scholarly journals Evaluating the Impact of Outpatient Multi-Dose Medication Packaging Service (MDMPS) on Medication Adherence and Clinical Outcomes

2020 ◽  
Vol 11 ◽  
pp. 215013272096508
Author(s):  
Pratibha Nair ◽  
Kok Wai Kee ◽  
Choon Siong Mah ◽  
Eng Sing Lee
Keyword(s):  
Blood Pressure ◽  
Medication Adherence ◽  
Clinical Outcomes ◽  
Low Density Lipoprotein ◽  
Medication Possession Ratio ◽  
Density Lipoprotein ◽  
Control Group ◽  
Improve Medication Adherence ◽  
Standard Medication ◽  
The Impact

Background: There is limited understanding on the impact of the multidose medication packaging service (MDMPS). Objectives: The main objective of this study was to evaluate changes in medication adherence in patients using MDMPS compared to patients receiving standard medication packaging (control group). The other objectives were to determine the association between medication adherence and clinical outcomes, and to assess patients’/caregivers’ perceptions toward MDMPS. Methods: A retrospective cohort study was conducted among primary care patients in Singapore enrolled into MDMPS between 2012 and 2017. Eligible patients were taking at least five chronic medications, diagnosed with Hypertension, Hyperlipidemia and/or Type 2 Diabetes, with prescription records for at least six months before and after the index period. They were matched to control patients based on the type of comorbidities and medication adherence status. Medication Possession Ratio (MPR), glycated hemoglobin (HbA1c), blood pressure and low-density lipoprotein-cholesterol (LDL-C) of both groups were compared between baseline and at least six months post-index period. Interviewer-administered questionnaires were also conducted for MDMPS patients. Results: The MPR of MDMPS patients (n = 100) increased by 0.37% ( P < .001) compared to the control group (n = 100). MDMPS patients with diabetes had reduced HbA1c by 0.1% after six months ( P = .022) but was not significant after 12 months. No significant changes were seen in blood pressure and LDL-C between both groups. At least 50% of patients were highly satisfied with MDMPS. Conclusion: MDMPS can improve medication adherence. Further studies are needed to understand its clinical impact.

Impact of Electronic Medication Reminder Caps on Patient Adherence and Blood Pressure

2021 ◽  
pp. 875512252110187
Author(s):  
Nicolette Mehas ◽  
Karen Suchanek Hudmon ◽  
Heather Jaynes ◽  
Steve Klink ◽  
Laura Downey ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Medication Adherence ◽  
Patient Adherence ◽  
Medication Possession Ratio ◽  
Self Report ◽  
Secondary Outcome ◽  
Control Group ◽  
Improve Medication Adherence ◽  
Electronic Reminder ◽  
The Impact

Background: Medication adherence is widely recognized as an essential component of chronic disease management, yet only 50% of patients take their medication as prescribed. Newer technologies have the potential to improve medication adherence. Objective: To conduct a pilot study estimating the impact of a pharmacy-dispensed electronic reminder cap (SMARxT cap), which also records cap openings, on medication adherence and blood pressure (BP). Methods: After a 30-day run-in period, 28 individuals were randomized to receive a SMARxT or placebo cap on each BP medication. The primary outcome was adherence measured via (1) the medication possession ratio, (2) number of cap openings, and (3) self-report. The secondary outcome was the average of 2 BP readings at 6 months. Mean changes from baseline to 6 months were compared between the 2 groups. Results: The medication possession ratio increased 2.7% in the SMARxT cap group and decreased 1.1% in the control group ( P = .13), and cap openings increased 11.9% in the SMARxT cap group and 9.9% in the control group ( P = .83). Self-reported adherence increased 1.1 points in the SMARxT cap group and 0.8 points in the control group ( P = .64). Systolic BP decreased 8.2 mm Hg in the SMARxT cap group and 2.8 mm Hg in the placebo cap group ( P = .35), and diastolic BP decreased to 6.2 mm Hg in the SMARxT cap group and was unchanged in the placebo cap group ( P = .06). Conclusions: Use of SMARxT cap showed nonsignificant improvement in medication adherence and BP lowering. This technology has potential to characterize and improve medication-taking behavior.

