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Background: Patients with chronic conditions need multiple medications daily to manage their condition. However, most patients have poor compliance, which affects the effectiveness of treatment. To address these challenges, we establish a medication reminder system for the intelligent generation of universal medication schedule (UMS) to remind patients with chronic diseases to take medication accurately and to improve safety of home medication. Methods: To design medication time constraint with one drug (MTCOD) for each drug and medication time constraint with multi-drug (MTCMD) for each two drugs in order to better regulate the interval and time of patients' medication. Establishment of a medication reminder system consisting of a cloud database of drug information, an operator terminal for medical staff and a patient terminal. Results: The cloud database has a total of 153,916 pharmaceutical products, 496,708 drug interaction data, and 153,390 pharmaceutical product-ingredient pairs. The MTCOD data was 153,916, and the MTCMD data was 8,552,712. An intelligent UMS medication reminder system was constructed. The system can read the prescription information of patients and provide personalized medication guidance with medication timeline for chronic patients. At the same time, patients can query medication information and get remote pharmacy guidance in real time. Conclusions: Overall, the medication reminder system provides intelligent medication reminders, automatic drug interaction identification, and monitoring system, which is helpful to monitor the entire process of treatment in patients with chronic diseases. [ABSTRACT FROM AUTHOR]

Emerging adults aged 18–29 have high rates of viral non-suppression, and poorer adherence to ART when compared to older adults. Semi-structured interviews were conducted with 24 emerging adults in Zimbabwe who had a recent history of viral non-suppression, to explore barriers and facilitators of adherence to ART. Interviews were coded using inductive thematic analysis. The mean age of participants was 23, 65% were male, and 79% reported acquiring HIV at birth. Twelve barriers to adherence were identified. Hiding HIV status due to the possible negative consequences of disclosure had a significant impact on adherence to ART. This was particularly important for emerging adults navigating starting intimate relationships. Being away from home, poverty, poor mental health, isolation, significant life events, alcohol, health systems barriers, and stigma were reported as barriers to adherence. Support from peers and family after disclosure of HIV status, phone-based reminders, problem-solving strategies to adhere, knowing others living with HIV, acted as facilitators to adherence to ART. Beliefs about medicines and relationships with health care providers acted as both barriers and facilitators to adherence. Interventions to reduce stigma, foster peer support, and therapy for common mental disorders could facilitate emerging adults aged 18–29 to adhere to ART. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa (HS) is a chronic, debilitating skin condition that requires multimodal treatment. Adherence remains a significant challenge for many patients due to complex nature of treatment, thus presenting a barrier to management success. This review summarizes the current literature on the factors associated with adherence to medications, and lifestyle behaviors in patients with HS and proposes strategies to improve adherence. In February 2023, a systematic literature search was conducted by two independent authors on PubMed and EMBASE for articles from 2000 to 2023 on hidradenitis suppurativa adherence. A total of 21 articles met inclusion/exclusion criteria for this review. Of the studies, 11 addressed systemic medication adherence, 3 addressed topical medication adherence, 2 addressed both systemic and topical medication adherence, and 5 addressed lifestyle/behavioral modification adherence. The generalizability of results was limited by differences in study design, outcome measures, and sample size. English-only articles with full texts were used. The most reported reasons for non-adherence included presence of side effects, cost of medications, low efficacy, and unclear instructions. Proposed strategies to improve adherence in HS patients include management of side effects, use of reminder systems, improved patient education, patient support groups, aid of family and caregivers, personalization of the medication regimen, and regular follow-ups with patients. PROSPERO Registration Number: CRD42023488549. [ABSTRACT FROM AUTHOR]

Background: People living with HIV (PLWH) are at increased risk of cardiometabolic disorders (CMD). Adequate access to care for both HIV and CMD is crucial to improving health outcomes; however, there is limited research that have examined couples' experiences accessing such care in resource-constrained settings. We aimed to identify barriers to accessing CMD care among PLWH in Malawi and the role of partners in mitigating these barriers. Methods: We conducted a qualitative investigation of barriers to CMD care among 25 couples in Malawi. Couples were eligible if at least one partner was living with HIV and had hypertension or diabetes (i.e., the index patient). Index patients were recruited from HIV care clinics in the Zomba district, and their partners were enrolled thereafter. Interviews were conducted separately with both partners to determine barriers to CMD care access and how partners were involved in care. Results: Participants framed their experiences with CMD care by making comparisons to HIV treatment, which was free and consistently available. The main barriers to accessing CMD care included shortage of medications, cost of tests and treatments, high cost of transportation to health facilities, lengthy wait times at health facilities, faulty or unavailable medical equipment and supplies, inadequate monitoring of patients' health conditions, some cultural beliefs about causes of illness, use of herbal therapies as an alternative to prescribed medicine, and inadequate knowledge about CMD treatments. Partners provided support through decision-making on accessing medical care, assisting partners in navigating the healthcare system, and providing financial assistance with transportation and treatment expenses. Partners also helped manage care for CMD, including communicating health information to their partners, providing appointment reminders, supporting medication adherence, and supporting recommended lifestyle behaviors. Conclusions: Couples identified many barriers to CMD care access, which were perceived as greater challenges than HIV care. Partners provided critical forms of support in navigating these barriers. With the rise of CMD among PLWH, improving access to CMD care should be prioritized, using lessons learned from HIV and integrated care approaches. Partner involvement in CMD care may help mitigate most barriers to CMD care. [ABSTRACT FROM AUTHOR]

Juvenile idiopathic arthritis can be influenced by pain, medication adherence, and physical activity. A new digital health intervention, InteractiveClinics, aims to monitor these modifiable risk factors. Twelve children, aged 10 to 18 years, received daily notifications on a smartwatch to record their pain levels and take their medications, using a customised mobile app synchronised to a secure web-based platform. Daily physical activity levels were automatically recorded by wearing a smartwatch. Using a quantitative descriptive research design, feasibility and user adoption were evaluated. The web-based data revealed the following: Pain: mean app usage: 68% (SD 30, range: 28.6% to 100%); pain score: 2.9 out of 10 (SD 1.8, range: 0.3 to 6.2 out of 10). Medication adherence: mean app usage: 20.7% (SD, range: 0% to 71.4%), recording 39% (71/182) of the expected daily and 37.5% (3/8) of the weekly medications. Pro-re-nata (PRN) medication monitoring: 33.3% (4/12), one to six additional medications (mean 3.5, SD 2.4) for 2–6 days. Physical activity: watch wearing behaviour: 69.7% (439/630), recording low levels of moderate-to-vigorous physical activity (mean: 11.8, SD: 13.5 min, range: 0–47 min). To conclude, remote monitoring of real-time data is feasible. However, further research is needed to increase adoption rates among children. [ABSTRACT FROM AUTHOR]

To improve medication adherence, we co-developed a digital, artificial intelligence (AI)-driven nudge intervention with stakeholders (patients, providers, and technologists). We used a human-centred design approach to incorporate user needs in creating an AI-driven nudge tool. We report the findings of the first stage of a multi-phase project: understanding user needs and ideating solutions. We interviewed healthcare providers (n = 10) and patients (n = 10). Providers also rated example nudge interventions in a survey. Stakeholders felt the intervention could address existing deficits in medication adherence tracking and were optimistic about the solution. Participants identified flexibility of the intervention, including mode of delivery, intervention intensity, and the ability to stratify to user ability and needs, as critical success factors. Reminder nudges and provision of healthcare worker contact were rated highly by all. Conversely, patients perceived incentive-based nudges poorly. Finally, participants suggested that user burden could be minimised by leveraging existing software (rather than creating a new App) and simplifying or automating the data entry requirements where feasible. Stakeholder interviews generated in-depth data on the perspectives and requirements for the proposed solution. The participatory approach will enable us to incorporate user needs into the design and improve the utility of the intervention. Our findings show that an AI-driven nudge tool is an acceptable and appropriate solution, assuming it is flexible to user requirements. [ABSTRACT FROM AUTHOR]

