The Medication Adherence Score: A Predictive Analytic Tool

Abstract Background Poor medication adherence is wide-spread and associated with poor clinical outcomes. Herein, we introduce the Medication Adherence Score, a predictive analytic tool designed to provide clinicians insight into adherence behavior over the subsequent twelve months. The aim of the study was to demonstrate the feasibility of such scoring of patients at the individual level. Methods This is a single arm, non-randomized, 2-center, retrospective cohort study conducted among patients diagnosed with atrial fibrillation. The model, developed by Fair Isaac Corporation on pharmacy refill data, predicts adherence behavior to cardiovascular drugs using demographic, geographic and socio-economic predictors. The primary outcome was the number of patients that could be scored at the individual level without reliance on past individual refill behavior. The score was normalized between zero (lowest adherence score) and one (highest adherence score) and patients were grouped: low adherence < 0.6, intermediate adherence between 0.6 and 0.8, high adherence > 0.8. The institutional review board approved the study. Results A total of 1110 patients were included in the study with a median age of 71 (IQR 63, 79). Most patients (807, 73%) could be scored at the patient level, and the remaining patients (303, 27%) were scored based on characteristics associated with the geography of their home address. There were 488 patients (44%) with a high adherence score (score > 0.8), 382 (34%) with an intermediate adherence score (score between 0.6 and 0.8) and 240 patients (22%) with a low score. Younger patients had on average lower scores than older patients, and males also had higher scores. Conclusions The Medication Adherence Score was successfully applied to an unselected group of atrial fibrillation patients: nearly a quarter of the cohort were identified as at risk for non-adherence. Future studies are necessary to assess the association of this predictive analytic model with clinical outcomes.

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Medication Adherence: Expanding the Conceptual Framework

American Journal of Hypertension ◽

10.1093/ajh/hpab046 ◽

2021 ◽

Author(s):

Marie Krousel-Wood ◽

Leslie S Craig ◽

Erin Peacock ◽

Emily Zlotnick ◽

Samantha O’Connell ◽

...

Keyword(s):

Older Adults ◽

Medication Adherence ◽

Conceptual Framework ◽

Clinical Outcomes ◽

Implicit Attitudes ◽

Explanatory Power ◽

Population Level ◽

Time Preferences ◽

Adherence Behavior ◽

Individual Level

Abstract Interventions targeting traditional barriers to antihypertensive medication adherence (AHMA) have been developed and evaluated, with evidence of modest improvements in adherence. Translation of these interventions into population-level improvements in adherence and clinical outcomes among older adults remains suboptimal. From the Cohort Study of Medication Adherence among Older adults (CoSMO), we evaluated traditional barriers to AHMA among older adults with established hypertension (N=1544; mean age=76.2 years, 59.5% women, 27.9% Black, 24.1% and 38.9% low adherence by proportion of days covered (i.e., PDC<0.80) and the 4-item Krousel-Wood Medication Adherence Scale (i.e., K-Wood-MAS-4≥1), respectively), finding that they explained 6.4% and 14.8% of variance in pharmacy refill and self-reported adherence, respectively. Persistent low adherence rates, coupled with low explanatory power of traditional barriers, suggest that other factors warrant attention. Prior research has investigated explicit attitudes toward medications as a driver of adherence; the roles of implicit attitudes and time preferences (e.g., immediate versus delayed gratification) as mechanisms underlying adherence behavior are emerging. Similarly, while associations of individual-level social determinants of health (SDOH) and medication adherence are well-reported, there is growing evidence about structural SDOH and specific pathways of effect. Building on published conceptual models and recent evidence, we propose an expanded conceptual framework that incorporates implicit attitudes, time preferences and structural SDOH, as emerging determinants that may explain additional variation in objectively and subjectively measured adherence. This model provides guidance for design, implementation and assessment of interventions targeting sustained improvement in implementation medication adherence and clinical outcomes among older women and men with hypertension.

