The relationship between patient-related factors and medication adherence among Nigerian patients taking highly active anti-retroviral therapy

Background: Through several initiatives, there are increasingly more people who have access to anti-retroviral therapy. Adherence to therapy is, however,necessary for successful management of disease.Objectives: The objectives of this study were to describe adherence rates and determine what patient-related factors are related to adherence to anti-retroviral therapy among adult patients in an HIV clinic located in Lagos, Nigeria.Methods: Adherence was measured using the two-week self-recall method. Barriers, satisfaction with therapy, and socio-demographic and clinical variables served as independent variables. Data were collected via self-administered surveys.Results: Most of the patients (79.5%) reported 100% adherence. The significant (p<0.05) barriers to adherence were forgetfulness, running out of medication, alcohol use, and medication side effects. For every unit increase in the number of barriers, patients were 60.8% less likely to be 100% adherent (p <0.05, odds ratio, OR = 0.392,95% CI = 0.295-0.523).Conclusion: Interventions should target helping patients cope with forgetfulness, specifically employing strategies to overcome busyness in schedules, being away from home, and tiredness.Keywords: Medication adherence, patients, anti-retroviral therap

The relationship between patient-related factors and medication adherence among Nigerian patients taking highly active anti-retroviral therapy.

Background: Through several initiatives, there are increasingly more people who have access to anti-retroviral therapy. Adherence to therapy is, however,necessary for successful management of disease. Objectives: The objectives of this study were to describe adherence rates and determine what patient-related factors are related to adherence to anti-retroviral therapy among adult patients in an HIV clinic located in Lagos, Nigeria. Methods: Adherence was measured using the two-week self-recall method. Barriers, satisfaction with therapy, and socio-demographic and clinical variables served as independent variables. Data were collected via self-administered surveys. Results: . Most of the patients (79.5%) reported 100% adherence. The significant (p<0.05) barriers to adherence were forgetfulness, running out of medication, alcohol use, and medication side effects. For every unit increase in the number of barriers, patients were 60.8% less likely to be 100% adherent (p <0.05, odds ratio, OR = 0.392,95% CI = 0.295-0.523). Conclusion: Interventions should target helping patients cope with forgetfulness, specifically employing strategies to overcome busyness in schedules, being away from home, and tiredness

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

A Motivational Interviewing Intervention to Improve Adherence to ACEIs/ARBs among Nonadherent Older Adults with Comorbid Hypertension and Diabetes

Background Hypertension and diabetes mellitus are independent risk factors for cardiovascular diseases. Due to the cardioprotective nature of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), they are recommended for patients with comorbid hypertension and diabetes. However, poor adherence to ACEIs/ARBs among older adults is a major public health concern. This study aimed to assess the effectiveness of a telephonic motivational interviewing (MI) intervention conducted by pharmacy students among a nonadherent older population (≥ 65 years old) with diabetes and hypertension. Methods Patients continuously enrolled in a Medicare Advantage Plan who received an ACEI/ARB prescription between July 2017 and December 2017 were identified. Group-based trajectory modeling (GBTM) was used to identify distinct patterns of ACEI/ARB adherence during the 1-year baseline period: adherent, gaps in adherence, gradual decline, and rapid decline in adherence. Patients from the three nonadherent trajectories were randomized into MI intervention or control group. The intervention consisted of an initial call and five follow-up calls administered by MI-trained pharmacy students and tailored to the baseline ACEI/ARB adherence trajectories. The primary outcome was adherence to ACEI/ARB during the 6- and 12-month periods post-MI implementation. The secondary outcome was discontinuation, defined as no refills for ACEI/ARB during the 6- and 12-month periods post-MI implementation. Multivariable regression analyses examined the impact of MI intervention on ACEI/ARB adherence and discontinuation while adjusting for baseline covariates. Results A total of 240 patients in the intervention group and 480 patients as randomly selected controls were included in this study. At 6 months, patients receiving the MI intervention had significantly better adherence (β = 0.06; p = 0.03) compared with the controls. Linear and logistic regression models also showed patients in the intervention group were more likely to be adherent than controls within 12 months of intervention implementation (β = 0.06; p = 0.02 and OR: 1.46; 95% CI 1.05–2.04, respectively). MI intervention did not have any significant impact on the ACEI/ARB discontinuation. Conclusion Patients who received the MI intervention were more likely to be adherent at 6 and 12 months following the intervention initiation, despite gaps in the follow-up calls due to COVID-19. Pharmacist-led MI intervention is an effective behavioral strategy to improve medication adherence among older adults and tailoring the intervention to past adherence patterns may enhance the intervention effectiveness