Purpose Medication nonadherence is a multifactorial healthcare problem that contributes to increased healthcare costs and morbidity. To improve medication adherence, specialty pharmacies offer services not typically provided by retail pharmacies such as benefits investigation, financial assistance, medication synchronization, and proactive refill reminders. This study assessed the impact of the specialty pharmacy care model on medication adherence for patients on nonspecialty medications. Methods This study was a quasi-experimental cohort comparison of patients who were transferred from a health-system retail pharmacy to a health-system specialty pharmacy between April 1, 2020, and June 30, 2021. The primary endpoint in this study was the difference in mean medication adherence proportion of days covered (PDC) between the post-transfer and pretransfer periods. Secondary outcomes included the proportion of patients with PDC of greater than 80%, medication adherence by drug group, shipment volumes, number of medications per shipment, and the mean copay per medication. Results In this study of 163 patients, use of a specialty pharmacy care model led to a significant increase of 7.0% in mean PDC, a significant increase in the percentage of patients with PDC of greater than 80%, a significant decrease in the number of shipments per 30 days per patient, a significant increase in the number of medications included per shipment, and a significant reduction in the mean copay per medication. Conclusion The findings in this study suggest that the application of the specialty pharmacy care model to nonspecialty pharmacy patients may improve medication adherence, decrease the number of shipments per patient sent from the pharmacy, and reduce patient copays. [ABSTRACT FROM AUTHOR]

Introduction Unpaid carers are an increasing proportion of the UK population. One of the many ways in which they help those they care for is assisting with medication adherence. Many older adults have medicines dispensed in pharmacy-filled multi-compartment medication compliance aids (pMCAs). However, evidence suggests that pMCAs may increase medication-related harm, and little is known about the interaction between the user, medication adherence systems and the carer. Aim To explore the views of carers supporting older adults to manage their medications with and without a pMCA. Method A researcher-administered questionnaire survey of carers supporting older adults to manage their medicines with or without a pMCA. Participants were recruited from inpatient wards, outpatient clinics and community services in central London. Responses were analysed by two independent researchers to identify overarching themes. Results Eighty-eight unpaid carers were interviewed and responses were categorised according to the medication adherence method used; 47 supported a user with a pMCA and 41 supported without a pMCA. The main themes were: Time, Responsibility and Mistakes, Waste and Sustainability, and Polypharmacy, with sub-themes of design of multi-compartment medication compliance aids, organisation and reassurance. Conclusion Supporting medication adherence puts considerable burden on carers regardless of whether a self- or pharmacy-filled medication compliance aid is used or not. Prescribers could alleviate this burden through regular medication review by considering the prescribing frequency and duration and medication rationalisation. Redesign of both pMCAs and systems surrounding their use could also help reduce carer's burden and environmental burden. [ABSTRACT FROM AUTHOR]

Purpose The Nudge Study is a patient level–randomized trial testing different text message medication refill reminders sent to patients assigned to 4 arms: (1) usual care, (2) generic text, (3) optimized text, and (4) optimized text plus chatbot. This report describes the frequency and types of patient questions sent to clinical pharmacists (CPs) following text reminders. Methods Patients were enrolled from Denver Health and Hospital Authority (DHHA) and Veterans Affairs Eastern Colorado Health Care System (VA ECHCS) from October 1, 2019, through May 30, 2021. Included patients responded to at least 1 text or interactive voice response (IVR) message. Patients were dichotomized as those who posed at least 1 question to a CP and those who posed no questions. Results Of the 6,325 patients enrolled in an intervention arm, 3,323 (52.5%) responded to at least 1 text or IVR message, and among those responding, 305 (9.2%) responded with a pharmacist question. Patient factors associated with submitting a CP question included age (45-74 years), enrollment from DHHA, and receipt of the optimized text or optimized text plus chatbot message versus the generic text. Questions to CP were in the following categories: medication related (48.2%), refill logistics (38.4%), cost (9.2%), and other (17.7%). Conclusion In a text messaging intervention focused on medication refills, there were few questions directed to the CP. Patients assigned to receive optimized texts were more likely to have questions. We hypothesize that this may suggest greater patient engagement regarding their condition, resulting in more questions. [ABSTRACT FROM AUTHOR]

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Non-adherence to a medication regime often has a negative impact on patient outcomes. With a relatively low cost, many countries are using short messaging services to reduce non-adherence rates. In Thailand, research using a short messaging service reminder for people to take their medications is understudied. This multi-center randomized controlled trial, 2-arm, parallel-group research aimed to determine the effects of 2-way SMS reminders on the medication adherence and quality of life of adults with type 2 diabetes mellitus. Data were collected from 63 participants with diabetes in a treatment group (33) and a control group (30). The sample consisted of adults aged 18 and older who were diagnosed with diabetes living in a northeast province of Thailand. All participants received standard care, but those in the treatment group also received a tailored 2-way short message service as a mobile health (mHealth) treatment for four months. Medication adherence was measured by the level of hemoglobin A1c. Quality of life was measured using the Thai version of a Quality-of-Life Questionnaire developed by the World Health Organization and the Diabetes-39 Questionnaire. Data were analyzed using descriptive statistics. One-way repeated measures ANOVA was used to compare hemoglobin A1c levels and quality of life mean scores across three-time points (0, 2, and 4 months). The results revealed that at the completion of the study, the participants in the treatment group had significantly lower hemoglobin A1c than those in the control group and significantly better health-related quality of life, demonstrating that the 2-way SMS reminder service improved their health outcomes. Thus, it is recommended that nurses should employ mHealth, such as 2-way SMS reminder solutions tailored to patients' daily routines. A future investigation comparing the cost-effectiveness and patient outcomes of different mHealth technologies is suggested. [ABSTRACT FROM AUTHOR]

Nonadherence to medicines is a global problem compromising health and economic outcomes for individuals and society. This article outlines how adherence is defined and measured, and examines the impact, prevalence and determinants of nonadherence. It also discusses how a psychosocial perspective can inform the development of interventions to optimise adherence and presents a series of recommendations for future research to overcome common limitations associated with the medication nonadherence literature. Nonadherence is best understood in terms of the interactions between an individual and a specific disease/treatment, within a social and environmental context. Adherence is a product of motivation and ability. Motivation comprises conscious decision-making processes but also from more 'instinctive', intuitive and habitual processes. Ability comprises the physical and psychological skills needed to adhere. Both motivation and ability are influenced by environmental and social factors which influence the opportunity to adhere as well as triggers or cues to actions which may be internal (e.g. experiencing symptoms) or external (e.g. receiving a reminder). Systematic reviews of adherence interventions show that effective solutions are elusive, partly because few have a strong theoretical basis. Adherence support targeted at the level of individuals will be more effective if it is tailored to address the specific perceptions (e.g. beliefs about illness and treatment) and practicalities (e.g. capability and resources) influencing individuals' motivation and ability to adhere. [ABSTRACT FROM AUTHOR]

Literature review reveals that adherence to prescribed therapy at hospital discharge averages around 50%. The purpose of this study was to evaluate adherence to prescribed therapy assessing the relationship between re-hospitalization rate at 30 days and degree of therapeutic adherence in a sample of elderly patients discharged from an acute geriatric ward using an Electronic Medication Packaging device, MePill. The study population (n = 56) was divided in 3 groups, a counseling group (A), a counseling + MePill device group (B) and a control group (C). Group A had 98.1% adherence to therapy, Group B had 100%, and control group had 90%. Analyzing the rate of hospitalization by type of intervention for Group A and C the hospitalization rate was 21% and 27.7%, respectively, whilst for Group B no patient was hospitalized. Participants in Group A and C had the shorter hospitalization-free survival as compared with subjects in Group B. [ABSTRACT FROM AUTHOR]