scholarly journals A Smartphone App to Improve Medication Adherence in Patients With Type 2 Diabetes in Asia: Feasibility Randomized Controlled Trial

10.2196/14914 ◽  
2019 ◽  
Vol 7 (9) ◽  
pp. e14914 ◽  
Author(s):  
Zhilian Huang ◽  
Eberta Tan ◽  
Elaine Lum ◽  
Peter Sloot ◽  
Bernhard Otto Boehm ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Medication Adherence ◽  
Usual Care ◽  
Clinical Outcomes ◽  
Intervention Group ◽  
Density Lipoprotein ◽  
Smartphone App ◽  
Control Group ◽  
Improve Medication Adherence

Background The efficacy of smartphone apps for improving medication adherence in type 2 diabetes is not well studied in Asian populations. Objective This study aimed to determine the feasibility, acceptability, and clinical outcomes of using a smartphone app to improve medication adherence in a multiethnic Asian population with type 2 diabetes. Methods We block randomized 51 nonadherent and digitally literate patients with type 2 diabetes between the ages of 21 and 75 years into two treatment arms (control: usual care; intervention: usual care+Medisafe app) and followed them up for 12 weeks. Recruitment occurred at a public tertiary diabetes specialist outpatient center in Singapore. The intervention group received email reminders to complete online surveys monthly, while the control group only received an email reminder(s) at the end of the study. Barriers to medication adherence and self-appraisal of diabetes were assessed using the Adherence Starts with Knowledge-12 (ASK-12) and Appraisal of Diabetes Scale (ADS) questionnaires at baseline and poststudy in both groups. Perception toward medication adherence and app usage, attitude, and satisfaction were assessed in the intervention group during and after the follow-up period. Sociodemographic data were collected at baseline. Clinical data (ie, hemoglobin A1c, body mass index, low-density lipoprotein, high-density lipoprotein, and total cholesterol levels) were extracted from patients’ electronic medical records. Results A total of 51 (intervention group: 25 [49%]; control group: 26 [51%]) participants were randomized, of which 41 (intervention group: 22 [88.0%]; control group: 19 [73.1%]) completed the poststudy survey. The baseline-adjusted poststudy ASK-12 score was significantly lower in the intervention group than in the control group (mean difference: 4.7, P=.01). No changes were observed in the clinical outcomes. The average 12-week medication adherence rate of participants tracked by the app was between 38.3% and 100% in the intervention group. The majority (>80%) of the participants agreed that the app was easy to use and made them more adherent to their medication. Conclusions Our feasibility study showed that among medication-nonadherent patients with type 2 diabetes, a smartphone app intervention was acceptable, improved awareness of medication adherence, and reduced self-reported barriers to medication adherence, but did not improve clinical outcomes in a developed Asian setting.

Effects of Comorbid Alcohol Use Disorder on the Clinical Outcomes of Schizophrenia: A Nationwide Population-based Study

2021 ◽  
Author(s):  
Soojin Ahn ◽  
Youngjae Choi ◽  
Woohyeok Choi ◽  
Young Tak Jo ◽  
Harin Kim ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Clinical Outcomes ◽  
Alcohol Use Disorder ◽  
Medication Possession Ratio ◽  
Small Sample ◽  
Control Group ◽  
Diagnostic Code ◽  
Psychiatric Admissions ◽  
Before And After ◽  
The Impact

Abstract BackgroundAlcohol use disorder (AUD) is a common psychiatric comorbidity in schizophrenia, associated with poor clinical outcomes and medication noncompliance. Most previous studies on the effect of alcohol use in patients with schizophrenia had limitations of small sample size and a cross-sectional design. Therefore, this study aimed to use a nationwide population database to investigate the impact of AUD on clinical outcomes of schizophrenia.MethodsData from the Health Insurance Review Agency database in South Korea from January 1, 2007 to December 31, 2016 was used. Among 64,442 patients with incident schizophrenia, 1,598 with comorbid AUD were selected based on the diagnostic code F10. We performed between- and within-group analyses to compare the rates of psychiatric admissions and emergency room (ER) visits and medication possession ratio (MPR) with control patients having schizophrenia matched for the onset age, sex, and observation period.ResultsThe rates of psychiatric admissions and ER visits decreased after the diagnosis of AUD in both groups; however, the decrease was significantly greater in patients with comorbid AUD compared to the control group. While the case group showed an increase in MPR after the diagnosis of AUD, MPR decreased in the control patients. The rates of psychiatric admissions, ER visits and MPR were worse in the schizophrenia group with comorbid AUD both before and after the diagnosis of AUD.ConclusionsClinical outcomes were worse in the comorbid AUD group than in the control group before and after the diagnosis of AUD. Considering that patients with schizophrenia with comorbid AUD had poorer clinical outcomes even before the diagnosis of AUD, schizophrenia with comorbid AUD could be a distinct subtype of schizophrenia.

