for over 9 years. They are focused on increasing patient adherence and education at the pharmacy level. Several times I have been asked to compare our services to theirs - however it is apples and oranges. We are both trying to get to the same goal - increasing patient medication adherence - we just have two distinct ways of doing it.
Medication non-adherence costs the US $300 BILLION annually in unnecessary health care costs and lost revenue. 1 in 2 patients does not take their medications as directed with 84% of them citing forgetfulness as the reason.
I think this market is big enough for a few players with different ideas of how to end this pandemic. It not only takes reminders, but education and lower drug costs to help eradicate the problem which affects us all in one way or another.
No one has a robust, web-based proprietary medical messaging platform that sends patient and caregiver created reminders via email, text and voice messaging. No one offers our hosted and enterprise solutions to industry. No one has 3.2M users and sends out 4M reminders daily. No one has a pro bono program that gives away their technology. No one is developing the next generation in Adherence 2.0 applications like we are.
Since that call, a handful of competitors have emerged offering similar products. In fact, one such competitor even used the same phrasing we have used on our website for two years to describe the services they offer and the industries they serve.
Competitors aside, Intelecare is still the gold standard - no matter how many other companies come into the space.
Even though our competitors charge for their reminders, we still offer a free service to patients and caregivers to ensure that they are helped with the #1 cause of medical non-adherence, forgetfulness. We still integrate our reminder platform into any existing web portal - both as an out of the box hosted solution and as a fully customized enterprise solution. We still offer our hosted email reminder platform pro-bono to non-profits that specialize in chronic disease states.
That being said, I found a press release from Adheris today announcing a study which results "showed that patients new to antidepressant treatment and those who had restarted therapy after a lapse of 6 or more months were twice as likely to discontinue therapy in the first 30 days of treatment versus patients previously dispensed an antidepressant."
This is significant because the first 30 days of therapy are integral to a patient continuing their therapy. "The practical implications of this study are that while all patients lapsed at an alarming rate over time, increased patient follow-up and education within the first 30 days of therapy in newly treated and lapsed patients restarting therapy are critical to help improve adherence and patient outcomes."
Adheris is a fantastic company that has been in the space for over 9 years. They are focused on increasing patient adherence and education at the pharmacy level. Several times I have been asked to compare our services to theirs - however it is apples and oranges. We are both trying to get to the same goal - increasing patient medication adherence - we just have two distinct ways of doing it.
Medication non-adherence costs the US $300 BILLION annually in unnecessary health care costs and lost revenue. 1 in 2 patients does not take their medications as directed with 84% of them citing forgetfulness as the reason.
I think this market is big enough for a few players with different ideas of how to end this pandemic. It not only takes reminders, but education and lower drug costs to help eradicate the problem which affects us all in one way or another.
Thursday, September 25, 2008
Frequency of and Risk Factors for Preventable Medication-Related Hospital Admissions in the Netherlands
Today's medication adherence themed abstract is brought to you by the Archives of Internal Medicine. Adverse medication reactions are not simply restricted to the US. As this study shows, even The Netherlands, with their advanced healthcare system, still could prevent almost half (46%) of their medication related hospital admissions.
Background:
Medication-related problems that lead to hospitalization have been the subject of many studies, many of which were limited to 1 hospital or lacked patient follow-up. Furthermore, little information exists on potential risk factors associated with preventable medication-related hospitalizations.
Methods:
A prospective multicenter study was conducted to determine the frequency and patient outcomes of medication-related hospital admissions. A case-control design was used to determine risk factors for potentially preventable admissions. All unplanned admissions in 21 hospitals were assessed during 40 days.
Controls were patients admitted for elective surgery. Cases and controls were followed up until hospital discharge. The frequency of medication-related hospital admissions, potential preventability, and outcomes were assessed. For potentially preventable medication-related admissions, risk factors were identified in the case-control study.
Results:
Almost 13 000 unplanned admissions were screened, of which 714 (5.6%) were medication related. Almost half (46.5%) of these admissions were potentially preventable, resulting in 332 case patients matched with 332 controls. Outcomes were favorable in most patients.
The main determinants of preventable medication-related hospital admissions were impaired cognition (odds ratio, 11.9; 95% confidence interval, 3.9-36.3), 4 or more comorbidities (8.1; 3.1-21.7), dependent living situation (3.0; 1.4-6.5), impaired renal function (2.6; 1.6-4.2), nonadherence to medication regimen (2.3; 1.4-3.8), and polypharmacy (2.7; 1.6-4.4).
Conclusions:
Adverse drug events are an important cause of hospitalizations, and almost half are potentially preventable. The identified risk factors provide a starting point for preventing medication-related hospital admissions.
Background:
Medication-related problems that lead to hospitalization have been the subject of many studies, many of which were limited to 1 hospital or lacked patient follow-up. Furthermore, little information exists on potential risk factors associated with preventable medication-related hospitalizations.
Methods:
A prospective multicenter study was conducted to determine the frequency and patient outcomes of medication-related hospital admissions. A case-control design was used to determine risk factors for potentially preventable admissions. All unplanned admissions in 21 hospitals were assessed during 40 days.
Controls were patients admitted for elective surgery. Cases and controls were followed up until hospital discharge. The frequency of medication-related hospital admissions, potential preventability, and outcomes were assessed. For potentially preventable medication-related admissions, risk factors were identified in the case-control study.
Results:
Almost 13 000 unplanned admissions were screened, of which 714 (5.6%) were medication related. Almost half (46.5%) of these admissions were potentially preventable, resulting in 332 case patients matched with 332 controls. Outcomes were favorable in most patients.
The main determinants of preventable medication-related hospital admissions were impaired cognition (odds ratio, 11.9; 95% confidence interval, 3.9-36.3), 4 or more comorbidities (8.1; 3.1-21.7), dependent living situation (3.0; 1.4-6.5), impaired renal function (2.6; 1.6-4.2), nonadherence to medication regimen (2.3; 1.4-3.8), and polypharmacy (2.7; 1.6-4.4).
Conclusions:
Adverse drug events are an important cause of hospitalizations, and almost half are potentially preventable. The identified risk factors provide a starting point for preventing medication-related hospital admissions.
Monday, September 22, 2008
Abstracts from Medline
Today I found several abstracts related to medication non-adherence, specifically these four that deal with measurement. All are from the HighWire Press out of Stanford.
Enjoy!
ONE: Testing the psychometric properties of the Medication Adherence Scale in patients with heart failure
OBJECTIVE:
Many factors may contribute to medication nonadherence in heart failure (HF), but no standard measure exists to evaluate factors associated with nonadherence. To fill this gap, we developed the Medication Adherence Scale (MAS) and tested its reliability and validity in patients with HF.
METHOD:
Questionnaire data were collected from 100 patients with HF at baseline using the MAS, and objective adherence data were collected for 3 consecutive months using the Medication Event Monitoring System.
RESULTS:
Principal component analysis yielded three factors that explained 63% of the variance in medication adherence: knowledge, attitudes, and barriers to medication adherence. Cronbach's alphas for these subscales ranged from .75 to .94, which supported their internal consistency. The Spearman rho correlation coefficients between the Medication Event Monitoring System and Knowledge, Attitudes, and Barriers scores were .25 to .31 (P < .05), demonstrating support for construct validity.