Background: Globally, type 2 diabetes has become increasing. As little is known about the effect of educational intervention on this population, this systematic review and meta-analysis evaluated the effectiveness of mobile phone text message reminders versus usual care to improve medication adherence among type 2 diabetes mellitus patients. Methods: PubMed, Google Scholar, Cochrane Library, Scopus, and African Journals Online, were searched. A random-effects model was employed to estimate combined effect sizes. Subgroup analyses were employed to investigate possible sources of heterogeneity between studies. The overall certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: A total of 9 trials with 1,121 participants were included in the review. The pooled estimated impact of mobile phone text message reminders on medication adherence was (SMD: 0.36; 95%CI; 0.14, 0.59) compared to usual care groups among patients with type 2 diabetes mellitus. In addition, subgroup analyses revealed greater medication adherence levels in those studies with intervention durations of more than six months and with self-report/refill adherence scale measurement (SMD: 0.21; 95%CI: 0.02, 0.40) and (SMD: 0.45; 95%CI: 0.22, 0.68), respectively. Conclusion: Mobile phone text messages can potentially lead to improved medication adherence levels in patients with Type 2 diabetes despite heterogeneity across the studies. Therefore, mobile phone text messaging when delivered in addition to usual care, have the potential to produce significant improvements in medication adherence. [ABSTRACT FROM AUTHOR]

Objectives: Considering the need of diabetic patients for accessing the care system and the role of modern media in health education and culture, we aimed to determine the effectiveness of educating via mobile SMS in controlling blood sugar. Moreover, the adherence to drug treatment of patients with type 2 diabetes was assessed. Methods: This quasi-experimental study was conducted in Isfahan City, Iran in 2018. A total of 100 diabetic patients participated in the case (intervention) and control groups. The control group underwent conventional therapies and training. SMS training was applied for the intervention group in addition to the conventional therapies. Collecting the information and data to assess adherence to patients' treatment was done using a researcher-made 18-item questionnaire. Analyzing data was performed in SPSS software, version 20 through the employment of the independent t test, paired t test, and multivariate analysis of covariance. Results: Based on the independent t test results, no significant difference was detected between the two study groups at any time points (P>0.05) in terms of the mean fasting blood sugar. However, by analysis of covariance and adjusting the fasting blood sugar level before the intervention in the studied groups, the mean fasting blood sugar was recognized to be significantly lower in the intervention group compared to the control group in the second month (P=0.048) and the third month after the intervention (P=0.008). Discussion: There is an association between SMS education and fasting blood sugar control and adherence to treatment in the studied patients. In the field of health care education, it is possible to use patient communication techniques and short message services to control follow-up and monitor interventions. [ABSTRACT FROM AUTHOR]

Black men who have sex with men (BMSM) experience higher rates of HIV infection than other groups. They also face disparities in linkage and retention to HIV care, as well as in viral suppression. To address the needs of the BMSM population living with HIV, we developed a novel intervention program (+LOVE), which integrated case management with behavioral health/crisis support. The intervention consisted of (1) a dedicated therapist; (2) an SMS (text message)-based engagement program, CareSignal that provided medication reminders and administered routine ecological momentary assessments (EMAs); (3) a triage crisis coordinator to respond to alerts generated by the EMA responses; and (4) a case manager. This study assessed the additional impact of the first three components of the intervention (a dedicated therapist, text messaging application, along with a triage crisis coordinator), compared with the fourth component alone, the current standard of care (a case manager) on access to HIV care, antiretroviral therapy (ART) adherence, and viral suppression. Analyzing electronic medical record data, survey data, and EMA response data extracted from CareSignal, we found that those who engaged in the behavioral health therapy had higher odds of remaining in HIV care than those who only engaged with the case manager. We also found that increased engagement with CareSignal led to an increased probability of achieving positive HIV-related health outcomes. Our results suggest that an integrated behavioral health/crisis support model of intervention integrated with case managementincreased positive outcomes over case management alone. [ABSTRACT FROM AUTHOR]

Objective: Interventions to elicit accountability capitalize on social behaviors to improve adherence but are distinct from reminders. However, little is known about the impact of accountability in reminder-based adherence interventions. Through a literature review, we aim to identify the frequency and effectiveness of accountability in reminder-based intervention studies.Methods: PubMed and PsycArticles were searched for reminder-based adherence studies. Articles were categorized as reminder-only or reminder with accountability studies. Studies were characterized by outcome measures, and differences between control and intervention groups were compared for studies that used electronic monitoring devices.Results: 165 studies met the inclusion criteria; 154 used reminders without accountability (93%). 79 of the 154 reminder-only studies (51%) improved adherence in intervention groups compared to controls. Eleven of the 165 studies (6.6%) included an accountability aspect. The intervention group had better adherence than controls in 10 out of the 11 reminder with accountability studies (91%).Conclusions: Although distinct from reminders, accountability can be incorporated in reminder-based interventions. However, it is not commonly included in reminder-based interventions.Practice Implications: It is important to consider accountability's effects on encouraging patient medication adherence. The addition of accountability interventions may further boost adherence, but few studies currently incorporate these types of interventions. [ABSTRACT FROM AUTHOR]

Background: Medication adherence plays a pivotal role in achieving the desired treatment outcomes. The proportion of HIV patients on second-line antiretroviral therapy is becoming a growing public health concern. However, to date, little attention has been given to second-line antiretroviral medication adherence. Moreover, the association between health facility characteristics and medication adherence has yet not been tested. Thus, this research was conducted to determine the magnitude of medication adherence and examine the role of facility-level determinants among HIV patients on second-line ART. Methods: A cross-sectional study was conducted on 714 HIV patients on second-line therapy who were selected via systematic random sampling in twenty public health facilities. Medication adherence was measured using the six-item Simplified Medication Adherence Questionnaire (SMAQ) tool. Data were collected in a personal interview as well as document reviews. A multi-level binary logistic regression was used to uncover individual and facility-level determinants. The effect size was presented using an adjusted odds ratio (AOR), and statistical significance was declared at a P value less than 0.05. Results: The magnitude of optimal medication adherence among HIV patients on second-line antiretroviral therapy was 69.5% (65.9–72.7%). Medication adherence was positively associated with the use of adherence reminder methods [AOR = 3.37, (95% CI 2.03–5.62)], having social support [AOR = 1.11, (95% CI 1.02–1.23)], and not having clinical depression [AOR = 3.19, (95% CI 1.93–5.27). The number of adherence counselors [AOR = 1.20, (95% CI 1.04–1.40)], teamwork for enhanced adherence support [AOR = 1.82, (95% CI 1.01–3.42)], and caseloads at ART clinics were all significantly correlated with ARV medication adherence at the facility level. Conclusions: A large proportion of HIV patients on second-line antiretroviral therapy had adherence problems. Both facility-level and individual-level were linked with patient medication adherence. Thus, based on the identified factors, individual and system-level interventions should be targeted. [ABSTRACT FROM AUTHOR]

Introduction: A mobile-based application is one of the potential solutions to manage conditions of people living with human immunodeficiency virus (HIV) in real-time. This study aimed to design and develop HIV self-management mobile application as a suitable solution for HIV self-management of people living with HIV. Material and methods: This study was a mixed-method in nature, carried out in five phases: 1) comparative study of existing mobile applications; 2) developed its' object-oriented conceptual model; 3) developed the initial version approved for production; 4) implementation of the final version of Aysoo, and 5) evaluation. Statistical population consisted of HIV-positive people who attended the Iranian Research Center for HIV/AIDS (IRCHA) in 2019. Results: Aysoo was developed for appropriate HIV self-management, which provided the following main functionalities: registration of clinical symptoms, HIV/acquired immune deficiency syndrome (AIDS) management information, educational information in different stages of HIV, specific care plans based on HIV viral load, reminders to encourage medication adherence, physical activities, nutrition, and in-person visits. Conclusions: HIV mobile-based self-management application Aysoo, has been developed in compliance with health information management (HIM) and infectious diseases experts' opinions. Aysoo is expected to be helpful in managing HIV condition and increase medication adherence of people living with HIV. [ABSTRACT FROM AUTHOR]

