Gambaran Kepatuhan Minum Obat Pada Pasien TB Paru : Literature Review

Compliance in treatment and taking Anti Tuberculosis Drugs (OAT) in pulmonary TB Patients is very necessary for consistency in increasing the success rate of treatment. Pulmonary TB Treatment must be done regularly. Otherwise, resistance to Anti Tuberculosis Drugs (OAT) will occur, the duration of taking the drug will be longer, and there will be an increase in the dose consumed. Especially, it is about an adherence to take OAT in patients with Multy-Drug Resistant (MDR) TB and TB with HIV. To find out the description of medication adherence in pulmonary TB patients and and characteristics in pulmonary TB patients. This study used a literature review design. The pill count compliance measurement method was conducted through a keyword search and used 5 articles from Google Scholar, ProQuest, and PubMed published in 2017 – 2021. From the 5 articles reviewed, the results showed that most of the respondents were male (68% or 314 respondents). The education level of most of the respondents was elementary school education (34% or 105 respondents). Most of the respondents were employed (62% or 164 respondents). Compliance with taking medication in pulmonary TB patients was 322 (70%) compliant, given intervention was 159 (92%) compliant, without intervention was 163 (56%) compliant, MDR TB non-adherent was 105 (95%), and TB with HIV 135 was (86%) complied. Compliance with taking Anti Tuberculosis Drugs (OAT) in pulmonary TB patients must be continuously improved and maintained to achieve the World Health Organization's target of increasing the success of pulmonary TB treatment consistently at results of 90%.Keywords: Compliance, Taking Medicines, TB Drugs, Pill Count, and Pulmonary TB AbstrakKepatuhan dalam pengobatan dan minum Obat Anti Tuberkulosis (OAT) pada pasien TB Paru sangat diperlukan konsistensinya dalam meningkatkan angka keberhasilan pengobatan. Pengobatan TB Paru harus dilakukan secara teratur, jika tidak akan terjadi resistensi pada Obat Anti Tuberkulosis (OAT), semakin lama durasi minum obat dan terjadi peningkatan dosis yang dikonsumsi. Terutama kepatuhan minum OAT pada pasien TB Multy Drug Resistant (MDR) dan TB dengan HIV. Mengetahui gambaran kepatuhan minum obat pada pasien TB Paru dan karakteristik pada pasien TB Paru. Desain Literature Review dengan metode pengukuran kepatuhan pill count melakukan pencarian melalui kata kunci dan menggunakan 5 artikel dari database hasil penulusuran elektronik pada Google Cendekia, ProQuest, Pubmed yang dipublish pada tahun 2017 – 2021. Dari 5 artikel yang di review di dapatkan hasil responden pada artikel sebagian besar berjenis kelamin laki – laki yaitu 314 (68%). Tingkat pendidikan responden sebagian besar berpendidikan SD yaitu 105 (34%), dan sebagian besar responden bekerja yaitu 164 (62%). Kepatuhan minum obat pada pasein TB dengan mengabaikan intervensi yang diberikan yaitu 322 (70%) patuh, diberikan intervensi 159 (92%) patuh, tanpa intervensi yang diberikan 163 (56%) patuh, TB MDR tidak patuh 105 (95%), dan TB dengan HIV 135 (86%) patuh. Kepatuhan minum Obat Anti Tuberkulosis (OAT) pada pasien TB Paru harus terus ditingkatkan dan dipertahankan untuk mencapai target World Heatlh Organisation dalam meningkatkan keberhasilan pengobatan TB Paru secara konsisten pada hasil ≥ 90%.Kata kunci: Kepatuhan; Minum Obat; Obat TB; Pill Count; dan TB Paru

Impact of Clinical Pharmacist Mediated Discharge Counseling and SMS Reminders Service on Medication Adherence in Chronic Disorders

