An Inca trail to the Holy Grail: digital medication adherence support for TB care

Abstract Background Based on several existing patient-oriented activities, Medicines Use Review (MUR) service was standardized and officially adopted in Slovenia in 2015. Service aims to provide adherence support and ensure safe and effective medicines use. Therefore, the aim of the study was to evaluate the benefits of MUR in Slovenia, primarily the impact on medication adherence. Methods A randomised controlled trial was performed in community pharmacies to compare MUR with standard care. Patients were randomised into either the test (patients received MUR by a certified MUR provider at visit 1), or control group. The study primary outcome was self-reported adherence to multiple medications, assessed by electronic ©Morisky Widget MMAS-8 Software at the first visit (V1) and after 12 weeks (V2). A sub-analysis of intentional and unintentional non-adherence was performed. MUR impact was defined as the relative difference in ©MMAS-8 score after 12 weeks between the test and control group. A multiple linear regression model was used to predict MUR impact based on baseline adherence (low versus medium and high). Several secondary outcomes (e.g. evaluation of drug-related problems (DRPs)) were also assessed. Results Data from 153 (V1) and 140 (V2) patients were analysed. Baseline adherence was low, moderate and high in 17.6, 48.4 and 34.0% patients, respectively. In the low adherence subpopulation, test group patients showed a 1.20 point (95% CI = 0.16–2.25) increase in total ©MMAS-8 score (p = 0.025) compared to control group patients. A 0.84 point (95% CI = 0.05–1.63) increase was due to intentional non-adherence (p = 0.038), and a 0.36 point (95% CI = − 0.23-0.95) was due to unintentional non-adherence (p = 0.226). Additionally, statistically significant decrease in the proportion of patients with manifested DRPs (p < 0.001) and concerns regarding chronic medicines use (p = 0.029) were revealed. Conclusion MUR service in Slovenia improves low medication adherence and is effective in addressing DRPs and concerns regarding chronic medicines use. Trial registration ClinicalTrials.gov - NCT04417400; 4th June 2020; retrospectively registered.

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The cost of HIV medication adherence support interventions: Results of a cross-site evaluation

AIDS Care ◽

10.1080/09540120500100635 ◽

2005 ◽

Vol 17 (8) ◽

pp. 927-937 ◽

Cited By ~ 16

Author(s):

B. R. Schackman ◽

R. Finkelstein ◽

C. P. Neukermans ◽

L. Lewis ◽

L. Eldred ◽

...

Keyword(s):

Medication Adherence ◽

Adherence Support ◽

Site Evaluation ◽

Hiv Medication ◽

The Cost ◽

Cross Site

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Support of medication adherence by community pharmacists in Czech and Slovak Republics: a questionnaire survey study

European Pharmaceutical Journal ◽

10.1515/afpuc-2017-0006 ◽

2018 ◽

Vol 65 (1) ◽

pp. 15-23 ◽

Cited By ~ 1

Author(s):

M. Molitorisová ◽

J. Kotlářová ◽

M. Snopková ◽

I. Waczulíková

Keyword(s):

Medication Adherence ◽

Questionnaire Survey ◽

Information Technologies ◽

Real Life ◽

Community Pharmacists ◽

Survey Study ◽

Categorical Variables ◽

Average Score ◽

Technical Equipment ◽

Adherence Support

Abstract Introduction: Intervention of pharmacists in medication adherence can meaningfully contribute to achieving therapeutic outcomes. Exploring the real-life readiness and opportunities of pharmacists may result in the adoption of measures, which could be seen through improvement of patients’ adherence to pharmacotherapy. Aim: The aim of the paper was to make a survey on community pharmacists’ potential in medication adherence support in its connectivity to technical and personnel factors, which underline the capacities of pharmacies in dealing with medication adherence. Methods: The questionnaire survey was conducted from October to December 2014 and involved 158 pharmacists from 117 Czech (CZ) and 41 Slovak (SK) community pharmacies. The structured questionnaire surveyed both technical and personnel factors, including provision of consultancy services related to medication adherence. Non-adherence risk reduction was evaluated by adopting Morisky Scale modified from the pharmacist’s perspective. Questionnaires outcomes were summarised in contingency tables and analyzed for associations between respective categorical variables using χ2 or exact tests and association coefficients. All results are reported as significant at P≤0.05. Results: The average score of adherence support (CZ/SK 1.95/1.93) was significantly higher as compared to that of persistence or concordance (P<0.001). Reduction of non-adherence risk reached the score of a medium degree (P=0.73, average 2.29 in CZ and 2.22 in SK). These findings were significantly associated with personnel capacities (provision of consultancy, preference for the use of recommended procedures in CZ (P<0.001), number of years of practice in SK (P=0.029)), while significant association with technical equipment (consultancy room) in the SK (P=0.037). Conclusion: The pharmaceutical care is developing towards the improvement of medication adherence in both countries - assuming a medium degree of adherence support. Further progress may be observed in strengthening the pharmacists’ personnel capacities, and accelerated mainly using information technologies, i.e. through technical capacities.