Effectiveness of Compounded Bioidentical Hormone Replacement Therapy: An Observational Cohort Study

<p>Abstract</p> <p>Background</p> <p>Bioidentical Hormone Replacement Therapy (BHRT) is believed it to be a safer and equally effective alternative to Conventional Hormone Therapy for the relief of menopausal symptoms; however, data are needed to support these claims. The objective of this study is to evaluate the effectiveness of compounded BHRT provided in six community pharmacies.</p> <p>Methods</p> <p>This was an observational cohort study of women between the ages of 18-89 who received a compounded BHRT product from January 1, 2003 to April 30, 2010 in six community pharmacies. Data included patient demographics, comorbidities, therapeutic outcomes, and hormone therapies. Women self-rated menopausal symptoms as absent, mild, moderate, or severe. Descriptive statistics were used to characterize the patient population, BHRT use, and adverse events. Patient symptom severity was compared at baseline and 3 to 6 months follow-up using the Wilcoxon signed-rank test.</p> <p>Results</p> <p>Women (n = 296) receiving BHRT at Oakdell Pharmacy had a mean (standard deviation) age of 52 (9) years. The most common BHRT dosage forms utilized were topical (71%) and oral (43%). Compounded BHRT regimens were generally initiated at low doses regardless of route. Women experienced a 25% decrease in emotional lability (p < 0.01), a 25% decrease in irritability (p < 0.01), and a 22% reduction in anxiety (p = 0.01) within 3 to 6 months. These women also experienced a 14% reduction in night sweats (p = 0.09) and a 6% reduction in hot flashes (p = 0.50).</p> <p>Conclusions</p> <p>This study demonstrates that compounded BHRT improves mood symptoms. Larger studies are needed to examine the impact on vasomotor symptoms, myocardial infarction and breast cancer.</p

Assessment of asthma patients\u27 willingness to pay for and willingness to give time to an asthma self-management program

Advances in pharmacotherapeutics have made asthma a disease that can be managed effectively on an outpatient basis. One of the solutions in helping patients manage their asthma is health education programs focusing on self-management. Despite the abundance of asthma management programs, researchers have found that patients are reluctant to enroll and complete the program. The purpose of this study was to determine factors that influence asthma patients\u27 willingness to pay and willingness to give time for an asthma self-management program. One hundred sixteen adult asthma patients (18–34 years) were surveyed on the following factors to determine their effect on willingness to pay and willingness to give time to an asthma self-management program: sociodemographic factors, predisposing, enabling, and reinforcing factors, level of asthma self-management, and health care utilization. Patients who were younger and employed, who indicated an interest in participating in a self-management program, who had greater perceived access to health care resources, who received less education from health care providers, and who exhibited suboptimal behaviors during asthma attacks were more likely to pay more for a program that would help them manage their asthma. This model was significant with 35 percent of the variance explained. Patients who were in the younger age group, who indicated an interest in participating in a self-management program, who had a higher number of comorbidities and who had more emergency room visits were willing to spend more time in an asthma self-management program. This model was significant with 18 percent of the variance explained. Overall the PRECEDE Model performed well in this study as exhibited by high explanatory power of the relationships, as well as significant models

The association between hydroxyurea adherence and opioid utilization among Texas Medicaid enrollees with sickle cell disease