Aims: This study aimed to assess the effect of discharge counseling with SMS reminders on medication adherence in chronic disorders. Study Design: Prospective randomized open-label trial Place and Duration of Study: The study was conducted at the dispensing department of a secondary care referral charity hospital located in a small village. The study was conducted for a period of six months from October 2018 to April 2019. Methodology: Upon consent, a total of 364 patients were enrolled in this study and randomized into two groups viz., intervention group (n=182) and control group (n=182) respectively, with and without discharge counseling and SMS reminder on medication usage by the clinical pharmacist. The level of medication adherence was measured using a pill count and visual analog scale (VAS) methods at two follow-up visits includes baseline and final follow-up visit (gap of two months). A two-sample Wilcoxon rank‑sum (Mann–Whitney) was used to compare the statistical mean difference of medication adherence levels between two groups at each follow‑up visit. Results: The mean age of intervention and control groups were 57.1±8.55 and 58.5±8.53; most of the subjects were >60 years of age and were typically suffering from hypertension (30.2%) and diabetes (34.8%). Initially, at baseline, the values of medication adherence level (pill-count method) were closer in both intervention (82.4±7.3) and control group (81.35±6.4), whereas at follow up visits, the levels of the intervention group (93.2±6.0, 95.6±2.25) were significantly increased (p<0.0001) as compared to the control group (81.2±8.5, 80.6±8.1). Conclusion: Thus, the statistical significance infers that the clinical pharmacist-mediated discharge counseling with SMS reminders would increase medication adherence levels in chronic disorders.

902. Unreturned Pill Bottles in the 1489 and 1490 Clinical Trials: An Important Measure of Poor Adherence that Is Often Ignored in Pill Count Calculations

Background Adherence to antiretroviral therapy is important for HIV suppression. In clinical trials, adherence is commonly measured by pill count; limitations are that unreturned pills may not have been taken and unreturned pill bottle data are omitted. This analysis focuses on the relationship between unreturned pill bottles as a measure of poor adherence and the overall effect on virologic success rates across all treatment groups. Methods Pill bottle return category (all bottles returned or ≥1 bottle unreturned) and return rates for participants across all treatment groups from two treatment-naïve INSTI clinical trials (Studies 1489 and 1490) were calculated. Association of bottle return category or rates with virologic events through week 144, including last on-treatment observation carried forward (LOCF) outcome, was determined; comparisons used Fisher’s exact or Wilcoxon rank sum test. Results Virologic suppression with ≥95% adherence by pill count can differ for those with unreturned pill bottles (Figure). In these studies, 60% of participants returned all their pill bottles through week 144; if one visit with ≥1 unreturned bottle was allowed, this percentage increased to 81%. The mean bottle return rate was 94% and did not differ by study, treatment arm, or sex. Failure to return pill bottles was significantly associated with lower suppression rates. Additionally, significant differences in pill bottle return rate (p &lt; 0.01) were observed by week 144 LOCF outcome (95% vs 77% mean return rate for those with HIV RNA &lt; 50 c/mL vs ≥50 c/mL), need for resistance testing (95% vs 77% return rate for those not tested vs tested), confirmed virologic failure (VF) (94% vs 90% return rate for those without VF vs with VF) and blip status (95% vs 92% return rate for those without blips vs with blips). HIV-1 Viral Loads of Two Participants with ≥95% Adherence by Pill Count through Week 144 Conclusion In these treatment-naïve INSTI clinical trials, failure to return pill bottles was associated with lower suppression rates. Although the calculated adherence rates in these studies was relatively high (median ≥95%), these calculations did not account for unreturned pill bottles. We believe that assessing adherence by both pill count and pill bottle return rate may provide a more complete picture of adherence in clinical trials. Disclosures Rima K. Acosta, BS, Gilead Sciences, Inc. (Employee, Shareholder) Grace Q. Chen, BS, Gilead Sciences, Inc. (Employee) Hailin Huang, PhD, Gilead Sciences, Inc. (Employee, Shareholder) Hui Liu, PhD, Gilead Sciences, Inc. (Employee, Shareholder) Kirsten L. White, PhD, Gilead Sciences, Inc (Employee, Shareholder)

629. High Efficacy of Bictegravir/Emtricitabine/Tenofovir Alafenamide (B/F/TAF) in African American Adults with HIV Including Those with Preexisting Resistance, Viral Blips, and Suboptimal Adherence

