scholarly journals When Multiple Objective Measures of Medication Adherence Indicate Incongruent Adherence Results: An Example with Pediatric Cancer

2020 ◽  
Vol 17 (6) ◽  
pp. 1956 ◽  
Author(s):  
Caitlin J. Cain ◽  
Andrea R. Meisman ◽  
Kirstin Drucker ◽  
Evrosina I. Isaac ◽  
Tanvi Verma ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Pediatric Cancer ◽  
Electronic Monitoring ◽  
Lymphoblastic Leukemia ◽  
Healthcare Providers ◽  
Dose Intensity ◽  
Maintenance Phase ◽  
Objective Measures ◽  
Treatment Regimens ◽  
Household Environment

Previous research suggests that children and adolescents with acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) often have difficulty adhering to complex treatment regimens during the maintenance phase of therapy. Measurement of treatment adherence can be done via objective (e.g., electronic monitoring (EM), pharmacological assays) or subjective methods (patient, parent, or physician reports). This paper provides an illustration of recommended strategies for comparing discrepancies between two objective measures of medication adherence (e.g., behavioral adherence using electronic monitoring versus pharmacological adherence using 6-mercaptopurine (6MP) metabolite data) within a relatively large cohort of pediatric patients with ALL or LBL (N = 139) who had longitudinal data for both measures of medication adherence over a 15-month period. Additionally, individual- and family-level factors such as gender, socioeconomic status, household environment, and dose intensity will be examined to identify possible sources of discrepancies between adherence measures. This information will provide practical advice for physicians, healthcare providers, and psychologists in identifying nonadherence and the caveats therein so patients achieve the best possible health outcomes.

scholarly journals Adherence to Oral Medications During Maintenance Therapy Among Children and Adolescents With Acute Lymphoblastic Leukemia: A Medication Refill Analysis

2017 ◽  
Vol 35 (2) ◽  
pp. 86-93 ◽  
Author(s):  
Yelena P. Wu ◽  
David D. Stenehjem ◽  
Lauri A. Linder ◽  
Bin Yu ◽  
Bridget Grahmann Parsons ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Medication Adherence ◽  
Maintenance Therapy ◽  
Pediatric Patients ◽  
Electronic Monitoring ◽  
Lymphoblastic Leukemia ◽  
Maintenance Phase ◽  
National Sample ◽  
Oral Medications ◽  
Medication Refill

Adherence to oral medications during maintenance therapy is essential for pediatric patients with acute lymphoblastic leukemia. Self-reported or electronic monitoring of adherence indicate suboptimal adherence, particularly among particular sociodemographic groups. This study used medication refill records to examine adherence among a national sample of pediatric patients with acute lymphoblastic leukemia. Patients in a national claims database, aged 0 to 21 years with a diagnosis of acute lymphoblastic leukemia and in the maintenance phase of treatment, were included. Medication possession ratios were used as measures of adherence. Overall adherence and adherence by sociodemographic groups were examined. Adherence rates were 85% for 6-mercaptopurine and 81% for methotrexate. Adherence was poorer among patients 12 years and older. Oral medication adherence rates were suboptimal and similar to or lower than previously documented rates using other methods of assessing adherence. Refill records offer a promising avenue for monitoring adherence. Additional work to identify groups most at-risk for poor adherence is needed. Nurses are well positioned to routinely monitor for medication adherence and to collaborate with the multidisciplinary team to address barriers to adherence.

scholarly journals Longitudinal Patterns of Social Problem-Solving Skills in an Ethnically Diverse Sample of Pediatric Patients with Cancer and their Caregivers

2020 ◽  
Vol 17 (5) ◽  
pp. 1581
Author(s):  
Evrosina Isaac ◽  
Urmila Sivagnanalingam ◽  
Andrea Meisman ◽  
Crista Wetherington Donewar ◽  
Linda Ewing ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Problem Solving ◽  
Racial Differences ◽  
Social Problem ◽  
Pediatric Patients ◽  
Lymphoblastic Leukemia ◽  
Clinical Care ◽  
Healthcare Providers ◽  
Social Problem Solving ◽  
Problem Solving Skills

