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

Factors associated with the willingness to quit smoking among a cohort of university students in the KSA

AbstractObjectivesThe aim of this study was to determine the predictors of the willingness to quit smoking among a cohort of male Saudi students.MethodsIn this cross-sectional study, a questionnaire was administered to a cohort of male students that were recruited from three institutes of higher education. Using the retrieved data, bivariate analysis and logistic regression tests were performed to assess the factors associated with the willingness to quit smoking.ResultsOf 467 participants, 24% of respondents were current smokers, while 65% of these smokers were willing to quit smoking. In the bivariate analysis, past attempts to quit smoking and the anti-smoking messages on TV and in newspapers were significantly associated with the willingness to quit smoking. Only one variable – past attempts to quit smoking – was a significant predictor of the willingness to quit smoking, as shown by the multivariate logistic regression analysis.ConclusionThe findings of this study indicate that Saudi male students who smoke are willing to quit smoking; having unsuccessfully attempted to quit smoking in the past, they are willing to try again. Successful programs should be developed for male university students in KSA to assist them in their quest to quit smoking and maintain cessation

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

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

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