Background BRAAVE 2020 demonstrated the efficacy of switching to bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) among African American adults with suppressed HIV through Week (W) 48 (Figure 1). We present resistance, viral blips, adherence, and virologic outcomes through W72. Figure 1. BRAAVE 2020 study design (phase 3, randomized, open-label, multicenter [USA], active-controlled study) and virologic suppression at weeks 24 and 48 *Allowed 3rd agents: any FDA-approved protease inhibitor, nonnucleoside reverse transcriptase inhibitor (except etravirine), integrase strand transfer inhibitor (except bictegravir), or maraviroc. Methods Enrollment criteria permitted NNRTI resistance (-R), PI-R, and certain NRTI-R (M184V/I allowed; K65R/E/N, ≥3 thymidine analog mutations [TAMs], or T69-insertions excluded) and excluded known primary INSTI-R. Preexisting drug resistance was assessed with historical genotypes and retrospective baseline proviral DNA genotyping. Adherence was calculated by pill count. Viral blips (transient HIV-1 RNA ≥50 copies/mL) and outcomes based on last available on-treatment HIV-1 RNA were assessed. Results 489 participants received B/F/TAF and had ≥1 post-switch HIV-1 RNA measurement. Baseline genotypic data from cumulative historical and/or proviral genotypes were available for 96% (468/489) in protease/reverse transcriptase and 93% (453/489) in integrase. Preexisting NRTI-R, M184V/I, ≥1 TAMs, NNRTI-R, and PI-R were observed in 15% (68/468), 11% (50/468), 8% (36/468), 22% (101/468), and 13% (61/468), respectively. Primary INSTI-R was detected post-randomization in 2% (11/453); all remained in the study and were included in efficacy analyses. Through W72, 99% (486/489) of participants had HIV-1 RNA &lt; 50 copies/mL at their last study visit, including all with baseline NRTI-R or INSTI-R (Figure 2). Mean frequency of viral blips was 1% per timepoint, and blips were not associated with virologic failure. 112 participants (23%) had &lt; 95% adherence by pill count, 98% (110/112) of whom had HIV-1 RNA &lt; 50 copies/mL at last visit, including 14 of 14 (100%) with &lt; 80% adherence. No participant discontinued due to lack of efficacy or had treatment emergent resistance to study drugs. Figure 2. Virologic suppression by preexisting resistance, viral blips, and adherence Conclusion Virologic suppression was maintained through W72 of B/F/TAF treatment, including those with preexisting resistance, viral blips, and suboptimal adherence. Continued HIV suppression and absence of treatment-emergent resistance demonstrate the efficacy of B/F/TAF in African Americans regardless of adherence or preexisting resistance to NNRTIs, PIs, or non-tenofovir NRTIs. Disclosures Kristen Andreatta, MSc, Gilead Sciences, Inc (Employee, Shareholder) Michelle L. D'Antoni, PhD, Gilead Sciences (Employee, Shareholder)Gilead Sciences, Inc (Employee, Shareholder) Silvia Chang, Masters, Gilead Sciences, Inc (Employee, Shareholder) Aiyappa Parvangada, MS Computational Biology, Gilead Sciences, Inc (Employee, Shareholder) Ross Martin, PhD, Gilead Sciences, Inc (Employee, Shareholder) Christiana Blair, MS, Gilead Sciences, Inc (Employee, Shareholder) Sean E. Collins, MD, MS, Gilead Sciences, Inc (Employee, Shareholder) Kirsten L. White, PhD, Gilead Sciences, Inc (Employee, Shareholder)

ANALYSIS OF THE EFFECTIVENESS OF COUNSELING AND DIGITAL BOOKLET BY PHARMACIST ON ADHERENCE AND PAIN CONTROL OF CANCER PATIENTS AT DHARMAIS CANCER HOSPITAL

Objective: This study aimed to compare the effectiveness of counseling and digital booklet on the level of treatment adherence through reduced pain scale, Morisky Medication Adherence Scale (MMAS-8) scores, and pill count scores in patients with cancer pain using opioid analgesics. Methods: The author conducted this study at Dharmais Cancer Hospital with a quasi-experimental design. The study sample consisted of 134 respondents who met the inclusion and exclusion criteria, underwent a counseling intervention, and received a digital booklet. The author divided the sample into two groups, the counseling group (n=67) and the digital booklet group (n=67). Adherence level was measured using MMAS-8 and pill count. The pain scale was measured using the Numerical Rating Scale. Those measurements were conducted before the intervention (pre-test) and after 2 weeks of provisioning counseling and receipt of the digital booklet (post-test). Results: The results showed that each counseling and digital booklet improve adherence (p<0.05) and decrease pain scale (p<0.05). There was a significant difference in changes in the level of adherence (p=0.027) between the two groups. However, there was no significant difference in changes in the pain scale (p=0.132) between the two groups. Conclusions: The analysis showed a significant difference (p<0.05) between adherence level and pain scale before and after intervention by both counseling and digital booklet. Nevertheless, adherent increasing and pain scale reduction by counseling is better than a digital booklet.