CONCLUSION:
These results support the reliability and validity of the MAS as a measure of knowledge, attitudes, and barriers of medication adherence.
TWO: Revision and validation of the medication adherence self-efficacy scale (MASES) in hypertensive African Americans
Study purpose was to revise and examine the validity of the Medication Adherence Self-Efficacy Scale (MASES) in an independent sample of 168 hypertensive African Americans: mean age 54 years (SD = 12.36); 86% female; 76% high school education or greater. Participants provided demographic information; completed the MASES, self-report and electronic measures of medication adherence at baseline and three months.
Confirmatory (CFA), exploratory (EFA) factor analyses, and classical test theory (CTT) analyses suggested that MASES is unidimensional and internally reliable. Item response theory (IRT) analyses led to a revised 13-item version of the scale: MASES-R. EFA, CTT, and IRT results provide a foundation of support for MASES-R reliability and validity for African Americans with hypertension. Research examining MASES-R psychometric properties in other ethnic groups will improve generalizability of findings and utility of the scale across groups. The MASES-R is brief, quick to administer, and can capture useful data on adherence self-efficacy.
THREE: Methods of assessing adherence to inhaled corticosteroid therapy in children and adolescents: adherence rates and their implications for clinical practice
Nonadherence to inhaled corticosteroid therapy is common and has a negative effect on clinical control, as well as increasing morbidity rates, mortality rates and health care costs. This review was conducted using direct searches, together with the following sources: Medline; HighWire; and the Latin American and Caribbean Health Sciences Literature database. Searches included articles published between 1992 and 2008. The following methods of assessing adherence, listed in ascending order by degree of objectivity, were identified: patient or family reports; clinical judgment; weighing/dispensing of medication, electronic medication monitoring; and (rarely) biochemical analysis.
Adherence rates ranged from 30 to 70%. It is recognized that the degree of adherence determined by patient/family reports or by clinical judgment is exaggerated in comparison with that obtained using electronic medication monitors. Physicians should bear in mind that true adherence rates are lower than those reported by patients, and this should be considered in cases of poor clinical control. Weighing the spray quantifies the medication and infers adherence. However, there can be deliberate emptying of inhalers and medication sharing. Pharmacies provide the dates on which the medication was dispensed and refilled. This strategy is valid and should be used in Brazil.
The use of electronic medication monitors, which provide the date and time of each triggering of the medication device, although costly, is the most accurate method of assessing adherence. The results obtained with such monitors demonstrate that adherence was lower than expected. Physicians should improve their knowledge on patient adherence and use accurate methods of assessing such adherence.
FOUR: Evidence-based Assessment of Adherence to Medical Treatments in Pediatric Psychology
Objectives:
Adherence to medical regimens for children and adolescents with chronic conditions is generally below 50% and is considered the single, greatest cause of treatment failure. As the prevalence of chronic illnesses in pediatric populations increases and awareness of the negative consequences of poor adherence become clearer, the need for reliable and valid measures of adherence has grown.
Methods:
This review evaluated empirical evidence for 18 measures utilizing three assessment methods: (a) self-report or structured interviews, (b) daily diary methods, and (c) electronic monitors.
Results:
Ten measures met the "well-established" evidence-based (EBA) criteria.
Conclusions:
Several recommendations for improving adherence assessment were made. In particular, consideration should be given to the use of innovative technologies that provide a window into the "real time" behaviors of patients and families. Providing written treatment plans, identifying barriers to good adherence, and examining racial and ethnic differences in attitudes, beliefs and behaviors affecting adherence were strongly recommended.
Enjoy!
ONE: Testing the psychometric properties of the Medication Adherence Scale in patients with heart failure
OBJECTIVE:
Many factors may contribute to medication nonadherence in heart failure (HF), but no standard measure exists to evaluate factors associated with nonadherence. To fill this gap, we developed the Medication Adherence Scale (MAS) and tested its reliability and validity in patients with HF.
METHOD:
Questionnaire data were collected from 100 patients with HF at baseline using the MAS, and objective adherence data were collected for 3 consecutive months using the Medication Event Monitoring System.
RESULTS:
Principal component analysis yielded three factors that explained 63% of the variance in medication adherence: knowledge, attitudes, and barriers to medication adherence. Cronbach's alphas for these subscales ranged from .75 to .94, which supported their internal consistency. The Spearman rho correlation coefficients between the Medication Event Monitoring System and Knowledge, Attitudes, and Barriers scores were .25 to .31 (P < .05), demonstrating support for construct validity.
CONCLUSION:
These results support the reliability and validity of the MAS as a measure of knowledge, attitudes, and barriers of medication adherence.
TWO: Revision and validation of the medication adherence self-efficacy scale (MASES) in hypertensive African Americans
Study purpose was to revise and examine the validity of the Medication Adherence Self-Efficacy Scale (MASES) in an independent sample of 168 hypertensive African Americans: mean age 54 years (SD = 12.36); 86% female; 76% high school education or greater. Participants provided demographic information; completed the MASES, self-report and electronic measures of medication adherence at baseline and three months.
Confirmatory (CFA), exploratory (EFA) factor analyses, and classical test theory (CTT) analyses suggested that MASES is unidimensional and internally reliable. Item response theory (IRT) analyses led to a revised 13-item version of the scale: MASES-R. EFA, CTT, and IRT results provide a foundation of support for MASES-R reliability and validity for African Americans with hypertension. Research examining MASES-R psychometric properties in other ethnic groups will improve generalizability of findings and utility of the scale across groups. The MASES-R is brief, quick to administer, and can capture useful data on adherence self-efficacy.
THREE: Methods of assessing adherence to inhaled corticosteroid therapy in children and adolescents: adherence rates and their implications for clinical practice
Nonadherence to inhaled corticosteroid therapy is common and has a negative effect on clinical control, as well as increasing morbidity rates, mortality rates and health care costs. This review was conducted using direct searches, together with the following sources: Medline; HighWire; and the Latin American and Caribbean Health Sciences Literature database. Searches included articles published between 1992 and 2008. The following methods of assessing adherence, listed in ascending order by degree of objectivity, were identified: patient or family reports; clinical judgment; weighing/dispensing of medication, electronic medication monitoring; and (rarely) biochemical analysis.
Adherence rates ranged from 30 to 70%. It is recognized that the degree of adherence determined by patient/family reports or by clinical judgment is exaggerated in comparison with that obtained using electronic medication monitors. Physicians should bear in mind that true adherence rates are lower than those reported by patients, and this should be considered in cases of poor clinical control. Weighing the spray quantifies the medication and infers adherence. However, there can be deliberate emptying of inhalers and medication sharing. Pharmacies provide the dates on which the medication was dispensed and refilled. This strategy is valid and should be used in Brazil.
The use of electronic medication monitors, which provide the date and time of each triggering of the medication device, although costly, is the most accurate method of assessing adherence. The results obtained with such monitors demonstrate that adherence was lower than expected. Physicians should improve their knowledge on patient adherence and use accurate methods of assessing such adherence.
FOUR: Evidence-based Assessment of Adherence to Medical Treatments in Pediatric Psychology
Objectives:
Adherence to medical regimens for children and adolescents with chronic conditions is generally below 50% and is considered the single, greatest cause of treatment failure. As the prevalence of chronic illnesses in pediatric populations increases and awareness of the negative consequences of poor adherence become clearer, the need for reliable and valid measures of adherence has grown.
