Treatment Adherence among Tuberculosis patients: A Concept Analysis

BACKGROUND OF THE STUDY: The principal difficulty of long-term tuberculosis (TB) treatment is patient nonadherence. During pandemic, nonadherence of TB treatment affects mortality since TB patients are more vulnerable with Covid-19. AIM OF THE STUDY: The purpose of this concept analysis was to clarify and analyze the concept of treatment adherence. METHODOLOGY: Analysis concept was conducted using the Walker and Avant’s method from relevant studies published by EBSCO, PubMed, ProQuest, Wiley Online Library, and Springer between 2003 - 2021. RESULTS: Five attributes characterizing the concept of treatment adherence from thirteen articles were identified: individual behavior, relationship, mutual participation, shared decision making, and agreement. CONCLUSION: This concept analysis revealed that TB treatment adherence involves many aspects, including the patient, family, society, health care professionals, and policy. These findings help to understand the contribution of major attributes, thereby promoting the body of knowledge on TB and contributing to its elimination during COVID-19 pandemic.

Reasons for antihypertensive medication nonadherence influence physician preferences for hypertension management

Background/Introduction Patient nonadherence to prescribed antihypertensive medications is a major contributor to low global hypertension control rates. Attitudes toward renal denervation vary between physicians and patients, with recent data showing that side effects from medications is a key factor influencing both patient nonadherence to prescribed medications and preferences for interventional treatment. The influence of patient nonadherence on physician recommendations for renal denervation is not well understood. Purpose To examine whether specific reasons for patient nonadherence influence physician preferences for renal denervation as a treatment option for hypertension. Methods Online surveys were fielded to general and interventional cardiologists in Europe and the United States. Physicians were asked to position their willingness to recommend renal denervation in the hypertension management pathway based on three factors of nonadherence: patients' preference not to take antihypertensive medications, medication side effects, and nonspecific nonadherence to medication. The surveys followed the highest industry standards ISO 20252. Results were compared using two-tailed Z tests. Results Over two-thirds of 501 physicians surveyed stated that they would recommend renal denervation for uncontrolled hypertension irrespective of the reason for nonadherence. This recommendation was significantly more common in the scenario of patient reported medication side effects as compared with desire not to take medications or other nonspecific reasons for nonadherence (p<0.001 for both; Figure) Conclusions Surveyed physicians were more likely to recommend renal denervation to patients reporting side effects with their antihypertensive medications than for other reasons of nonadherence. These findings underscore the influence of patient-specific reasons for medication nonadherence on provider recommendations as part of a shared decision-making process when evaluating different options for hypertension management. FUNDunding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Medtronic

Emerging Therapeutics, Technologies, and Drug Development Strategies to Address Patient Nonadherence and Improve Tuberculosis Treatment

Imperfect medication adherence remains the biggest predictor of treatment failure for patients with tuberculosis. Missed doses during treatment lead to relapse, tuberculosis resistance, and further spread of disease. Understanding individual patient phenotypes, population pharmacokinetics, resistance development, drug distribution to tuberculosis lesions, and pharmacodynamics at the site of infection is necessary to fully measure the impact of adherence on patient outcomes. To decrease the impact of expected variability in drug intake on tuberculosis outcomes, an improvement in patient adherence and new forgiving regimens that protect against missed doses are needed. In this review, we summarize emerging technologies to improve medication adherence in clinical practice and provide suggestions on how digital adherence technologies can be incorporated in clinical trials and practice and the drug development pipeline that will lead to more forgiving regimens and benefit patients suffering from tuberculosis. Expected final online publication date for the Annual Review of Pharmacology and Toxicology, Volume 62 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Sensitive, High-Throughput Liquid Chromatography-Tandem Mass Spectrometry Analysis of Atorvastatin and Its Pharmacologically Active Metabolites in Serum for Supporting Precision Pharmacotherapy

The antihyerlipidemic drug atorvastatin (ATR) is used worldwide as part of the strategy to prevent cardiovascular events. The high prevalence of patient nonadherence remains an important challenge which could be addressed efficiently by precision pharmacotherapy based on therapeutic drug monitoring (TDM). ATR is metabolized to pharmacologically active metabolites, and evidence shows that the sums of ATR acid and lactone form concentrations (ATR + ATRL), or of ATR and hydroxylated metabolites (ATR + MET) should be assayed. A method is presented for the analysis of these substances in serum. Method validation included the estimation of the quantitative relationship between the concentrations and the standard deviations (SD), which supports the optimal incorporation of TDM results into nonparametric pharmacokinetic models. The concentrations of the analytes were evaluated in human subjects receiving ATR. The method’s performance improved by taking the sums of acid and lactone concentrations into account. The concentration–SD relationship was linear, and we recommend applying Theil’s regression for estimating the assay error. All analytes could be detected by 2 h post dose in the samples of human subjects. The changes in metabolite/parent drug concentration ratios in time depended on the dose. The method is suitable for the TDM of ATR with a focus on precision pharmacotherapy.

Dietary assessment and patient-perspective reasons for poor adherence to diet and exercise post bariatric surgery

Objective Obesity prevalence is increasing, and as an outcome, bariatric procedures are on the rise. Previous articles about bariatric surgery disclosed tremendous results. This study aims to assess eating patterns and identify the reasons behind poor adherence to diet and exercise in postbariatric patients. Results According to the questionnaire used, the majority (85.5%) of our patients scored “good”, 12% scored “fair”, and only 2% scored “excellent”. None scored “needs improvement”. Fruits had a mean consumption of 1.51 ± 0.79 and vegetables 1.78 ± 0.76. The main reasons for patient nonadherence to healthy eating were low self-discipline (48%), lack of motivation (28%), and availability of healthy food and being too busy to prepare healthy meals, both at 25%. Additionally, 55.9% of the study subjects engaged in physical activity. Lack of time (47%), low self-discipline (38%), and weather (32%) were the primary reasons for not exercising regularly.

Dietary Assessment and Patient-Perspective Reasons for Poor Adherence to Diet and Exercise Post Bariatric Surgery

Objective: Obesity prevalence is increasing, and as an outcome, bariatric procedures are on the rise. Previous articles about bariatric surgery disclosed tremendous results. This study aims to assess eating patterns and identify the reasons behind poor adherence to diet and exercise in postbariatric patients.Results: According to the questionnaire used, the majority (85.5%) of our patients scored “good”, 12% scored “fair”, and only 2% scored “excellent”. None scored “needs improvement”. Fruits had a mean consumption of 1.51 ± 0.79 and vegetables 1.78 ± 0.76. The main reasons for patient nonadherence to healthy eating were low self-discipline (48%), lack of motivation (28%), and availability of healthy food and being too busy to prepare healthy meals, both at 25%. Additionally, 55.9% of the study subjects engaged in physical activity. Lack of time (47%), low self-discipline (38%), and weather (32%) were the primary reasons for not exercising regularly.

Dietary Assessment and Patient-Perspective Reasons for Poor Adherence to Diet and Exercise Post Bariatric Surgery

Objective: Obesity prevalence is increasing, and as an outcome, bariatric procedures are on the rise. Previous articles about bariatric surgery disclosed tremendous results. This study aims to assess dietary eating patterns and identify the reasons behind poor adherence to diet and exercise in postbariatric patients.Results: According to the questionnaire used, the majority (85.5%) of our patients scored “good”, 12% scored “fair”, and only 2% scored “excellent”. None scored “needs improvement”. Fruits had a mean consumption of 1.51 ± 0.79 and vegetables 1.78 ± 0.76. The main reasons for patient nonadherence to healthy eating were low self-discipline (48%), lack of motivation (28%), and availability of healthy food and being too busy to prepare healthy meals, both at 25%. Additionally, 55.9% of the study subjects engaged in physical activity. Lack of time (47%), low self-discipline (38%), and weather (32%) were the primary reasons for not exercising regularly.

A Pantheoretical Framework to Optimize Adherence to Healthy Lifestyle Behaviors and Medication Adherence: The Use of Personalized Approaches to Overcome Barriers and Optimize Facilitators to Achieve Adherence

Patient nonadherence to healthy lifestyle behaviors and medical treatments (like medication adherence) accounts for a significant portion of chronic disease burden. Despite the plethora of behavioral interventions to overcome key modifiable/nonmodifiable barriers and enable facilitators to adherence, short- and long-term adherence to healthy lifestyle behaviors and medical treatments is still poor. To optimize adherence, we aimed to provide a novel mobile health solution steeped in precision and personalized population health and a pantheoretical approach that increases the likelihood of adherence. We have described the stages of a pantheoretical approach utilizing tailoring, clustering/profiling, personalizing, and optimizing interventions/strategies to obtain adherence and highlight the minimal engineering needed to build such a solution.

Urea for Chronic Hyponatremia

Background: Hyponatremia is the most common electrolyte disorder encountered clinically. While acute and/or severe hyponatremia is commonly associated with significant symptoms, milder and more chronic forms of hyponatremia remain clinically inconspicuous. Recent evidence suggests that even milder forms of hyponatremia are associated with increased morbidity and mortality. Despite this, currently available treatments for chronic hyponatremia lack data on efficacy and/or have important limitations related to patient nonadherence, adverse side effects, and/or significant costs. Consequently, there is a clear need for investigation of alternative treatments for this common condition. Summary: Small case series conducted in Europe since the early 1980s suggest that urea, an oral osmotic diuretic that increases urinary water excretion, is safe and effective for the treatment of chronic hyponatremia. In 2016, a novel formulation of urea became available in the United States. Our group recently reported the first and only study describing the efficacy and safety of this American formulation of oral urea among hospitalized patients with hyponatremia. Key Messages: Oral urea appears to be an effective, safe, and well-tolerated therapeutic strategy in the management of chronic hyponatremia.

Statistical Methods for Adjusting Estimates of Treatment Effectiveness for Patient Nonadherence in the Context of Time-to-Event Outcomes and Health Technology Assessment: A Systematic Review of Methodological Papers

Introduction. Medication nonadherence can have a significant negative impact on treatment effectiveness. Standard intention-to-treat analyses conducted alongside clinical trials do not make adjustments for nonadherence. Several methods have been developed that attempt to estimate what treatment effectiveness would have been in the absence of nonadherence. However, health technology assessment (HTA) needs to consider effectiveness under real-world conditions, where nonadherence levels typically differ from those observed in trials. With this analytical requirement in mind, we conducted a review to identify methods for adjusting estimates of treatment effectiveness in the presence of patient nonadherence to assess their suitability for use in HTA. Methods. A “Comprehensive Pearl Growing” technique, with citation searching and reference checking, was applied across 7 electronic databases to identify methodological papers for adjusting time-to-event outcomes for nonadherence using individual patient data. A narrative synthesis of identified methods was conducted. Methods were assessed in terms of their ability to reestimate effectiveness based on alternative, suboptimal adherence levels. Results. Twenty relevant methodological papers covering 12 methods and 8 extensions to those methods were identified. Methods are broadly classified into 4 groups: 1) simple methods, 2) principal stratification methods, 3) generalized methods (g-methods), and 4) pharmacometrics-based methods using pharmacokinetics and pharmacodynamics (PKPD) analysis. Each method makes specific assumptions and has associated limitations. Five of the 12 methods are capable of adjusting for real-world nonadherence, with only g-methods and PKPD considered appropriate for HTA. Conclusion. A range of statistical methods is available for adjusting estimates of treatment effectiveness for nonadherence, but most are not suitable for use in HTA. G-methods and PKPD appear to be more appropriate to estimate effectiveness in the presence of real-world adherence.