Analysis Of The Effect Of Age On Medication Adherence With Oral Antidiabetes And Oral Antihypertension Drugs Using Pill Count Method

Compliance with taking medication is a problematic patients who get polypharmacy prescribing, this is because of the many drugs that must be consumed. As a result of the consumption of many drugs that cause sufferers of degenerative diseases are not compliant to take medication and health awareness decreases. This is not only experienced in elderly and geriatric patients but in adulthood also experience non-compliance with taking medication due to the many activities, lazy to take medication and also forget. This study was conducted to analyze the effect of age on adherence to taking oral antidiabetic drugs and oral antihypertensive drugs using the pill count method at the Regional Hospital of South Surabaya. The Pill Count method was chosen in this study with the aim of analyzing patient compliance in taking medication by calculating the remaining drug based on the rules of use and dosage when the patient returns to control. In addition, this study also aims to determine the effect of age on patient compliance in taking oral antidiabetic drugs and oral antihypertensive drugs. This research is descriptive observational with prospective data collection. Data analysis used descriptive and continued with statistical analysis using Chi-Square. The results of this study that adherence to take medication for elderly patients who received oral antidiabetic drug therapy obtained as much as 96.7% and 90% in adult patients. Compliance to oral antihypertension drugs in adult patients are 90% and 83.3% in elderly patients. Age does not effect compliance patients with Chi-Square analysis with p value = 0,301 and 0,448 > 0.05.

Novel application of Kaplan-Meier methods to model tolerance for nonadherence to imatinib in patients with chronic myeloid leukemia (CML) in the ADAGIO study.

7038 Background: Although adherence to imatinib treatment has been shown to be critical for attaining treatment response among patients with CML, some studies have suggested a 7.3-9.9% nonadherence tolerance margin before loss of treatment effects. We aimed to model probabilistically the margin of tolerance required to ensure treatment response among patients prescribed imatinib and the margin, if any, before treatment response is at risk. Methods: We performed a post hoc analysis of the ADAGIO study conducted in Belgium on 169 evaluable patients ( Blood 2009). Using the pill count ratio as, what in conventional survival analysis would be, the time variable, we modeled the cumulative likelihood of treatment response as a function of increasing pill count adherence. We applied Kaplan-Meier methods to model the likelihood of complete cytogenetic (CCyR), complete hematological (CHR), major molecular (MMR) and optimal (OR) (as defined by the European Leukemia Net) response as a function of 90-day pill count adherence. Kaplan-Meier methods thus estimated the tolerance for nonadherence to imatinib by calculating the 1 minus Kaplan-Meier estimate for treatment response. Results: Analyses (see Table) showed that ̃100% adherence of prescribed dose is associated with probabilities (rounded) of 0.84 for CHR, 0.83 for CCyR, 0.82 for OR, and 0.77 for MMR; compared to, 0.37 (CHR and CCyR), 0.35 (OR), and 0.39 (MMR) at 90% adherence. (of 0.7698 (MMR). Increasing the intake of imatinib from 90% to 100% of the prescribed dose increased the likelihood of the various treatment responses by 1.95 to 2.35-fold. Conclusions: Our findings challenge any previously estimated tolerance for nonadherence. There is virtually no margin for nonadherence if the objective is to optimize the likelihood of treatment response, and only a minimal margin to avoid impaired treatment response. Under such adherence, response rates similar to those in the pivotal IRIS trial can be obtained. Clinicians must assess and promote patient adherence, and patients must be perfectly adherent.[Table: see text]

Iron and Folic Acid Supplementation Compliance and Associated Factors among Pregnant Women Attending Antenatal Clinic in Shalla District, Southwest Ethiopia: A Cross-Sectional Study

