scholarly journals Why individual‐level interventions are not enough: Systems‐level determinants of oral anticancer medication adherence

Cancer ◽  
2020 ◽  
Vol 126 (16) ◽  
pp. 3606-3612 ◽  
Author(s):  
Lorraine T. Dean ◽  
Marshalee George ◽  
Kimberley T. Lee ◽  
Kimlin Ashing
Keyword(s):  
Medication Adherence ◽  
Individual Level ◽  
Oral Anticancer Medication

Medication Adherence: Expanding the Conceptual Framework

2021 ◽  
Author(s):  
Marie Krousel-Wood ◽  
Leslie S Craig ◽  
Erin Peacock ◽  
Emily Zlotnick ◽  
Samantha O’Connell ◽  
...  
Keyword(s):  
Older Adults ◽  
Medication Adherence ◽  
Conceptual Framework ◽  
Clinical Outcomes ◽  
Implicit Attitudes ◽  
Explanatory Power ◽  
Population Level ◽  
Time Preferences ◽  
Adherence Behavior ◽  
Individual Level

Abstract Interventions targeting traditional barriers to antihypertensive medication adherence (AHMA) have been developed and evaluated, with evidence of modest improvements in adherence. Translation of these interventions into population-level improvements in adherence and clinical outcomes among older adults remains suboptimal. From the Cohort Study of Medication Adherence among Older adults (CoSMO), we evaluated traditional barriers to AHMA among older adults with established hypertension (N=1544; mean age=76.2 years, 59.5% women, 27.9% Black, 24.1% and 38.9% low adherence by proportion of days covered (i.e., PDC<0.80) and the 4-item Krousel-Wood Medication Adherence Scale (i.e., K-Wood-MAS-4≥1), respectively), finding that they explained 6.4% and 14.8% of variance in pharmacy refill and self-reported adherence, respectively. Persistent low adherence rates, coupled with low explanatory power of traditional barriers, suggest that other factors warrant attention. Prior research has investigated explicit attitudes toward medications as a driver of adherence; the roles of implicit attitudes and time preferences (e.g., immediate versus delayed gratification) as mechanisms underlying adherence behavior are emerging. Similarly, while associations of individual-level social determinants of health (SDOH) and medication adherence are well-reported, there is growing evidence about structural SDOH and specific pathways of effect. Building on published conceptual models and recent evidence, we propose an expanded conceptual framework that incorporates implicit attitudes, time preferences and structural SDOH, as emerging determinants that may explain additional variation in objectively and subjectively measured adherence. This model provides guidance for design, implementation and assessment of interventions targeting sustained improvement in implementation medication adherence and clinical outcomes among older women and men with hypertension.

scholarly journals User acceptance of an app-based adherence intervention: Perspectives from patients taking oral anticancer medications

2018 ◽  
Vol 25 (2) ◽  
pp. 390-397 ◽  
Author(s):  
Eskinder Eshetu Ali ◽  
Sharlene Si Ling Chan ◽  
Jo Lene Leow ◽  
Lita Chew ◽  
Kevin Yi-Lwern Yap
Keyword(s):  
Medication Adherence ◽  
Technology Acceptance ◽  
Relative Advantage ◽  
Theory Approach ◽  
Attitudes And Beliefs ◽  
Face To Face ◽  
Intention To Adopt ◽  
Field Notes ◽  
Oral Anticancer Medication ◽  
Adoption Intention

Background Widespread adoption by patients is imperative for the success of app-based interventions for enhancing adherence to oral anticancer medications. Patients' attitudes and beliefs should be evaluated to understand determinants of their acceptance and adoption of such interventions. Objective To identify factors that influence cancer patients' intention to adopt an app-based system for enhancing oral anticancer medication adherence. Methods This study was conducted as part of the usability evaluation of an app-based system for enhancing adherence. We followed the grounded theory approach employing audio-recorded face-to-face interviews for data collection from patients taking oral anticancer medications (n = 15) and caregivers of such patients (n = 3). Data analysis involved verbatim transcription of all interviews, coding of the transcripts and field notes, detailed memo writing, and constant comparative evaluation of emergent categories. Results A conceptual framework of facilitating and hindering factors for users' adoption intention for an oral anticancer medication adherence app was developed. Findings suggest that facing difficulties in maintaining adherence and patients' perceived superiority of the app over their current methods facilitate adoption intention. In contrast, having to pay, lack of language options and users' perception of low competence in using an app were the hindrance factors. Conclusion This study showed that adoption of adherence apps could be explained by technology acceptance constructs, such as performance expectancy. Adoption intention was also facilitated by patients perceived vulnerabilities in maintaining adherence to their medications, which was a health behaviour construct. Implementation of app-based programs should address patients' perceived vulnerabilities and relative advantage of the app over their current methods. Clinicians and app developers should also consider the financial, technological and language barriers for end users.

