Medication adherence before an increase in antihypertensive therapy: A cohort study using pharmacy claims data

Introduction: Failure to take medications regularly leads to poorer health outcomes. The Pediatric Rheumatology Adherence Questionnaire (PRAQ) is an effective tool for assessing medication adherence in rheumatic patients. Therefore, we aimed to determine the factors associated with poor medication adherence among children with rheumatic diseases. Methods: This was a cross-sectional study. Patients with rheumatic diseases who had taken at least one medication and had been followed up at our pediatric rheumatology clinic were included in the study, together with their caregivers. Patients with poor medication adherence were characterized as those who had taken less than 80% of their prescribed drugs, as determined using the pill count method. The original PRAQ was translated and validated in Thai language and was completed by caregivers and literate patients over age 13years. Interviewing for additional problems with taking medications was conducted. We performed descriptive and logistic regression analyses. Results: From 210 patients, 52.86% had juvenile idiopathic arthritis (JIA), and 46.19% had connective tissue diseases. The mean patient age was 14.10 ± 4.74years, with a median (interquartile range) disease duration of 4.33 (2.08-6.98)years. PRAQ scores in the group with poor adherence were significantly higher than scores in the group with good adherence (11.00 ± 3.47 vs. 9.51 ± 3.16, p = 0.004). Enthesitis-related arthritis (ERA) (odds ratio [OR] 9.09, 95% confidence interval [CI] 1.25-66.18; p = 0.029) and polyarticular JIA (OR 6.43, 95% CI 1.30-31.75; p = 0.022) were associated with poor treatment adherence. Disease duration ≥5years (OR 3.88, 95% CI 1.17-12.87; p = 0.027), active disease (OR 6.49, 95% CI 1.76-23.99; p = 0.005), PRAQ scores ≥12 (OR 6.48, 95% CI 1.76-23.82; p = 0.005), forgetting to take medications (OR 14.18, 95% CI 4.21-47.73; p < 0.001), and unawareness about the importance of the medicines (OR 44.18, 95% CI 11.30-172.73; p < 0.001) were predictors of poor drug adherence. Conclusion: In the present study, poor medication adherence was found in one-fourth of children with rheumatic illnesses, particularly those with ERA, polyarticular JIA, longer disease duration, active disease, and high PRAQ scores. The most frequent reasons for inadequate medication adherence were forgetfulness and unawareness about the importance of disease control and consistency with treatment.

BACKGROUND: Adherence to medications is an important factor in effective prevention of diabetes complications. Assessment of treatment adherence is necessary for the effective treatment planning. This study was undertaken with the objective of assessing adherence to diabetes medications, association between adherence & glycemic control and factors affecting the poor adherence among the Type 2 DM patients. METHODOLOGY: A total of 236 diabetic patients were included in this cross sectional study. The required sample was obtained by simple random sampling from line listing of diabetic cases in the study area. Patients above the age of 18 years diagnosed with type 2 DM & on regular treatment for at least one year were included in the study. Glycemic control was assessed by the measuring glycated hemoglobin (A1C) value. RESULTS: The overall prevalence of poor adherence to diabetic medications i.e. brief medication adherence score ≥ 1 among the participants was 58.89%. There was a significant association between poor diabetic medication adherence level and their glycemic status. The majority of nonadherent patients (62.58%) had poor glycemic control state as compared to adherent patients (37.42%). Although female, frequent change in drug regimen, higher annual direct cost expenditure had higher percentages of poor medication adherence, none of these variables significantly related to poor medication adherence. However, it was found that education ≤10 years of schooling , duration of disease ≥5 years , frequency of dosing thrice daily and presence of other co-morbidities were significantly related to a low adherence level. CONCLUSION: A high percentage of the study population was poorly adherent to the diabetic medication. A more concerning fact was the significant association of the non-compliance with poor glycemic control, which emphasized the role of a repeated patient education regarding drug adherence.

