A Systematic Review of Medication Adherence Thresholds Dependent of Clinical Outcomes

Baumgartner, Pascal C.; Haynes, R. Brian; Hersberger, Kurt E.; Arnet, Isabelle

doi:10.3389/fphar.2018.01290

Cited by 159 publications

(134 citation statements)

References 37 publications

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“…Categorical variables are presented as numbers or percentages. Although the validity of the historical 80% threshold remains uncertain (19), it is generally considered that suboptimal adherence becomes clinically significant when <80% of the prescribed medication is taken (20,21). This leads to a study-and sample-specific SAMS cut-off of 13 points for clinically meaningful/significant nonadherence.…”

Section: Discussionmentioning

confidence: 99%

What Predicts Different Kinds of Nonadherent Behavior in Elderly People With Parkinson's Disease?

et al. 2020

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Background: Detailed knowledge about nonadherence to medication could improve medical care in elderly patients. We aimed to explore patterns and reasons for nonadherence in people with Parkinson's disease (PD) aged 60 years and older. Methods: Detailed clinical data and adherence (German Stendal Adherence with Medication Score) were assessed in 230 patients with PD (without dementia). Descriptive statistics were used to study reasons for nonadherence in detail, and general linear models were used to study associations between clusters of nonadherence and clinical parameters. Results: Overall, 14.2% (n = 32) of the patients were fully adherent, 66.8% (n = 151) were moderately nonadherent, and 19.0% (n = 43) showed clinically meaningful nonadherence. In the multivariable analysis, nonadherence was associated with a lower education level, higher motor impairment in activities of daily living, higher number of medications per day, and motor complications of PD. Three clusters of nonadherence were observed: 59 (30.4%) patients reported intentional nonadherence by medication modification; in 72 (37.1%) patients, nonadherence was associated with forgetting to take medication; and 63 (32.5%) patients had poor knowledge about the prescribed medication. A lower education level was mainly associated with modification of medication and poorer knowledge about prescribed medication, but not with forgetting to take medication. Patients with motor complications, which frequently occur in those with advanced disease stages, tend to be intentionally nonadherent by modifying their prescribed medication. Increased motor problems and a higher total number of drugs per day were associated with less knowledge about the names, reasons, and dosages of their prescribed medication. Conclusions: Elderly patients with PD report many reasons for intentional and non-intentional nonadherence. Understanding the impact of clinical parameters on different patterns of nonadherence may facilitate tailoring of interventions and counseling to improve outcomes.

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Section: Discussionmentioning

confidence: 99%

What Predicts Different Kinds of Nonadherent Behavior in Elderly People With Parkinson's Disease?

et al. 2020

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“…The RCS method fits a smooth continuous curve of adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) across adherence levels, allowing for cubic form changes at knot points (we selected knots for 30%, 60%, and 90% adherence) and a linear form in the tails (below 30% and above 90%) . An adherence level of 80% was chosen as the reference point for calculation of HRs because this threshold is widely used to define “good” adherence . We restricted RCS plots to adherence more than or equal to 30% because of small frequencies below 30%.…”

Section: Methodsmentioning

confidence: 99%

“…Some studies compare these calculations by their means and medians. The traditional way of interpreting the estimates is to convert the continuous measure to a binary variable with a cut‐off of 80% representing “good adherence.” Few studies have compared these adherence measures against their ability to predict clinical outcomes and whether these adherence measures should be used as categorical or continuous variables.…”

Section: Introductionmentioning

confidence: 99%

Comparison of medication adherence measures derived from linked administrative data and associations with mortality using restricted cubic splines in heart failure patients

Qin

Hung

Knuiman

et al. 2020

Pharmacoepidemiology and Drug

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Purpose: There is no gold standard method to calculate medication adherence using administrative drug data. We compared three common methods and their ability to predict subsequent mortality in patients with heart failure (HF).Methods: Person-linked population-based datasets were used to identify 4234 patients (56% male, mean age of 76), who survived 1 year (landmark period) following hospitalization for HF in Western Australia from 2003 to 2008. Adherence was estimated by the medication possession ratio (MPR), MPR modified (MPRm), and proportion of days covered (PDC) in patients dispensed a renin-angiotensin system inhibitor (RASI) and/or β-blocker within the landmark period. Adjusted Cox regression models that fitted restricted cubic splines (RCS) assessed the relationship between medication adherence and 1-year all-cause death postlandmark period.Results: In the landmark period, 87% and 68% of the HF cohort were dispensed RASI and β-blockers, respectively. Mean adherence estimates for RASI and β-blockers were 90% and 79% for MPR, 96% and 86% for MPRm, and 82% and 73% for PDC, respectively. In RCS models, MPRm was not associated with subsequent 1-year death in either the RASI or β-blocker group, while MPR was independently associated with death in the RASI group only (P ≤ .01). However, PDC as a binary variable (PDC <80% or ≥80%) or continuous variable was independently associated with 1-year death in both RASI and β-blocker groups (all P ≤ .02).Conclusion: Proportion of days covered calculated from administrative drug data provides a more conservative estimate of adherence than MPR or MPRm and was the most consistent predictor of subsequent mortality in an HF cohort using RCS analysis. K E Y W O R D Sadministrative data, analytical methods, evidence-based medicines, heart failure, medication adherence, pharmacoepidemiology, restricted cubic splines This work has not been presented or published anywhere.

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“…Proxy for drug adherence was defined as a proportion of day covered by an antihypertensive drug >80% in the year preceding clinical examination, based on the number of drug boxes purchased during the year and reported by the SNDS database …”

Section: Introductionmentioning

confidence: 99%

Patterns of hypertension management in France in 2015: The ESTEBAN survey

Vallée¹,

Gabet

Grave

et al. 2020

J of Clinical Hypertension

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The purposes of this study were to describe the hypertensive population and therapeutic management of hypertension in adults between 18 and 74 years of age in France in 2015.Esteban survey is a cross-sectional survey with a clinical examination conducted in a representative sample of French adults aged 18-74 years between 2014 and 2016.Esteban was entirely public-funded. Blood pressure (BP) was measured during clinical examination with a standardized protocol, and pharmacological treatment was collected through the exhaustive Système National des Données de Santé (SNDS) database. Hypertension was defined by systolic BP (SBP)> 140 mm Hg, diastolic BP (DBP)> 90 mm Hg or treatment with BP-lowering drugs. The therapeutic control of treated hypertensive patients was defined by SBP < 140 mm Hg and DBP < 90 mm Hg.Adherence to drug treatment was defined as more than 80% of days covered by BPlowering drug per year. The prevalence of hypertension was 31.3%. 74.7% of aware hypertensive participants taking an antihypertensive drug, and 57.7% of them were treated with a single antihypertensive pharmacological class. Overall, among hypertensives, 24.3% had a satisfactory BP control. Only 49.7% of treated hypertensives participants were controlled, and 33.6% of them were adherent to their drug treatment. The prevalence of hypertension in France remains high, with only 74.7% of the aware hypertensive participants receiving pharmacological therapy and only 48.9% of aware hypertensives with a BP at goal. More effective measures are needed to improve clinical management of hypertension in France.

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A Systematic Review of Medication Adherence Thresholds Dependent of Clinical Outcomes

Cited by 159 publications

References 37 publications

What Predicts Different Kinds of Nonadherent Behavior in Elderly People With Parkinson's Disease?

What Predicts Different Kinds of Nonadherent Behavior in Elderly People With Parkinson's Disease?

Comparison of medication adherence measures derived from linked administrative data and associations with mortality using restricted cubic splines in heart failure patients

Patterns of hypertension management in France in 2015: The ESTEBAN survey

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