Nonadherence to a long-term therapy, including diabetes mellitus, is one of the global problems that need to be overcome. This study aims to determine the effect of pillbox use and education by pharmacists toward medication adherence in patients with diabetes mellitus in a Primary Health Care Center in Mataram. This research was an experimental research design with pretest-posttest with control group design. The study was conducted from October to December 2019 at Tanjung Karang Primary Health Care Center, Mataram. Measurement of adherence was done using the Adherence to Refill and Medication Scale questionnaire. The higher the score, the more nonadherence the patients. Patients were divided into three groups, which were the control group, educational intervention group, and pillbox and educational intervention group. Each group consisted of 11 patients. Patients' medication adherence increased from 19.54 (SD 4.37) to 15.18 (SD 2.64) in the education and pillbox intervention group (p=0.004). Whereas, in the education and control group, the adherence did not provide a significant change (p>0.05). Based on the difference in adherence scores, it was known that what contributed to changes in compliance was refilling medicine and intentional nonadherence in taking medicine subscale (p=0.024). Providing education and pillbox done by pharmacists at the Primary Health Care Center can increase adherence to the therapy of diabetes mellitus patients. Pharmacists at the Primary Health Care Center can use the intervention model to improve the level of adherence of patients with chronic illness. [ABSTRACT FROM AUTHOR]

Mobile health (mHealth) has gained considerable interest recently due to its potential to improve health outcomes in developing countries with high outreach yet low costs. Several studies have explored the use of short message service (SMS) reminders to improve antiretroviral (ARV) retention and adherence, with mixed results. The majority of these studies has a quantitative nature and employs randomized designs, which do not provide further qualitative insights about other possible impacts of the messages. Based on the qualitative assessment of an SMS intervention in Burkina Faso, which complemented a (quantitative) Randomized Controlled Trial (RCT), we show that beyond the functional role of improving ARV retention and adherence, SMS messages can also play important symbolic roles in offering psychosocial support to people living with HIV (PLHIV) and improving their perception of life. Concomitantly, we show that sufficient (ICT) literacy skills cannot be taken for granted in resource-poor settings. Yet, regardless of (ICT) literacy skills, the symbolism of care was perceived. Furthermore, we highlight the importance of complementing quantitative evidence of mHealth interventions with qualitative assessments. [ABSTRACT FROM AUTHOR]

Postoperative nausea and vomiting (PONV) degrades patient experience and increases healthcare costs. Estimates of PONV range from 10% to 80%. The Apfel Simplified Score is an evidence-based instrument for determining individual risk of PONV. Scoring enables anesthesia providers to match antiemetic strategies with the calculated risk of PONV. Data were collected across 3 times. After the Apfel scoring system was automated into the electronic medical record, providers were more likely to increase PONV prophylaxis for patients at highest risk and reduce prophylaxis for patients at lowest risk. Rates of PONV remained similar at baseline (34.7%) and in the early postimplementation period (38.8%); a modest reduction was observed in the final period (26.5%). Intravenous ondansetron, the most common antiemetic at baseline, was not available in the early postimplementation period, which may partially explain the initial increase in PONV. While ondansetron was unavailable, providers began using 3 other antiemetics, a practice that persisted once intravenous ondansetron returned. The Apfel score is an evidence-based tool that providers can use to reduce the risk of PONV. This electronic tool and the reminder cards have been shared across the US Military Health System, fostering an organizational culture that values targeted prophylaxis for PONV. [ABSTRACT FROM AUTHOR]

Introduction In India, chronic diseases account for 53% of deaths and 44% of disability-adjusted-life-years lost.1 Management of chronic diseases requires long-term medication usage, but a high burden of medication non-adherence represents a major public health challenge in India.2,3 Low adherence is associated with poor patient outcomes that further accentuates healthcare costs.4 Implementing cost-effective interventions targeted at improving adherence are urgently warranted to improve outcomes and reduce complications arising from the growing burden of chronic diseases. However, the majority of evidence for medication adherence improving strategies is based on more economically developed countries and existing reviews in low- and middleincome countries tend to focus on specific diseases across countries. We conducted, to our knowledge, the first systematic review evaluating interventions aimed at improving medication adherence for chronic diseases in India. Methods The study was conducted according to the PRISMA 2020 framework. Included studies were those that were randomised control trials (RCTs), involving subjects with non-communicable chronic diseases located in India, looking at any intervention with the aim of improving medication adherence and which measured adherence as a primary or secondary outcome. Methodological quality was assessed using the Cochrane RoB2. Results A PRISMA flow diagram is shown below (Fig 1). 22 RCTs were included in this review. Educational interventions provided by pharmacists (seven studies) or community health workers (four studies) showed strong evidence for improving adherence across a range of chronic diseases. Reminder-based systems were moderately effective when implemented alone (two studies) and synergised well with education-based interventions to improve adherence (four studies). Other individual studies sought to improve training for community health workers, utilise a multidisciplinary team approach, employ psychological based interventions or use polypill-based approaches. For five studies, we found that there were significant improvements in measures of adherence without corresponding improvements in clinical parameters that represented disease control. Five studies were deemed low risk of bias, six were high risk and 11 were assessed as some concerns. Discussion There is moderate evidence for adherence improving strategies for patients with chronic diseases in India, although further large-scale RCTs over long timeframes are required to evaluate real-world effectiveness and costs. Patient education was found to be the most consistent intervention for improving medication adherence, reflecting reasons for non-adherence often involving patients' beliefs and poor health literacy.2,5 Reminder-based systems were most useful when combined with patient education, perhaps reflecting the need to first address underlying barriers to adherence attributable to suboptimal patient provider communication. Other interventions, such as psychology-based approaches, are less cost-effective and scalable, and their usefulness may be limited to those with poor adherence refractory to other interventions. Mixed methodological quality, short study timeframes and heterogenous use of outcome measures were the primary limitations to this review. Conclusion Patient education strategies and reminder-based systems are effective strategies for improving medication adherence and clinical outcomes in patients with chronic diseases in India, suggesting the need for enhanced strategic focus on these areas and their incorporation in local health policy. [ABSTRACT FROM AUTHOR]

Background: Pre-exposure prophylaxis (PrEP) is an effective biomedical strategy to prevent transmission of HIV infection, although medication adherence remains a challenge. We present the protocol for a multicentre randomised controlled trial to measure the effectiveness of a real-time monitoring and just-in-time intervention on medication adherence among PrEP users in China.Methods: Study participants will include 1000 men who have sex with men (MSM) from four cites in China (Shenyang, Beijing, Chongqing and Shenzhen) attending a tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) PrEP project as part of a real-world, prospective multicentre cohort study (CROPrEP). Participants will be randomised into the intervention and control arms in a 1:1 ratio. Participants in the intervention arm will be provided with remote real-time monitoring equipment that triggers twice just-in-time SMS (Short Messaging Service) medication reminders to PrEP users every half an hour when a scheduled dosage is missed, and followed with just-in-time SMS medication reminders to clinicians half an hour when there is no supplement after the second just-in-time SMS reminder to PrEP users. Clinicians will initiate individualised telephone intervention as soon as possible upon receipt of the just-in-time SMS missed dose alert. Those in the control arm will only receive generic weekly SMS reminders. The study will last 6 months. Participants will be seen at follow-up visits at three and 6 months. Trial outcomes to be measured include self-reported adherence assessed via questionnaire and pill counts, as well as drug concentration test results.Discussion: Medication adherence is critical to achieve optimal benefits from PrEP. This study will be the first individualised behaviour intervention using real-time technology to increase adherence among MSM PrEP users globally. If found effective, a real-time monitoring and just-in-time intervention system may be utilized for improving adherence and thus effectiveness of global PrEP application.Trial Registration: This study registered at ClinicalTrials.gov ( ChiCTR1900025604 ) on September 2, 2019. [ABSTRACT FROM AUTHOR]