Methods:
This review evaluated empirical evidence for 18 measures utilizing three assessment methods: (a) self-report or structured interviews, (b) daily diary methods, and (c) electronic monitors.
Results:
Ten measures met the "well-established" evidence-based (EBA) criteria.
Conclusions:
Several recommendations for improving adherence assessment were made. In particular, consideration should be given to the use of innovative technologies that provide a window into the "real time" behaviors of patients and families. Providing written treatment plans, identifying barriers to good adherence, and examining racial and ethnic differences in attitudes, beliefs and behaviors affecting adherence were strongly recommended.
Tuesday, September 16, 2008
Medication Noncompliance and Substance Abuse Among Patients with Schizophrenia
Today's medication adherence related abstract comes from Psychiatry Online. It is from a Veterans Affairs Field Program for Mental Health and was originally published over 10 years ago, however it is still often cited. The results are not that surprising, however it brought to mind alcoholism and how it is related to medication non-adherence and to mental health.
With both schizophrenia and bipolar disorder, the rates of alcoholism are much higher than the average. I have always viewed this alcoholism as self-medicating behavior - thus the patients are adherent to their self prescribed drinking regime. I wonder how side effects came into play as most of the psychiatric medications heighten the effects to alcohol?
OBJECTIVE:
The study examined the effect of medication noncompliance and substance abuse on symptoms of schizophrenia.
METHODS:
Short-term inpatients with a diagnosis of schizophrenia were enrolled in a longitudinal outcomes study and continued to receive standard care after discharge. At baseline and six-month follow-up, Brief Psychiatric Rating Scale (BPRS) scores and data on subjects' reported medication compliance, drug and alcohol abuse, usual living arrangements, and observed side effects were obtained. The number of outpatient contacts during the follow-up period was obtained from medical records. Relationships between the dependent variables-medication noncompliance and follow-up BPRS scores-and the independent variables were analyzed using logistic and linear regression models.
RESULTS:
Medication noncompliance was significantly associated with substance abuse. Subjects who abused substances, had no outpatient contact, and were noncompliant with medication had significantly greater symptom severity than other groups.
CONCLUSIONS:
Substance abuse is strongly associated with medication noncompliance among patients with schizophrenia. The combination of substance abuse, medication noncompliance, and lack of outpatient contact appears to define a particularly high-risk group.
With both schizophrenia and bipolar disorder, the rates of alcoholism are much higher than the average. I have always viewed this alcoholism as self-medicating behavior - thus the patients are adherent to their self prescribed drinking regime. I wonder how side effects came into play as most of the psychiatric medications heighten the effects to alcohol?
OBJECTIVE:
The study examined the effect of medication noncompliance and substance abuse on symptoms of schizophrenia.
METHODS:
Short-term inpatients with a diagnosis of schizophrenia were enrolled in a longitudinal outcomes study and continued to receive standard care after discharge. At baseline and six-month follow-up, Brief Psychiatric Rating Scale (BPRS) scores and data on subjects' reported medication compliance, drug and alcohol abuse, usual living arrangements, and observed side effects were obtained. The number of outpatient contacts during the follow-up period was obtained from medical records. Relationships between the dependent variables-medication noncompliance and follow-up BPRS scores-and the independent variables were analyzed using logistic and linear regression models.
RESULTS:
Medication noncompliance was significantly associated with substance abuse. Subjects who abused substances, had no outpatient contact, and were noncompliant with medication had significantly greater symptom severity than other groups.
CONCLUSIONS:
Substance abuse is strongly associated with medication noncompliance among patients with schizophrenia. The combination of substance abuse, medication noncompliance, and lack of outpatient contact appears to define a particularly high-risk group.
Monday, September 8, 2008
One-month adherence in children with new-onset epilepsy: white-coat compliance does not occur.
Today's Medication Adherence related abstract comes from Medscape.
OBJECTIVES:
Adherence to antiepileptic drug therapy plays an important role in the effectiveness of pharmacologic treatment of epilepsy. The purpose of this study was to use an objective measure of adherence to (1) document patterns of adherence for the first month of therapy for children with new-onset epilepsy, (2) examine differences in adherence by demographic and epilepsy variables, and (3) determine whether treatment adherence improves for a short time before a clinic visit (eg, "white-coat compliance").
METHODS:
Participants included 35 children with new-onset epilepsy (mean age: 7.2 years; 34% female; 66% white) and their caregivers. Children had a diagnosis of partial (60%), generalized (29%), or unclassified (11%) epilepsy. Adherence to treatment was electronically monitored with Medication Event Monitoring System TrackCap, starting with the first antiepileptic drug dose. Adherence was calculated across a 1-month period and for the 1, 3, and 5 days before and 3 days after the clinic appointment.
RESULTS:
Adherence for the first month of treatment in children with new-onset epilepsy was 79.4%. One-month adherence was higher in children of married parents and those with higher socioeconomic status but did not correlate with child's gender, age, epilepsy type, prescribed medication, seizure frequency, or length of time since seizure onset. Adherence across the entire 1-month period was not different from adherence for the 1, 3, or 5 days before or 3 days after the clinic visit.
CONCLUSIONS:
Poor adherence seen for children with new-onset epilepsy during the first month of antiepileptic drug therapy is a cause for concern. Several demographic variables influence adherence to treatment, whereas the proximity to a clinic visit does not. Additional studies are needed to document whether this trend continues longitudinally and determine the clinical impact of poor adherence.
MY COMMENTS:
I wonder if the adherence rates dropping has something to do with the caregivers? 79% is not that bad - better than average - but it is only for 1 month, and with a severe affliction such as epilepsy, being able to see the effects of non-adherence has a serious impact.
OBJECTIVES:
Adherence to antiepileptic drug therapy plays an important role in the effectiveness of pharmacologic treatment of epilepsy. The purpose of this study was to use an objective measure of adherence to (1) document patterns of adherence for the first month of therapy for children with new-onset epilepsy, (2) examine differences in adherence by demographic and epilepsy variables, and (3) determine whether treatment adherence improves for a short time before a clinic visit (eg, "white-coat compliance").
METHODS:
Participants included 35 children with new-onset epilepsy (mean age: 7.2 years; 34% female; 66% white) and their caregivers. Children had a diagnosis of partial (60%), generalized (29%), or unclassified (11%) epilepsy. Adherence to treatment was electronically monitored with Medication Event Monitoring System TrackCap, starting with the first antiepileptic drug dose. Adherence was calculated across a 1-month period and for the 1, 3, and 5 days before and 3 days after the clinic appointment.
RESULTS:
Adherence for the first month of treatment in children with new-onset epilepsy was 79.4%. One-month adherence was higher in children of married parents and those with higher socioeconomic status but did not correlate with child's gender, age, epilepsy type, prescribed medication, seizure frequency, or length of time since seizure onset. Adherence across the entire 1-month period was not different from adherence for the 1, 3, or 5 days before or 3 days after the clinic visit.
CONCLUSIONS:
Poor adherence seen for children with new-onset epilepsy during the first month of antiepileptic drug therapy is a cause for concern. Several demographic variables influence adherence to treatment, whereas the proximity to a clinic visit does not. Additional studies are needed to document whether this trend continues longitudinally and determine the clinical impact of poor adherence.
