Search

Introduction: Medication non-adherence is a major contributor to suboptimal disease treatment across medical specialties and is a particular hurdle with topicals. While adherence is a patient behavior affected by many socioeconomic and health system factors, physicians can play an important role in encouraging good adherence. Areas covered: We discuss methods for measuring adherence, including ethics of such research, provide select examples of dermatology-specific adherence studies, and conclude with physician-focused practices to improve patients' adherence. Articles were selected from a PubMed search spanning 2003 to 10 December 2023, using the following terms: 'dermatology,' 'medication,' 'treatment,' 'adherence,' 'compliance,' and 'intervention.' Expert opinion: Poor adherence to treatment is a major cause of poor treatment outcomes. As the goal of medical care is to achieve successful treatment outcomes, encouraging good adherence may be as much a foundation of care as making the right diagnosis and prescribing the right treatment. Taking a doctor-centric perspective on reasons for non-adherence may be more productive than simply finding fault with the patient. Establishing trust and accountability is a foundation for good adherence; after establishing the provider-patient relationship, physicians can improve adherence by incorporating behavioral and counseling strategies, communicating through technology, and advocating for distribution of validated educational information. [ABSTRACT FROM AUTHOR]

Introduction: To establish a prediction model to predict immunosuppressive medication (IM) nonadherence in kidney transplant recipients (KTRs) based on a combined theory framework. Methods: This polycentric, cross-sectional study included 1191 KTRs from October 2020 to February 2021 in China, with 1011 KTRs enrolled in the derivation set and 180 in the external validation set. Variables selected based on the combined theory of planned behavior (TPB)/health belief model (HBM) theory were analyzed by the least absolute shrinkage and selection operator (LASSO). Internal 10 cross-validation was conducted to determine the optimal lambda value. The receiver operating characteristic (ROC) curve, specificity, and sensitivity were used to evaluate the prediction model, and further assessment was run by external validation. Results: IM nonadherence rate was 38.48% in the derivation set and 37.22% in the validation set. The LASSO model was developed with eight predictors for IM nonadherence: age, preoperative drinking history, education, marital status, perceived barriers, social support, perceived behavioral control, and perceived susceptibility. The model demonstrated acceptable discrimination with the area under the ROC curve of 0.797 (95% CI: 0.745-0.850) in the internal validation set and 0.757 (95% CI: 0.684-0.829) in the external validation set. The specificity and sensitivity in the internal validation and external validation set were 0.741, 0.748, 0.673, and 0.716, respectively. Conclusions: The LASSO model was developed to guide identifying high-risk nonadherent patients and timely and effective interventions to improve their prognosis and survival. [ABSTRACT FROM AUTHOR]

Hypertension is the main global risk factor for cardiovascular disease. Despite this, less than half of treated hypertensive patients are controlled. One reason for this is nonadherence, a major unmet need in hypertension pharmacotherapy. Small interfering RNA (small interfering ribonucleic acid) therapies inhibit protein translation, and, when linked to N-acetylgalactosamine, allow liver-specific targeting, and durability over several months. Targeted knockdown of hepatic angiotensinogen, the source of all angiotensins, offers a precision medicine approach. This article describes the molecular basis for durability over months and the 24-h tonic target inhibition observed after one administration. We present an analysis of the published phase I trials using zilebesiran, a siRNA targeting hepatic angiotensinogen, which reduces blood pressure (BP) by up to 20 mmHg, lasting 24 weeks. Finally, we examine data evaluating reversibility of angiotensinogen knockdown and its relevance to the future clinical utility of zilebesiran. Further studies should assess safety, efficacy, and outcomes in larger, more broadly representative groups. An advantage of zilebesiran is the potential for bi-annual dosing, thereby reducing nonadherence and improving control rates. It may also reduce nighttime BP due to 24-h tonic control. The provision of adherence assessment services will maximize the clinical value of zilebesiran. [ABSTRACT FROM AUTHOR]

