Directly Observed Therapy Linked To Lower Mortality In Multi-Drug Resistant TB

MedicalResearch.com Interview with:
Dr. Jorge Salinas MD
Epidemic intelligence service officer
Division of Tuberculosis Elimination
Centers for Disease Control and Prevention 

MedicalResearch.com: What is the background for this study?

Response: Because multidrug-resistant TB (MDR TB) treatment regimens are less effective, more complex, and are more likely to have side effects that are difficult to tolerate than regimens for drug-susceptible TB, patients with MDR TB are at a higher risk of dying. Directly observed therapy (a therapy by which patients meet with a healthcare worker at a regularly scheduled time and place so the healthcare worker can observe the patient taking their TB medication) is recommended to treat all forms of TB disease, including MDR TB.

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Risk Factors for Nonadherence to Antihypertensive Treatment

MedicalResearch.com Interview with:

Dr. Gupta Pankaj

Dr.Gupta

Dr. Gupta Pankaj
Consultant Metabolic Physician/Chemical Pathologist

Dr. Patel Prashanth - Consultant Metabolic Physician/Chemical Pathologis

Dr. Patel

Dr. Patel Prashanth – Consultant Metabolic Physician/Chemical Pathologist

Department of Metabolic Medicine and Chemical Pathology
University Hospitals of Leicester NHS Trust, UK

 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Non-adherence or patients not taking their medications as prescribed is known since the time of Hippocrates. It is the key reason why blood pressure is well controlled in only around 50% of patients with hypertension, despite the availability of good medicines. Non-adherence leads to poorer cardiovascular outcomes and is thought to cost $100 billion to the US health economy. A crucial reason for the lack of progress in improving adherence has been the previous lack of a clinically useful objective measure.

We and others have developed a robust and reliable biochemical screening method to assess for non- adherence to antihypertensive medications in urine or blood using a technique called liquid chromatography-tandem mass spectrometry.  We have previously reported a single centre study that demonstrated high rates of non-adherence in patients attending a hypertension clinic.

Since, then we have set up a National Centre for Adherence Testing (NCAT, ncat@uhl-tr.nhs.uk) in the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust (UHL) and receive samples from around 25 hypertension clinics across UK. This study analysed data from~1400 patients consisting of samples received in UHL and also from a cohort of patients in the Czech Republic.

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More Work Needed To Ensure Compliance With High Intensity Statins After Heart Attack

MedicalResearch.com Interview with:

Robert Rosenson, MD Professor of Medicine and Cardiology Icahn School of Medicine at Mount Sinai New York

Dr. Rosenson

Robert Rosenson, MD
Professor of Medicine and Cardiology
Icahn School of Medicine at Mount Sinai
New York

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: High intensity statin therapy is underutilized in patients with acute coronary syndromes. In 2011, 27% of patients were discharged on a high intensity statin (Rosenson RS, et al. J Am Coll Cardiol).

In this report, we investigate the factors associated with high adherence to high intensity statin. High adherence to high intensity statins was more common among patients who took high intensity statin prior to their hospitalization, had fewer comorbidities, received a low-income subsidy, attended cardiac rehabilitation and more visits with a cardiologist.

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Why Do So Many Stroke Survivors Give Up On Preventive Medications?

MedicalResearch.com Interview with:
Anna De Simoni

NIHR Academic Clinical Lecturer in Primary Care Research
Centre for Primary Care and Public Health
Barts and The London School of Medicine and Dentistry
London E1 2AB

MedicalResearch.com: What is the background for this study?

Response: Three in 10 stroke survivors will go on to have a further stroke, which causes greater disability or even death. Secondary prevention medications, including antihypertensives, blood thinning and lipid lowering agents, such as statins, can reduce risk of stroke recurrence by up to 75 per cent. However, patients’ persistence with these medications decreases over time because a minority of people experience side effects, which are mild in most cases.

The analysis, involving Queen Mary University of London and the University of Cambridge and published in the journal Family Practice, was performed on the archives from TalkStroke, a UK online forum hosted by the Stroke Association. The forum is used by patients with stroke and their carers, and generated 21,596 posts during 2004-2011. 50 participants were found to discuss GP advice on prevention medications in 43 discussion threads.

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Money for Medication Improved Adherence To Medications for Psychosis

MedicalResearch.com Interview with:

 Ernst L Noordraven MSc, PhD student Department of Psychiatry Epidemiological and Social Psychiatric Research institute Erasmus University Medical Center Rotterdam Netherlands

Ernst L Noordraven

Ernst L Noordraven MSc, PhD student
Department of Psychiatry
Epidemiological and Social Psychiatric Research institute
Erasmus University Medical Center
Rotterdam Netherlands

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Provision of financial incentives is a promising intervention for improving adherence in patients taking antipsychotic medication. We aimed to assess the effectiveness of this intervention for improving adherence to antipsychotic depot medication in patients with psychotic disorders, irrespective of their previous compliance.