Background: With China experiencing unprecedented economic development and social change over the past three decades, Chinese policy makers and health care professionals have come to view mental health as an important outcome to monitor. Our study conducted an epidemiological study of psychosis in Guangdong province, with 20 million real-world follow-up records in the last decade.Methods: Data was collected from Guangdong mental health information platform from 2010 to 2019, which had standardized disease registration and follow-up management for nearly 600,000 patients with six categories of mental diseases and 400,000 patients with schizophrenia. We conducted clinical staging for the disease course of the patients and divided the data with various factors into different stages of disease. Quantitative analysis was utilized to investigate the high relevant indicators to the disease. The results were projected on geography map for regional distribution analysis.Results: The majority cases of mental disease incidence were between the age of 15 and 29, while the peak age for both male and female was between 20 to 24 years old. The disease course with the largest number of patients' cases was between 5 to 10 years. The therapeutic effect of patients gradually decreased with the development of disease course, while the risk increased with the disease course. The analysis of influencing factors showed that poor economic conditions incurred higher risk scores, and good medication adherence was effective in improving treatment outcomes. In addition, receiving good education contributed to the reduction of the risk of schizophrenia and the improvement of the efficiency of early treatment. Through the analysis of regional distribution of schizophrenia disease, developed economic conditions and favorable resource conditions could promote the reduction of disease risk, while in economically backward regions, it often accompanied with lower therapeutic effect and higher disease risk.Conclusions: Certain demographic factors had a relatively prominent impact on the therapeutic effect and risk of schizophrenia, such as high-quality medication adherence. Therapeutic effect and risk were highly correlated. Backward economic conditions often associated with poor efficacy and higher risk assessment, and the developed economy and better medical resource are beneficial for the treatment of psychotic. [ABSTRACT FROM AUTHOR]

Can personal digital assistants such as Amazon Alexa help to improve patients' adherence to their medicines? Here, the authors discuss the potential and the limitations of this technology, and describe their pilot study in patients with diabetes and other underlying health conditions. [ABSTRACT FROM AUTHOR]

Consistent dosing of tenofovir/emtricitabine-based HIV pre-exposure prophylaxis (PrEP) can reduce HIV infection risk by up to 92%. However, clinical trials have shown low PrEP adherence (34-71%), resulting in reduced effectiveness. To improve PrEP's effectiveness, adherence to a daily PrEP regimen is essential. This report explores patients' patterns of PrEP initiation and use and their PrEP-related perceptions to provide greater understanding of patient motivations for beginning and adhering to PrEP. At two urban primary care clinics, individual coaching sessions that included semistructured interviews were offered to 10 PrEP patients. Regarding PrEP initiation, 30% of patients were advised to use PrEP by their nurse practitioners (NPs), while the remaining patients requested PrEP themselves. Before they initiated PrEP, all patients were familiar with it through social contacts or internet-based research. Patients' PrEP-related perceptionswere identified, including perceived pros and cons of PrEP use, and degrees of PrEP knowledge, uncertainty, and fear. Primary care NPs should take detailed sexual histories to avoid overlooking PrEP candidates. In addition, primary care NPs should introduce easy-to-access, Internet-based resources to reinforce patient education. Last, PrEP promotional campaigns should be focused at the community level in gay, bisexual, transgender and queer populations. [ABSTRACT FROM AUTHOR]

Rationale: Tuberculosis treatment lasts for 6 months or more. Treatment adherence is critical; regimen length, among other factors, makes this challenging. Globally, analyses mapping common types of nonadherence are lacking. For example, is there a greater challenge resulting from early treatment cessation (discontinuation) or intermittent missed doses (suboptimal dosing implementation)? This is essential knowledge for the development of effective interventions and more "forgiving" regimens, as well as to direct national tuberculosis programs.Objectives: To granularly describe how patients take their tuberculosis medication and the temporal factors associated with missed doses.Methods: The present study included patients with pulmonary tuberculosis enrolled in the control arm of a pragmatic, cluster-randomized trial in China of electronic reminders to improve treatment adherence. Treatment was the standard 6-month course (180 d), dosed every other day (90 doses). Medication monitor boxes recorded adherence (box opening) without prompting reminders. Patterns of adherence were visualized and described. Mixed-effects logistic regression models examined the temporal factors associated with per-dose suboptimal dosing implementation, adjusting for clustering within a participant. Cox regression models were used to examine the association between early suboptimal dosing implementation and permanent discontinuation.Results: Across 780 patients, 16,794 (23.9%) of 70,200 doses were missed, 9,487 of which were from suboptimal dosing implementation (56.5%). By 60 days, 5.1% of participants had discontinued, and 14.4% had discontinued by 120 days. Most participants (95.9%) missed at least one dose. The majority of gaps were of a single dose (71.4%), although 22.6% of participants had at least one gap of 2 weeks or more. In adjusted models, the initiation-continuation phase transition (odds ratio, 3.07 [95% confidence interval, 2.68-3.51]) and national holidays (1.52 [1.39-1.65]) were associated with increased odds of suboptimal dosing implementation. Early-stage suboptimal dosing implementation was associated with increased discontinuation rates.Conclusions: Digital tools provide an unprecedented step change in describing and addressing nonadherence. In our setting, nonadherence was common; patients displayed a complex range of patterns. Dividing nonadherence into suboptimal dosing implementation and discontinuation, we found that both increased over time. Discontinuation was associated with early suboptimal dosing implementation. These apparent causal associations between temporal factors and nonadherence present opportunities for targeted interventions.Clinical trial registered with the ISRCTN Registry (ISRCTN46846388). [ABSTRACT FROM AUTHOR]

Background: The health behaviors and blood pressure control of patients with hypertension who have had a stroke are unsatisfactory. A protocol of a comprehensive reminder system has been published, and the results of 3 months of implementation have demonstrated improved patient health behaviors and blood pressure control. The continuity of the intervention effect on these variables after 3 months was not clear. Objective: The aim of this study was to determine the impact of a comprehensive reminder system intervention on health behaviors, medication adherence, blood pressure, disability, and stroke recurrence in patients with hypertension who have had a stroke from baseline to 6 months after discharge. Method: A multicenter, assessor-blinded, randomized controlled trial was conducted with 174 patients with hypertension who have had a stroke. The intervention consisted of health belief education, a calendar handbook, weekly short message services, and telephone interviews. Data were collected at baseline and at 3 and 6 months after discharge. Results: Repeated-measures analysis of variance and single-effect analysis revealed that, compared with the control group, improvements of health behaviors, medication adherence, blood pressure, and disability of participants in the intervention group were superior. From 3 to 6 months after discharge, these trends remained or continually improved, whereas a downward trend was observed in the control group. There were only 2 stroke recurrences within 6 months, and no statistically significant difference between groups was found. Conclusion: The comprehensive reminder system improved patients' health behaviors and medication adherence and reduced blood pressure and disability; the effect extended to 6 months after discharge. [ABSTRACT FROM AUTHOR]

Poor adherence to complex medication regimens is a global problem that affects the treatment of chronic diseases, which involves polypharmacy and requires long-term administration of medications. The most significant barrier to medication adherence in older adults is patient-related factors. The purpose of this study was to find evidence from the current literature to evaluate the effectiveness of electronic medication packaging (EMP) devices on improving medication adherence in older patients. MEDLINE and EMBASE databases were searched based on inclusion/exclusion criteria, focusing on medication adherence and EMP devices with specific technological features. Search results included studies with experiences of patients with four different devices and various medical conditions. Study results indicated that EMP devices may improve medication adherence in older patients. However, due to insufficient evidence that supports their effectiveness specifically in the aging population, further clinical validation in older adults is recommended to draw strong conclusions. [Poor adherence to complex medication regimens is a global problem that affects the treatment of chronic diseases, which involves polypharmacy and requires long-term administration of medications. The most significant barrier to medication adherence in older adults is patient-related factors. The purpose of this study was to find evidence from the current literature to evaluate the effectiveness of electronic medication packaging (EMP) devices on improving medication adherence in older patients. MEDLINE and EMBASE databases were searched based on inclusion/exclusion criteria, focusing on medication adherence and EMP devices with specific technological features. Search results included studies with experiences of patients with four different devices and various medical conditions. Study results indicated that EMP devices may improve medication adherence in older patients. However, due to insufficient evidence that supports their effectiveness specifically in the aging population, further clinical validation in older adults is recommended to draw strong conclusions. [Journal of Gerontological Nursing, 46(3), 27–36.] [ABSTRACT FROM AUTHOR]