Pediatric patients with acute lymphoblastic leukemia and lymphoblastic lymphoma are prescribed a daily oral chemotherapy medication named 6-mercaptopurine. Adherence to this medication is vital for survival and decreased risk for disease relapse. Adaptive problem-solving strategies are important for adhering to this complex regimen. This manuscript examined ethnic and racial differences in social problem-solving domains (Social Problem-Solving Inventory) among patients aged 7–19 years old who were diagnosed with cancer; and, their caregivers (N = 139). This was a 15-month longitudinal study. We also examined differences in medication adherence based on behavioral adherence measures. Our study found significant differences between minority and non-minority reporters across multiple social problem-solving domains (p < 0.05). However, there were no significant differences observed for medication adherence. Our findings underscore the importance of implementing culturally sensitive interventions in clinical care that could ultimately positively impact health behaviors, interactions with healthcare providers, and long-term health outcomes.

scholarly journals Electronic Monitoring of Medication Adherence in Early Maintenance Phase Treatment for Pediatric Leukemia and Lymphoma: Identifying Patterns of Nonadherence

2013 ◽  
Vol 40 (1) ◽  
pp. 75-84 ◽  
Author(s):  
Jennifer M. Rohan ◽  
Dennis Drotar ◽  
Melissa Alderfer ◽  
Crista Wetherington Donewar ◽  
Linda Ewing ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Electronic Monitoring ◽  
Maintenance Phase ◽  
Pediatric Leukemia

scholarly journals Gender Differences in the Risk of Ischemic Heart Disease According to Healthcare Utilization and Medication Adherence among Newly Treated Korean Hypertensive Patients

2021 ◽  
Vol 18 (3) ◽  
pp. 1274
Author(s):  
Jiae Shin ◽  
Dongwoo Ham ◽  
Hee Young Paik ◽  
Sangah Shin ◽  
Hyojee Joung
Keyword(s):  
Gender Differences ◽  
Heart Disease ◽  
Medication Adherence ◽  
Ischemic Heart Disease ◽  
Healthcare Utilization ◽  
Healthcare Providers ◽  
Ischemic Heart ◽  
Health Examination ◽  
Men And Women ◽  
Hypertensive Patients

We aimed to investigate gender differences in ischemic heart disease (IHD) according to healthcare utilization and medication adherence among newly treated Korean hypertensive adults. The National Sample Cohort version 2.0 of the National Health Insurance Service was used for analysis. Newly treated hypertensive patients ≥ 20 years and without IHD in 2002 were selected from a population that underwent health examination during 2003–2006. Of those patients, 11,942 men and 11,193 women were analyzed and followed up for 10 years. We determined the association between IHD and healthcare utilization and medication adherence using the Cox proportional hazards model. Hypertensive women patients had a lower risk of IHD than men patients (hazard ratio [HR] = 0.93, 95% confidence interval [CI] 0.88–1.00). The IHD risk was increased in patients who visited healthcare providers > 12 times/person-year (HR = 2.97, 95% CI 2.79–3.17), paid high out-of-pocket expense/person-year (HR = 1.55, 95% CI 1.41–1.69), and had medication nonadherence (HR = 1.67, 95% CI 1.58–1.77). However, the risk was decreased in patients who used both urban and rural areas (HR 0.75, 95% CI 0.67–0.84) and mixed types of providers (HR = 0.93, CI 0.88–0.99). The risk of IHD was significantly different between men and women only in the visiting frequency to healthcare providers (men, HR = 3.21, 95% CI 2.93–3.52; women, HR = 2.78, 95% CI 2.53–3.04, p for interaction = 0.0188). In summary, the risk of IHD was similar according to healthcare utilization and medication adherence between men and women, except visiting frequency to healthcare providers.

scholarly journals Relations between cognitive status and medication adherence in patients treated for memory disorders

2012 ◽  
Vol 3 (1) ◽  
pp. 2 ◽  
Author(s):  
Raymond L. Ownby ◽  
Christopher Hertzog ◽  
Sara J. Czaja
Keyword(s):  
Medication Adherence ◽  
Electronic Monitoring ◽  
Cognitive Status ◽  
Path Model ◽  
Elderly Persons ◽  
Poor Health Status ◽  
Memory Problems ◽  
Treatment Conditions ◽  
Electronic Monitoring Device ◽  
Over Time