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Perceived Stigma and Fear of Unintended Disclosure are Barriers in Medication Adherence in Adolescents with Perinatal HIV in Botswana: A Qualitative Study

BioMed Research International ◽

10.1155/2019/9623159 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 5

Author(s):

Sphiwe Madiba ◽

Unaswi Josiah

Keyword(s):

Medication Adherence ◽

Qualitative Study ◽

Age Groups ◽

Structural Factors ◽

Hiv Status ◽

Perceived Stigma ◽

Major Barrier ◽

Perinatal Hiv ◽

Adherence Support ◽

Clinic Visits

Background. Maintaining optimal adherence to antiretroviral treatment (ART) is a challenge for adolescents with perinatally HIV (ALPHIV), and there is little consensus on what factors contribute to adherence in this population. This study assessed self-reported medication adherence among ALPHIV and explored structural factors that hinder or motivate them to adhere. Methods. This qualitative study used in-depth interviews with ALPHIV at the infectious disease control centre of a teaching hospital in Botswana. Thirty adolescents aged 12–19 years who were aware of their HIV status were recruited purposively. Transcribed interviews were analysed using the thematic approach and NVivo data analysis software. Findings. Nonadherence was a problem across age groups and gender. Perceived stigma was a major barrier to ART adherence. The fear of stigma and unintended disclosure were more pronounced in those attending boarding school. The adolescents were not willing to take medication in front of roommates and outside of the home. They opted for hiding and taking medication in privacy which led to missed doses. The heightened fear of being seen collecting ART medication affected keeping appointments for clinic visits. Fear of stigma also influenced the choice of action when there was a clash between school activities, dosing times, and scheduled clinic appointments for ART refill. The home environment was the main facilitator for adherence. Support was the strongest motivator for adolescents to adhere and keep up with clinic visits. On a personal level, the desire to be healthy and live long was a major motivator to adhere. Conclusions. The fear of stigma shaped the adolescents’ adherence behaviour. Perceived stigma affected the time and place to take medication, the visit to the clinic for ART refill, and self-disclosure of HIV status. There is need to encourage adolescents to self-disclose their HIV status to friends since the fear of unintended disclosure fuelled perceived stigma. Planning of clinic appointments should also be consistent with realistic daily activities of adolescents.

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Enhancing community pharmacists’ provision of medication adherence support to older adults: A mixed methods study using the Theoretical Domains Framework

Research in Social and Administrative Pharmacy ◽

10.1016/j.sapharm.2020.03.004 ◽

2021 ◽

Vol 17 (2) ◽

pp. 406-418 ◽

Cited By ~ 2

Author(s):

Deborah E. Patton ◽

Cristín Ryan ◽

Carmel M. Hughes

Keyword(s):

Older Adults ◽

Mixed Methods ◽

Medication Adherence ◽

Theoretical Domains Framework ◽

Community Pharmacists ◽

Mixed Methods Study ◽

Adherence Support

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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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PMU80 - ENHANCING MEDICATION ADHERENCE THROUGH AN ADHERENCE SUPPORT PROGRAM

Value in Health ◽

10.1016/j.jval.2018.09.1916 ◽

2018 ◽

Vol 21 ◽

pp. S321

Author(s):

M Hanna ◽

B Yap ◽

M Crooks ◽

N Pojskic ◽

L Mandlsohn ◽

...

Keyword(s):

Medication Adherence ◽

Support Program ◽

Adherence Support

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Digital Medication Adherence Support: Could Healthcare Providers Recommend Mobile Health Apps?