Our 12-month randomized controlled trial showed that financial incentives improved adherence to antipsychotic depot medications in patients with psychotic disorders, regardless of their level of compliance at study entrance. Patients received either treatment as usual plus a financial reward for each depot of medication received (€30 per month if fully compliant; intervention group) or treatment as usual alone (control group). Based on the use of depot registrations from 155 patients (92%), the adjusted difference in adherence was 14·9% (95% CI 8·9–20·9%; p<0·0001) in favour of the intervention group.

Our study is also the first to demonstrate that the effects on medication adherence persist after monetary rewards are discontinued, for at least a 6-month follow-up period (adjusted difference 6·5%, 95% CI 2·0–10·9; p=0·047).

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New Capsule Can Reside in Stomach and Deliver Drugs for Several Weeks After Single Ingestion

MedicalResearch.com Interview with:

C. Giovanni Traverso, MB, BChir, PhD Gastroenterologist and biomedical engineer Division of Gastroenterology at BWH Instructor of medicine at Harvard Medical School.

Dr. Traverso

C. Giovanni Traverso, MB, BChir, PhD
Gastroenterologist and biomedical engineer
Division of Gastroenterology at BWH
Instructor of medicine at Harvard Medical School

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We developed a drug delivery system capable of safely residing in the stomach for 2 weeks. Furthermore we demonstrated the capacity of the novel dosage form, in the shape of a star, to protect the drug from the acidic stomach environment and also slowly release drug over the course of 14 days.

We applied this new technology towards efforts targeting the elimination of malaria. Specifically, we focused on a drug called ivermectin that has been used to treat parasites but also has the benefit of being toxic to malaria-carrying mosquitos when they bite someone who has ivermectin in their system.

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Electronic Prescriptions More Likely To Be Filled By Patients

MedicalResearch.com Interview with:

Adewole S. Adamson, MD, MPP Department of Dermatology The University of North Carolina at Chapel Hill Chapel Hill, NC

Dr.Adewole S. Adamson

Adewole S. Adamson, MD, MPP
Department of Dermatology
The University of North Carolina at Chapel Hill
Chapel Hill, NC

MedicalResearch.com: What is the background for this study?

Response: As the United States has moved to increasing levels of electronic medical record keeping, electronic prescribing has become an important part of improving the quality of care and patient experience. E-prescribing increases co-ordination between pharmacist and physician and decreases prescription errors. However, it is less certain whether e-prescribing affects patient primary adherence to medications, meaning whether or not a patient will fill and pick up their medication at the pharmacy. Although it may seem intuitive that primary adherence would increase by removing the patient from the prescription-to-pharmacy routing process, there have been few studies directly comparing primary adherence of patients given traditional paper prescriptions versus e-prescriptions.

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Big Data Using Predictive Analytics Aims To Improve Medication Adherence

Neil Smiley

Neil Smiley

MedicalResearch.com Interview with:
Neil Smiley

Founder and CEO of Loopback Analytics

Editor’s note: Loopback Analytics mission is to “integrate data across a myriad of healthcare information systems to bridge the expanding gaps within the care continuum”. CEO Neil Smiley discusses the problem of medication adherence and possible means to address the issue.

MedicalResearch.com: What is meant by medication “adherence”? How big a problem does this represent in term of health care outcomes and costs?

Response: Medication adherence is the degree to which a patient is taking medications as prescribed. Poor medication adherence takes the lives of 125,000 Americans annually, and costs the health care system nearly $300 billion a year in additional doctor visits, emergency department visits and hospitalizations.

MedicalResearch.com: What can be done by health care providers, systems and pharmacists to improve medication adherence?

Response: There are many potential failure points after a prescription is written, that range from affordability, transportation, literacy, confusion over brand vs. generics, duplication of therapy. Many patients simply stop taking medications when they start feeling better or fail to refill chronic maintenance medications. Healthcare providers can improve adherence by anticipating and eliminating potential points of failure before they become problems. For example, high risk patients leaving the hospital are less likely to be readmitted if they get their prescriptions before they are discharged. Follow-up consultations by pharmacists can assist patients with side effects that may otherwise cause patients to abandon their treatment plan and provide patients with education on how to take medications correctly.

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Some US Regions and Ethnicities At Greater Risk of Non-Adherence to Blood Pressure Medications

MedicalResearch.com Interview with:

Matthew Ritchey, DPT, PT, OCS, MPH Epidemiologist Division for Heart Disease and Stroke Prevention National Center for Chronic Disease Prevention and Health Promotion

Dr. Matthew Ritchey

Matthew Ritchey, DPT, PT, OCS, MPH
Epidemiologist
Division for Heart Disease and Stroke Prevention
National Center for Chronic Disease Prevention and Health Promotion

MedicalResearch.com: What is the background for this study?