MY COMMENTS:
I wonder if the adherence rates dropping has something to do with the caregivers? 79% is not that bad - better than average - but it is only for 1 month, and with a severe affliction such as epilepsy, being able to see the effects of non-adherence has a serious impact.
Monday, August 25, 2008
What I Found Today
Lots of news about medication adherence today. As part of my job, I often educate people about the effects of medication non-adherence when pitching them our services. It is surprising how many people are unaware of the pandemic, even though there has been so much research over the last 20 years about it.
I am always looking around the web for more information, and today I have found a few companies attacking medication non-adherence through a variety of ways.
At The Earth Times, a press release about Pleio launching their GoodStart program with the Outcomes Personal Pharmacy Network. I have been following this Canadian company for awhile, and it is great to see they are in the marketplace. Their niche is helping patients stay adherent to their medications for the 1st 100 days through a handful of interventions at the pharmacy level.
It is great to use the pharmacist in the intervention, however how will this slow down the fulfillment procedures at the pharmacy? Patients are already yearning for a more automated system, what if they have to wait even longer for the 1st time fill, and wait for the people ahead of them to enroll in the program?
Two stories from MarketWatch. The first, a press release about HC Innovations signing a LoA to use InforMedix's Med-eXpert System for up to 500 of ECI's complex patients. I have been following InforMedix for over a year, and they have made some great steps toward increasing medication adherence pill dispenser /monitor. In fact, it is being used in AETNA's Medication Adherence Lottery Clinical Trial.
I am surprised there is not more news from the NACDS Conference this weekend, since I have only seen this press release about ValueTrak from ValuCentric and PDX. Their new program allows for linking of ValueCentric's trade data with PDX-Rx.com's prescription data to give manufacturers a "full visibility of their product activity".
And finally this weird story from The Chicago Tribune about a man who stole the identity of a mentally disabled friend to get heart by-pass surgery.
"You can't just walk in with somebody's Medicaid card like it's a credit card and have heart surgery done," said Jeff Nelligan, spokesman for the federal Centers for Medicare and Medicaid Services. "A doctor would need to know blood type, cardiac history, medical history and other comprehensive records that just couldn't be faked. This doesn't make sense."
Very bizarre that this would happen with all of the checks and balances in place at a hospital for such an expensive procedure.
Enjoy the news!
I am always looking around the web for more information, and today I have found a few companies attacking medication non-adherence through a variety of ways.
At The Earth Times, a press release about Pleio launching their GoodStart program with the Outcomes Personal Pharmacy Network. I have been following this Canadian company for awhile, and it is great to see they are in the marketplace. Their niche is helping patients stay adherent to their medications for the 1st 100 days through a handful of interventions at the pharmacy level.
It is great to use the pharmacist in the intervention, however how will this slow down the fulfillment procedures at the pharmacy? Patients are already yearning for a more automated system, what if they have to wait even longer for the 1st time fill, and wait for the people ahead of them to enroll in the program?
Two stories from MarketWatch. The first, a press release about HC Innovations signing a LoA to use InforMedix's Med-eXpert System for up to 500 of ECI's complex patients. I have been following InforMedix for over a year, and they have made some great steps toward increasing medication adherence pill dispenser /monitor. In fact, it is being used in AETNA's Medication Adherence Lottery Clinical Trial.
I am surprised there is not more news from the NACDS Conference this weekend, since I have only seen this press release about ValueTrak from ValuCentric and PDX. Their new program allows for linking of ValueCentric's trade data with PDX-Rx.com's prescription data to give manufacturers a "full visibility of their product activity".
And finally this weird story from The Chicago Tribune about a man who stole the identity of a mentally disabled friend to get heart by-pass surgery.
"You can't just walk in with somebody's Medicaid card like it's a credit card and have heart surgery done," said Jeff Nelligan, spokesman for the federal Centers for Medicare and Medicaid Services. "A doctor would need to know blood type, cardiac history, medical history and other comprehensive records that just couldn't be faked. This doesn't make sense."
Very bizarre that this would happen with all of the checks and balances in place at a hospital for such an expensive procedure.
Enjoy the news!
Thursday, August 21, 2008
Some Quickies From Around the Web
I have been working on a couple of interesting blog posts, specifically one about Twitter for health. I am working on the proper angle, outlining how I use the service, and how others can as well. It is taking longer than I thought, so I appologize.
Here are some quick snippets of news from other sources that I have seen this week so far. Sorry for the retread.
At Psychiatry MMC, there is an abstract about short-acting versus long-acting medications for the treatment of ADHD:
"Medication adherence is also a well-known problem in a chronic disorder like ADHD, with only about 20 percent of patients remaining on the same medication 15 months after first being prescribed that medication. The need for multiple daily dosing of immediate-release medications only further increases the risk of nonadherence in children, adolescents, and adults.
As there is a significant likelihood that one of the parents of a child with ADHD will also have ADHD (often undiagnosed), or another psychiatric disorder, there is potentially a significant risk that the parent will forget to give the additional immediate-release doses of medication to the child every 4 to 6 hours."
Over at MedTrack Alert, they discuss how juices can interfere with medication absorption:
"Researchers say grapefruit juice has been known to dangerously increase the amount of medication absorbed into the body--particularly drugs for high cholesterol and high blood pressure. But a new study by the same researchers has found that apple, orange, and grapefruit juice may also decrease the absorption of some meds, including drugs commonly used to treat diabetes, cancer, allergies, and some antibiotics."
Dr. Showalter at Alignmap discussed the new medication adherence tool: Zuri. FD it is kind of a competitor to Intelecare, however you do not have to spend $200 on a new device and adapt to new technology - Intelecare works with your existing cellphone, land line and computer. Also, you don't have to pay $40 - $50 a month for online services.
The Healthcare Blog now has it's own channel on ICYou. Hat tip to @mindofandre on Twitter.
SHPS to present at Harvard Colloquium about Six Sigma Principles Drive Healthcare Behavior Change -- Using Medication Compliance to Improve Healthcare Outcomes.
Over at Health Management Rx, Jen gets exited about the NextHealth Model launching in beta soon.
That is it for now. You can follow me on Twitter and contribute to the conversation.
Here are some quick snippets of news from other sources that I have seen this week so far. Sorry for the retread.
At Psychiatry MMC, there is an abstract about short-acting versus long-acting medications for the treatment of ADHD:
"Medication adherence is also a well-known problem in a chronic disorder like ADHD, with only about 20 percent of patients remaining on the same medication 15 months after first being prescribed that medication. The need for multiple daily dosing of immediate-release medications only further increases the risk of nonadherence in children, adolescents, and adults.
As there is a significant likelihood that one of the parents of a child with ADHD will also have ADHD (often undiagnosed), or another psychiatric disorder, there is potentially a significant risk that the parent will forget to give the additional immediate-release doses of medication to the child every 4 to 6 hours."
Over at MedTrack Alert, they discuss how juices can interfere with medication absorption:
"Researchers say grapefruit juice has been known to dangerously increase the amount of medication absorbed into the body--particularly drugs for high cholesterol and high blood pressure. But a new study by the same researchers has found that apple, orange, and grapefruit juice may also decrease the absorption of some meds, including drugs commonly used to treat diabetes, cancer, allergies, and some antibiotics."
Dr. Showalter at Alignmap discussed the new medication adherence tool: Zuri. FD it is kind of a competitor to Intelecare, however you do not have to spend $200 on a new device and adapt to new technology - Intelecare works with your existing cellphone, land line and computer. Also, you don't have to pay $40 - $50 a month for online services.
