Electronic Pillbox May Improve Adherence To Complicated Medication Regime

MedicalResearch.com Interview with:

Bethany J. Foster, MD MSCE Montreal Children’s Hospital Department of Pediatrics,  Department of Epidemiology, Biostatistics, and Occupational Health McGill University, Montreal, QC, Canada

Dr. Foster

Bethany J. Foster, MD MSCE
Montreal Children’s Hospital
Department of Pediatrics,
Department of Epidemiology, Biostatistics, and Occupational Health
McGill University, Montreal, QC, Canada

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

Response: Adolescent and young adult kidney transplant recipients have the highest risk of graft loss of any age group. One of the main reasons for this is not taking their anti-rejection medications as prescribed. Our study had the goal of testing an intervention to try to improve young patients’ adherence to their strict medication schedule. The intervention included feedback of how well they were taking their medications (which was monitored electronically), text message reminders for medication doses, and individualized coaching to address their personal barriers to taking their medications.

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Study Finds Patients Equally Likely To Fill Paper vs Electronic Prescriptions

MedicalResearch.com Interview with:

Shannon Toohey, MD, MAEd Associate Residency Director, Emergency Medicine Assistant Clinical Professor, Emergency Medicine University of California, Irvine Editor-in-Chief Journal of Education and Teaching in Emergency Medicine

Dr. Toohey

Shannon Toohey, MD, MAEd
Associate Residency Director, Emergency Medicine
Assistant Clinical Professor, Emergency Medicine
University of California, Irvine
Editor-in-Chief
Journal of Education and Teaching in Emergency Medicine

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

Response: Electronic prescriptions (e-prescriptions) are now the predominant form of prescription used in the US. Concern has been raised that this form of prescription may be more difficult for emergency department (ED) patients to utilize than traditional printed prescriptions, given the unplanned nature of most ED visits at all times of day.

While there are disincentives for physicians who choose not to use them, many emergency physicians are still concerned that it could decrease compliance in their patients.
This study evaluated prescription compliance in insured patients at a single center. In our studied population, we found that patients were as equally likely to fill paper and e-Prescriptions.

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Patients Frequently Decline Insulin For About Two Years After Recommendation

MedicalResearch.com Interview with:

Alexander Turchin, MD, MS Director of Quality in  Diabetes in the Division of Endocrinology, Diabetes and Hypertension Brigham and Women's Hospital

Dr. Turchin

Alexander Turchin, MD, MS
Director of Quality in
Diabetes in the Division of Endocrinology, Diabetes and Hypertension
Brigham and Women’s Hospital 

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

Response: Anecdotally, many clinicians report that their patients with diabetes frequently decline recommendations to start treatment with insulin. However, until now, there was no systematic information available on this phenomenon.

Our study has found that 30% of patients initially decline their healthcare providers’ recommendation to start insulin therapy. Patients who do ultimately start treatment with insulin, do it on average more than two years after initially declining it.

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Fixed-Dose Blood Pressure Medications Save Money In The Long Run

MedicalResearch.com Interview with:

Kalyani B. Sonawane, PhD Assistant Professor/ PhD Program Director Department of Health Services Research, Management and Policy College of Public Health and Health Professions University of Florida Gainesville, FL 32610

Dr. Sonawane

Kalyani B. Sonawane, PhD
Assistant Professor/ PhD Program Director
Department of Health Services Research, Management and Policy
College of Public Health and Health Professions
University of Florida
Gainesville, FL 32610

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

Response: Almost one-third of Americans have high blood pressure. Of those patients who are prescribed medication to control their blood pressure, about 30 percent have problems with side effects and nearly 50 percent will not have their blood pressure controlled within the first year of taking medication. In such scenarios, physicians have the option to either add a medication, such as fixed-dose combination, to the patient’s regimen or gradually increase a patient’s dose of their current drug to achieve blood pressure control; and gradually decrease the dose of their current drug or switch to a different drug to resolve side effects. Using healthcare claims data, we compared the economic impact of these alternative treatment modification strategies.

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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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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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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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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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Acute MI Often Changes Compliance With Prescribed Statins

MedicalResearch.com Interview with:

Ian Kronish, MD, MPH Florence Irving Assistant Professor of Medicine Center for Behavioral Cardiovascular Health Columbia University Medical Center

Dr. Ian Kronish

Ian Kronish, MD, MPH
Florence Irving Assistant Professor of Medicine
Center for Behavioral Cardiovascular Health
Columbia University Medical Center

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

Dr. Kronish: Prior studies have shown that adherence to statins is suboptimal both in patients prescribed statins for primary prevention and in high-risk patients who are prescribed statins to prevent recurrent events. But, to our knowledge, prior studies had not examined the impact of a hospitalization for a myocardial infarction (MI) on subsequent adherence to statins. We wondered whether the hospitalization would serve as a wake-up call that led patients to become more adherent after the MI. At the same time, we were concerned that the physical and psychological distress that arises after a hospitalization for an MI may lead to a decline in statin adherence.