Response: High blood pressure is a leading cause of heart disease, stroke, kidney disease and death. Unfortunately, almost one in three U.S. adults (around 75 million) has high blood pressure, and nearly half of that group (about 34 million) doesn’t have it under control.

As part of CDC’s ongoing efforts to monitor trends and risk factors contributing to cardiovascular disease, we collaborated with colleagues at the Centers for Medicare and Medicaid Services to look at blood pressure medicine nonadherence among Medicare Part D enrollees ages 65 and over. Being nonadherent means that patients skip doses of their medicine or stop taking it altogether.

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Policy Changes Have Reduced Cost-Related Medication Nonadherence

MedicalResearch.com Interview with:

Elizabeth Geneva Wood, MHPA Department of Health Policy and Administration College of Nursing Washington State University Spokane

Ellizabeth Wood

Elizabeth Geneva Wood, MHPA
Department of Health Policy and Administration
College of Nursing
Washington State University
Spokane

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Many people don’t fill prescriptions because they can’t afford them, which is risky for their health. The problem of cost-related nonadherence to prescriptions (CRN) was increasing in prevalence over time until several major policy changes in the 2000s that were intended to help prescription affordability and/or access to health insurance. We observed that each of these major policy changes corresponded with a decrease in CRN among the policy’s target population.

For seniors, CRN dropped in 2006, when Medicare Part D came into effect. For younger adults (19-25), CRN dropped in 2010, when the Affordable Care Act began allowing them to stay on their parents’ insurance. Cost-related nonadherence rates also dropped for all non-elderly adults (including the younger ones) in 2014 and 2015, when the Medicaid expansion and the introduction of the health insurance marketplaces offered coverage to many previously-uninsured adults.

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Study By Quest Diagnostics Finds Half of Americans Misuse Their Drugs

MedicalResearch.com Interview with:

F. Leland McClure III, MSci, PhD, F-ABFT Medical science liaison director Quest Diagnostics

Dr. F. Leland McClure

F. Leland McClure III, MSci, PhD, F-ABFT
Medical science liaison director
Quest Diagnostics

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Many physicians associate Quest Diagnostics with their lab service needs because of our leadership in laboratory testing. But Quest is more than a lab, which is why we refer to ourselves as a diagnostic information services provider. This means that we help providers, health plans and even patients use the insights we derive from our lab testing data to deliver better care, quality and outcomes, both for the patient and the managed population.

Our 2016 Quest Diagnostics Health Trends(TM) Prescription Drug Monitoring Report is an example of how we provide important health insights from Quest’s laboratory data. Prescription drug misuse is a major epidemic in the United States. Laboratory testing can help identify if a patient is using or misusing prescribed medications. For instance, lab tests can show evidence of additional medications and other drugs in a patient’s urine specimen, suggesting potentially dangerous drug combinations. Earlier this year, the CDC issued guidelines that call for laboratory testing for patients prescribed certain medications, such as opioids, that carry a risk of abuse.

Quest’s prescription drug monitoring services help the physician identify if a patient is taking or not taking up to about four dozen drugs, such as oxycodone, Adderall XR® and Percocet®. For the Quest analysis, we analyzed more than 3 million de-identified lab test results.

In this report, we found that 54 percent of patients’ results tested in 2015 showed evidence of drug misuse, slightly above the 53 percent misuse rate in 2014. That is certainly unacceptably high, but it’s a significant decline from the high of 63 percent we observed in 2011.

We also found that an increasing proportion of patients who misuse medications combine their prescription medication with non-prescribed drugs. Among patients with inconsistent test results, forty-five percent of these patients showed evidence of one or more other drug(s) in addition to their prescribed drug regimen. That’s much higher than our findings of 35 percent in 2014 and 2013, 33 percent in 2012, and 32 percent in 2011.

Finally, we were alarmed by the data showing the connection between heroin and benzodiazepines misuse. Our data showed one in three heroin users combine their drug use with benzodiazepines, the vast majority of which were unprescribed. This is an extremely dangerous practice given that benzodiazepines can have strong respiratory depressant effects when combined with other substances. Drug combinations, but particularly of heroin with benzodiazepines, can be potentially very dangerous, leading to coma and even death in some cases.

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Pharmacist-Led Program Reduced Hospital Readmissions Through Improved Medication Adherence

MedicalResearch.com Interview with:

Jennifer Polinski, Senior Director Enterprise Evaluation and Population Health Analytics CVS Health Woonsocket, Rhode Island

Jennifer Polinski

Jennifer Polinski, Senior Director
Enterprise Evaluation and Population Health Analytics
CVS Health
Woonsocket, Rhode Island

MedicalResearch.com: What is the background for this study?

Response: Unnecessary and often preventable hospital readmissions are a growing and costly issue. An estimated one in seven patients discharged from a hospital is readmitted within 30 days, and startlingly, readmissions are associated with more than $41 billion in additional health care costs per year. In addition, evidence suggests that approximately 66 percent of hospital readmissions are the result of adverse health events related to medication non-adherence.

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