Frontiers in Medical Technology ◽

10.3389/fmedt.2020.616242 ◽

2021 ◽

Vol 2 ◽

Author(s):

Claudine Backes ◽

Carla Moyano ◽

Camille Rimaud ◽

Christine Bienvenu ◽

Marie P. Schneider

Keyword(s):

Medication Adherence ◽

Mobile Phones ◽

Mobile Health ◽

Data Protection ◽

Evaluation Method ◽

Healthcare Providers ◽

European Economic Area ◽

Online Questionnaire ◽

Search Terms ◽

Adherence Support

Adherence to prescribed medication is suboptimal in 50% of the chronic population, resulting in negative medical and economic outcomes. With the widespread use of mobile phones worldwide, medication adherence apps for mobile phones become promising medication adherence aids thanks to simplicity, user-friendliness, and accessibility for the public. Yet, until today, there is insufficient evidence in favor of using mobile health (mHealth) apps to increase medication adherence. This study aims to develop a methodology for scientific and end-user (patient) mHealth evaluation (a) to identify medication adherence apps search terms, (b) to evaluate identified apps based on scientific criteria, and (c) to report best smartphone apps evaluated by patients. Search terms were identified via literature review and expertise. Firstly, an online questionnaire was developed to identify frequently used search terms by recruited patients. Related medication adherence apps were identified and selected using predefined inclusion criteria. Secondly, identified apps were evaluated thanks to a scientific evaluation method and a created online questionnaire for patient feedback. Recruited patients were invited to test and evaluate the selected apps. Out of 1,833 free-of-charge and 307 paid apps identified, only four free-of-charge and three paid apps remained included in the study after eligibility criteria. None of the selected app reached a high score. Looking at the overall scores, Medisafe (59%), MyTherapy (56%), and Meds on time (44%) received the highest scores in the scientific app evaluation. In the patient evaluation, Dosecast (3.83 out of five points), Medisafe (3.62), and SwissMeds (3.50) received the highest scores. None of the apps in this research has undergone a process for certification, for example, CE marking, through a notified body. Security and data protection aspects of existing apps highly contribute to these low evaluation scores through little information on patient's data processing and storage. This might be corrected through the introduction of General Data Protection Regulation (GDPR) in the European Economic Area (EEA) and more scrutiny through regulatory bodies in the EU/EEA and the USA. None of the applications should be recommended by healthcare providers. In addition, clinical studies with chronic patients are necessary to measure long-term app impacts.

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Smokers’ perspectives of tobacco dependency medications and medication adherence during a quit attempt in an urban NHS stop smoking service : a qualitative study

10.21203/rs.3.rs-17174/v1 ◽

2020 ◽

Author(s):

Carol Jane Sanders ◽

Antje LINDENMEYER ◽

John MARRIOTT

Keyword(s):

Medication Adherence ◽

Electronic Cigarettes ◽

Tobacco Dependence ◽

Social Contexts ◽

Structured Interviews ◽

Quit Attempt ◽

Adherence To Medication ◽

Stop Smoking ◽

Adherence Support ◽

Treatment Context

Abstract Background: Smoking and poor medication adherence are both associated with increased morbidity, mortality and immense costs for the healthcare system. Numerous studies have investigated the barriers and facilitators of medication adherence among patients with chronic disease. However, the factors influencing adherence to medication targeted to reduce smoking remain unexplored. In order to achieve further reduction of smoking prevalence, improvement of medication adherence is essential. Thus, this study aims to uncover and understand adult smokers’ attitudes towards adherence to medication to reduce tobacco dependence. Methods: A purposive approach was used to recruit smokers aged over 18 and motivated to quit using pharmacotherapy. In-depth semi-structured interviews were conducted with a diverse sample of eleven smokers who were engaged with a NHS Stop Smoking Program. Data were thematically analysed using PRIME theory . Results: Smokers were active decision makers regarding their tobacco dependence medications. Adherence was influenced by smokers’ evaluations, plans, access to support and experiential learning, highlighting the need for tailored adherence support. Conflicting views about medication were held by all participants. Side effects, fear of dependency and inability to stop cravings influenced initiation and adherence. Electronic cigarettes were viewed negatively. Adherence was influenced by their unique psycho-social contexts including deep-rooted personal rejection and, fear of medicines. These attitudes influenced smokers’ beliefs, decisions about quitting and the role and use of medications in the quitting process. Conclusions: Tobacco dependency is a unique treatment context with specific adherence issues. Lay perspectives of medications to support quit attempts differ from the medical viewpoint. Adherence to tobacco dependency regimens is a challenging goal, inhibited by many complex factors. There is a need for smoking cessation interventions to respond to individual medication beliefs and concerns to help to build a smoker’s confidence that an individual can take their tobacco dependency mediation as prescribed and maximise benefits.

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