Objective: Frequent monitoring of patients with early rheumatoid arthritis (RA) is required for achieving good outcomes. This study was undertaken to investigate the influence of text message (SMS)-enhanced monitoring on early RA outcomes.Methods: We randomized 166 patients with early, disease-modifying antirheumatic drug-naive RA to receive SMS-enhanced follow-up or routine care. All patients attended visits at 0, 3, and 6 months, and a follow-up visit at 12 months. Treatment was at the physicians' discretion. The intervention included 13 SMSs during weeks 0-24 with questions concerning medication problems (yes/no) and disease activity (patient global assessment [PtGA], scale 0-10). Patients were contacted if response SMSs indicated medication problems or PtGA exceeded predefined thresholds. Primary outcome was 6-month Boolean remission (no swollen or tender joints and normal C-reactive protein levels). Quality of life (QoL; measured by the Short Form 36 survey) and Disease Activity Score in 28 joints (DAS28) were assessed.Results: Six and 12-month follow-up data were available for 162 and 157 patients, respectively. In the intervention group, 46% of the patients (38 of 82) reported medication problems and 49% (40 of 82) reported text message PtGAs above the alarm limit. Remission rates at 6 months (P = 0.34) were 51% in the intervention group and 42% in the control group. These rates were 57% and 43% at 12 months (P = 0.17) in the intervention and control groups, respectively. The respective mean ± SD DAS28 scores for the intervention and control groups were 1.92 ± 1.12 and 2.22 ± 1.11 at 6 months (P = 0.09); and 1.79 ± 0.91 and 2.08 ± 1.22 at 12 months (P = 0.28). No differences in QoL were observed.Conclusion: The study did not meet the primary outcome despite a trend favoring the intervention group. This may be explained by the notably high overall remission rates. [ABSTRACT FROM AUTHOR]

Medication adherence is important for glycaemic control. However, less than half of those with Type 2 diabetes take medications as prescribed. One of the known barriers to medication adherence is forgetfulness. Given the current ubiquity of smartphones, diabetes self‐management apps represent a valuable avenue for providing medication reminders to help users adhere to their medication treatments and improve health outcomes. We assessed 181 diabetes management apps for the presence of medication reminder features and compared their characteristics with the evidence provided in studies showing the effectiveness of SMS reminders. We found that only 55.8% of the apps had a basic medication reminder function, although those that had them conformed to the characteristics of SMS reminders shown to be effective. This is an important missed opportunity for diabetes management apps to contribute not only to improving medication adherence, but also in having a positive effect on the health outcomes of this population. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of self-management education tailored to health literacy on medication adherence and blood pressure control.Method: This randomized controlled trial was conducted in 2018 with 118 elderly people with uncontrolled primary hypertension and inadequate health literacy. Self-management education was developed on the basis of the health literacy index. Medication adherence and blood pressure were assessed using 8-items Morisky Medication Adherence Scale and a mercury sphygmomanometer, respectively.Results: At baseline, there were no significant between-group differences regarding participants' demographic characteristics, medical history, and medication adherence. After the intervention, between-group comparisons adjusted for pretest scores showed a significant reduction in the mean score of systolic and diastolic blood pressure and increase adherence to medication due to intervention (P < 0.05). However, the proportions of controlled systolic and diastolic blood pressure were not statistically significant different between-group (P > 0.05).Conclusion: Self-management education tailored to health literacy significantly promotes medication adherence but has no significant effects on control of blood pressure.Practice Implication: To promote adherence to antihypertensive medications, tailored patient education to Health literacy is recommended. Limited pieces of evidence are available on the effectiveness of health literacy index-based interventions, so further studies are required. [ABSTRACT FROM AUTHOR]

Background and Objectives Managing medications can be stressful for spousal caregivers, but little is known about particular aspects of medication management that are most consequential for caregiving outcomes. We examined care stressors and resources related to medication management, their associations with role overload among spousal caregivers, and whether these links vary by care recipients' number of chronic health conditions and dementia status. Research Design and Methods This cross-sectional study included 377 spousal caregivers of adults aged 65 and older from the 2011 National Health and Aging Trends Study and National Study of Caregiving. Linear regressions were estimated to evaluate how medication-related stressors (ordering medication, keeping track of medications, giving injections) and resources (medication reminder systems, shared medication management within the spousal dyad) are associated with caregivers' role overload. Care recipients' number of chronic health conditions and dementia status were considered as moderators. Models controlled for caregivers' sociodemographic characteristics, chronic health conditions, and other care tasks. Results Caregivers who administered injections reported more role overload, whereas those who worked with care recipients to jointly manage medications reported less role overload. Keeping track of medications was linked to caregivers' greater role overload when care recipients had 5 or more chronic health conditions. Finally, care recipients' use of medication reminder systems was linked to less role overload for caregivers of a partner with dementia. Discussion and Implications Devising strategies to assist spousal caregivers in the more onerous components of medication management and promote resources that mitigate medication-related stress may improve caregiver well-being. [ABSTRACT FROM AUTHOR]

Objective: The objective of the current work was to assess the frequency of non-adherence behaviors and potential association with patients' experience with healthcare and beliefs in medicines self-reported by patients with four different chronic conditions.Methods: Patients responded anonymously to a survey comprising five non-adherence behaviors (based on physician and patient input), an assessment of patients' experience with healthcare using the validated Instrument to Evaluate the EXperience of PAtients with Chronic diseases (IEXPAC), and a validated Spanish version of the Beliefs about Medicines Questionnaire (BMQ). Associations of non-adherence behavior were analyzed using logistic regression models.Results: Of 1530 respondents, 53.1% reported ≥1 non-adherence behavior. Non-adherence rates were 59.8% in diabetes mellitus (DM), 56.0% in rheumatic disease, 55.6% in inflammatory bowel disease, and 42.8% in human immunodeficiency virus (HIV) infection patients (p < .001). IEXPAC and BMQ scores were higher in adherent vs. non-adherent patients. In multivariate analysis, non-adherence behavior was strongly associated with lower overall BMQ, lower BMQ Necessity scores and higher BMQ Concerns scores (p < .001 for all), and with a lower IEXPAC self-management score (p = .007), but not with the overall IEXPAC score. Non-adherence was more frequent in DM patients compared with HIV infection patients (p < .001).Conclusions: Patients' beliefs in medicines-a lower perception for the necessity of medication, and higher concerns in taking medication-and low patient self-management experience score were associated with non-adherence behavior. These are modifiable aspects that need to be addressed to increase medication adherence in chronic disease. [ABSTRACT FROM AUTHOR]

Background: Compliance is commonly and always being confused with concordance, which is a process by which a patient and health care provider make discussion and decisions together about treatment and their outcomes. General worldwide, noncompliance is a major obstacle and main challenges to the effective and efficient health care delivery. Estimation in 2003 by the World Health Organization indicates that only approximately 50% of chronic diseases patients that us living in developed countries follow their treatment as scheduled and recommended by clinicians. Objectives: To report on the status and future trends of Medications adherence. Materials: Published journal article and conference reports. Method: Data Extraction, data on area related to the patients and healthcare providers for non-adherence to the Medications were gleaned from various publications. Results and Conclusion: Low compliance to prescribed medical is a complex problem, especially for patients with a chronic illness. With increasing numbers of medications shown to do better than harm when taken as prescribed, low compliance is a growing concern, seriously undermining the benefits of current medical care. Medical non-compliance has been identified as a major public health problem that imposes a considerable financial burden upon modern health care systems. [ABSTRACT FROM AUTHOR]