The Healthcare Blog now has it's own channel on ICYou. Hat tip to @mindofandre on Twitter.
SHPS to present at Harvard Colloquium about Six Sigma Principles Drive Healthcare Behavior Change -- Using Medication Compliance to Improve Healthcare Outcomes.
Over at Health Management Rx, Jen gets exited about the NextHealth Model launching in beta soon.
That is it for now. You can follow me on Twitter and contribute to the conversation.
Friday, August 15, 2008
How Hurricane Katrina Affected Medication Adherence
Today's medical adherence related abstract comes from The American Journal of The Medical Sciences:
Background:
Previous research indicates that many patients with hypertension ran out of medications and had difficulties getting refills immediately after Hurricane Katrina. The extended effect of Hurricane Katrina on antihypertensive medication adherence is not well characterized.
Methods:
Data were analyzed for 2194 participants who completed the baseline survey for the Cohort Study of Medication Adherence among Older Adults between August 2006 and September 2007. Based on pre-Katrina zip codes, the study population was categorized into high- and low-affected areas. Low medication adherence was defined as a score less than 6 on the 8-item Morisky Medication Adherence Scale.
Results:
Prevalence of low adherence was similar among participants living in high and low affected areas. Low medication adherence was similar for participants with greater than or less than 25% of the residence damaged by Hurricane Katrina and for participants with and without symptoms of post-traumatic stress disorder.
In high affected areas, nonsignificant associations were present for those who had moved since the storm and those with a friend or immediate family member who had died in the month after the storm. These factors were not associated with low medication adherence in low affected areas. In both high- and low-affected areas, lower scores on the hurricane coping self-efficacy scale were associated with low medication adherence (P < 0.05).
Conclusions:
The effect of Hurricane Katrina on patient adherence to antihypertensive medication was limited in the second year after the storm. Intrinsic patient factors, such as low coping self-efficacy, remain important factors associated with low adherence.
Background:
Previous research indicates that many patients with hypertension ran out of medications and had difficulties getting refills immediately after Hurricane Katrina. The extended effect of Hurricane Katrina on antihypertensive medication adherence is not well characterized.
Methods:
Data were analyzed for 2194 participants who completed the baseline survey for the Cohort Study of Medication Adherence among Older Adults between August 2006 and September 2007. Based on pre-Katrina zip codes, the study population was categorized into high- and low-affected areas. Low medication adherence was defined as a score less than 6 on the 8-item Morisky Medication Adherence Scale.
Results:
Prevalence of low adherence was similar among participants living in high and low affected areas. Low medication adherence was similar for participants with greater than or less than 25% of the residence damaged by Hurricane Katrina and for participants with and without symptoms of post-traumatic stress disorder.
In high affected areas, nonsignificant associations were present for those who had moved since the storm and those with a friend or immediate family member who had died in the month after the storm. These factors were not associated with low medication adherence in low affected areas. In both high- and low-affected areas, lower scores on the hurricane coping self-efficacy scale were associated with low medication adherence (P < 0.05).
Conclusions:
The effect of Hurricane Katrina on patient adherence to antihypertensive medication was limited in the second year after the storm. Intrinsic patient factors, such as low coping self-efficacy, remain important factors associated with low adherence.
Monday, August 11, 2008
Hard of (Ad)hearing in Pharma Exec Magazine
I came across this article in Pharmaceutical Executive Magazine this morning, even though it was published on August 1st.
George Koroneos writes about Big Pharma's take on medication adherence programs and different people's take on adherence, including our friend Dr. Nash from the Jefferson Medical College. Nothing really new in the article, but it is a good summary of some programs that have worked - ie. Gardasil.
Enjoy!
George Koroneos writes about Big Pharma's take on medication adherence programs and different people's take on adherence, including our friend Dr. Nash from the Jefferson Medical College. Nothing really new in the article, but it is a good summary of some programs that have worked - ie. Gardasil.
Enjoy!
Friday, August 1, 2008
A Video Game Improves Behavioral Outcomes in Adolescents and Young Adults With Cancer: A Randomized Trial
BONUS Medication adherence abstract! From the AAP:
OBJECTIVE.
Suboptimal adherence to self-administered medications is a common problem. The purpose of this study was to determine the effectiveness of a video-game intervention for improving adherence and other behavioral outcomes for adolescents and young adults with malignancies including acute leukemia, lymphoma, and soft-tissue sarcoma.
METHODS.
A randomized trial with baseline and 1- and 3-month assessments was conducted from 2004 to 2005 at 34 medical centers in the United States, Canada, and Australia. A total of 375 male and female patients who were 13 to 29 years old, had an initial or relapse diagnosis of a malignancy, and currently undergoing treatment and expected to continue treatment for at least 4 months from baseline assessment were randomly assigned to the intervention or control group.
The intervention was a video game that addressed issues of cancer treatment and care for teenagers and young adults. Outcome measures included adherence, self-efficacy, knowledge, control, stress, and quality of life. For patients who were prescribed prophylactic antibiotics, adherence to trimethoprim-sulfamethoxazole was tracked by electronic pill-monitoring devices (n = 200). Adherence to 6-mercaptopurine was assessed through serum metabolite assays (n = 54).
RESULTS.
Adherence to trimethoprim-sulfamethoxazole and 6-mercaptopurine was greater in the intervention group. Self-efficacy and knowledge also increased in the intervention group compared with the control group. The intervention did not affect self-report measures of adherence, stress, control, or quality of life.
CONCLUSIONS.
The video-game intervention significantly improved treatment adherence and indicators of cancer-related self-efficacy and knowledge in adolescents and young adults who were undergoing cancer therapy. The findings support current efforts to develop effective video-game interventions for education and training in health care.
OBJECTIVE.
Suboptimal adherence to self-administered medications is a common problem. The purpose of this study was to determine the effectiveness of a video-game intervention for improving adherence and other behavioral outcomes for adolescents and young adults with malignancies including acute leukemia, lymphoma, and soft-tissue sarcoma.
METHODS.
A randomized trial with baseline and 1- and 3-month assessments was conducted from 2004 to 2005 at 34 medical centers in the United States, Canada, and Australia. A total of 375 male and female patients who were 13 to 29 years old, had an initial or relapse diagnosis of a malignancy, and currently undergoing treatment and expected to continue treatment for at least 4 months from baseline assessment were randomly assigned to the intervention or control group.
The intervention was a video game that addressed issues of cancer treatment and care for teenagers and young adults. Outcome measures included adherence, self-efficacy, knowledge, control, stress, and quality of life. For patients who were prescribed prophylactic antibiotics, adherence to trimethoprim-sulfamethoxazole was tracked by electronic pill-monitoring devices (n = 200). Adherence to 6-mercaptopurine was assessed through serum metabolite assays (n = 54).
RESULTS.
Adherence to trimethoprim-sulfamethoxazole and 6-mercaptopurine was greater in the intervention group. Self-efficacy and knowledge also increased in the intervention group compared with the control group. The intervention did not affect self-report measures of adherence, stress, control, or quality of life.
CONCLUSIONS.
The video-game intervention significantly improved treatment adherence and indicators of cancer-related self-efficacy and knowledge in adolescents and young adults who were undergoing cancer therapy. The findings support current efforts to develop effective video-game interventions for education and training in health care.