The association between multimorbidity and poor adherence with cardiovascular medications

The aim of this study was to evaluate the relationship between oral ulcer activity and medication adherence according to gender in Behçet's disease (BD) patients. The study group included 330 BD patients (F/M: 167/163, mean age: 38.5±10.5 years). Oral ulcer activity and medication adherence were evaluated in the previous month. Medication adherence was evaluated using the 8-item Morisky Medication Adherence Scale (MMAS-8) having a score range of "0" to "8" with high scores indicating better adherence. Low adherence was defined as <6 points on MMAS-8. Over half of the group had active oral ulcers (n=219, 66.4%) within the month preceding the visit. The number of oral ulcers was significantly higher in female patients with low medication adherence (2.39±3.24) than in the rest of the female group (1.28±2.05; p=0.023). Although a similar trend was also observed in male patients (2.14±3.3 vs. 1.81±2.31), a significant relationship was not observed (p=0.89). The frequency of medication intake per day was lower in patients with high medication adherence than in the rest of the study group (p=0.04). Low medication adherence is a hidden risk factor in the management of BD. Poor adherence was associated with oral ulcer activity in female BD patients.

BackgroundNon-adherence to medication represents a modifiable risk factor for patients with type 2 diabetes mellitus (T2DM). Identification of patients with poor adherence can have a significant impact on clinical and socio-economic outcomes in the management of diabetes. This study aimed to assess medication adherence and its associated factors among patients with T2DM attending a non-communicable disease (NCD) clinic in a rural community health centre (CHC) in eastern India.MethodsThe study was a facility-based study that included 207 study participants with an age greater than 18 years. A structured questionnaire was used to collect data on socio-demographic characteristics, health-seeking behaviour, self-care practices, risk factors, clinical information on diabetes, prescription practices, and medication practices. The Hill-Bone Medication Adherence Scale (HB-MAS) has been used to assess medication adherence among study participants.ResultsThe study found that the medication adherence rate among the study participants was 67.1%. On multivariate analysis, subjects with social insurance (adjusted odds ratio (AOR) = 2.73, 95% confidence interval (CI) = 1.01-7.38, p-value = 0.047), current smoking status (AOR = 5.47, 95% CI = 1.55-19.23, p-value = 0.008), anxiety (AOR= 3.52, 95% CI= 1.62- 7.61, p-value= 0.001), polypharmacy (AOR= 3.79, 95% CI= 1.25- 11.45, p-value= 0.018), and using alternative medicine (AOR= 5.82, 95% CI= 1.58 - 21.39, p-value= 0.008), were found to have a significantly higher chance of non-adherence. On the other hand, patients practising regular physical activity (AOR = 0.31, 95% CI= 0.12-0.79, p-value = 0.015) and with deprescription (AOR = 0.12, 95% CI= 0.03-0.47, p-value = 0.002) were found to have less chance of non-adherence as compared to their counterparts.ConclusionThe study highlights the need to identify patients with poor medication adherence and develop interventions according to their requirements through a holistic approach. The study contributes to the existing literature on medication adherence among diabetes patients in rural healthcare settings in eastern India.

Introduction: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease which significantly impacts health-related quality of life.1 Bimekizumab (BKZ) is a humanized IgG1 monoclonal antibody that selectively inhibits interleukin (IL)-17F in addition to IL-17A.2 ere, the cumulative benefit of BKZ treatment on HS clinical response (HiSCR) through 16 and 48 weeks (wks) is reported using area under the curve (AUC) analyses.Procedure/study: Pooled data from BE HEARD I&amp;II included an initial (Wks0–16) and maintenance treatment period (Wks16–48).3 Randomization: 2:2:2:1 (initial/maintenance) BKZ 320mg every 2 wks (Q2W)/Q2W, BKZ Q2W/Q4W, BKZ Q4W/Q4W, or placebo (PBO)/BKZ Q2W. HiSCR50/75/90 response was achieved at a given visit if there was ≥50/75/90% reduction in the total abscess/inflammatory nodule count with no increase from baseline in abscess or draining tunnel count. Cumulative clinical benefit estimation: total AUC through Wk48 for HiSCR50/75/90 achievers. Calculation of estimated number of days patients achieved each response: proportion of total possible AUC for each outcome multiplied by total number of days in the period (Wks0–16: 112 days, Wks0–48: 336). Data are reported as observed case, where N represents number of patients with a non-missing lesion count assessment in the given week, and percentages are calculated accordingly (i.e. where data recorded after an intercurrent event are included).Results: Overall, 1,014 patients were randomized to BKZ Q2W/Q2W (N=288), BKZ Q2W/Q4W (N=292), BKZ Q4W/Q4W (N=288) and PBO/BKZ Q2W (N=146). Through 16wks, the total number of days patients achieved HiSCR50 was almost double in BKZ Q2W/Q2W (47 days), BKZ Q2W/Q4W (49), and BKZ Q4W/Q4W (47) groups vs PBO (27). To Wk16, the total number of days patients achieved HiSCR75/90 was at least double in the BKZ groups vs PBO. To Wk48, total number of days with HiSCR50 achievement: BKZ Q2W/Q2W, 211; BKZ Q2W/Q4W, 212; BKZ Q4W/Q4W, 206 vs PBO/BKZ Q2W, 178. Comparable results were observed for HiSCR75/90 at Wk48, with BKZ groups maintaining higher responses vs PBO. Conclusion: High levels of cumulative clinical benefit were observed for patients on BKZ through Wk16; benefits increased substantially through Wk48. The cumulative benefit of BKZ through 48wks was evident for patients receiving continuous BKZ and PBO switchers. The total number of days of clinical outcome achievement remained higher in those on continuous BKZ vs PBO switchers. These results demonstrate the rapid, high-level and durable responses that can be obtained with BKZ.

