Medication adherence part one: Understanding and assessing the problem

Neiheisel, Mary B.; Wheeler, Kathy J.; Roberts, Mary Ellen

doi:10.1002/2327-6924.12099

Cited by 20 publications

(34 citation statements)

References 42 publications

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“…Because nonadherence is not discussed regularly in clinical practice, it is often a hidden problem (29,30). Clinicians are unable to recognize the condition as a reason for treatment failure, which then leads to unpredictable clinical activation or lack of disease control.…”

Section: Discussionmentioning

confidence: 99%

Oral ulcer activity in Behcet’s disease: Poor medication adherence is an underestimated risk factor

et al. 2017

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Objective: The aim of this study was to evaluate the relationship between oral ulcer activity and medication adherence according to gender in Behçet's disease (BD) patients. Material and Methods:The study group included 330 BD patients (F/M: 167/163, mean age: 38.5±10.5 years). Oral ulcer activity and medication adherence were evaluated in the previous month. Medication adherence was evaluated using the 8-item Morisky Medication Adherence Scale (MMAS-8) having a score range of "0" to "8" with high scores indicating better adherence. Low adherence was defined as <6 points on MMAS-8.Results: Over half of the group had active oral ulcers (n=219, 66.4%) within the month preceding the visit. The number of oral ulcers was significantly higher in female patients with low medication adherence (2.39±3.24) than in the rest of the female group (1.28±2.05; p=0.023). Although a similar trend was also observed in male patients (2.14±3.3 vs. 1.81±2.31), a significant relationship was not observed (p=0.89). The frequency of medication intake per day was lower in patients with high medication adherence than in the rest of the study group (p=0.04). Conclusion:Low medication adherence is a hidden risk factor in the management of BD. Poor adherence was associated with oral ulcer activity in female BD patients.

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Section: Discussionmentioning

confidence: 99%

Oral ulcer activity in Behcet’s disease: Poor medication adherence is an underestimated risk factor

et al. 2017

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“…6,7 Successful pharmacotherapy is ultimately contingent on medication adherence. 11 This is a persistent problem, with little evidence that overall adherence rates have improved in >50 years. 11 This is a persistent problem, with little evidence that overall adherence rates have improved in >50 years.…”

Section: Introductionmentioning

confidence: 99%

“…However, nonadherence remains a significant issue in health care, with consumption rates of prescribed medications reported to be as low as 50%, [8][9][10] resulting in increased morbidity, mortality, and more than $300 billion in avoidable health care costs annually. 11 This is a persistent problem, with little evidence that overall adherence rates have improved in >50 years. 12,13 Among newly diagnosed pediatric patients with epilepsy, rates of nonadherence are as high as 58%.…”

Section: Introductionmentioning

confidence: 99%

Correction of medication nonadherence results in better seizure outcomes than dose escalation in a novel preclinical epilepsy model of adherence

et al. 2019

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Summary Objective Medication nonadherence directly contributes to poor seizure control. A lack of emphasis on correcting poor adherence and failures in patient adherence can result in unwarranted alterations to a patient's drug regimen. We have modeled nonadherent patients in an animal model of epilepsy to study how alterations to pharmacotherapy, made without consideration of a patient's adherence, result in changes to seizure control. Methods Newly diagnosed rats with epilepsy were treated with carbamazepine (CBZ) during a 4‐week baseline period to establish their baseline seizure rate in the presence of 50% adherence. Next, animals were randomized to one of three treatment interventions and monitored for 6 weeks. Groups included: (1) no change in therapy—rats continued the 50% adherent paradigm; (2) dose escalation—the dose of CBZ was doubled, and the 50% adherent paradigm continued; and (3) nonadherence corrected—rats continued the initial dose of CBZ, but the adherence rate was adjusted to 100% (ie, fully adherent). Results The rats in the no change in therapy arm displayed a 61% increase in seizure burden over the 6‐week intervention phase. Similarly, rats in the dose escalation arm had a 66% worsening of their daily seizure burden. In contrast, rats in the nonadherence corrected arm displayed a 33% reduction in their daily seizure burden; a significant improvement when compared to the normalized seizure burden scores of rats in the other two treatment arms (P < 0.01). Significance We found that failure to correct medication nonadherence resulted in an increase in daily seizure burden in rats, even following dose escalation. In the presence of nonadherence, dose escalation worsened seizure control. In contrast, correcting nonadherence alone resulted in improved seizure control. These findings suggest that improving adherence should be prioritized over dose escalation in the clinical management of uncontrolled epilepsy.

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“…Patient self‐report (the approach most frequently used in the above studies) is a simple, inexpensive, subjective approach to adherence assessment; however, it is prone to underestimation of nonadherence, since patients (or parents) often wish to provide socially desirable answers to questions about their medicine taking behaviour . By contrast, measurement of the concentration of a medicine (or metabolite) in blood is an objective method, but can be expensive and requires blood sampling . Furthermore, longitudinal blood sampling e.g.…”

Section: Introductionmentioning

confidence: 99%

A multiple methods approach to determine adherence with prescribed mycophenolate in children with kidney transplant

Almardini

Taybeh

Alsous

et al. 2019

Brit J Clinical Pharma

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Aims: The aim of this study was, to use a multiple methods approach, including, for the first time, dried blood spot (DBS) sampling with population pharmacokinetic interpretation, to assess adherence to mycophenolate in children with kidney transplant. A second aim was to identify patient/parental factors that influenced adherence and to link adherence behaviour to clinical outcomes.Methods: A convenience sample of 33 children with kidney transplant (age ≤ 18 years) who had been prescribed mycophenolate for at least 3 months were recruited from participating outpatient clinics in the UK and Jordan. Medication adherence was determined via self-report questionnaires, medication refill data from dispensing records, and via mycophenolic acid concentrations in plasma and DBS samples obtained from children during a clinic visit.Results: Through triangulation of results from the different methodological approaches a total of 12 children (36.4%) were deemed to be nonadherent with their prescribed mycophenolate treatment. Logistic regression analysis indicated that nonadherence was significantly associated with the presence of mycophenolate side effects. Poor adherence was positively linked to measures of poor clinical outcomes (hospitalisation and the need for kidney biopsy).Conclusions: Despite the imperative regarding medication adherence to help prevent organ rejection, a significant proportion of children are not fully adherent with their therapy. Side-effects appear to be an important factor leading to nonadherence.Measurement of mycophenolate in DBS samples, coupled with the use of population pharmacokinetics modelling, was a convenient direct approach to assessing adherence in children with kidney transplant and has the potential to be introduced into routine practice. KEYWORDS adherence, dried blood spot, kidney transplant, mycophenolic acid The clinical responsibility for patients throughout the study lay with their hospital doctors and their individual general practitioners. Dr Reham Almardini acted as local PI in Queen Rania Hospital for Children, Amman while Dr Karl McKeever acted as local PI in the Royal Belfast Hospital for Sick Children.

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Medication adherence part one: Understanding and assessing the problem

Cited by 20 publications

References 42 publications

Oral ulcer activity in Behcet’s disease: Poor medication adherence is an underestimated risk factor

Oral ulcer activity in Behcet’s disease: Poor medication adherence is an underestimated risk factor

Correction of medication nonadherence results in better seizure outcomes than dose escalation in a novel preclinical epilepsy model of adherence

A multiple methods approach to determine adherence with prescribed mycophenolate in children with kidney transplant

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