Background. Iron-folate supplementation for a pregnant mother is a cost-effective intervention to reduce iron deficiency anemia during pregnancy. The aim of this study was to assess the iron-folic acid supplements and associated factors among pregnant women attending antenatal clinics in the public health center of Shalla district, Southwest Ethiopia. Methods. Institutional-based cross-sectional study design was conducted among 402 randomly selected pregnant mothers between February and April 2019. Data were collected using an interviewer-administered structured questionnaire from pregnant mothers attending antenatal care and using iron-folate supplements. Descriptive and multivariate logistic regression analyses were employed. Results. Pill count compliance rate was found to be (154) 38.3%. Pregnant mothers who had anemia in their previous pregnancy [(AOR = 11.35, 95% CI: 4.76–27.03)], counseling on iron-folate supplements [(AOR = 11.39, 95% CI: 5.09–27.03)], awareness of the benefit of the iron-folate supplements [(AOR = 2.22, 95% CI: 1.18–3.92)], and being a member of the Health Development Army [(AOR = 2.11, 95% CI: (1.2, 3.9)] were significantly associated with compliance with iron-folate supplement. Conclusion. Compared to the World Health Organization cut-off point, the pill count compliance rate of iron-folate supplementation among pregnant women in the study area was very low. Previous history of anemia and lack of knowledge about its benefit were some of the factors associated with it. Therefore, the healthcare providers should give continuous awareness creation and counseling services focusing on the benefit of iron-folate supplementation for pregnant mothers and their neonates.

Peningkatan Kepatuhan Minum Obat Melalui Konseling Apoteker pada Pasien Diabetes Mellitus Tipe 2 di Puskesmas Halmahera Kota Semarang

Ketidakpatuhan obat merupakan salah satu permasalahan dalam pengobatan Diabetes Mellitus (DM). Kepatuhan minum obat pasien DM berperan penting dalam menjaga kadar gula darah dalam rentang normal dan mencegah komplikasi. Peran apoteker diperlukan untuk meningkatkan pengetahuan dan perilaku pengobatan sehingga tingkat kepatuhan dikatakan baik. Tujuan penelitian ini adalah untuk mengetahui pengaruh konseling pada kepatuhan obat dan kadar gula darah pada pasien DM tipe 2 di Puskesmas Halmahera Semarang. Penelitian ini merupakan penelitian pre-eksperimental dengan rancangan <em>The One Group Pretest-Posttest</em>. Pengambilan data dilakukan pada periode April-Mei 2019 di Puskesmas Halmahera Semarang dan di rumah pasien. Kepatuhan obat diukur menggunakan instrument <em>Morisky, Green, and Levine Medication Adherence Questionnaire </em>(MGL MAQ) dan <em>pill count</em>. Kepatuhan berdasarkan MGL MAQ dianalisis menggunakan uji<em> Wilcoxon</em><em>, </em>dan didapatkan<em> p-value</em> 0,000 sehingga dapat dikatakan kepatuhan minum obat sebelum dan sesudah konseling apoteker berbeda signifikan. Kepatuhan obat menggunakan <em>pill count</em> didapatkan hasil patuh 62,80% dan tidak patuh 37,14%. Dapat disimpulkan bahwa konseling apoteker di Puskesmas Halmahera Semarang berpengaruh pada kepatuhan minum obat pasien DM tipe 2.

The impact of opioid prescribing reduction interventions on prescribing patterns across orthopedic subspecialties

Objective: To date, the majority of studies have focused on the adverse effect of opioid overutilization on outcomes, risk factors for overutilization and dependence, and the development of procedure-specific guidelines. We present the results of a multiphased approach to reducing opioid prescribing.Design: A retrospective pre-post study of opioid prescriptions across 386,393 patient encounters was conducted. The preintervention cohort included patient encounters from November 2016 to March 2017, and the post-intervention cohort included encounters from April 2017 to October 2019.Setting: Single-institution orthopedic practice.Patients, participants: 386,393 patient encounters.Intervention: Multiple prescribing reduction interventions were implemented from April 2017 to July 2018.Main outcome measure: Average morphine milligram equivalent (MME) per patient encounter.Results: Implementation of the interventions resulted in an average reduction of 15.2 MME per encounter (54.5 percent) compared to the preimplementation cohort (pre: avg. MME = 27.9, SD 113.6; post: avg. MME = 12.7, SD 66.1; p 0.001). The number of pills per opioid prescription was reduced by 13.4 (29.5 percent) (pre: avg. pill count = 45.5, S.D. 25.1; post: avg. pill count = 32.1, SD 21.1; p 0.001), and the percent of patients receiving opioids was reduced from 8.3 percent to 5.8 percent (p 0.001). Prescribing compliance was evaluated for 7,664 surgical encounters, with 98.2 percent of prescriptions meeting stated guidelines; 5.5 percent of these encounters required second prescriptions.Conclusions: The use of a multiphase approach effectively reduced the opioid prescribing patterns of a large orthopedic practice and was successful across subspecialties. This approach provides a template that other institutions may use to reduce opioid overprescribing in orthopedic practices.