Improving the adherence of type 2 diabetes mellitus patients with pharmacy care: a systematic review of randomized controlled trials

BACKGROUND: Oral medication for patients with type 2 diabetes mellitus plays an important role in diabetes care and is associated with a high level self-care behavior and self-management. However, poor adherence to diabetes treatment is common which causes severe health complications and increased mortality. Barriers to adherence may consist of complex treatment regimens often along with long-term multi-therapies, side effects due to the medication as well as insufficient, incomprehensible or confusing information or instructions provided by the health care provider. Multidisciplinary approaches can support adherence success and can enable a more effective management of diabetes care. One approach in diabetes care can be the involvement of a pharmacist. The aim was to analyze the effectiveness of adherence-enhancing pharmacist interventions for oral medication in type 2 diabetes mellitus. METHODS: A systematic review of randomized controlled trials. The study quality was assessed with the Cochrane risk of bias tool. RESULTS: Of 491 hits, six publications were included. Two studies mainly examining educational interventions showed a significant improvement in adherence. Moreover, the quality of the included studies was deficient. CONCLUSION: Although pharmacist interventions might potentially improve adherence to type 2 diabetes mellitus medication, high-quality studies are needed to assess effectiveness

50% adherence of patients suffering chronic conditions – where is the evidence? [50% Adhärenz bei Patienten mit chronischen Erkrankungen – wo ist die Evidenz?]

[english] The World Health Organization states that in a widespread report that “in developed countries, adherence among patients suffering chronic diseases averages only 50%”. We followed the quoted references to this statement. The data basis for this statement is one randomized controlled trial (RCT) on hypertensive steel workers in Canada published in 1975 and one study dealing with neurotic outpatients in Pennsylvania, USA published in 1965. Both studies are not suitable to assume such generalized adherence estimation and are not for different reasons transferable to today’s patient care.<br>[german] Die Weltgesundheitsorganisation (WHO) gibt in einem sehr verbreiteten Bericht an, dass die Therapietreue bei Patienten mit chronischen Erkrankungen bei durchschnittlich 50% in entwickelten Ländern liegt. Wir haben anhand der Literaturhinweise die Basis dieser Aussage verfolgt. Die Basis dieser Aussage ist lediglich eine randomisierte kontrollierte Studie (RCT) an kanadischen Stahlarbeitern mit Hypertension von 1975 sowie eine US-amerikanische Studie an neurotischen Patienten von 1965. Beide Studien sind nicht geeignet eine derart generalisierte Aussage zu treffen und darüber hinaus nicht auf die gegenwärtige Patientenversorgung übertragbar

Adherence enhancing interventions for oral anticancer agents: A systematic review

Background: The use of oral anticancer agents has increased in the last decades. Adherence is a crucial factor for the success of oral anticancer agent therapy. However, many patients are non-adherent. Objective: The objective was to evaluate the effectiveness of adherence interventions in patients taking oral anticancer agents. Methods: A systematic literature search was performed in Medline and Embase. Titles and abstracts and in case of potential relevance, full-texts were assessed for eligibility according to the predefined inclusion criteria. The study quality was evaluated. Both process steps were carried out independently by two reviewers. Relevant data on study design, patients, interventions and results were extracted in standardized tables by one reviewer and checked by a second reviewer. Results: Six controlled studies were included. Only one study was randomized. The study quality was moderate to low. One study showed statistically significant results in favor of the adherence intervention, two studies showed a tendency in favor of the intervention, one study showed an inconsistent result depending on the adherence definition and one study showed almost identical adherence rates in both groups. One study showed a tendency in favor of the control group. Conclusions: Although most of the interventions are not very effective, it appears that certain adherence enhancing interventions could have a promising effect. One crucial point is the consideration of the baseline adherence when choosing patients to avoid ceiling effects. The evidence is limited due to lack of sufficient studies and partly inconsistent results. Further high quality studies are needed. (C) 2013 Elsevier Ltd. All rights reserved

Pay for performance for hospitals

Pay-for-Performance (P4P) is a payment model that rewards health care providers for meeting pre-defined targets for quality indicators or efficacy parameters to increase the quality or efficacy of care

Systematic review finds overlapping reviews were not mentioned in every other overview

The objective of this study was to determine if the authors mention overlapping reviews in overviews (reviews of reviews). In addition, we aimed to calculate the actual overlap in published overviews using newly introduced, validated measures

COST-EFFECTIVENESS OF ADHERENCE INTERVENTIONS FOR HIGHLY ACTIVE ANTIRETROVIRAL THERAPY: A SYSTEMATIC REVIEW

The objective of this systematic review was to evaluate the cost-effectiveness of interventions aiming to increase the adherence to highly active antiretroviral therapy (HAART) in HIV-infected patients in developed countries (WHO stratum A)

Effect of increased enteral protein intake on plasma and urinary urea concentrations in preterm infants born at < 32 weeks gestation and < 1500 g birth weight enrolled in a randomized controlled trial – a secondary analysis

Abstract Background Feeding breast milk is associated with reduced morbidity and mortality, as well as improved neurodevelopmental outcome but does not meet the high nutritional requirements of preterm infants. Both plasma and urinary urea concentrations represent amino acid oxidation and low concentrations may indicate insufficient protein supply. This study assesses the effect of different levels of enteral protein on plasma and urinary urea concentrations and determines if the urinary urea-creatinine ratio provides reliable information about the protein status of preterm infants. Methods Sixty preterm infants (birthweight < 1500 g; gestational age < 32 weeks) were enrolled in a randomized controlled trial and assigned to either a lower-protein group (median protein intake 3.7 g/kg/d) or a higher-protein group (median protein intake 4,3 g/kg/d). Half the patients in the higher-protein group received standardized supplementation with a supplement adding 1.8 g protein/100 ml milk, the other half received individual supplementation depending on the respective mother’s milk macronutrient content. Plasma urea concentration was determined in two scheduled blood samples (BS1; BS2); urinary urea and creatinine concentrations in weekly spot urine samples. Results The higher-protein group showed higher plasma urea concentrations in both BS1 and BS2 and a higher urinary urea-creatinine-ratio in week 3 and 5–7 compared to the lower-protein group. In addition, a highly positive correlation between plasma urea concentrations and the urinary urea-creatinine-ratio (p < 0.0001) and between actual protein intake and plasma urea concentrations and the urinary urea-creatinine-ratio (both p < 0.0001) was shown. Conclusions The urinary urea-creatinine-ratio, just like plasma urea concentrations, may help to estimate actual protein supply, absorption and oxidation in preterm infants and, additionally, can be determined non-invasively. Further investigations are needed to determine reliable cut-off values of urinary urea concentrations to ensure appropriate protein intake. Trial registration Clinicaltrials.gov; NCT01773902 registered 15 January 2013, retrospectively registered

Adherence influencing factors in patients taking oral anticancer agents: A systematic review

The use of oral anticancer agents increased steadily in the last decades. Although oral anticancer agent adherence is important for a successful treatment, many patients are insufficiently adherent