Comparison of persistence rates of acetylcholine-esterase inhibitors in a state Medicaid program

Objective: To compare levels of persistency between cholinesterase inhibitors (ChEIs) among a Medicaid patient population of older adults. Methods: Survival analysis was used to assess differences in discontinuation between ChEIs (donepezil versus rivastigmine and galantamine), and for difference in patient gender, age, race, and care setting. Results: Rates of discontinuation increased from 42.7% (95% CI = 39.9-45.5) at 12 months to 84.8% (95% CI = 82.3-87.3) at 24 months. In multivariate models, no significant difference in discontinuation existed prior to 365 days. However, patients dispensed donepezil were less likely to discontinue as compared with users of the other two ChEIs after the first year (RR = 0.70; CI = 0.499-0.983; p \u3c 0.04). Patients of white race were less likely to discontinue (RR = 0.549; 95% CI = 0.43-0.82; p = 0.0015), while gender, care setting, and age were not associated with discontinuation. Conclusions: One-year persistence rates were similar between different ChEIs. Among patients persisting with ChEI medication for at least 12 months, users of donepezil were slightly more likely to continue to persist at 24 months. Nearly half of patients failed to persist with ChEI therapy for at least 12 months. Our findings underscore the limitations of the ChEI medications and the urgent need for effective and tolerable therapeutic options for patients having dementia. © 2008 Abughosh and Kogut, publisher and licensee Dove Medical Press Ltd

Parents\u27 Knowledge, Attitudes and Beliefs of Childhood Fever Management in Jordan: a Cross-Sectional Study

Background: Studies have demonstrated that some parents have limited knowledge and several false beliefs regarding fever, its management and role in illness. Objective: The aims of this study were to investigate parents\u27 knowledge, attitudes and beliefs regarding childhood fever management in Jordan in comparison to current National Institute for Health and Care Excellence (NICE) and Italian fever management guidelines. Methods: An observational, survey-based cross-sectional study design was carried out with a convenience sample of 419 Jordanian adult parents in Irbid governorate area, Jordan. The survey consisted of four major categories with 32 ‘yes/no’ and multiple-choice questions. Descriptive statistics were presented, and chi-square test/ Fisher exact test and a t-test were performed to compare the demographics in this study to the frequencies of oral vs. rectal drug administration and beliefs about the usefulness of alternating drugs. SAS 9.3 was used to conduct all the statistical analysis at a significance level of 0.05. Results: Our results indicated that a high proportion of parents use rectal route for temperature measurement (37%) and medication administration (50%). Approximately half the parents administer treatment when temperature is above 38°C (48%)and only 10% based their calculation of dose on weight. Approximately half the parents reported deciding the right antipyretic medication (59%) and the right dose (48%) to administer to their un-well child using previous advice they have had from their pediatrician. The chi-square test showed no significant differences with any of the demographics with beliefs regarding the usefulness of alternating drugs, while a significant association between the site used in administering the drugs and sex (p=0.003), age category (p=0.03) and number of kids (p=0.029) were documented. Conclusion: Our results indicate that parents often misuse the antipyretics medications, incorrectly manage their child’s fever, follow inappropriate practices to reduce fever, and generally have poor knowledge of basic information regarding fever. As the data suggest that a high proportion of parents use the rectal route for temperature measurement and medication administration, educational programs may be necessary to ensure the process of taking rectal temperature readings is safe and sanitary, especially among female parents, younger age groups and those with 3 or less kids. Findings from this study underscore the need to develop and evaluate programs that educate parents and provide them with the knowledge base required to better manage their children’s fevers

Comparative Effectiveness of Smoking Cessation Medications among Schizophrenic Smokers

Objective: To examine which medication could lead to a higher short and long term smoking abstinence in patients with schizophrenia. Methods: A retrospective cohort study was conducted using General Electric (GE) medical records database (1995 – 2011). The cohort consisted of adult smokers with diagnosis of schizophrenia newly initiating cessation medication. Short term and long term outcomes of cessation were measured at 3 weeks and 1 year. Descriptive and chi-square analyses were used to determine the frequencies and associations of patient characteristics with the abstinence outcomes. Logistic regression models were carried out to determine the predictors of short term and long term abstinence. Results: The cohort consisted of 3,976 patients. Abstinence rate was highest for Varenicline, followed by Bupropion, NRT, and lastly combination at week 12. At one year, abstinence rate was highest for Varenicline, followed by combination, NRT, and lastly Bupropion. Age, race, household locations and receiving counseling were associated with abstinence. No significant differences were found between cessation medications. Conclusions: There were no statistically significant differences in quitting with type of cessation medication. Predictors of better abstinence identified included older age, white race, western household location. These factors should be considered when designing future interventions for schizophrenic population as this minority population may need more tailored approaches to achieve a successful cessation outcome