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Self-reported Morisky 8 item medication adherence scale to statins concords with pill count method and correlates with serum lipid profile parameters and Serum HMGCoA Reductase levels

10.1101/19006148 ◽

2019 ◽

Author(s):

Abhinav Grover ◽

Mansi Oberoi ◽

Harmeet Rehan ◽

Lalit Gupta ◽

Madhur Yadav

Keyword(s):

Medication Adherence ◽

Lipid Profile ◽

Density Lipoprotein ◽

Correlation Coefficients ◽

Pill Count ◽

Self Report ◽

Adherence Score ◽

Count Method ◽

High Adherence ◽

Adherence Scale

ABSTRACTBackgroundIt is imperative that non-compliance to statins be identified and addressed to optimize the clinical benefit of statins. Patient self-reporting methods are convenient to apply in clinical practice but need to be validated.ObjectiveWe studied the concordance of a patient self-report method, MMAS (Morisky eight item medication adherence scale) with pill count method in measuring adherence to statins and their correlation with extended lipid profile parameters and serum HMGCoA-R (hydroxymethylglutaryl coenzyme A reductase) enzyme levels.MethodsMMAS and pill count method were used to measure the adherence to statins in patients on statins for any duration. Patients were subjected to estimation of extended lipid profile and serum HMGCoA-R levels at the end of 3 months follow-up.ResultsOut of a total of 200 patients included in the study, 117 patients had low adherence (score less than 6 on MMAS) whereas 65 and 18 patients had medium (score 6 to less than 8) and high adherence (score of 8) respectively. Majority of patients who had low adherence to statins by MMAS were nonadherent by pill count method yielding concordance of 96.5%. Medium or high adherence to statins by MMAS method had concordance of 89.1% with pill count method. The levels of total cholesterol, low density lipoprotein-cholesterol, apolipoprotein B and HMGCoA-R were significantly negatively correlated with compliance measured by pill count and MMAS with similar correlation coefficients. HMGCoA-R levels demonstrated a plateau phenomenon with levels being 9-10 ng/ml when compliance to statin therapy was greater than 60% by pill count and greater than 6 on Morisky scale.ConclusionIn conclusion, MMAS and pill count methods showed concordance in measuring adherence to statins. These methods need to be explored further for their interchangeability as surrogates for biomarker levels.

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Patient and Physician Factors Associated With Adherence to Diabetes Medications

The Diabetes Educator ◽

10.1177/0145721712440333 ◽

2012 ◽

Vol 38 (3) ◽

pp. 397-408 ◽

Cited By ~ 48

Author(s):

Antoinette M. Schoenthaler ◽

Brian S. Schwartz ◽

Craig Wood ◽

Walter F. Stewart

Keyword(s):

Medication Adherence ◽

Primary Care Physicians ◽

Medication Possession Ratio ◽

Related Factors ◽

Patient Beliefs ◽

Individual Level ◽

Physician Relationship ◽

Oral Hypoglycemic Medications ◽

The Individual ◽

Main Effects

Purpose The purpose of this study was to examine the influence of patient and physician psychosocial, sociodemographic, and disease-related factors on diabetes medication adherence. These factors were also examined as effect modifiers of the association between quality of the patient-physician relationship and medication adherence. Methods Data were collected from 41 Geisinger Clinic primary care physicians and 608 of their patients with type 2 diabetes. Adherence to oral hypoglycemic medications was calculated using a medication possession ratio based on physician orders in electronic health records (MPREHR). MPREHR was defined as the proportion of total time in the 2 years prior to study enrollment that the patient was in possession of oral hypoglycemic medications. Linear regression was used to examine the influence of patient- and physician-level factors on adherence. Effect modification of the patient-physician relationship-adherence association was evaluated by adding the main effects of the individual-level factors and their cross-products to the models. Results In adjusted analyses, satisfaction with the physician’s patient education skills, patient beliefs about the need for their medications, and lower diabetes-related knowledge were associated with better adherence to oral hypoglycemic medications. Shorter duration of time with diabetes and taking only oral hypoglycemic medications were also associated with better adherence. Finally, the association between shared decision making and medication adherence was significantly modified by patients’ level of social support. Conclusions This study identified several patient-, physician-, and disease-related factors that should be targeted to maximize the potential for developing tailored adherence-enhancing interventions within the context of a collaborative patient-physician relationship.

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Prevalensi dan Determinan Hipertensi di Pulau Jawa, Tahun 2004

Kesmas National Public Health Journal ◽

10.21109/kesmas.v1i2.312 ◽

2006 ◽

Vol 1 (2) ◽

pp. 57

Author(s):

Zamhir Setiawan

Keyword(s):