© 2020 Academy of Managed Care Pharmacy (AMCP). All rights reserved. BACKGROUND: Individuals with sickle cell disease (SCD) suffer from recurrent catastrophic pain crises that are often managed by opioid analgesics. Being adherent to hydroxyurea has been associated with decreased health care resource use for pain; however, evidence of its association with opioid use is limited. OBJECTIVE: To determine if adherence to hydroxyurea is associated with opioid use among patients with SCD. METHODS: This retrospective study used Texas Medicaid data from September 1, 2011, to August 31, 2016 (study period). The index date was the date of hydroxyurea initiation. Patients who were aged 2-63 years at the index date, had ≥1 inpatient or ≥2 outpatient SCD diagnoses during the study period, had ≥1 hydroxyurea prescription during the identification period (September 1, 2011-August 31, 2015), had no diagnosis of other indications for hydroxyurea during the study period, and were continuously enrolled for at least 12 months after the index date were included. Hydroxyurea adherence was measured using medication possession ratio (MPR). The study outcomes (measured 1-year post-index) were (a) opioid use; (b) number of opioid prescriptions; (c) strong opioid use (morphine, hydromorphone, fentanyl, and methadone); (d) number of strong opioid prescriptions; (e) high-dose opioid use (≥50 mg morphine milligram equivalent [MME]); and (f) days supply for opioid prescriptions. Covariates included demographic (age and gender) and clinical (vaso-occlusive crisis [VOC], avascular necrosis, iron overload, acute chest syndrome, and blood transfusion) characteristics. Descriptive, bivariate (chi-square and Wilcoxon-Mann-Whitney tests), multiple logistic regression, and negative binomial regression analyses were performed. RESULTS: 1,146 patients (18.3 [12.3] years) met the inclusion criteria. Of these, 19.6% were adherent to hydroxyurea (defined as MPR ≥ 80%) and mean (SD) MPR was 48.3% (29.7%). In the 1 year following hydroxyurea initiation, 923 (80.5%) patients had ≥1 opioid prescription with 7.6 (9.4) opioid prescriptions per patient, while 259 (22.6%) patients had ≥1 strong opioid prescription with 1.5 (4.4) strong opioid prescriptions per patient. Average (SD) opioid dose was 41.7 (74.3) mg MME, and 27.1% had high daily MME doses (≥50 mg MME). Average (SD) opioid days supply was 83.1 (112.2) days. After adjusting for covariates, compared with being nonadherent, being adherent to hydroxyurea was associated with a 50.5% decreased risk of having strong opioids (OR=0.495, 95% CI=0.278-0.879, P=0.0165). Additionally, SCD-related complications (VOC, avascular necrosis, and iron overload) and older age were significant factors associated with opioid use and higher MME. Post hoc analyses showed that being adherent to hydroxyurea was significantly associated with lower probabilities of experiencing SCD-related complications. CONCLUSIONS: Results showed that patients with SCD are moderately adherent to hydroxyurea. Being adherent to hydroxyurea was found to be associated with a lower risk of receiving a prescription for strong opioids. Findings suggest that close monitoring and interventions to improve adherence may help mitigate strong opioid use among these patients

A comparison of national immunization rates to immunization rates of Latino diabetic patients receiving clinical pharmacist interventions in a federally qualified community health centre (FQHC)

Objectives: To compare national immunization rates to immunization rates of Latino patients receiving clinical pharmacist interventions in a federally qualified community health centre (FQHC) in 2010. Methods: This is a retrospective electronic medical record (EMR) review conducted in an FQHC in El Paso, Texas. Adults (≥18) with diabetes who were seen by a clinical pharmacist between 1 January 2010 and 31 December 2010 were queried on the basis of 2010 vaccination criteria for the following vaccines: hepatitis A (HepA), hepatitis B, influenza, pneumococcal, tetanus-diphtheria-acellular pertussis (Tdap) and zoster. Each patient\u27s EMR was reviewed to calculate immunization rates. Study immunization rates (SIRs), overall national immunization rates (OIRs) and national Hispanic immunization rates (HIRs) were compared using z-tests for proportions. The SIRs for each vaccine were calculated using the following formula: number of patients vaccinated/number of eligible patients. OIRs and HIRs were obtained from the 2010 National Health Interview Survey. Key findings: Patients (n=330) were 56.1±12.7 years, primarily women (73.9%) and Latinos (96.7%). SIRs of HepA (33.3%), pneumococcal-ages 19-64 (46.2%) and Tdap (42.7%) were significantly (P\u3c0.0001) higher when compared with both HIRs (10.3%, 14.8%, 4.8% respectively) and OIRs (10.7%, 18.5%, 8.2% respectively). Regarding zoster, the SIR (10.0%) was significantly (P\u3c0.05) higher than the HIR (4.4%) but not significantly different from the OIR (14.4%). Conclusion: Clinical pharmacists can play a significant role in increasing adult vaccination rates. Providing access to vaccines and health education for patients have become more important with the growing needs of a culturally diverse and ageing population. © 2014 Royal Pharmaceutical Society