&lt;p&gt;The modern era of psychopharmacology began in the 1950s with the discovery of the antipsychotic drug chlorpromazine (Thorazine). Since then, many drugs have been developed, investigated, and marketed for the treatment of all forms of mental illness. Although medications are not completely effective for all patients, most individuals will generally derive some satisfactory benefit from an appropriately prescribed medication. However, even the best medications do not work in patients who do not take them. Although not taking medication reliably is well recognized as a common problem, surprisingly, patients and their prescribers can grossly overestimate medication adherence. For this reason, the concept of medication adherence is a more practically important pharmacotherapy issue than is expert knowledge in clinical psychopharmacology. In this article, the importance of medication adherence, the factors associated with poor adherence, and some approaches for improving adherence is discussed. &lt;/p&gt;&lt;h4&gt;ABOUT THE AUTHOR&lt;/h4&gt; &lt;p&gt;Robert H. Howland, MD, is Associate Professor of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania.&lt;/p&gt; &lt;p&gt;Address correspondence to Robert H. Howland, MD, Associate Professor of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213; e-mail: &lt;a href="mailto:HowlandRH@upmc.edu"&gt;HowlandRH@upmc.edu&lt;/a&gt;.&lt;/p&gt; &lt;p&gt;Dr. Howland has disclosed no relevant financial relationships.&lt;/p&gt; &lt;h4&gt;EDUCATIONAL OBJECTIVES&lt;/h4&gt; &lt;ol&gt;&lt;li&gt; Review why medication adherence is important.&lt;/li&gt; &lt;li&gt;Describe some of the factors associated with poor medication adherence.&lt;/li&gt; &lt;li&gt;Discuss some approaches to improving medication adherence.&lt;/li&gt; &lt;/ol&gt;

DUPILUMAB REDUCES SEVERE OUTPATIENT ASTHMA EXACERBATIONS, CUMULATIVE DOSE, AND TOTAL NUMBER OF DAYS OF SYSTEMIC CORTICOSTEROID USE AMONG PATIENTS WITH MODERATE-TO-SEVERE TYPE-2 ASTHMA

BackgroundLow socioeconomic status and poor medication adherence are known to be associated with increased morbidity and mortality among patients with hypertension, but their combined effects have not been studied. We therefore evaluated the joint association of household income and medication adherence with death and cardiovascular disease in patients newly treated for hypertension.Methods and ResultsThis was a nationwide cohort study using the Korean National Health Insurance database. We included 1 651 564 individuals, aged 30 to 80 years, with newly treated hypertension and no prior cardiovascular disease and followed them for 10 years. Main exposures were household income in quintiles and adherence to antihypertensive medication, estimated by medication possession ratio: good (≥0.8), moderate (0.5 to <0.8), or poor (<0.5). The primary outcomes were all‐cause and cardiovascular deaths. Higher mortality risk was observed in patients with low income (adjusted hazard ratio=1.50, 99% CI=1.46‐1.53; lowest versus highest quintile) and poor medication adherence (adjusted hazard ratio=1.66, 99% CI=1.63‐1.68; poor versus good adherence). When compared with the highest‐income and good‐adherence group, adjusted hazard ratio (99% CI) of death was 1.56 (1.52‐1.61) for highest‐income poor‐adherers, 1.46 (1.41‐1.51) for lowest‐income good‐adherers, and 2.46 (2.38‐2.54) for lowest‐income poor‐adherers (P for interaction <0.001).ConclusionsLow socioeconomic status and poor adherence to antihypertensive medication are associated with increased mortality and cardiovascular disease risks, but patients with low income are subject to larger excess risks by nonadherence. This highlights the potential importance of promoting medication adherence for risk reduction, especially in low‐income patients with hypertension.

Objectives: This study aimed to investigate the prevalence and influencing factors of medication adherence in children with central precocious puberty (CPP), and provide references for clinical practice. Methods: Children under 12years of age with CPP and their caregivers at a women's and children's hospital were selected for a cross-sectional study from February to May 2023, and a questionnaire was used to collect basic characteristics of pediatric patients and their caregivers, information of medication, cognition of medication, and medication adherence. The 8-item Morisky Medication Adherence Scale (MMAS-8) was adopted to assess medication adherence, and the potential influencing factors were explored by univariate and multivariate analyses. Results: A total of 125 valid questionnaires were collected. The medication adherence rate of children with CPP reported by caregivers was 76.0%. The univariate analysis showed that the percentage of parental caregivers (p = 0.027), the age of caregivers (p = 0.029), the education level of caregivers (p = 0.001), the financial burden (p < 0.000), the incidence of adverse effects (p = 0.008), and the cognition of medication including the importance of medication (p = 0.002), the dosage of medication (p = 0.002), the adverse effects of medication (p = 0.007), the harm of non-compliance with medication (p < 0.000), and the evaluation of the price of medication (p = 0.003) in the poor adherence group were significantly inferior to those in the better adherence group. The multivariate analysis showed that the higher incidence of adverse effects (p = 0.20), not understanding the harm of non-compliance with medication (p = 0.004), and evaluation of the price of medication as expensive (p = 0.043) were independent risk factors for poor medication adherence. Conclusion: Medication adherence in children with CPP is relatively better, and the factors leading to poor medication adherence are mainly on the caregivers of pediatric patients. It is recommended to increase the health education among caregivers of children with CPP to enhance the cognition of the condition and medication, and further improve the therapeutic efficacy for CPP.

BackgroundAdherence to medications and healthy lifestyles are important health behaviours for hypertension control and may be influenced by food insecurity and socioeconomic status (SES). We examined associations between food insecurity and SES with medication adherence and healthy lifestyle practices among patients with hypertension in Colombia and Jamaica.MethodsIn a cross-sectional survey of hypertensive patients attending primary health centres in Colombia and Jamaica we collected self-reported demographic, education and employment information. Food insecurity was measured using two questions from the modified United States Department of Agriculture (USDA) food security instrument – was there sufficient money for 1) weekly food purchases and 2) healthy foods. Medication adherence was classified as high vs. low/medium using the IMPACTS-MAS questionnaire. Healthy lifestyle was scored using a 6-point scale as unfavourable (score ≤ 3) or favourable (score 4–6), 1 point each for eating less salt, exercising regularly, consuming ≥ 2 servings fruits and ≥ 3 servings vegetables daily, and reduced alcohol consumption or 2 points for abstinence. Multivariable logistic regression with medication adherence categories and lifestyle practice scores as dependent variables assessed associations with food insecurity and SES.ResultsOf 576 participants (Colombia 288; Jamaica 288), Colombians were older (66.5 years vs. 62.5 years, p < 0.001), had higher education attainment and were less likely to be employed/retired. Colombians had less food insecurity (64.6% vs. 89.0% p < 0.001), higher medication adherence (88.2% vs 50.7% p < 0.001) and more favourable lifestyle practices (86.2% vs. 47.2% p < 0.001). Food insecurity in both countries was inversely related to education, having private health insurance, high medication adherence and healthy lifestyle practices. In multivariable models, food insecurity was associated with increased odds of unfavourable lifestyle practice scores, (OR = 2.4; 95% CI: 1.1, 5.2 p = 0.028) and poor medication adherence (OR = 1.9; 95% CI: (1.0, 3.7) p = 0.072), after adjusting for age, sex, country, marital status, education and employment and having ≥ 2 chronic illnesses. No associations with the other SES examined.ConclusionFood insecure hypertensive patients had increased odds of unfavourable lifestyle practices and were twice as likely to have poor medication adherence. Strategies to address food insecurity may have a positive impact on hypertension control in low resource settings.