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Hypertension: Screening For Medication Non-Adherence Critical Before Renal Denervation

MedicalResearch.com Interview with:

Dr Prashanth Patel MSc, FRCP, FRCPath Consultant Metabolic Physician/ Chemical Pathologist and Head of Service Department of Chemical Pathology and Metabolic Diseases Honorary Senior Lecturer, Dept of Cardiovascular Sciences University of Leicester

Dr. Patel Prashanth

Dr Prashanth Patel MSc, FRCP, FRCPath
Consultant Metabolic Physician/ Chemical Pathologist and Head of Service
Department of Chemical Pathology and Metabolic Diseases
Honorary Senior Lecturer
Dept of Cardiovascular Sciences
University of Leicester

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

Dr. Patel: Hypertension (HTN) is one of the most important and common chronic treatable condition. It affects nearly one third of the adult population. Nearly one fifth of patients treated for hypertension are thought to be resistant to treatment and these patients have a high mortality from cardiovascular diseases. Percutaneous radiofrequency catheter-based renal sympathetic denervation (renal denervation, RD) may be a potential treatment for resistant hypertension. Although RD is a safe procedure, it is irreversible and expensive. It is important that patients’ suitability for renal denervation is carefully assessed to maximise the potential benefits of the procedure. Therefore causes of pseudo-resistant hypertension namely white-coat hypertension, suboptimal pharmacological antihypertensive treatment and non-adherence to antihypertensive medications and secondary hypertension are needed to be robustly ruled out before considering a patient as suitable for renal denervation.

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Over Half of Post Cardiac Bypass Patients Not Taking Recommended Statins and Aspirin

MedicalResearch.com Interview with:

Dr. Kevin Curl, MD Sidney Kimmel Medical College Jefferson University

Dr. Kevin Curl

Dr. Kevin Curl, MD
Sidney Kimmel Medical College
Jefferson University 

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

Dr. Curl: If left untreated, half of coronary bypass vein grafts will become occluded within 10 years of surgery.  We reviewed the health records of over 350 patients who had a previous coronary artery bypass graft (CABG) a minimum of three years prior.  Our goal was to identify the long-term trends with medication adherence in this high risk population, namely aspirin and statin medications.  The American College of Cardiology and the American Heart Association recommend both statins and aspirin medications unless they are unsafe for the individual patient. The mean age of the study population was 69 years, most patients had previously undergone “triple bypass” with 3 grafts, and the mean time from surgery was 11 years.  We found that only 52 percent of patients were taking both aspirin and a statin medication. In addition, patients not taking a statin had higher (22 percent) low-density lipid or “bad” cholesterol.

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Women Attend Fewer Cardiac Rehabilitation Sessions Than Men

MedicalResearch.com Interview with:

Sherry L. Grace, PhD Professor, School of Kinesiology and Health Science York University Sr. Scientist, Cardiorespiratory Fitness Team Toronto Rehabilitation Institute, University Health Network Toronto Western Hospital Toronto, ON

Dr. Sherry Grace

Sherry L. Grace, PhD
Professor, School of Kinesiology and Health Science
York University
Sr. Scientist, Cardiorespiratory Fitness Team
Toronto Rehabilitation Institute, University Health Network
Toronto Western Hospital
Toronto, ON

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

Dr. Grace: Cardiac rehabilitation is an outpatient chronic disease management program. It is a standardized model of care, comprised of risk factor assessment and management, exercise training, patient education, as well and dietary and psychosocial counseling. Patients generally attend two times a week for several months.

Participation in cardiac rehab has been shown to reduce death and disability. This is a dose-response association, such that more cardiac rehab participation is associated with even less death, etc. Therefore, it is important that patients adhere to the program, or participate in all the prescribed sessions.

No one has ever reviewed patient adherence to cardiac rehab in a systematic way. It has always been assumed that patients only attend about half of prescribed sessions. Also, many studies have shown that women attend fewer sessions than men. However, this has been known for some time, so we would hope that in the current era, this sex difference would not exist. No study has ever aggregated and analyzed sex differences in program adherence, so we set out to do this.