The ability of patients to adhere to medication regimens is considered critical to achieving optimal results. Many patients are discharged with aspirin (ASA) as an anticoagulant for venous thrombosis embolism prophylaxis after joint replacement surgery. In studies where ASA was prescribed as an antithrombotic after selected orthopaedic surgeries, both lack of understanding and missing doses were identified as factors that affected adherence rates (D. Wittig-Wells et al., 2015, 2017 ). The purpose of this study was to explore the preliminary impact of a preset telephone alarm on medication adherence in adults prescribed ASA for 35 days after knee or hip arthroplasty. This was a randomized controlled trial ( n = 79). Adherence was measured with a four-question self-reporting tool. Average age was 61 years. The majority were female (59.5%) and Caucasian (62.0%) with college or graduate degree-level education (78.5%). When comparing the groups, there were no significant differences between the two groups for the demographics of age, gender, and race. The alarm group had significantly better adherence rates, with fewer people who forgot to take their ASA; only 29.7% of the alarm group ever forgot to take their medication compared with 59.5% of the no-alarm group ( p = .008). It seems that simple cell phone alarms can serve as effective reminders to patients to take selected medications as prescribed. [ABSTRACT FROM AUTHOR]

Background Sepsis remains the top cause of morbidity and mortality of hospitalised patients despite concerted efforts. Clinical decision support for sepsis has shown mixed results reflecting heterogeneous populations, methodologies and interventions. Objectives To determine whether the addition of a real-time electronic health record (EHR)-based clinical decision support alert improves adherence to treatment guidelines and clinical outcomes in hospitalised patients with suspected severe sepsis. Design Patient-level randomisation, single blinded. Setting Medical and surgical inpatient units of an academic, tertiary care medical centre. Patients 1123 adults over the age of 18 admitted to inpatient wards (intensive care units (ICU) excluded) at an academic teaching hospital between November 2014 and March 2015. Interventions Patients were randomised to either usual care or the addition of an EHR-generated alert in response to a set of modified severe sepsis criteria that included vital signs, laboratory values and physician orders. Measurements and main results There was no significant difference between the intervention and control groups in primary outcome of the percentage of patients with new antibiotic orders at 3 hours after the alert (35% vs 37%, p=0.53). There was no difference in secondary outcomes of in-hospital mortality at 30 days, length of stay greater than 72 hours, rate of transfer to ICU within 48 hours of alert, or proportion of patients receiving at least 30 mL/kg of intravenous fluids. Conclusions An EHR-based severe sepsis alert did not result in a statistically significant improvement in several sepsis treatment performance measures. [ABSTRACT FROM AUTHOR]

Many people living with HIV (PLWH) pass through correctional facilities each year, a large proportion of whom do not maintain viral suppression following release. We examined the effects of imPACT, an intervention designed to promote post-release viral suppression, on antiretroviral therapy (ART) adherence. PLWH awaiting release from prisons in two southern states were randomized to imPACT (consisting of motivational interviewing, care linkage coordination, and text message medication reminders) versus standard care (SC). ART adherence, measured by unannounced monthly telephone pill counts, was compared between study arms over 6 months post-release. Of 381 participants eligible for post-release follow-up, 302 (79%) completed ≥ 1 of 6 possible pill counts (median: 4; IQR 1–6). Average adherence over follow-up was 80.3% (95% CI 77.5, 83.1) and 81.0% (78.3, 83.6) of expected doses taken in the imPACT and SC arms, respectively. There was no difference between arms when accounting for missing data using multiple imputation (mean difference = − 0.2 percentage points [− 3.7, 3.3]), controlling for study site and week of follow-up. Of the 936 (40.9%) pill counts that were missed, 212 (22.7%) were due to re-incarceration. Those who missed pill counts for any reason were more likely to be unsuppressed, suggesting that they had lower adherence. However, missingness was balanced between arms. Among PLWH released from prison, ART adherence averaged > 80% in both study arms over 6 months—a level higher than seen with most other chronic diseases. However, missing data may have led to an overestimate of adherence. Factors independent of the intervention influence ART adherence in this population and should be identified to inform future targeted interventions. [ABSTRACT FROM AUTHOR]

Older adults manage multiple medications for chronic disease and those living in rural areas are impacted by health care disparities due to health provider shortages and fewer pharmacies. The use of downloadable medication reminder apps on smartphones may serve as a strategy for medication self-management of chronic diseases. In this feasibility study, thirteen rural older adult participants downloaded Medisafe® and used the app to manage their daily medications. The community-dwelling aging adults in this pilot perceived the Medisafe® as not difficult to use, useful for medication tracking and providing reminders for the self-management of multiple medications. [ABSTRACT FROM AUTHOR]

Medication adherence correlates with morbidity and mortality in patients with chronic heart failure (CHF), but is difficult to assess. We conducted a retrospective methodological cohort study in 3,808 CHF patients, calculating adherence as proportion of days covered (PDC) utilizing claims data from 2010 to 2015. We aimed to compare different parameters' influence on the PDC of elderly CHF patients exemplifying a complex chronic disease. Investigated parameters were the assumed prescribed daily dose (PDD), stockpiling, and periods of hospital stay. Thereby, we investigated a new approach using the PDD assigned to different percentiles. The different dose assumptions had the biggest influence on the PDC, with variations from 41.9% to 83.7%. Stockpiling and hospital stays increased the values slightly. These results queries that a reliable PDC can be calculated with an assumed PDD. Hence, results based on an assumed PDD have to be interpreted carefully and should be presented with sensitivity analyses to show the PDC's possible range. [ABSTRACT FROM AUTHOR]

Background: Modern tuberculosis (TB) treatment approaches require innovative adherence strategies. Objectives: This study aimed to explore the feasibility of using short message service (SMS) reminders through mobile phones to improve treatment adherence among TB patients. Materials and Methods: An exploratory sequential design was applied; initially, qualitative data collection was conducted among TB patients and TB program officers. A content analysis was done and messages were then developed. The messages were pretested using focus group discussions (FGDs), and a quantitative method using quasi-experiment on 120 TB patients. All the patients received a standard directly observed therapy short reminder, but only intervention group received daily SMS reminders (n = 60), the data were then analyzed using logistic regression. Results: Reminder messages can be sent directly to young TB patients or indirectly to the relatives of elderly patients. There are four phases of emotional states, which TB patients go through during treatment starting with disappointment and desperation after being diagnosed, grievance during the initiation of treatment, high and then low desire to follow treatment. Reminder messages aimed at improving treatment adherence should correspond to those conditions and motivate, inform, and facilitate TB patients to overcome all the obstacles during treatment. SMS reminders should also be short, informal, and easy to understand. Treatment adherence was significantly higher among the intervention group compared to the control group (odds ratio = 10.73) after controlling for demographics, accessibility, and adverse drug reaction. Conclusions: SMS through mobile phone is a feasible form of media to remind TB patients and to improve adherence to treatment in low-resource facilities. [ABSTRACT FROM AUTHOR]