Patient and Physician Factors Associated With Adherence to Diabetes Medications

2012 ◽  
Vol 38 (3) ◽  
pp. 397-408 ◽  
Author(s):  
Antoinette M. Schoenthaler ◽  
Brian S. Schwartz ◽  
Craig Wood ◽  
Walter F. Stewart
Keyword(s):  
Medication Adherence ◽  
Primary Care Physicians ◽  
Medication Possession Ratio ◽  
Related Factors ◽  
Patient Beliefs ◽  
Individual Level ◽  
Physician Relationship ◽  
Oral Hypoglycemic Medications ◽  
The Individual ◽  
Main Effects

Purpose The purpose of this study was to examine the influence of patient and physician psychosocial, sociodemographic, and disease-related factors on diabetes medication adherence. These factors were also examined as effect modifiers of the association between quality of the patient-physician relationship and medication adherence. Methods Data were collected from 41 Geisinger Clinic primary care physicians and 608 of their patients with type 2 diabetes. Adherence to oral hypoglycemic medications was calculated using a medication possession ratio based on physician orders in electronic health records (MPREHR). MPREHR was defined as the proportion of total time in the 2 years prior to study enrollment that the patient was in possession of oral hypoglycemic medications. Linear regression was used to examine the influence of patient- and physician-level factors on adherence. Effect modification of the patient-physician relationship-adherence association was evaluated by adding the main effects of the individual-level factors and their cross-products to the models. Results In adjusted analyses, satisfaction with the physician’s patient education skills, patient beliefs about the need for their medications, and lower diabetes-related knowledge were associated with better adherence to oral hypoglycemic medications. Shorter duration of time with diabetes and taking only oral hypoglycemic medications were also associated with better adherence. Finally, the association between shared decision making and medication adherence was significantly modified by patients’ level of social support. Conclusions This study identified several patient-, physician-, and disease-related factors that should be targeted to maximize the potential for developing tailored adherence-enhancing interventions within the context of a collaborative patient-physician relationship.

scholarly journals Characteristics of patients presenting with septic wounds in selected hospitals in Kajiado County, Kenya

2021 ◽  
Author(s):  
Ruth Kaanto ◽  
John Kagira ◽  
Kenneth Waititu ◽  
Maina Ngotho ◽  
Naomi Maina ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Healthcare Access ◽  
Water Source ◽  
Lower Limbs ◽  
Wound Management ◽  
Individual Level ◽  
The Individual ◽  
Social And Cultural Factors

Background: Wound management is a serious global health problem. The objective of this study was to describe the characteristics of patients presenting with septic wounds in selected hospitals in Kajiado County, Kenya, and their association with selected factors.Methods: We purposively sampled 182 patients with septic wounds and collected data using questionnaires whose statistical relationship between various patients' characteristics, including the data collected Likert-scale design was assessed.Results: A majority (73.1%) of the patients presented with one wound. Most (54.4%) of the wounds were located on the lower limbs and mainly (23.1%) caused by road traffic accidents. The majority of the wounds had lasted for 1-2 weeks at the time of presentation, and the wound sizes were mainly >11 mm. We found a significant association (p<0.05) between number of wounds and age, marital status, and highest education level. The wound causes were significantly associated with gender, age, occupation, and sub-county of residence. Wound duration was significantly associated with understanding prescribed medication, adherence to dosage, water source, alcoholism, and cigarette smoking. Wound improvement was significantly associated with patients' understanding of the prescribed medication, adherence to dosage and water source, alcoholic status, and cigarette smoking.Conclusions: Individual patient, social and cultural factors were associated with septic wounds characteristics, suggesting that addressing them at the individual level using proper hygiene and cleanliness at home and workplaces is key. Policies to reduce traffic accidents, increase literacy, and promote healthcare access need to be promoted to reduce the wound sepsis burden.  

scholarly journals The Medication Adherence Score: A Predictive Analytic Tool

2020 ◽  
Author(s):  
Tom Brouwer ◽  
Reinoud E. Knops ◽  
Martin C. Burke ◽  
Vivek Y. Reddy
Keyword(s):  
Atrial Fibrillation ◽  
Medication Adherence ◽  
Clinical Outcomes ◽  
Adherence Behavior ◽  
Individual Level ◽  
Analytic Tool ◽  
Adherence Score ◽  
Study Results ◽  
High Adherence ◽  
The Individual

Abstract Background Poor medication adherence is wide-spread and associated with poor clinical outcomes. Herein, we introduce the Medication Adherence Score, a predictive analytic tool designed to provide clinicians insight into adherence behavior over the subsequent twelve months. The aim of the study was to demonstrate the feasibility of such scoring of patients at the individual level. Methods This is a single arm, non-randomized, 2-center, retrospective cohort study conducted among patients diagnosed with atrial fibrillation. The model, developed by Fair Isaac Corporation on pharmacy refill data, predicts adherence behavior to cardiovascular drugs using demographic, geographic and socio-economic predictors. The primary outcome was the number of patients that could be scored at the individual level without reliance on past individual refill behavior. The score was normalized between zero (lowest adherence score) and one (highest adherence score) and patients were grouped: low adherence < 0.6, intermediate adherence between 0.6 and 0.8, high adherence > 0.8. The institutional review board approved the study. Results A total of 1110 patients were included in the study with a median age of 71 (IQR 63, 79). Most patients (807, 73%) could be scored at the patient level, and the remaining patients (303, 27%) were scored based on characteristics associated with the geography of their home address. There were 488 patients (44%) with a high adherence score (score > 0.8), 382 (34%) with an intermediate adherence score (score between 0.6 and 0.8) and 240 patients (22%) with a low score. Younger patients had on average lower scores than older patients, and males also had higher scores. Conclusions The Medication Adherence Score was successfully applied to an unselected group of atrial fibrillation patients: nearly a quarter of the cohort were identified as at risk for non-adherence. Future studies are necessary to assess the association of this predictive analytic model with clinical outcomes.

scholarly journals The Association Between Patient-Reported and Objective Oral Anticancer Medication Adherence Measures: A Systematic Review

2016 ◽  
Vol 43 (5) ◽  
pp. 576-582 ◽  
Author(s):  
Thomas Atkinson ◽  
Vivian Rodríguez ◽  
Mallorie Gordon ◽  
Isabelle Avildsen ◽  
Jessica Emanu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Medication Adherence ◽  
Patient Reported ◽  
Oral Anticancer Medication

Assessing the need for improved strategies and medication-related education to increase adherence for oral anticancer medications in the young adult oncology population

2017 ◽  
Vol 24 (5) ◽  
pp. 337-342 ◽  
Author(s):  
Anupama Divakaruni ◽  
Elizabeth Saylor ◽  
Alison P Duffy
Keyword(s):  
Medication Adherence ◽  
Young Adult ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
University Of Maryland ◽  
Patient Reported ◽  
Adherence Monitoring ◽  
The University ◽  
Oral Anticancer Medication ◽  
Education Process

Rationale Oral anticancer medication adherence is a critical factor in optimizing cancer treatment outcomes and minimizing toxicity. Although potential adherence barriers exist, it is not well understood how these factors impact adherence. Methods This is a prospective, single-center, patient survey-based study conducted at the University of Maryland Greenebaum Comprehensive Cancer Center including 18- to 39-year-old patients who have been actively taking an oral anticancer medication for at least one month from 1 April 2013 to 1 April 2016. The primary objective of this study is to describe institutional practices for medication education and adherence monitoring practices as perceived by young adult patients at the University of Maryland Greenebaum Comprehensive Cancer Center and to describe practice consistency with recommendations from the American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards. The secondary objectives include patient-reported facilitators and barriers to oral anticancer medication adherence. Results Seventeen patients completed the survey; 24% ( n = 4) of patients denied receiving information about what to do in case of a missed dose. The most common facilitators of adherence include understanding of disease and treatment (88%, n = 15), perceived severity of illness (82%, n = 14), and use of oral anticancer medications (82%, n = 14). The most common barriers to adherence are side effects (59% n = 10), forgetfulness (47%, n = 8), and depressive symptoms (35%, n = 6). Conclusion Based on patient-reported guideline adherence, improvement is needed in including family, caregivers, and others in the education process as well as providing education about plan for missed doses and drug–drug and drug–food interactions. The strengths of the current medication education and adherence monitoring practices as perceived by the young adult patient population include education about the purpose and goals of treatment, the planned duration and schedule, side effects, and when to seek medical attention. The data collected from this survey can aid in future development and implementation of interventions aimed at improving medication adherence, such as integrating clinical pharmacy services into oral chemotherapy monitoring and education process.

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