Barriers to Medication Adherence in Poorly Controlled Diabetes Mellitus
Your daily dose of medication non-adherence abstract from Sage Journals.
Purpose
The purpose of this study is to characterize the adherence and medication management barriers for adults with poorly controlled type 2 diabetes mellitus (DM) (those with A1c 9% or above) and to identify specific adherence characteristics associated with poor diabetes control.
Methods
This was a cross-sectional analysis of baseline data from a randomized, controlled diabetes intervention conducted in University of Washington (UW) Medicine Clinics in the greater Seattle, Washington, area. The goal of the original study was to evaluate the effect of a pharmacist intervention on improving diabetes control over 12 months.
Evaluation measures for medication adherence included self-reported adherence and medication management challenges using the Morisky question format and difficulty with taking medications for each diabetes medication based on the Brief Medication Questionnaire. Specific adherence characteristics associated with poor diabetes control (A1c >9%) were identified using multivariate regression analysis.
Results
Seventy-seven subjects (mean A1c, 10.4%; mean duration of DM, 7 years) were studied. The most common adherence challenges included paying for medications (34%), remembering doses (31%), reading prescription labels (21%), and obtaining refills (21%). Taking more than 2 doses of DM medication daily (β = .78, SE = 0.32, P = .02) and difficulty reading the DM medication prescription label (β = .76, SE = 0.37, P = .04) were significantly associated with higher hemoglobin A1c. Self-reported adherence was not related to A1c control.
Conclusions
In this study, we identified 2 factors that were associated with poorer A1c control. These findings highlight the importance of identifying potential challenges to medication adherence for those with DM and providing support to minimize or resolve these barriers to control.
MY THOUGHTS
I am glad to see another study that supports cost and forgetfulness as the two major factors of medication non-adherence, but at the same time I am not glad to see it. I had an interesting thought the other day: with companies and health plans reducing and eliminating co-pays for generic medications for chronic diseases, and with pharmacos' PAPs, will this cost factor be eliminated in 10 years?
Most likely distribution and obtaining refills with then rise as factors, and forgetfulness is still #1 with 84% nationally. I have talked about a pharmacy system that will automatically send refills to patients, whether they trigger the refill or not. This eliminates some factors, but, this also has some problems. As one person who commented to a post last week, the way she takes her pills, she is on a 38 day schedule for a 30 day script - thus she would end up with extra pills every month.
As we all know, medication adherence is America's #1 Drug Problem that needs to be addressed by all stake holders. I will continue to report what I find in my research to explore how we can "fix" this issue.
Purpose
The purpose of this study is to characterize the adherence and medication management barriers for adults with poorly controlled type 2 diabetes mellitus (DM) (those with A1c 9% or above) and to identify specific adherence characteristics associated with poor diabetes control.
Methods
This was a cross-sectional analysis of baseline data from a randomized, controlled diabetes intervention conducted in University of Washington (UW) Medicine Clinics in the greater Seattle, Washington, area. The goal of the original study was to evaluate the effect of a pharmacist intervention on improving diabetes control over 12 months.
Evaluation measures for medication adherence included self-reported adherence and medication management challenges using the Morisky question format and difficulty with taking medications for each diabetes medication based on the Brief Medication Questionnaire. Specific adherence characteristics associated with poor diabetes control (A1c >9%) were identified using multivariate regression analysis.
Results
Seventy-seven subjects (mean A1c, 10.4%; mean duration of DM, 7 years) were studied. The most common adherence challenges included paying for medications (34%), remembering doses (31%), reading prescription labels (21%), and obtaining refills (21%). Taking more than 2 doses of DM medication daily (β = .78, SE = 0.32, P = .02) and difficulty reading the DM medication prescription label (β = .76, SE = 0.37, P = .04) were significantly associated with higher hemoglobin A1c. Self-reported adherence was not related to A1c control.
Conclusions
In this study, we identified 2 factors that were associated with poorer A1c control. These findings highlight the importance of identifying potential challenges to medication adherence for those with DM and providing support to minimize or resolve these barriers to control.
MY THOUGHTS
I am glad to see another study that supports cost and forgetfulness as the two major factors of medication non-adherence, but at the same time I am not glad to see it. I had an interesting thought the other day: with companies and health plans reducing and eliminating co-pays for generic medications for chronic diseases, and with pharmacos' PAPs, will this cost factor be eliminated in 10 years?
Most likely distribution and obtaining refills with then rise as factors, and forgetfulness is still #1 with 84% nationally. I have talked about a pharmacy system that will automatically send refills to patients, whether they trigger the refill or not. This eliminates some factors, but, this also has some problems. As one person who commented to a post last week, the way she takes her pills, she is on a 38 day schedule for a 30 day script - thus she would end up with extra pills every month.
As we all know, medication adherence is America's #1 Drug Problem that needs to be addressed by all stake holders. I will continue to report what I find in my research to explore how we can "fix" this issue.
Friday, July 25, 2008
EnrichMap: A Profile for Medication Non-Adherence
Dr. Alan Showalter, leader of the AlignMap empire, has been working for many years in the field of medication non-adherence, and has developed a patient survey and compliance profile which can be found on EnrichMap.com .
Here is their statement of purpose from their website:
"EnrichMap focuses on proactively managing adherence to treatment regimen in clinical trials by identifying, prior to enrollment in the study, groups of patients based on their behavioral patterns pertinent to compliance and providing pragmatic, group-specific strategies to minimize unnecessary treatment failures caused by noncompliance and, in turn, reduce the consequent morbidity and mortality, research confoundments, delays, and financial waste."
I took the plunge a few months ago and was delivered a very interesting report and "compliance assignment based on a national population PROFILE". I apologize that it has taken me so long to post.
Based on my responses to the Emap questionnaire the results indicated compliance related characteristics in two groups, with nearly equal weight to both sets of traits. The Primary Compliance Group is "Sage & Satisfied", the Secondary Compliance Group is "Security Seeking". The report is two pages. I am going to summarize a few statements from the report, some of which I agree with, some not. My comments are in bold.
Sage & Satisfied
The most significant characteristic of individuals with the Sage and Satisfied Group is their confidence in and positive view of traditional healthcare. They trust their doctors and believe that trust is reciprocated by the clinicians’ genuine concern for their patients. This is TRUE.
As one might expect, they are more likely than average to evaluate any treatment they are receiving as successful and report few negative or adversarial experiences with healthcare professionals. They quietly embrace the notion that they bear a personal responsibility for implementing good healthcare practices. This is TRUE.
This group is more likely to monitor their own health, including participation in recommended screenings (e.g., mammograms and colonoscopies), and to take appropriate action upon discovering problems (e.g., promptly contacting their doctor). They are willing to make use of any medical specialty from dermatology to dentistry. This is TRUE.
The Sage and Satisfied are conscientious, concerned and educated. They are responsive to healthcare ideas that have become accepted as “common sense” or are endorsed by an authority. They read food labels, recycle, and avoid smokers. This is TRUE.
They are exceptionally active and are, in fact, the most heavily involved in all types of personal and social activities surveyed, whether intellectual and physical in nature. Sort of true. I play golf, tennis, swim and walk my dog. Somewhat social.
Unsurprisingly, the Sage and Satisfied also have the lowest incidence of self-destructive habits such as smoking and heavy use of alcohol. I stopped smoking 2.5 years ago.