Background: Recurrent use of oral corticosteroids (OCS) and over‐use of short‐acting beta‐2‐agonists (SABA) are factors associated with adverse side effects and asthma‐related death. We aim to quantify high OCS exposure, SABA over‐use and its association with prescription and adherence to maintenance treatment for respiratory disease, among patients with prescriptions for respiratory disease, from the Portuguese electronic prescription and dispensing database (BDNP). Methods: This was a 1‐year (2016) retrospective population‐based analysis of a random sample of adult patients from the BDNP, the nationwide compulsory medication prescription system. We assessed high OCS exposure (dispensing ≥ 4 packages containing 20 doses of 20 mg each of prednisolone‐equivalent, ≥ 1600 mg/year) on patients on persistent respiratory treatment (PRT‐prescription for > 2 packages of any respiratory maintenance medications). Excessive use of SABA was defined as having a ratio of SABA‐to‐maintenance treatment > 1 or having SABA over‐use (dispensing of > 1 × 200 dose canister/month, of 100 μg of salbutamol‐equivalent). Factors associated with high OCS exposure were assessed by multinomial logistic regression. Results: The estimated number of patients on PRT was 4786/100,000 patients. OCS was prescribed to more than 1/5 of the patients on PRT and 101/100,000 were exposed to a high‐dose (≥ 1600 mg/year). SABA excessive use was found in 144/100,000 patients and SABA over‐use in 24/100,000. About 1/6 of SABA over‐users were not prescribed any controller medication and 7% of them had a ratio maintenance‐to‐total ≥ 70% (high prescription of maintenance treatment). Primary adherence (median%) to controller medication was 66.7% for PRT patients, 59.6% for patients exposed to high OCS dose and 75.0% for SABA over‐users. High OCS exposure or SABA over‐use were not associated with primary adherence. High OCS exposure was associated with a maintenance‐to‐total medication ratio < 70% (insufficient prescription of maintenance treatment), age > 45 years old and male sex. Conclusions: Exposure to high‐dose of OCS (101 per 100,000 patients) and SABA over‐use (24 per 100,000) were frequent, and were associated with a low maintenance‐to‐total prescription ratio but not with primary non‐adherence. These results suggest there is a need for initiatives to reduce OCS and SABA inappropriate prescribing. [ABSTRACT FROM AUTHOR]

The interviewer first oriented patients to the concepts of controller and rescue medications then displayed their actual controller medication and asked them to state whether it was a controller or a rescue drug. Our findings suggest that educational interventions designed to improve asthma medication adherence in adults should emphasize the role of controller medications and clearly and repeatedly distinguish the purposes and uses of controller and rescue medications. [Extracted from the article]

Context: An increasing number of oral cancer treatments require patient adherence and symptom self-management.Objectives: The report presents the effects of a medication reminder and symptom management intervention directed at patients initiating new oral oncolytic agents.Methods: Patients (N = 272) were recruited at six comprehensive cancer centers, interviewed over the telephone after oral agent initiation, and randomized to either standard care or a medication reminder and symptom management intervention. In the intervention arm, the automated system called patients daily to remind them about taking their medications and weekly to assess 18 symptoms and refer patients to a printed Medication Management and Symptom Management Toolkit. Severity of 18 symptoms was also assessed during telephone interviews at Week 4 (midintervention), Week 8 (postintervention), and Week 12 (follow-up). Adherence was measured using the relative dose intensity, the ratio of dose taken by patient out of dose prescribed by the oncologist, and assessed using pill counts at Weeks 4, 8, and 12 and prescribing information from medical records.Results: The relative dose intensity was high and did not differ by trial arm. Symptom severity was significantly lower (P < 0.01) in the experimental arm at Week 8 but not at Weeks 4 or 12.Conclusion: Adherence may be less of a problem than originally anticipated, and intervention was not efficacious possibly because of already high rates of patient adherence to oral oncolytic medication during first 12 weeks. Longer follow-up in future research may identify subgroups of patients who need interventions to sustain adherence. [ABSTRACT FROM AUTHOR]

Background: Methamphetamine (METH) use poses a barrier to antiretroviral therapy (ART) adherence. We evaluated the efficacy of the individualized texting for adherence building (iTAB) intervention among persons living with HIV (PLWH) who meet criteria for METH use disorder. We examined daily associations between ART adherence and text-reported METH use and depressed mood.Methods: We conducted a single site, 2-arm, 6-week, pilot randomized clinical trial comparing a personalized, bidirectional, text messaging system (iTAB; n = 50) to an active control condition (n = 25). All participants received adherence psychoeducation and daily texts assessing METH use and depressed mood. The iTAB group received personalized daily ART reminder texts. ART adherence was monitored using Medication Event Monitoring System (MEMS) caps.Results: Response rates to daily ART reminder texts were high (79%), with good concordance between MEMS-derived and text-reported ART adherence (p < .001). Intervention groups did not differ in MEMS-derived ART adherence (68% iTAB, 70% active control; p = .68); however, participants in the iTAB group had fewer METH use days (median 14.4 iTAB, 22.0 active control; p = .05). Text-reported METH use, but not depressed mood, was associated with poorer MEMS-derived ART adherence.Conclusions: High text response rates and good concordance between MEMS-derived and text-reported adherence suggests text messaging is a feasible intervention delivery approach that provides a valid indication of ART adherence. Reductions in METH use among iTAB participants suggest daily health reminders may help attenuate substance use. Further research is needed to substantiate daily text messaging as a harm reduction approach. [ABSTRACT FROM AUTHOR]

Objective To assess the efficacy of a mixed intervention, educational, and reminder calendar of the intake, as a strategy to improve therapeutic adherence with dabigatran in patients with non-valvular atrial fibrillation (NVAF). Methods This was a prospective, longitudinal, multi-center study, carried out in 110 specialized healthcare centers in Spain. Seven hundred and twenty-six patients treated with dabigatran prescribed for stroke prevention were included. A cluster randomization was performed based on two groups: (1) Control Group (CG) as usual clinical practice, and (2) Intervention Group (IG) with a mixed strategy: (a) Healthcare education, and (b) Use of a reminder calendar for taking the anticoagulant medication. Three visits took place: baseline and follow-up at 6 and 12 months. Compliance was measured by using electronic monitors (MEMS). Average adherence percentage (%; Average AP) and daily compliance (%; Daily AP) was calculated. A patient was considered adherent when AP was 80-100%. Results Six hundred and twenty-five patients completed the study (315 in the IG and 310 in the CG). Daily AP was 91.97% at 6 months and 91.05% after 12 months in the IG and 82.26% and 82.63% in the CG. Average adherence was 90.79% and 89.20% in the IG and 64.51% and 63.22% in the CG at 6 and 12 months, respectively. Significant differences were observed in the Daily AP and Average AP, with higher percentages in the IG. In the non-adherents group, the number of concomitant drugs, baseline, and 6 months SBP values, 6 and 12 months DBP values, and weight, total cholesterol, and LDL cholesterol were significantly higher. The number needed to treat (NNT) was 3.84 patients to prevent one non-adherence. Conclusions A mixed intervention, consisting of patient education and a simple calendar reminder of drug intake, is an effective strategy to improve dabigatran therapeutic adherence in patients with NVAF. The percentage of adherence with dabigatran was high. [ABSTRACT FROM AUTHOR]

Aims: Examine barriers for taking glucose-lowering oral medications, associated baseline characteristics, strategies used, and the adherence impact in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study.Methods: We studied youth prescribed oral diabetes medications over two years (N = 611, 583, and 525 at 6, 12, and 24 months). Clinicians documented barriers (e.g. forgetting, routines, other concerns) in the subsample that reported missed doses (N = 423 [69.2%], 422 [72.4%], and 414 [78.9%] at 6, 12, and 24 months, respectively). Adherence strategies were also assessed (e.g. family, schedule, reminder device) using standard questions. Logistic regression was used to analyze associations with medication adherence.Results: Those missing doses were not different from the total sample (61.5% female, 13.9 ± 2.0 years, >80% racial/ethnic minorities). No baseline demographic or clinical predictors of barriers to medication adherence were identified. Among those for whom barriers were assessed, "forgetting" with no reason named (39.3%) and disruptions to mealtime, sleep, and schedule (21.9%) accounted for the largest proportion of responses. Family support was the primary adherence strategy identified by most youth (≥50%), followed by pairing the medication regimen with daily routines (>40%); the latter strategy was associated with significantly higher adherence rates (p = 0.009).Conclusions: Family supported medication adherence was common in this mid-adolescent cohort, but self-management strategies were also in evidence. Findings are similar to those reported among youth with other serious chronic diseases. Prospective studies of multi-component family support and self-management interventions for improving medication adherence are warranted.Trial Registration: ClinicalTrials.gov NCT00081328. [ABSTRACT FROM AUTHOR]