HIV-infected children are now living into adolescence and early adulthood in large numbers due to the availability and increased use of antiretroviral therapy (ART). However, receipt of HIV status disclosure among children remains low. We assessed the association between disclosure of HIV status and adherence to ART among children in the Masaka region of Uganda using multivariable logistic regression with generalised linear models with Poisson log-link function and robust variance in Stata software version 15.1. Data were collected from 524 assenting children aged 12–17 years between March and December 2020. Results show that, although not statistically significant, children who received disclosure of their HIV status reported improved ART adherence compared to children with no disclosure. Out-of-school children with post-primary education and children on first-line ART regimens were significantly more likely to report improved ART in both crude and adjusted analyses. Innovative interventions to promote progressive disclosure of HIV status to children on ART, in school, are needed to improve their ART adherence. There is also a need to evaluate the suitability of current counselling interventions provided to children being switched to second-line ART regimens to delay the need for third-line ART regimens. [ABSTRACT FROM AUTHOR]

Cost-related nonadherence to medications is a commonly encountered problem posed by many patients, and specifically among elderly patients who use multiple chronic medications. This study aims to explore the prevalence of medication cost-related nonadherence and its predictors in Jordan. A cross-sectional study was conducted between February 2019 and May 2019 in Jordan. The CRN questionnaire was used as a measure to assess the prevalence of cost-related nonadherence. Logistic regression was used to determine predictors of medication cost-related nonadherence. The prevalence rate of CRN was 29.6% (95% CI: 27.0–32.3). Participants who are married or widowed were found to have higher odds of being non-adherent due to medication costs, with an odds ratio of 1.55 (95%CI: 1.19–2.00) and 1.95 (95%CI: 1.20–3.15), respectively. Lower educational level was associated with higher odds of being non-adherent 1.95 (95%CI: 1.25–3.05). Being retired was associated with higher odds of being non-adherent (2.20 (95%CI: 1.49–3.27)). Cost-related nonadherence is a common problem in Jordan and was most prevalent among those with hypertension and diabetes mellitus, low-income, and low levels of education. Our findings could help in developing interventions to improve cost-related medication nonadherence in developing countries. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is the long-lasting chronic inflammatory skin condition associated with cutaneous hyper-reactivity and triggered by environmental factors. The attributes of AD include dry skin, pruritus, lichenification and frequent eczematous abrasions. This has a strong heritable aspect and typically occurs with asthma and allergic rhinitis. The complex pathological mechanism behind AD etiology is epidermal barrier destruction resulting in the lack of filaggrin protein that can induce inflammation and T-cell infiltration. T-helper 2 cell-mediated pathways also bear the responsibility of damage to the epidermal barrier. Certain causative factors for AD include microbial imbalance of skin microbiota, immunoglobulin-E-induced sensitization and neuro-inflammation. Numerous beneficial topical and oral treatments have been available to patients and there are even more drugs in the pipeline for the treatment of AD. Topical moisturizers, corticosteroids, anti-inflammatory agents such as calcineurin inhibitors, phototherapy, cAMP-specific 3, 5 half-cyclic phosphodiesterase 4 inhibitors and systemic immunosuppressants are widely available for AD treatments. Different positions and pathways inside the immune system including JAK-STAT, phosphodiesterase 4, aryl hydrocarbon receptor and T-helper 2 cytokines are targeted by above-mentioned drug treatments. Instead of the severe side effects of topical steroids and oral antihistamines, herbal plants and their derived phytoconstituents are commonly used for the treatment of AD. A clear understanding of AD's cellular and molecular pathogenesis through substantial advancement in genetics, skin immunology and psychological factors resulted in advancement of AD management. Therefore, the review highlights the recent advancements in the understanding of clinical features, etiology, pathogenesis, treatment and management and non-adherence to AD treatment. [ABSTRACT FROM AUTHOR]