Medication adherence has been increasingly recognized as an important factor in elderly persons’ health. Various studies have shown that medication non-adherence is associated with poor health status in this population. As part of a study of the effects of two interventions to promote medication adherence in patients treated for memory problems, information on medication adherence and cognitive status was collected at 3-month intervals. Twenty-seven participants (16 men, 11 women, age 71-92 years) were assigned to control or treatment conditions and adherence was evaluated with an electronic monitoring device. Cognitive status was evaluated at 3- month intervals beginning in April of 2003 and continuing through September of 2006. We have previously reported on the effectiveness of these interventions to promote adherence. In this paper, we examine the relations of cognitive status and adherence over time using a partial least squares path model in order to evaluate the extent to which adherence to cholinesterase medications was related to cognitive status. Adherence predicted cognitive status at later time points while cognition did not, in general, predict adherence. Results thus suggest that interventions to ensure high levels of medication adherence may be important for maintaining cognitive function in affected elderly people.

scholarly journals Assessing Medication Adherence Simultaneously by Electronic Monitoring and Pill Count in Patients With Mild-to-Moderate Hypertension

2010 ◽  
Vol 23 (2) ◽  
pp. 149-154 ◽  
Author(s):  
H. A. W. van Onzenoort ◽  
W. J. Verberk ◽  
A. G. H. Kessels ◽  
A. A. Kroon ◽  
C. Neef ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Moderate Hypertension ◽  
Electronic Monitoring ◽  
Pill Count

Abstract 148: Association of Dosing Frequency on Medication Adherence in Patients with Non-Valvular Atrial Fibrillation

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Tanya Burton ◽  
Lauren J Lee ◽  
Ying Fan ◽  
Winghan Jacqueline Kwong
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Medication Adherence ◽  
Health Plan ◽  
Index Date ◽  
Improve Medication Adherence ◽  
Treatment Regimens ◽  
Pharmacy Claims ◽  
Comorbidity Burden ◽  
Dosing Frequency

Objective: Previous studies suggest that the complexity of a dosing regimen may affect medication adherence. We examined the association between dosing frequency and adherence for 2 concomitant medications commonly prescribed to patients with non-valvular atrial fibrillation (NVAF), metoprolol (MET) and carvedilol (CAR). Methods: A retrospective claims study from a large US commercial and Medicare Advantage health plan analyzed data of adults ( > 18 years) with 1 inpatient or 2 outpatient claims for NVAF between 1/1/2008 - 12/31/2010. Patients with > 2 pharmacy claims for MET or CAR were analyzed separately. Within MET and CAR samples, once-daily (QD) and twice-daily (BID) cohorts were defined by the dosing frequency on pharmacy claims. The index date was set as the date of the first MET or CAR claim. Patients were continuously enrolled in the health plan for 1 year before (pre-index) and 1 year after (post-index) the index date. MET patients were required to have > 1 pre-index claim for acute myocardial infarction, angina, heart failure, or hypertension; CAR patients were required to have ≥1 claim for heart failure or hypertension. Patients using both QD and BID formulations of the index medication were excluded. Adherence to the index medication was assessed by the proportion of days covered (PDC) during the post-index period. PDC between QD and BID patients was compared using logistic regression to adjust for demographic and pre-index clinical characteristics. The proportion of QD and BID patients who discontinued the index medication (defined by a gap > 30 days) during the post-index period was also compared. Results: The analysis included 11,621 MET patients (QD: 6,084; BID: 5,537) and 4,393 CAR patients (QD: 203; BID: 4,190). Mean (SD) age was 70 (12) years for MET and CAR patients; 59% of MET and 69% of CAR patients were male. Compared to patients with BID dosing, patients with QD dosing were on average younger, more likely to be male, and had a lower comorbidity burden. Fewer patients discontinued MET or CAR with QD than BID dosing (MET: 38% vs. 51%, p<0.001; CAR: 39% vs. 48%, p=0.009). The proportion of patients with PDC > 80% was greater for patients with QD than BID dosing (MET: 62% vs. 50%, p< 0.001; CAR: 63% vs. 53%, p=0.004). MET patients with BID dosing were less likely to achieve PDC > 80% than patients with QD dosing (adjusted OR: 0.66; 95% CI: 0.609-0.712). CAR patients with BID dosing were less likely to achieve PDC > 80% than patients with QD dosing (adjusted OR: 0.69; 95% CI: 0.508-0.934). Among MET and CAR patients, age <60 years was associated with lower adherence (p<0.001) while prior use of index medication was associated with higher adherence (p≤0.001) to the index medication. Conclusion: Medication adherence to MET and CAR was higher with QD than BID dosing. Quality initiatives that reduce the dosing frequency of treatment regimens may improve medication adherence among NVAF patients.