Secondary Compliance Group: Security Seeking
Individuals in the Security-Seeking Group are second only to those from the Sage and Satisfied Group in demonstrating a positive view of physicians and healthcare. They have the strongest belief in the power of medication as a remedy (and in the power of medication to cause problems, especially if not used appropriately). This is TRUE.
Consequently, it is hardly surprising that these individuals maintain close relationships with doctors and agree with the importance of following medical directions. They rarely express concern or cynicism about the skill and integrity of clinicians. I am very cynical, but do believe that the doctor knows more than me. I do seek 2nd and 3rd opinions though.
Their only common complaint about the medical system, in fact, is the number of restrictions their third-party healthcare funding places on the services they receive.This is NOT TRUE.
Despite their fearfulness, members of this Group are not hypochondriac. They, in fact, perceive their health as being good. They are average in the frequency and variety of clinical interventions and in their use of non prescription medications and vitamins. They do read printed instructions. This is TRUE, but I do not take vitamins.
They neither demand excessive medical attention nor avoid seeking necessary help. The Security-Seeking Group is second only to the Sage and Satisfied in adhering to their doctors’ prescribed treatment. True to their defining characteristics, the Security-Seeking Group makes healthcare choices based on the overwhelming need to avoid risks. This is TRUE.
While attentive to their physicians’ instructions, they are reluctant to seek medical information. Even if the trusted clinician offers them written material, they mistrust it – or at least their own interpretation of it. As would be expected, these individuals avoid self diagnoses and novel medical methodologies. This is NOT TRUE.
Overall, the EnrichMap survey and profile are great tools to help a patient identify who they are and why they are non-adherent. No two patients are the same, so it is difficult to make a group and classify a patient in that group then expect all the characteristic to fit said patient. Sage and Satisfied pretty much nailed my medical behavior, whereas Security Seeking was a little off - but still 60% correct with my behavioral pattern.
If you are interested, the survey is free to take, and I would recommend visiting the site. FD: Dr. Showalter bribed me for this plug. No, his treatment of medication non-adherence with his blog posts and research has been an inspiration for me, and my blog. His humor abounds, while seriously addressing awareness and concern. I am glad he is back to blogging after a few months away.
Stay Adherent!
Here is their statement of purpose from their website:
"EnrichMap focuses on proactively managing adherence to treatment regimen in clinical trials by identifying, prior to enrollment in the study, groups of patients based on their behavioral patterns pertinent to compliance and providing pragmatic, group-specific strategies to minimize unnecessary treatment failures caused by noncompliance and, in turn, reduce the consequent morbidity and mortality, research confoundments, delays, and financial waste."
I took the plunge a few months ago and was delivered a very interesting report and "compliance assignment based on a national population PROFILE". I apologize that it has taken me so long to post.
Based on my responses to the Emap questionnaire the results indicated compliance related characteristics in two groups, with nearly equal weight to both sets of traits. The Primary Compliance Group is "Sage & Satisfied", the Secondary Compliance Group is "Security Seeking". The report is two pages. I am going to summarize a few statements from the report, some of which I agree with, some not. My comments are in bold.
Sage & Satisfied
The most significant characteristic of individuals with the Sage and Satisfied Group is their confidence in and positive view of traditional healthcare. They trust their doctors and believe that trust is reciprocated by the clinicians’ genuine concern for their patients. This is TRUE.
As one might expect, they are more likely than average to evaluate any treatment they are receiving as successful and report few negative or adversarial experiences with healthcare professionals. They quietly embrace the notion that they bear a personal responsibility for implementing good healthcare practices. This is TRUE.
This group is more likely to monitor their own health, including participation in recommended screenings (e.g., mammograms and colonoscopies), and to take appropriate action upon discovering problems (e.g., promptly contacting their doctor). They are willing to make use of any medical specialty from dermatology to dentistry. This is TRUE.
The Sage and Satisfied are conscientious, concerned and educated. They are responsive to healthcare ideas that have become accepted as “common sense” or are endorsed by an authority. They read food labels, recycle, and avoid smokers. This is TRUE.
They are exceptionally active and are, in fact, the most heavily involved in all types of personal and social activities surveyed, whether intellectual and physical in nature. Sort of true. I play golf, tennis, swim and walk my dog. Somewhat social.
Unsurprisingly, the Sage and Satisfied also have the lowest incidence of self-destructive habits such as smoking and heavy use of alcohol. I stopped smoking 2.5 years ago.
Secondary Compliance Group: Security Seeking
Individuals in the Security-Seeking Group are second only to those from the Sage and Satisfied Group in demonstrating a positive view of physicians and healthcare. They have the strongest belief in the power of medication as a remedy (and in the power of medication to cause problems, especially if not used appropriately). This is TRUE.
Consequently, it is hardly surprising that these individuals maintain close relationships with doctors and agree with the importance of following medical directions. They rarely express concern or cynicism about the skill and integrity of clinicians. I am very cynical, but do believe that the doctor knows more than me. I do seek 2nd and 3rd opinions though.
Their only common complaint about the medical system, in fact, is the number of restrictions their third-party healthcare funding places on the services they receive.This is NOT TRUE.
Despite their fearfulness, members of this Group are not hypochondriac. They, in fact, perceive their health as being good. They are average in the frequency and variety of clinical interventions and in their use of non prescription medications and vitamins. They do read printed instructions. This is TRUE, but I do not take vitamins.
They neither demand excessive medical attention nor avoid seeking necessary help. The Security-Seeking Group is second only to the Sage and Satisfied in adhering to their doctors’ prescribed treatment. True to their defining characteristics, the Security-Seeking Group makes healthcare choices based on the overwhelming need to avoid risks. This is TRUE.
While attentive to their physicians’ instructions, they are reluctant to seek medical information. Even if the trusted clinician offers them written material, they mistrust it – or at least their own interpretation of it. As would be expected, these individuals avoid self diagnoses and novel medical methodologies. This is NOT TRUE.
Overall, the EnrichMap survey and profile are great tools to help a patient identify who they are and why they are non-adherent. No two patients are the same, so it is difficult to make a group and classify a patient in that group then expect all the characteristic to fit said patient. Sage and Satisfied pretty much nailed my medical behavior, whereas Security Seeking was a little off - but still 60% correct with my behavioral pattern.
If you are interested, the survey is free to take, and I would recommend visiting the site. FD: Dr. Showalter bribed me for this plug. No, his treatment of medication non-adherence with his blog posts and research has been an inspiration for me, and my blog. His humor abounds, while seriously addressing awareness and concern. I am glad he is back to blogging after a few months away.
Stay Adherent!
Wednesday, June 18, 2008
Non-adherent Epileptics 3x More Likely To Die
This is an article from MedPage that really speaks to the importance of medication adherence.
Here is just the first paragraph or so:
BIRMINGHAM, Ala., June 18 -- Faithfully taking epilepsy medication may be a matter of survival, according to findings of a large observational study.
Patients in three state Medicaid databases who took prescribed epilepsy medication less than 80% of the time were three times more likely to die than those who took their medication regularly over the course of a three-month period, found Edward Faught, M.D., of the University of Alabama at Birmingham, and colleagues
Here is just the first paragraph or so:
BIRMINGHAM, Ala., June 18 -- Faithfully taking epilepsy medication may be a matter of survival, according to findings of a large observational study.