Real-World Adherence with Pegcetacoplan in Paroxysmal Nocturnal Hemoglobinuria Compared with Previously Reported Oral Medication Adherence Rates

A previous study suggests an association between poor medication adherence and excess mortality in chronic disease. The purpose of this study was to assess the association between medication adherence and risk of cardiovascular disease (CVD), all-cause mortality, and hospitalization in type 2 diabetes. We conducted an electronic search on many electronic databases from inception to 27 April 2016. We selected randomized controlled trials and case-control and cohort studies reporting on CVD, all-cause mortality, or hospitalization outcomes by adherence in adults with type 2 diabetes. Two reviewers independently screened for eligible studies and extracted outcome data. Pooled relative risks (RRs) were calculated using a random-effects meta-analysis; risk of bias in each of the included studies was assessed using the GRADE approach. Eight observational studies were included (n = 318,125). The mean rate of poor adherence was 37.8% (95% CI 37.6-38.0). Adjusted estimates were provided by five studies only. The RRs of good (≥80%) versus poor adherence to medication were 0.72 (95% CI 0.62-0.82, I2 = 0%, three studies) for all-cause mortality and 0.90 (0.87-0.94, I2 = 63%, seven studies) for hospitalization. No evidence of small study bias was observed. Only one study reported CVD outcomes by adherence. We identified no trials reporting on outcomes by adherence, suggesting a systematic failure to include this information. Pooled estimates from available observational studies suggest that good medication adherence is associated with reduced risk of all-cause mortality and hospitalization in people with type 2 diabetes, although bias cannot be excluded as an explanation for these findings.

Introduction: Poor medication adherence is a known preventable factor which can adversely affect desired achievable blood pressure (BP) target. Strict control of blood pressure is essential among patients who have diabetes and hypertension (HT) in order to prevent complications. This is the first study conducted among 371diabetic patients with co-existing HT to examine the antihypertensive medication adherence in Sri Lanka to date. Materials and Methods: This cross-sectional study was done in the general medical clinics of Jaffna Teaching Hospital from October 2019 to November 2019. Results: The majority (66.6%) of the patients were female. Mean age of the participants was 60.93 ± 9.77. The total mean score for modified MASES (Medication Adherence Self Efficacy Scale) was 48.1 ± 3.81. A negative correlation was noted between MASES scores and systolic (r= -0.033) and diastolic (r=- 0.083) blood pressure. Median score 49 was used to classify the patients into optimal or suboptimal adherence to antihypertensive medication. A significant percentage (43.4%CI: 38.4-48.5) of research participants were sub optimally adhered to antihypertensive medication. Among the associated factors explored, gender (P-0.007), low-income (P-0.002) and employed people (P-0.046) showed significant association with poor adherence. However, the number of co-morbidities (P-0.335), number of medications (P-0.454), duration of hypertension (P-0.440), and frequency of clinical visits (P-0.373) were not significantly associated with anti-hypertensive medication adherence. Conclusion: This finding has an implication in clinical practice to improve the quality of care. Professionals should give consideration to above socio-demographic factors (gender, income, and occupation) before prescribing appropriate medication and its dosing schedule for hypertension.

Poor medication adherence is associated with negative health outcomes. We investigated whether poor medication adherence increases the rate of falls as part of Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston (MOBILIZE Boston), a prospective, community-based cohort recruited for the purpose of studying novel risk factors for falls. A total of 246 men and 408 women (mean age, 78 years) were followed for the occurrence of falls (median follow-up, 1.8 years). Adherence was assessed by the Morisky scale based on the following four questions: whether an individual ever forgets, is careless at times, stops taking medications when feels better, or stops taking medications when feels worse. Low adherence was defined as a "yes" answer to one or more questions. High adherence was defined as a "no" answer to every question. Forty-eight percent of subjects were classified as having low medication adherence. The rate of falls in the low adherence group was 1.1 falls/person-year (95% confidence interval [CI]: 1.0-1.3) compared with 0.7 falls/person-year (95% CI: 0.6-0.8) in the high adherence group. After adjusting for age, sex, race/ethnicity, education, alcohol use, cognitive measures, functional status, depression, and number of medications, low medication adherence was associated with a 50% increased rate of falls compared with high medication adherence (rate ratio = 1.5, 95% CI: 1.2-1.9; p < .001). Low medication adherence may be associated with an increased rate of falls among older adults. Future studies should confirm this association and explore whether interventions to improve medication adherence might decrease the frequency of falls and other serious health-related outcomes.