Risk Factor ◽

Rural Areas ◽

Urban Areas ◽

Analysis Method ◽

Hypertension Status ◽

Individual Level ◽

Level Measurement ◽

Study Results ◽

Ecological Measurement ◽

The Individual

Hipertensi merupakan faktor risiko utama kardiovaskuler yang merupakan penyebab utama kematian di seluruh dunia. Peningkatan umur harapan hidup dan perubahan gaya hidup meningkatkan faktor risiko hipertensi di berbagai negara. Tujuan penelitian ini (1) Mengetahui prevalensi hipertensi dan penyebarannya di Pulau Jawa tahun 2004. (2) Mengetahui faktor-faktor sosiodemografi yang berhubungan dengan kejadian hipertensi. (3) Mengetahui kontribusi dan dampak potensial masing-masing faktor tersebut. Penelitian dengan rancangan studi Ekologi Multilevel ini menggabungkan variabel tingkat pengukuran individu dengan tingkat pengukuran ekologi dalam analisis bersama, dengan unit analisis individu. Analisis kontekstual dilakukan melalui kerangka konsep hipertensi, menggunakan metode analisis regresi logistik ganda, dengan status hipertensi sebagai variabel dependen. Data variabel dependen dan variabel perancu yang merupakan data pengukuran tingkat individu diambil dari data SKRT 2004. Data sosiodemografi tingkat pengukuran ekologi sebagai variabel independen utama, diperoleh dari Profil Kesehatan Indonesia, Statistik Indonesia, Statistik Kesehatan, Statistik Kesejahteraan Rakyat, danData Departemen Dalam Negeri, unit pengamatan provinsi. Hasil penelitian ini menunjukkan prevalensi hipertensi di Pulau Jawa 41,9%, dengan kisaran di masing-masing provinsi 36,6%-47,7%. Prevalensi di perkotaan 39,9% (37,0%-45,8%) dan di perdesaan 44,1% (36,2%-51,7%). Kata kunci: Hipertensi, faktor sosiodemografiAbstractHypertension is a main risk factor of cardiovascular disease which is ranked as number one cause of death in the world. The increase of life expectancy and changes in life style have increased the prevalence of hypertension risk factor in both developed and developing countries. The objectives of this study are (1) To know the prevalence and distribution of hypertension in di Java island, in year 2004. (2) To know sosiodemographic factors related to hypertension. (3) To know the contribution of each sosiodemographic factor toward hypertension. The study used multilevel ecologic study design that integrated both individual and ecological level variables measurement. The analysis method used in this study was contextual analysis and multiple logistic regression with hypertension status as dependent variable. The individual level measurement of variables such as hypertension status and age, job, education and sex is taken from Household Health Survey (SKRT) 2004. The sosiodemographic data which was ecological measurement level served as the main independent variables were taken from Indonesian Health Profile, Indonesian Health Statistics, Public Welfare Statistics and data from Department of Internal Affair, particularly from Province Surveillance Unit. The study results showed that the prevalence of hypertension in Java Island was 41.9%, with range of prevalence in provincial level of 36.6%-47.7%. The prevalence in urban areas was 39.9% (37.0%-45.8%) and in rural areas was 44.1% (36.2%-51.7%)Keywords: Hypertension, sosiodemographic factors

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Characteristics of patients presenting with septic wounds in selected hospitals in Kajiado County, Kenya

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20212762 ◽

2021 ◽

Author(s):

Ruth Kaanto ◽

John Kagira ◽

Kenneth Waititu ◽

Maina Ngotho ◽

Naomi Maina ◽

...

Keyword(s):

Medication Adherence ◽

Traffic Accidents ◽

Road Traffic ◽

Healthcare Access ◽

Water Source ◽

Lower Limbs ◽

Wound Management ◽

Individual Level ◽

The Individual ◽

Social And Cultural Factors

Background: Wound management is a serious global health problem. The objective of this study was to describe the characteristics of patients presenting with septic wounds in selected hospitals in Kajiado County, Kenya, and their association with selected factors.Methods: We purposively sampled 182 patients with septic wounds and collected data using questionnaires whose statistical relationship between various patients' characteristics, including the data collected Likert-scale design was assessed.Results: A majority (73.1%) of the patients presented with one wound. Most (54.4%) of the wounds were located on the lower limbs and mainly (23.1%) caused by road traffic accidents. The majority of the wounds had lasted for 1-2 weeks at the time of presentation, and the wound sizes were mainly >11 mm. We found a significant association (p<0.05) between number of wounds and age, marital status, and highest education level. The wound causes were significantly associated with gender, age, occupation, and sub-county of residence. Wound duration was significantly associated with understanding prescribed medication, adherence to dosage, water source, alcoholism, and cigarette smoking. Wound improvement was significantly associated with patients' understanding of the prescribed medication, adherence to dosage and water source, alcoholic status, and cigarette smoking.Conclusions: Individual patient, social and cultural factors were associated with septic wounds characteristics, suggesting that addressing them at the individual level using proper hygiene and cleanliness at home and workplaces is key. Policies to reduce traffic accidents, increase literacy, and promote healthcare access need to be promoted to reduce the wound sepsis burden.