Background: The identification of factors associated with nonadherence to psychotherapy would allow a better prevention of this problem. Aim: To investigate factors associated with nonadherence in psychotherapy, its possible effect on outcomes, and reasons for therapy dropout. Method: Prospective analytic observational study of patients who initiated psychotherapy (N = 144). Sociodemographic, general clinical, treatment-related, subjective, psychological, psychopathologic, and outcome variables were evaluated at baseline and 1, 3, 6, and 12 months later. Objective nonadherence (dropout and irregularity), subjective nonadherence (poor patient engagement), and global nonadherence (combination of both) were analyzed. Results: Global nonadherence was 66%. Global nonadherence was associated with substance use or abuse (OR = 2.64) and younger age (OR = 0.97). Objective nonadherence was associated with active working status (OR = 4.11), younger age (OR = 1.04) and substance use or abuse (OR = 2.35). Subjective nonadherence was associated with worse insight in psychotherapy (OR = 0.95) and poor pharmacologic adherence (OR = 0.55). Contextual reasons (25.8%) were the most commonly reported cause of dropout. Time in psychotherapy was associated with outcome variables. Conclusions: Nonadherence to psychotherapy is frequent. To reduce nonadherence in psychotherapy, specific interventions for reducing substance use and abuse, measures aimed at facilitating access to Community Mental Health Units, and enhancing insight in psychotherapy should be implemented. [ABSTRACT FROM AUTHOR]

Purpose: Our aim was to develop a theoretical account of the behavioural pattern of adherence to home-based inspiratory muscle training (IMT) in people with chronic obstructive pulmonary disease (COPD), performed as two daily sessions of 30 breaths with mechanical threshold loading. Methods: This was a qualitative study based on the classic grounded theory method. We conducted interviews with people living with COPD recruited after completion of 6 weeks of outpatient pulmonary rehabilitation program in 2015. Concurrently, we generated data and performed analyses by means of constant comparative analysis and theoretical sampling that focused on the behavioural characteristics of adherence to IMT. Results: We achieved theoretical saturation of substantive codes with 33 interviews, nine of which were with men. The participants' mean age and forced expired volume in the first second were 65 (SD 8) years and 59.1 (SD 13.9) percent of predicted, respectively. Seventeen participated in face-to-face interviews, and 16 participated in telephone interviews. The core category "Preserving Integrity" emerged as representative of the primary pattern of behaviour related to the inspiratory muscle-training regimen. Through this pattern, the participants resolved the main concern of losing integrity. Preserving Integrity involved three behavioural modes of adherence to home-based IMT: evading, misgiving, and involving modes. Conclusions: The participants' behavioural modes regarding adherence revealed patterns of both intended and unintended nonadherence. In particular, support offered by healthcare professionals should target people with unintended nonadherence and scepticism about the effects of IMT to maximise the possibility of adherence. When implementing inspiratory muscle training, healthcare professionals should be prepared to spend considerable time providing attention and support to participants who feel challenged during the execution of inspiratory muscle training. Support offered by healthcare professionals should target people with scepticism about the effects of inspiratory muscle training to maximise the possibility of adherence. Intended adherence to inspiratory muscle training appeared to be firmly rooted, which means that healthcare professionals can pay less attention to patients with strong intentions to ensure adherence. [ABSTRACT FROM AUTHOR]

Digital medicine is a medical treatment that combines technology with drug delivery. The promises of this combination are continuous and remote monitoring, better disease management, self-tracking, self-management of diseases, and improved treatment adherence. These devices pose ethical challenges for patients, providers, and the social practice of medicine. For patients, having both informed consent and a user agreement raises questions of understanding for autonomy and informed consent, therapeutic misconception, external influences on decision making, confidentiality and privacy, and device dependability. For providers, digital medicine changes the relationship where trust can be verified, clinicians can be monitored, expectations must be managed, and new liability risks may be assumed. Other ethical questions include direct third-party monitoring of health treatment, affordability, and planning for adverse events in the case of device malfunction. This article seeks to lay out the ethical landscape for the implementation of such devices in patient care. [ABSTRACT FROM AUTHOR]

Objective: Nonadherence to phosphate binding medication (PBM) compromises the efficacy of treatment for chronic kidney disease, but its causes are poorly understood. This study sought to explore patient attitudes towards PBM and to evaluate the utility of the necessity-concerns framework for understanding adherence to PBM. Design: A sample of 221 dialysis patients currently prescribed PBM were surveyed from eight UK renal units. Main Outcome Measures: Demographic data and clinical information, alongside the Beliefs about Medicines Questionnaire and the medication adherence report scale were reported. Results: Low adherence to PBM was predicted by reduced beliefs in personal need for PBM (OR?=?.34; 95% CI: .14–.83;p?