Patients in three state Medicaid databases who took prescribed epilepsy medication less than 80% of the time were three times more likely to die than those who took their medication regularly over the course of a three-month period, found Edward Faught, M.D., of the University of Alabama at Birmingham, and colleagues
Thursday, June 5, 2008
Kevin Aniskovich's DM Colloquium Presentation
As Director of Corporate Development for Intelecare, I sometimes blog about what we are doing as a company and how we are helping the various stakeholders in healthcare by enabling patient medical adherence. I would be remiss not to mention our CEO's (Kevin Aniskovich) presentation at the DM Colloquium last month.
The title: Effectively Increasing Patient Adherence as a 360 Degree Approach. He also introduced the term Adherence 2.0 (in line with Health 2.0) and released the preliminary findings of a survey on the utilization of employee wellness programs.
Hope you enjoy!
The title: Effectively Increasing Patient Adherence as a 360 Degree Approach. He also introduced the term Adherence 2.0 (in line with Health 2.0) and released the preliminary findings of a survey on the utilization of employee wellness programs.
Hope you enjoy!
Thursday, May 22, 2008
A Case of Medication Non-adherence
Is this an acceptable case of medication non-adherence or just my own lack of planning? Of course there is no acceptable reason for medication adherence - if you want to get better, you take your medications. Plain and simple.
I lived through the agonizing pain of flushing with 1000 mg of Niaspan, including the spaciness, and insomnia due to the nightmares of my flesh burning. The cost of switching to a HSA with three medications for me, two for my wife and two for my son - luckily back to a regular payor. And created Intelecare reminders to help me remember to take my medications (one trick I like is to keep some meds at work, just in case).
So here is my case: My wife went into labor with our second son two weeks early, at 2 am on a Saturday night. She woke me at 4 am and told me that we had to leave for the hospital immediately. I quickly packed a toilet kit for us both (including my meds but not hers) and some clothes, then went to the hospital; she gave birth at 5:45 am. Our medication schedules were not top of mind. Luckily for her, the nurses knew she was on medication, and the attending physician prescribed her a two day supply.
Once we settled into our room at 8 am or so, I did not unpack our bags. We napped until 1:30 pm and then started accepting visitors. I went home at 9 pm or so with our 1st son, and realized I left all my meds at the hospital. Thus, I ended the day non-adherent to my two morning, and two nighttime medications.
The next day was a rush of our nanny starting, buying items for the baby (car seat, diapers, new bottles, etc...), and fielding calls. I made it to the hospital around 1:30 for lunch, but the bag I packed for Courtenay still was not open. I had more errands to run, then returned around 7 for dinner. I finally got my medications, and took that nights does when I went to bed.
The next morning (Tuesday), I only had two more Tricor, so I called in a refill, but was unable to pick it up until yesterday (8 days late). Luckily I had my extra stash in my office.
Now these medications I take are for asymptomatic conditions - high cholesterol, and high triglycerides - but what if they were for asthma, diabetes, or high blood pressure and I suffered an attack?
Life sometimes gets in the way of staying adherent to your medication schedule. I usually operate at 100% adherent to my daily schedule - whether the morning disbursement is at 7:30 am when I brush my teeth or 9 am when I get into the office. My test results were too positive not to continue taking my meds. These drugs lowered all of my levels, and put me in a safe zone - although I still need to go down a few points, and now my sugar levels are higher which is characteristic of one of my meds.
I gave myself a pass for Monday and Tuesday of last week. But my overall adherence for the month dropped significantly. Maybe I should keep an extra supply in my car as well?
Monday, April 21, 2008
Breathalizer for Measuring Medication Adherence
So many of the studies on medication adherence are based on self reporting, that you can never really get an accurate account of when someone actually takes their medication. If you have a two way enabled device, the patient can text back that they took their pills, without taking them. If you have a pill bottle top monitor, it just lets the researcher know that someone has taken off the top of the pill bottle. With pillboxes that automatically dispense medications, again, you don't know if the patient has taken the pills, just that they were dispensed.
This article from the UF website, cites a breath monitoring device developed by UF scientists to monitor medication compliance. I have so say it is a pretty good concept for individuals who are housebound. It reminds me of the breathalizers that convicted DUI felons have to have installed in their cars if they want to drive again. They breathe in, and if there is no alcohol, they can start the car.
Here is a excerpt:
“The machine sits in your home and when it’s time for you to take your medication, it makes a beeping noise. If you don’t hit a button after about five minutes, it’s going to beep louder and louder until you come,” Melker said. “If you don’t come after a certain amount of time, the machine can call the clinical trial coordinator and indicate that subject or patient didn’t take the medication as prescribed.”
The device, which is slightly smaller than a shoebox, records the results of each breath test, allowing patients to bring a memory card or USB key to the clinic once a month and receive a printout of their results. Eventually, the researchers hope to reduce the size of their detection device to fit inside a cell phone. But for now, they’re satisfied that the technology works.
“The doctor can see how often you took it and exactly what time. If it made the patient really sick or dizzy and they didn’t take it, they can find out why,” Melker said. “It’s not just a question of did I or didn’t I take it, but when you took it or why you didn’t take it.”
The researchers developed the adherence monitor by incorporating minute amounts of an alcohol into a gel capsule. The additive, called 2-butanol, is one of many GRAS — Generally Recognized as Safe — compounds approved by the Food and Drug Administration for use in foods.
“We wanted (patients) to swallow a chemical and have it transform into something else that’s easy to monitor,” said Matthew Booth, an assistant professor of anesthesiology at the UF College of Medicine and an investigator in the study. “When it hits the stomach lining and liver, an enzyme converts the alcohol to a gas that can be measured in the breath.”
This article from the UF website, cites a breath monitoring device developed by UF scientists to monitor medication compliance. I have so say it is a pretty good concept for individuals who are housebound. It reminds me of the breathalizers that convicted DUI felons have to have installed in their cars if they want to drive again. They breathe in, and if there is no alcohol, they can start the car.
Here is a excerpt:
“The machine sits in your home and when it’s time for you to take your medication, it makes a beeping noise. If you don’t hit a button after about five minutes, it’s going to beep louder and louder until you come,” Melker said. “If you don’t come after a certain amount of time, the machine can call the clinical trial coordinator and indicate that subject or patient didn’t take the medication as prescribed.”
The device, which is slightly smaller than a shoebox, records the results of each breath test, allowing patients to bring a memory card or USB key to the clinic once a month and receive a printout of their results. Eventually, the researchers hope to reduce the size of their detection device to fit inside a cell phone. But for now, they’re satisfied that the technology works.
“The doctor can see how often you took it and exactly what time. If it made the patient really sick or dizzy and they didn’t take it, they can find out why,” Melker said. “It’s not just a question of did I or didn’t I take it, but when you took it or why you didn’t take it.”
The researchers developed the adherence monitor by incorporating minute amounts of an alcohol into a gel capsule. The additive, called 2-butanol, is one of many GRAS — Generally Recognized as Safe — compounds approved by the Food and Drug Administration for use in foods.
“We wanted (patients) to swallow a chemical and have it transform into something else that’s easy to monitor,” said Matthew Booth, an assistant professor of anesthesiology at the UF College of Medicine and an investigator in the study. “When it hits the stomach lining and liver, an enzyme converts the alcohol to a gas that can be measured in the breath.”
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