Comparing Continuous and Binary Group-based Trajectory Modeling Using Statin Medication Adherence Data

Abstract Background Preventative inhaled treatments preserve lung function and reduce exacerbations in Cystic Fibrosis (CF). Self-reported adherence to these treatments is over-estimated. An online platform (CFHealthHub) has been developed with patients and clinicians to display real-time objective adherence data from dose-counting nebulisers, so that clinical teams can offer informed treatment support. Methods In this paper, we identify pre-implementation barriers to healthcare practitioners performing two key behaviours: accessing objective adherence data through the website CFHealthHub and discussing medication adherence with patients. We aimed to understand barriers during the pre-implementation phase, so that appropriate strategy could be developed for the scale up of implementing objective adherence data in 19 CF centres. Thirteen semi-structured interviews were conducted with healthcare practitioners working in three UK CF centres. Qualitative data were coded using the Theoretical Domains Framework (TDF), which describes 14 validated domains to implementation behaviour change. Results Analysis indicated that an implementation strategy should address all 14 domains of the TDF to successfully support implementation. Participants did not report routines or habits for using objective adherence data in clinical care. Examples of salient barriers included skills, beliefs in consequences, and social influence and professional roles. The results also affirmed a requirement to address organisational barriers. Relevant behaviour change techniques were selected to develop implementation strategy modules using the behaviour change wheel approach to intervention development. ConclusionsThis paper demonstrates the value of applying the TDF at pre-implementation, to understand context and to support the development of a situationally relevant implementation strategy. Contribution to the literature· Research indicates that the implementation of healthcare innovations may be more likely to succeed when context and theory are taken into consideration. · In this study, healthcare professionals identified barriers to two behaviours that were key to the implementation of a national Cystic Fibrosis (CF) healthcare innovation. By coding barriers to the Theoretical Domains Framework (TDF), a contextually relevant implementation strategy was developed, with a focus on clinician behaviour change. · The study highlights the challenges CF teams face when implementing new remote monitoring of medication adherence, and provides an important opportunity to apply the TDF in the pre-implementation phase of a healthcare innovation.

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Communicating Electronic Adherence Data to Physicians—Consensus-Based Development of a Compact Reporting Form

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph181910264 ◽

2021 ◽

Vol 18 (19) ◽

pp. 10264

Author(s):

Fine Dietrich ◽

Andreas Zeller ◽

Melanie Haag ◽

Kurt E. Hersberger ◽

Isabelle Arnet

Keyword(s):

Medication Adherence ◽

Pharmacological Treatment ◽

Graphical Representations ◽

Consensus Development ◽

Adherence Data ◽

Adherence Monitoring ◽

First Time

Information on medication adherence is missing in patient files, although it might be helpful to optimize treatment. An adherence report that presents data from electronic adherence monitoring and provides recommendations regarding pharmacological treatment could close this gap. We aimed to develop an adherence reporting form that combines suitable calculations and graphical representations to facilitate the physicians’ interpretation of (non-)adherence. Two consensus development panels were conducted. First, pharmacists with expertise in adherence monitoring debated the items needed to calculate and illustrate electronic adherence data. Second, physicians discussed the items they would need for an adherence report and were encouraged to propose new items. Preference was indicated by raising a green or red card. Voting was repeated until consensus was obtained. Third, first drafts of the adherence reporting form were created by two pharmacists. Seven pharmacists agreed on four metrics to express medication adherence and three graphical representations. Five physicians approved the four metrics and rated the dot chart as the most useful illustration for judging the patient’s adherence patterns. Additionally, they required a clinical–pharmaceutical evaluation of the adherence estimates considering drug-related properties. We developed an adherence reporting form for the first time in a compact format and based on the recommendations of experts. In addition, we considered the preferences of physicians, who appreciated the clarity of the reporting form.

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Feasibility study for supporting medication adherence for adults with cystic fibrosis: mixed-methods process evaluation

BMJ Open ◽

10.1136/bmjopen-2020-039089 ◽

2020 ◽

Vol 10 (10) ◽

pp. e039089

Author(s):

Daniel Hind ◽

Sarah J Drabble ◽

Madelynne A Arden ◽

Laura Mandefield ◽

Simon Waterhouse ◽

...

Keyword(s):

Cystic Fibrosis ◽

Medication Adherence ◽

Process Evaluation ◽

Working Hours ◽

Prescription Data ◽

Team Members ◽

Treatment Regimens ◽

Adherence Support ◽

Adherence Data ◽

Registration Number

ObjectivesTo undertake a process evaluation of an adherence support intervention for people with cystic fibrosis (PWCF), to assess its feasibility and acceptability.SettingTwo UK cystic fibrosis (CF) units.ParticipantsFourteen adult PWCF; three professionals delivering adherence support (‘interventionists’); five multi-disciplinary CF team members.InterventionsNebuliser with data recording and transfer capability, linked to a software platform, and strategies to support adherence to nebulised treatments facilitated by interventionists over 5 months (± 1 month).Primary and secondary measuresFeasibility and acceptability of the intervention, assessed through semistructured interviews, questionnaires, fidelity assessments and click analytics.ResultsInterventionists were complimentary about the intervention and training. Key barriers to intervention feasibility and acceptability were identified. Interventionists had difficulty finding clinic space and time in normal working hours to conduct review visits. As a result, fewer than expected intervention visits were conducted and interviews indicated this may explain low adherence in some intervention arm participants. Adherence levels appeared to be >100% for some patients, due to inaccurate prescription data, particularly in patients with complex treatment regimens. Flatlines in adherence data at the start of the study were linked to device connectivity problems. Content and delivery quality fidelity were 100% and 60%–92%, respectively, indicating that interventionists needed to focus more on intervention ‘active ingredients’ during sessions.ConclusionsThe process evaluation led to 14 key changes to intervention procedures to overcome barriers to intervention success. With the identified changes, it is feasible and acceptable to support medication adherence with this intervention.Trial registration numberISRCTN13076797; Results.

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PMU127 DIABETES, HYPERTENSION, AND STATIN MEDICATION ADHERENCE AND DEPRESSION

Value in Health ◽

10.1016/j.jval.2020.04.890 ◽

2020 ◽

Vol 23 ◽

pp. S257

Author(s):

Y. Mu ◽

L. Feng ◽

M. Taitel

Keyword(s):

Medication Adherence ◽

Statin Medication

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