There are little data on antiretroviral therapy (ART) adherence among patients in Eastern Europe, despite the high incidence of HIV infection and the growing number of HIV-infected individuals who are being prescribed ART. The aim of this study was to measure rates of adherence to ART and factors associated with nonadherence among patients receiving care at an outpatient HIV clinic in Estonia. The study was based on cross-sectional data from a convenience sample of 144 patients receiving outpatient HIV care. Data were obtained via interviewer-administered surveys and data abstraction from clinical records. Adherence was measured from a 3-day patient self-report. Among 144 participants (mean age 33.8 years), two-thirds (63%) had been infected with HIV through intravenous drug use. Most (74%) were co-infected with hepatitis C (HCV). Perfect adherence over the last 3 days was commonly reported (88% [95% CI 81–92%]) with nonperfect adherence associated with greater concerns about the potential adverse consequences of taking ART (adjusted odds ratio [AOR] 4.8, 95% CI 1.2–34.0) and average (versus good/very good) self-reported health status (AOR 4.7, 95% CI 1.2–31.4). Self-reported ART adherence in this sample of Estonian HIV-positive patients in clinical care was similar to rates observed in Western Europe and other developed countries. Results suggest that adherence education and support may be most helpful if they specifically target the development of positive beliefs, reduction of negative expectancies towards ART. [ABSTRACT FROM PUBLISHER]

Patient nonadherence is widespread and costly. This paper provides a brief narrative review of research on (non)adherence and validates a clinically useful three-factor heuristic model to guide practitioners as they work with patients to improve adherence. This model is based on the most stable findings from meta-analyses and large-scale empirical studies, reflects the realities of medical practice and offers recommendations for assessing and enhancing patient adherence, particularly in chronic disease management. The model comprises three important clinical actions: (1) insuring that patients have the right information and know how to adhere – including listening to patients’ concerns, encouraging their participation and partnership in decision-making, building trust and empathy, and enhancing recall; (2) helping patients believe in their treatment and become motivated to commit to it – that is, addressing the cognitive, social, cultural normative and contextual factors that affect patients’ beliefs, attitudes and motivation; and (3) assisting patients to overcome practical barriers to treatment adherence and develop a workable strategy for long-term disease management – including assessing and enhancing patients’ social support, identifying and treating their depression and helping patients overcome cost-related treatment barriers. [ABSTRACT FROM PUBLISHER]

Objective: Treatment of schizophrenia in patients with comorbid substance use (alcohol/illicit drug use, abuse, or dependence) presents challenges for public health systems. Substance use in people with schizophrenia is up to four times greater than the general population and is associated with medication nonadherence and poor outcomes. Therefore, continuous antipsychotic treatment in this population may pose more of a challenge than for those with schizophrenia alone. Many clinical trials and treatment recommendations in schizophrenia do not take into consideration substance use, as people with comorbid substance use have typically been excluded from most antipsychotic trials. Nonetheless, antipsychotic treatment appears to be as efficacious in this population, although treatment discontinuation remains high. The objective of this review was to highlight the importance and utility of considering long-acting injectable antipsychotics for patients with schizophrenia and comorbid substance use. Methods: We did a literature search using PubMed with keywords schizophrenia and substance use/abuse/dependence, nonadherence, antipsychotics, long-acting injectables, relapse, and psychosocial interventions. We limited our search to human studies published in English and 4,971 articles were identified. We focused on clinical trials, case reports, case series, reviews, and meta-analyses, resulting in 125 articles from 1975 to 2011. Results: Our review suggests the potential role of long-acting injectables for people with comorbid substance use and schizophrenia in leading to improvements in psychopathology, relapse prevention, fewer rehospitalizations, and better outcomes. Conclusions: While more research is needed, long-acting antipsychotics should be considered an important option in the management of cases of schizophrenia and comorbid substance use. [ABSTRACT FROM PUBLISHER]