scholarly journals Age at period cessation and trajectories of cardiovascular risk factors across mid and later life

Heart ◽  
2020 ◽  
Vol 106 (7) ◽  
pp. 499-505 ◽  
Author(s):  
Linda Marie O'Keeffe ◽  
Diana Kuh ◽  
Abigail Fraser ◽  
Laura D Howe ◽  
Debbie Lawlor ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Later Life ◽  
Glycated Haemoglobin ◽  
Lipoprotein Cholesterol ◽  
The Impact

ObjectiveTo examine the association between age at period cessation and trajectories of anthropometry, blood pressure, lipids and glycated haemoglobin (HbA1c) from midlife to age 69 years.MethodsWe used data from the UK Medical Research Council National Survey of Health and Development to examine the association between age at period cessation and trajectories of systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI) and waist circumference (WC) from 36 to 69 years and trajectories of triglyceride, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and HbA1c from 53 to 69 years.ResultsWe found no evidence that age at period cessation was associated with trajectories of log triglyceride, LDL-C and HDL-C from 53 to 69 years and trajectories of SBP or DBP from 36 to 69 years, regardless of whether period cessation occurred naturally or due to hysterectomy. While we found some evidence of associations of age at period cessation with log BMI, log WC and log HbA1c, patterns were not consistent and differences were small at age 69 years, with confidence intervals that spanned the null value.ConclusionHow and when women experience period cessation is unlikely to adversely affect conventional cardiovascular risk factors across mid and later life. Women and clinicians concerned about the impact of type and timing of period cessation on conventional cardiovascular intermediates from midlife should be reassured that the impact over the long term is small.

Western diet in the perinatal period promotes dysautonomia in the offspring of adult rats

2016 ◽  
Vol 8 (2) ◽  
pp. 216-225 ◽  
Author(s):  
R. Vidal-Santos ◽  
F. N. Macedo ◽  
M. N. S. Santana ◽  
V. U. De Melo ◽  
J. L. de Brito Alves ◽  
...  
Keyword(s):  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Systolic Arterial Pressure ◽  
Perinatal Period ◽  
Western Diet ◽  
Control Group ◽  
Standard Diet ◽  
Adult Rats ◽  
Male Wistar Rats ◽  
The Impact

The present study investigated the impact of a western diet during gestation and lactation on the anthropometry, serum biochemical, blood pressure and cardiovascular autonomic control on the offspring. Male Wistar rats were divided into two groups according to their mother’s diet received: control group (C: 18% calories of lipids) and westernized group (W: 32% calories of lipids). After weaning both groups received standard diet. On the 60th day of life, blood samples were collected for the analysis of fasting glucose and lipidogram. Cardiovascular parameters were measured on the same period. Autonomic nervous system modulation was evaluated by spectrum analysis of heart rate (HR) and systolic arterial pressure (SAP). The W increased glycemia (123±2v. 155±2 mg/dl), low-density lipoprotein (15±1v. 31±2 mg/dl), triglycerides (49±1v. 85±2 mg/dl), total cholesterol (75±2v. 86±2 mg/dl), and decreased high-density lipoprotein (50±4v. 38±3 mg/dl), as well as increased body mass (209±4v. 229±6 g) than C. Furthermore, the W showed higher SAP (130±4v. 157±2 mmHg), HR (357±10v. 428±14 bpm), sympathetic modulation to vessels (2.3±0.56v. 6±0.84 mmHg2) and LF/HF ratio (0.15±0.01v. 0.7±0.2) than C. These findings suggest that a western diet during pregnancy and lactation leads to overweight associated with autonomic misbalance and hypertension in adulthood.