No Advantage of Dexamethasone Over Prednisolone for the Outcome of Standard- and Intermediate-Risk Childhood Acute Lymphoblastic Leukemia in the Tokyo Children's Cancer Study Group L95-14 Protocol

2005 ◽  
Vol 23 (27) ◽  
pp. 6489-6498 ◽  
Author(s):  
Shunji Igarashi ◽  
Atsushi Manabe ◽  
Akira Ohara ◽  
Masaaki Kumagai ◽  
Tomohiro Saito ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Controlled Trial ◽  
Survival Rates ◽  
Maintenance Phase ◽  
Childhood Acute Lymphoblastic Leukemia ◽  
Intermediate Risk ◽  
Free Survival ◽  
Prospective Randomized Controlled Trial ◽  
Standard Risk

Purpose To evaluate whether dexamethasone (DEXA) yields a better outcome than prednisolone (PRED) in a prospective, randomized, controlled trial for the treatment of childhood acute lymphoblastic leukemia (ALL). Patients and Methods Two hundred thirty-one standard-risk (SR) patients and 128 intermediate-risk (IR) non–B-cell ALL patients were registered from March 1995 to March 1999. After random assignment in each group, the PRED arm patients received PRED 60 mg/m2 during induction followed by PRED 40 mg/m2 over four intensifications in the SR group and three intensifications in the IR group. DEXA arm patients received DEXA 8 mg/m2 during induction and DEXA 6 mg/m2 during the intensifications. The maintenance phase was continued until week 104. Results Event-free survival rates at 8 years in the DEXA and PRED arms were 81.1% ± 3.9% (n = 117) and 84.4% ± 5.2% (n = 114), respectively, in the SR group (P = .217) and 84.9% ± 4.6% (n = 62) and 80.4% ± 5.1% (n = 66), respectively, in the IR group (P = .625). The primary reason for treatment failure was marrow relapse. Only two extramedullary relapses occurred in the DEXA arm compared with seven relapses in the PRED arm. Although complications were more prevalent in the DEXA arm than in the PRED arm, fatal toxicity was rare both groups. Conclusion DEXA administered at 8 mg/m2 during induction and 6 mg/m2 during intensification showed no advantage over PRED administered at 60 mg/m2 during induction and 40 mg/m2 during intensification in both the SR and IR groups.

scholarly journals Acute Lymphoblastic Leukemia, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology

2021 ◽  
Vol 19 (9) ◽  
pp. 1079-1109
Author(s):  
Patrick A. Brown ◽  
Bijal Shah ◽  
Anjali Advani ◽  
Patricia Aoun ◽  
Michael W. Boyer ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Supportive Care ◽  
Lymphoblastic Leukemia ◽  
Philadelphia Chromosome ◽  
Treatment Strategies ◽  
Adolescent And Young Adult ◽  
Cancer Center ◽  
Nccn Guidelines ◽  
Treatment Regimens

The NCCN Guidelines for Acute Lymphoblastic Leukemia (ALL) focus on the classification of ALL subtypes based on immunophenotype and cytogenetic/molecular markers; risk assessment and stratification for risk-adapted therapy; treatment strategies for Philadelphia chromosome (Ph)-positive and Ph-negative ALL for both adolescent and young adult and adult patients; and supportive care considerations. Given the complexity of ALL treatment regimens and the required supportive care measures, the NCCN ALL Panel recommends that patients be treated at a specialized cancer center with expertise in the management of ALL This portion of the Guidelines focuses on the management of Ph-positive and Ph-negative ALL in adolescents and young adults, and management in relapsed settings.

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