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Most Patients Referred By Genetic Screening For Breast MRI Do Not Have Study Performed

MedicalResearch.com Interview with:

Stamatia Destounis, MD, FSBI, FACR Elizabeth Wende Breast Care, LLC, Clinical Professor of Imaging Sciences University of Rochester School of Medicine and Dentistry  Rochester NY 14620

Dr. Stamatia Destounis

Stamatia Destounis, MD, FSBI, FACR
Elizabeth Wende Breast Care, LLC,
Clinical Professor of Imaging Sciences
University of Rochester
School of Medicine and Dentistry
 Rochester NY 14620 

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

Dr. Destounis: Identification of women who have an increased risk of breast cancer is important, as they are often eligible for additional screening methods, such as breast MRI. One criterion for eligibility for screening breast MRI is >20% lifetime risk of breast cancer, as determined by risk assessment models through genetic counseling.

At my facility, we have incorporated a genetics program. Through the program we are flagging and identifying a large volume of patients who are potentially eligible for additional services. This study was conducted to determine the value of screening MRI in the patient subgroup who have undergone genetic counseling at my facility. In this group we found 50% of patients who were referred for counseling were also recommended to have screening MRI. However, only 21.3% of those recommended actually pursued the exam. Of those patients who did have a screening MRI, 4 were diagnosed with breast cancer, all of which were invasive and node negative. We ultimately had a 10% biopsy rate and 50% cancer detection rate in this subgroup.
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Patients Take Only Little More Than Half Prescribed Antibiotic After leaving Hospital For Skin Infections

MedicalResearch.com Interview with:

Loren G. Miller, M.D., M.P.H. Professor of Medicine, David Geffen School of Medicine at UCLA Division of Infectious Diseases Los Angeles BioMedical Research Institute at Harbor-UCLA Torrance CA 90502

Dr. Loren Miller

Loren G. Miller, M.D., M.P.H.
Professor of Medicine,
David Geffen School of Medicine at UCLA
Division of Infectious Diseases
Los Angeles BioMedical Research Institute at Harbor-UCLA
Torrance CA 90502 

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

Dr. Miller: We know that medication adherence (compliance) by patients to all sort of treatments for a variety of diseases is suboptimal. Adherence to medication varies a lot by disease state (e.g. it is typically high in cancer and low in hypertension), but adherence to antibiotics for skin infection is unstudied. We wanted to find out what adherence is to antibiotics for patients with skin infections is and whether it was associated with important clinical outcomes.

We measured patients adherence to antibiotic dosing by using medication containers fitted with electronic caps that reported when the patient opened the antibiotic container.
We followed 87 patients who had been hospitalized and suffered S. aureus associated skin and soft tissue infections

We found that patients with S. aureus skin and soft tissue infections, on average, took just 57% of their prescribed antibiotic doses after leaving the hospital. Lower antibiotic adherence was associated with a higher chance of skin infection relapse or recurrence.

Interestingly, we also found a large discrepancy in patient reports and the electronic measurement. Patients reported taking, on average, 96% of their medication, or nearly twice the 57% reported by the electronic caps. This suggests that asking patients how well they took their medication is highly problematic as non-adherent patients will typically vastly overstate their medication adherence.

We also found higher rates of non-adherence to antibiotic regimens among patients who were prescribed more than one antibiotic after leaving the hospital, didn’t see the same healthcare provider for follow-up visits or felt they didn’t have a regular healthcare provider

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Mail Order Pharmacies Linked To Better Compliance With Stroke Medications

MedicalResearch.com Interview with:
Dr-William-Patrick-Neil

William P. Neil, MD

Vascular Neurologist
SCPMG Regional Stroke Champion
Neurology   

Medical Research: What is the background for this study?

Dr. Neil: Stroke survivors are less likely to have a recurrent stroke, or other complications if they take their medications as prescribed by their doctor. Mail order pharmacies are increasingly being used to deliver medications for a variety of diseases, and their use is associated with better medication adherence.  We wanted to see whether stroke patients who use mail-order pharmacies were more likely to have good medication adherence than those who used  local pharmacies.

Medical Research: What are the main findings?

Dr. Neil: We looked through a large electronic medical database in California, and found a total of 48,746 people discharged from the hospital with a stroke, and who also filled either a cholesterol medication or an anticoagulant (blood thinner). Of these, 136,722 refills were from a local pharmacy and 68,363 were by mail. Overall, patients were adherent to the medications 46.5% of the time if they picked up the medication from the pharmacy and 74% of the time if they had prescriptions mailed to them.

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