Abstract P048: Effect of Hurricane Katrina on Medication Adherence and Blood Pressure among Hypertensive Veterans

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Angela M Thompson ◽  
M.A. Krousel-Wood ◽  
Hao Mei ◽  
Larry Webber ◽  
Jiang He ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Medication Adherence ◽  
Hurricane Katrina ◽  
New Orleans ◽  
Cardiovascular Events ◽  
Medication Possession Ratio ◽  
Group Differences ◽  
P Value ◽  
Antihypertensive Medications ◽  
The Impact

Background. An increase in cardiovascular events and blood pressure (BP) has been reported in the aftermath of major natural disasters. This increase may be due to acute psychological stress, physiologic suffering, or lack of appropriate healthcare services in these situations. Objectives. Using retrospective cohort data from the Veterans Administration, we examined the impact of Hurricane Katrina on medication adherence and BP control among 1000 hypertensive patients from New Orleans, Louisiana compared to 1000 patients from an area not affected by the hurricane, Alexandria, Louisiana. Methods. Antihypertensive medication refills were identified from electronic pharmacy records, and blood pressure readings recorded during routine examinations were extracted from electronic patient data. Adherence to antihypertensive medications was assessed using the medication possession ratio (MPR), a standard method of quantifying refills. MPR was classified as low (<0.80) or high (≥0.80). Multivariable-adjusted regression methods were used to examine change in BP from the 6 months before the hurricane to 6 months after the hurricane. Results. In the year before Hurricane Katrina, the proportion of patients with low MPR was similar for patients in New Orleans (11.8% [106 of 902]) and Alexandria (11.3% [105 of 931], p-value=0.75 for group differences). In the year following the hurricane, there was a significant increase in the proportion of New Orleans patients with low MPR (24.1% [155 of 643]), compared to Alexandria (11.2% [94 of 838], p-value<0.001 for group differences). The unadjusted mean (95% Confidence Interval) increase in BP from the pre-Katrina to post-Katrina period was 6.6 (4.7, 8.3) mmHg systolic/5.7 (4.6, 6.8) mmHg diastolic and 2.1 (0.8, 3.5) mmHg systolic/1.2 (0.4, 2.0) mmHg diastolic among patients in New Orleans and Alexandria, respectively (p-value<0.001 for group differences). After adjustment for age, race, pre-Katrina BP, and post-Katrina MPR as a continuous variable, the mean increase in BP remained significantly higher among patients in New Orleans at 5.9 (4.3, 7.6) mmHg systolic/4.5 (3.5, 5.5) mmHg diastolic, compared to those in Alexandria where mean increase was 2.0 (0.8, 3.2) mmHg systolic /1.5 (0.7, 2.2) mmHg diastolic (p-value < 0.001 for group differences). Conclusion. BP significantly increased among hypertensive veterans in New Orleans as compared to Alexandria after Hurricane Katrina. This increase was only in part explained by changes in medication adherence. Future disaster planning should provide veterans with a rapid and easily-available method of accessing medications and health services and should anticipate increased BP and potential cardiovascular events among patients with hypertension.

scholarly journals Mobile Apps to Improve Medication Adherence in Cardiovascular Disease: Systematic Review and Meta-analysis

10.2196/24190 ◽  
2021 ◽  
Vol 23 (5) ◽  
pp. e24190
Author(s):  
Shahd Al-Arkee ◽  
Julie Mason ◽  
Deirdre A Lane ◽  
Larissa Fabritz ◽  
Winnie Chua ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Health Care ◽  
Medication Adherence ◽  
Clinical Outcomes ◽  
Mobile Health ◽  
Health Care Professionals ◽  
Mobile Apps ◽  
Meta Analysis ◽  
Improve Medication Adherence

Background Adherence rates of preventative medication for cardiovascular disease (CVD) have been reported as 57%, and approximately 9% of all CVD events in Europe are attributable to poor medication adherence. Mobile health technologies, particularly mobile apps, have the potential to improve medication adherence and clinical outcomes. Objective The objective of this study is to assess the effects of mobile health care apps on medication adherence and health-related outcomes in patients with CVD. This study also evaluates apps’ functionality and usability and the involvement of health care professionals in their use. Methods Electronic databases (MEDLINE [Ovid], PubMed Central, Cochrane Library, CINAHL Plus, PsycINFO [Ovid], Embase [Ovid], and Google Scholar) were searched for randomized controlled trials (RCTs) to investigate app-based interventions aimed at improving medication adherence in patients with CVD. RCTs published in English from inception to January 2020 were reviewed. The Cochrane risk of bias tool was used to assess the included studies. Meta-analysis was performed for clinical outcomes and medication adherence, with meta-regression analysis used to evaluate the impact of app intervention duration on medication adherence. Results This study included 16 RCTs published within the last 6 years. In total, 12 RCTs reported medication adherence as the primary outcome, which is the most commonly self-reported adherence. The duration of the interventions ranged from 1 to 12 months, and sample sizes ranged from 24 to 412. Medication adherence rates showed statistically significant improvements in 9 RCTs when compared with the control, and meta-analysis of the 6 RCTs reporting continuous data showed a significant overall effect in favor of the app intervention (mean difference 0.90, 95% CI 0.03-1.78) with a high statistical heterogeneity (I2=93.32%). Moreover, 9 RCTs assessed clinical outcomes and reported an improvement in systolic blood pressure, diastolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol levels in the intervention arm. Meta-analysis of these clinical outcomes from 6 RCTs favored app interventions, but none were significant. In the 7 trials evaluating app usability, all were found to be acceptable. There was a great variation in the app characteristics. A total of 10 RCTs involved health care professionals, mainly physicians and nurses, in the app-based interventions. The apps had mixed functionality: 2 used education, 7 delivered reminders, and 7 provided reminders in combination with educational support. Conclusions Apps tended to increase medication adherence, but interventions varied widely in design, content, and delivery. Apps have an acceptable degree of usability; yet the app characteristics conferring usability and effectiveness are ill-defined. Future large-scale studies should focus on identifying the essential active components of successful apps. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42019121385; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=121385

scholarly journals Decreased Serum NCAM Levels Associated with Cognitive Impairment in Vascular Dementia

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Jun Zhao ◽  
Wei Lu ◽  
Junshan Li ◽  
Lei Liu ◽  
Xiumin Zhao
Keyword(s):  
Blood Pressure ◽  
Vascular Dementia ◽  
Clinical Characteristics ◽  
Formal Education ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Enzyme Linked Immunosorbent Assay ◽  
Control Group ◽  
And Control ◽  
Moca Score

Objective. Neural cell adhesion molecule (NCAM), a glycoprotein widely distributed in the brain, has recently been shown to regulate neuroplasticity. However, the role of NCAM in vascular dementia (VaD) is still unclear. The purpose of this study is to determine whether NCAM is involved in the course of VaD. Methods. Continuous recruitment of VaD patients and control population to join this study. Doctors or nurses are responsible for collecting their clinical characteristics including age, gender, formal education, heart rate, supine systolic blood pressure, supine diastolic blood pressure, fasting glucose, high-density lipoprotein, and low-density lipoprotein. Each participant received the Montreal Cognitive Assessment (MoCA) scale after being enrolled in the group. At the same time, their peripheral blood was collected, and their serum NCAM levels were measured by enzyme-linked immunosorbent assay (ELISA). Results. 98 VaD patients and 83 age- and sex-matched controls were enrolled. There was no significant statistical difference between the VaD group and the control group in terms of the comparison of clinical characteristics ( p > 0.05 ). The MoCA score of VaD patients was significantly lower than that of the controls ( 27.9 ± 1.4 vs. 23.0 ± 2.1 points, p < 0.001 ). In addition, the circulating NCAM level of VaD patients was also significantly lower than that of controls ( 21.7 ± 3.8 vs. 17.6 ± 4.2  ng/mL, p < 0.001 ). The circulating NCAM level of VaD patients was significantly positively correlated with MoCA score ( r = 0.285 , p = 0.026 ). After adjusting for clinical characteristics, circulating NCAM levels are still an independent pathogenic factor of VaD (regression coefficient = 0.223 , p = 0.034 ). Conclusions. VaD patients have low circulating NCAM levels, which can be used as a potential predictor of VaD.

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