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Sustainable Social and Individual Implications of Telework: A New Insight into the Romanian Labor Market

Sustainability ◽

10.3390/su11133506 ◽

2019 ◽

Vol 11 (13) ◽

pp. 3506 ◽

Cited By ~ 3

Author(s):

Alina-Mihaela Dima ◽

Claudia-Elena Țuclea ◽

Diana-Maria Vrânceanu ◽

Gabriela Țigu

Keyword(s):

Latent Variables ◽

Structural Equation ◽

Local Community ◽

Management Strategies ◽

Work Force ◽

Individual Level ◽

Study Results ◽

Managerial Implications ◽

The One ◽

The Individual

This research aims to evaluate the individual and social implications of telework, along with the foreseeable permanent result that could be generated. Consistent with this objective, a survey has been carried out on a sample of 1180 Romanian employees, on which a model has been developed, based on structural equation modelling. The model includes five latent variables, on the one hand targeting telework features and on the other hand, its possible effects on individuals and society. At an individual level, the study results emphasize that telework could contribute to a better work–life balance and could also help teleworkers to develop specific teleworking abilities. At a social level, telework could generate sustainable effects targeting the long-term management of the work force and providing solutions to potential problems at local community levels. The managerial implications of this study are directed toward the need to implement a series of sustainable human resource management strategies and efficient employee training and development programs. Moreover, organizations need to be more proactive in assuming corporate social responsibilities.

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Long‐Term Medication Adherence Trajectories to Direct Oral Anticoagulants and Clinical Outcomes in Patients With Atrial Fibrillation

Journal of the American Heart Association ◽

10.1161/jaha.121.021601 ◽

2021 ◽

Author(s):

Jaejin An ◽

Zoe Bider ◽

Tiffany Q. Luong ◽

T. Craig Cheetham ◽

Daniel T. Lang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Medication Adherence ◽

Clinical Outcomes ◽

Rate Ratio ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Adherence Rate ◽

Nonvalvular Atrial Fibrillation ◽

Early Discontinuation

Background Direct oral anticoagulants (DOACs) are widely used in patients with nonvalvular atrial fibrillation for stroke prevention. However, long‐term adherence to DOACs and clinical outcomes in real‐world clinical practice is not well understood. This study evaluated long‐term medication adherence patterns to DOAC therapy and clinical outcomes in a large US integrated health care system. Methods and Results We included adult patients with nonvalvular atrial fibrillation who newly initiated DOACs between 2012 and 2018 in Kaiser Permanente Southern California. Long‐term (3.5 years) adherence trajectories to DOAC were investigated using monthly proportion of days covered and group‐based trajectory models. Factors associated with long‐term adherence trajectories were investigated. Multivariable Poisson regression analyses were used to investigate thromboembolism and major bleeding events associated with long‐term adherence trajectories. Of 18 920 patients newly initiating DOACs, we identified 3 DOAC adherence trajectories: consistently adherent (85.2%), early discontinuation within 6 months (10.6%), and gradually declining adherence (4.2%). Predictors such as lower CHA 2 DS 2 ‐VASc (0–1 versus ≥5) and previous injurious falls were associated with both early discontinuation and gradually declining adherence trajectories. Early discontinuation of DOAC therapy was associated with a higher risk of thromboembolism (rate ratio, 1.40; 95% CI, 1.05–1.86) especially after 12 months from DOAC initiation but a lower risk of major bleed compared with consistent adherence (rate ratio, 0.48; 95% CI, 0.30–0.75), specifically during the first 12 months following DOAC initiation. A gradual decline in adherence to DOACs was not statistically significantly associated with thromboembolism outcomes compared with consistent adherence. Conclusions Although a large proportion of patients with nonvalvular atrial fibrillation were adherent to DOAC therapy over 3.5 years, early discontinuation of DOAC was associated a higher risk of thromboembolic events. Future tailored interventions for early discontinuers may improve clinical outcomes.

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Psycholinguistic Evidence for Incipient Language Change in Mexican Spanish: The Extension of Differential Object Marking

Languages ◽

10.3390/languages6030131 ◽

2021 ◽

Vol 6 (3) ◽

pp. 131

Author(s):

Begoña Arechabaleta Regulez ◽

Silvina Montrul

Keyword(s):

Language Change ◽

Linguistic Knowledge ◽

Differential Object Marking ◽

Individual Level ◽

Oral Production ◽

Grammaticality Judgments ◽

Study Results ◽

On Line ◽

Object Marking ◽

The Individual

Spanish marks animate and specific direct objects overtly with the preposition a, an instance of Differential Object Marking (DOM). However, in some varieties of Spanish, DOM is advancing to inanimate objects. Language change starts at the individual level, but how does it start? What manifestation of linguistic knowledge does it affect? This study traced this innovative use of DOM in oral production, grammaticality judgments and on-line comprehension (reading task with eye-tracking) in the Spanish of Mexico. Thirty-four native speakers (ages 18–22) from the southeast of Mexico participated in the study. Results showed that the incidence of the innovative use of DOM with inanimate objects varied by task: DOM innovations were detected in on-line processing more than in grammaticality judgments and oral production. Our results support the hypothesis that language variation and change may start with on-line comprehension.

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Medical adherence in hypertensive patients treated by triple fixed-dose combination of amlodipine / indapamide / perindopril arginine (results of the Study DOKAZATEL’STVO)

Arterial’naya Gipertenziya (Arterial Hypertension) ◽

10.18705/1607-419x-2019-25-3-285-294 ◽

2019 ◽

Vol 25 (3) ◽

pp. 285-294

Author(s):

Zh. D. Kobalava ◽

E. A. Troitskaya ◽

M. A. Markova ◽

Y. V. Khruleva

Keyword(s):

Medication Adherence ◽

Study Drug ◽

Home Blood Pressure ◽

Fixed Dose Combination ◽

Fixed Dose ◽

Targeted Interventions ◽

Adherence Score ◽

High Adherence ◽

Dose Combination ◽

Design And Methods

Objective. To estimate changes in medication adherence in patients treated with fixed-dose combination of amlodipine / indapamide / perindopril arginine included in DOKAZATEL’STVO observational study.Design and methods. Effects of the fixed-dose combination of amlodipine / indapamide / perindopril arginine on medication adherence were assessed in 1554 patients who filled in the questionnaire at baseline and at the last visit. Primary outcomes of the study included the change in the office and ambulatory (home blood pressure (BP) monitoring) systolic and diastolic BP from baseline to 3 months and rate of the achievement of target BP < 140/90 mmHg after 3-month treatment. Adherence was assessed by special questionnaire.Results. The fixed-dose combination of amlodipine / indapamide / perindopril arginine resulted in the decrease in systolic BP by 39.5 mmHg and diastolic BP by 18.8 mmHg after 3 months. Target office BP < 140/90 mmHg was achieved in 87 %. High adherence at baseline was observed in 7,1 % patients, after 3 months of treatment — in 38,3 % (p < 0,001). Mean adherence score increased from 2,9 ± 1,6 to 5,0 ± 1,1 (p < 0,001). Study drug intake was associated with increase in motivation and awareness from 38 % to 95,4 % and from 19,8 % to 67,3 %, respectively (p < 0,001 for trend).Conclusions. The administration of the fixed-dose combination of amlodipine / indapamide / perindopril arginine was associated with well tolerated BP decrease and significant increase in medication adherence and motivation even in the absence of specific targeted interventions.

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Cultural Influences on Environmental Consciousness and Green Environmental Behavior

International Journal of Marketing Studies ◽

10.5539/ijms.v11n1p20 ◽

2019 ◽

Vol 11 (1) ◽

pp. 20

Author(s):

Bashar S. Gammoh ◽

Sam C. Okoroafo ◽

Anthony C. Koh

Keyword(s):

United States ◽

Environmental Behavior ◽

Cultural Influences ◽

Measurement Model ◽

The United States ◽

Cultural Norms ◽

Environmental Consciousness ◽

Individual Level ◽

Study Results ◽

The Individual

This paper focuses on investigating the relationship between culture and green attitudes and environmental behavior across two countries representing societies with different cultural norms. The paper presents a theoretical model suggesting that individual level cultural differences influence consumer’s environmental consciousness which then influence their green consumerism and active ecological Behaviors’. Data was collected using survey research from two countries representing societies with different cultural norms—the United States and India. SmartPLS was used to assess the quality of the measurement model and test the proposed research hypotheses. Although the United States is a society that is generally driven by individualism and mastery orientation, study results indicate that at the individual level people attitudes and behaviors might be influenced by different orientations depending on the consumption situation. Overall, study findings highlight the value in understanding the influence of cultural factors at the individual level and not just at the country level.

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