Lack of improvement in long-term post-transplant outcomes in recent times has highlighted nonadherence to immunosuppressive therapy as a major risk factor for poor patient outcomes. A once-daily immunosuppressive dosing regimen has been shown to be associated with improved patient adherence and, possibly, better long-term outcomes. Consequently, tacrolimus prolonged release (Advagraf®) has been developed to ensure similar efficacy and safety to Prograf®, with the added benefit of once-daily dosing. Phase II pharmacokinetic studies have demonstrated that patients can be converted from Prograf to Advagraf on a one-to-one total daily-dose basis and that trough levels can be monitored using the systems already in place. Studies investigating de novo use have shown that Advagraf can be initiated within the same dose range as Prograf, and that trough levels should be monitored over time, with the dose adjusted accordingly to maintain exposure within the appropriate therapeutic range. Large multicenter Phase III studies have demonstrated the good long-term efficacy and safety profiles of Advagraf, and suggest that Advagraf also has the potential to provide the added benefits of lower inter- and intrasubject variability compared with Prograf. In one large Phase III study, measures of renal function also favored Advagraf over Prograf. In conclusion, once-daily Advagraf treatment could potentially enhance post-transplantation adherence to medication and, consequently, improve long-term graft protection while maintaining adequate immunosuppression. [ABSTRACT FROM AUTHOR]

Asthma is a very prevalent disease in the United States, and the incidence is rising for a variety of reasons. Although progress has been made on several therapeutic fronts, adherence to asthma therapy, particularly controller medications, remains poor. This review of data from the past five years will focus on factors associated with nonadherence, barriers to adherence, factors associated with adherence, and finally strategies for improving. Communication between the health care provider and patient is paramount in improving adherence to medical therapy for asthma and thereby improving control of the disease. [ABSTRACT FROM AUTHOR]

Timely and important studies are reviewed and commentaries provided by leading palliative care clinicians. Symptoms and treatment side effects addressed in this issue are: cardiovascular risk due to NSAIDs or COX-2 inhibitors; prolongation of the QT interval due to methadone use; depression and its treatment with scopolamine; adverse drug reactions related to cardiovascular medications, and their association with ethnicity; and medication nonadherence in Medicare enrollees due to cost considerations. [ABSTRACT FROM AUTHOR]

Depression is a common disorder with painful symptoms and, frequently, social impairment and decreased quality of life. The disorder has a tendency to be long lasting, often with frequent recurrence of symptoms. The risk of relapse and the severity of the symptoms may be reduced by correct antidepressant medication. However, the medication is often insufficient, both in respect to dosage and length of time. The reasons for incorrect medication are many, with lack of adherence to treatment being the most important. Although some patients taking antidepressant medication experience side effects, this may not be the most frequent reason for immature discontinuation of treatment. Other reasons for decreased adherence have been investigated in recent years. The patient's beliefs about the disorder and beliefs about antidepressants, including lack of conviction that the medication is needed and fear of dependence of antidepressant medicine, have a great influence on adherence to treatment. [ABSTRACT FROM AUTHOR]

The current highly active antiretroviral therapy (HAART), i.e., triple combination treatment including a protease inhibitor, allows for long-term suppression of HIV-replication. The intake guidelines, however, are very strict and, like many other HIV positive patients, drug users have problems in achieving good therapy compliance. As a result, the effectiveness of the medication therapy is seriously jeopardized. This qualitative study, involving in-depth interviews with 27 “hard drug” users in Amsterdam, seeks to provide better insights into the extent of adherence to HAART. In addition, factors that impede or facilitate adherence have been listed in order to develop and improve strategies. The study shows that almost half of the “hard drug” users interviewed do not adhere to the therapy. A large number of determinants for adherence were identified at the level of medication, the individual, and the environment. Many of these determinants can be influenced, which means that they can provide clues for the effective implementation of measures that may enhance effectiveness of treatment. [ABSTRACT FROM AUTHOR]