Patient-Reported Barriers to Adherence Among ACEI/ARB Users from a Motivational Interviewing Telephonic Intervention

Purpose: Hypertension is a common comorbidity among type 2 diabetes mellitus (T2DM) patients, which increases the risk of cardiovascular diseases. Despite the proven benefit of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in this population, poor medication adherence is prevalent, resulting in higher complications and mortality rate. Motivational interviewing (MoI) has demonstrated effectiveness in improving medication adherence and identifying barriers. This study aimed to assess and identify patient-reported barriers to adherence to ACEI/ARB from an MoI telephonic intervention conducted by student pharmacist interns. Patients and Methods: This retrospective study was conducted within an MoI intervention customized by past ACEI/ARB adherence trajectories for nonadherent patients with T2DM and hypertension enrolled in a Medicare Advantage Plan. Adherence barriers were extracted from the interviewers’ notes by two independent researchers. Descriptive analysis was performed to summarize the overall frequency of barriers as well as across trajectory groups, identified from the initial and follow-up calls. Results: In total, 247 patients received the initial MoI call from which 41% did not communicate any barrier for ACEI/ARB use despite having low adherence. About 59% of the patients reported at least one barrier during the initial call. The most common barriers included forgetfulness, discontinuation by physicians, side effects, multiple comorbidities, polypharmacy, lack of knowledge about disease/medication, and cost issues. The follow-up calls helped with uncovering at least one new barrier for 28 patients who previously communicated a different issue with their medication during the first call. Additionally, 18 patients with initial denial for having any barrier to adherence reported at least one barrier throughout the follow-up calls. Conclusion: This study summarized patient-reported barriers to ACEI/ARB adherence from an MoI telephonic intervention performed among nonadherent patients. Identifying specific barriers for patients may help to further design tailored interventions that address the barriers and improve adherence

Adherence Barriers to Oral Endocrine Therapy Among Breast Cancer Patients

Breast cancer is the most common type of cancer among women and the 2nd most prevalent cause of cancer deaths in women in the United States. Approximately 70-80% of all breast cancer express hormone receptors (HR) and are called HR-positive (HR+) breast cancer. For HR+ breast cancer, the standard systematic therapy is endocrine therapy (ET) which include selective estrogen receptor modulators like Tamoxifen, and aromatase inhibitors to inhibit the estrogen synthesis. For patients diagnosed with early-stage HR+ breast cancer, ET reduces breast cancer recurrence, metastasis, and mortality. The clinical benefit of ET is maximized when ET is taken daily for 5-10 years. Despite the well-documented clinical benefit of ET, nearly 50% of breast cancer survivors taking ET are non-adherent and 70% discontinue therapy before the recommended 5year. Low adherence and early discontinuation are associated with an increased risk of mortality, enhanced medical costs and lower quality of life years. The determinants of non-adherence and non-persistence are multi-dimensional and should be considered when designing interventions to enhance adherence.Pharmaceutical Health Outcomes and Policy, Department o

COVID-19 Infection among People with HIV/AIDS in Africa: Knowledge Gaps, Public Health Preparedness and Research Priorities

The emergence of novel virus SARS-CoV-2 that causes COVID-19 has complicated Africa’s public health challenges, especially with the pre-existing epidemics such as HIV/AIDS. We highlight the known evidence related to COVID-19 infections among people with HIV (PWH) with specific reference to Africa. The knowledge gaps, level of public health preparedness and the potential research priorities are also outlined. Although the epidemiology and clinical course of COVID-19 in HIV patients are evolving, existing evidence indicate that the disease outcomes are comparable to that of the general population. However, PWH with low CD4 cell counts may have worse outcomes than individuals with restored immunity, whereas old age and co-morbidities such as obesity, hypertension and diabetes can further increase their overall risk. While there may be slight disruption of HIV service delivery in selected African countries, the resilience and resourcefulness of others have helped to sustain HIV service delivery and enhanced the level of public health preparedness and fight against the pandemic. The paucity of data and research studies on HIV-COVID-19 coinfection in Africa, call for concerted efforts to address these limitations. Keywords: • COVID-19 • SARS-CoV-2 • HIV • PWH • Public Health • Research • Africa   Copyright © 2021 Essien, et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited