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Introduction: Poor adherence to pharmacological treatment is prevalent in schizophrenia, affecting more than half of patients at some time, with increased risks of clinical worsening, adverse outco...

Background: Poor adherence to treatment is a worldwide problem and is also recognised in managing low back pain (LBP). Objective: This review aims to evaluate the rate of adhering to physical activity advice. Data sources: A systematic review was conducted by searching 12 databases from January 2000 to December 2019. Study selection: Studies were eligible when assessing LBP patients' adherence to activity advice. Data extraction: Key data extracted related to adherence to home-based exercise and/or physical activity advice given to patients over 18 who suffer from non-specific LBP. Data synthesis: After screening, 28 studies (out of 1171) were eligible for analysis. Given the studies' outcomes, a qualitative summary was created. Results: Adherence rates varied from 8% to 91%. Bias was likely in three out of 18 randomised trials. Outcomes of the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies ranged from 5 to 11 positive scores out of 14. Limitations: Variability in describing activity advice, the use of different types of outcomes and the use of subjective measurement tools compromised the outcomes of this review. Conclusions: The proportion of fully adhering patients is unclear. Therefore, more objective and uniform assessment tools are needed to assess adherence in future studies.

Low adherence and persistence values, which indicate real-life efficiency, have been widely reported in patients suffering from COPD (Chronic Obstructive Pulmonary Disease). Poor adherence may be related to treatment dosage, thus, simplifying the dosing regimen might improve adherence. The objective of the present study was either to evaluate adherence and persistence in primary drugs used in COPD treatment after 3 years in real life and assess whether the different dosing regimen affects adherence levels to therapy.A pharmacological, observational, non-interventional, retrospective study was carried out by taking into consideration the drugs dispensed between 1 January 2011 and 31 December 2018 at the hospital pharmacy of Pescara. Adherence was reckoned as the ratio between Received Daily Dose (RDD) and Prescribed Daily Dose (PDD). Treatment persistence was reckoned as the time from the start of treatment until its discontinuation. The evaluation of the two drug used indices was carried out by using three different dose regimens: Defined Daily Dose (DDD), minimum daily dose, maximum daily dose.During the study period, 52,374 patients met the inclusion criteria, and after applying the exclusion criteria, 3432, 3608, and 3594 were eligible for analysis by maximum daily, dose, DDD, and minimum daily dose, respectively. For the majority of active ingredients, adherence data was less than 0.8, that is the cut-off universally accepted as ideal value for adherence. In terms of adherence, a statistically significant difference has been highlighted in active ingredients requiring a single daily inhalation, with respect to active ingredients requiring multiple inhalations. Persistence curves have shown no statistically significant difference.It would be appropriate to promote the use of drugs which require a single daily dose in order to improve adherence in these patients.

Zufan Gebrehiwot, Yohannes Tadiwos School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, EthiopiaCorrespondence: Yohannes TadiwosSchool of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, EthiopiaTel +251 912039585Email ytadios@yahoo.comBackground: Antimicrobial resistance (AMR) results in treatment failure and spread of the infection, which will cause prolonged illness, increased mortality, and financial burdens. Some factors that are responsible for inappropriate use of antimicrobials include lack of expertise by health care professionals and problems in diagnosis.Objective: To assess the knowledge and belief related to AMR among health care professionals in HFSUH in Harar, Ethiopia.Methodology: A cross-sectional study was conducted on 153 physicians, nurses, and pharmacists from HFSUH, which were selected using stratified sampling with proportional allocation. Data were collected from March 1 to March 30, 2017, and were analyzed using the Statistical Package for Social Sciences (SPSS 20.0).Results: Only 132 participants were willing to participate from the 153 health care providers; of whom, 35 (26.5%) were physicians, 86 (65.2%) were nurses, and 11 (8.3%) were pharmacists. MRSA was mentioned as the prominent resistant bacteria by 74.3% of the physician, 59.3% of the nurses, and 63.6% of the pharmacists. The majority consider the overuse of antibiotics, poor infection control, sub-standard antibiotic, and patients’ poor adherence as factors for AMR. AMR was considered a problem worldwide, country, and hospital level. Forty percent of the physicians, 32.6% of the nurses, and 63.6% of the pharmacists consider the patient influence on the prescriber as the cause; whereas, 31.4% of the physician, 48.8% nurses, and 36.4% of the pharmacists consider the failure of previous treatment as the major cause of unnecessary antimicrobial prescription.Conclusion: The information the health care professionals have about the different resistant bacteria, on the different factors that cause unnecessary antibiotic prescription and on how to use susceptibility testing is low. All professionals should take regular AMR training and select antibiotics based on tests and minimize the risk of AMR.Keywords: antimicrobial resistance, health care professionals, Hiwot Fana Specialized University Hospital

Background: Acute coronary syndrome (ACS) patients are widely treated with long-term beta-blocker therapy after cardiac event. Especially for low-risk patients, the benefits of beta-blockers on survival and the optimal therapy duration remain unclear. We investigated the effect of adherence to beta-blockers on long-term survival of ACS patients. Methods and results: A total of 1855 consecutive ACS patients who underwent angiography and survived 30 days after were followed for a median of 8.6 years. During follow-up, 30.1% (n = 558) of patients died. Adherence was assessed as yearly periods covered by medication purchases and investigated as a dynamic time-dependent variable in Cox proportional hazards models. In a univariable model, non-adherence to beta-blockers was associated with higher all-cause mortality (Hazard ratio [HR] 2.99, 95% confidence interval [CI] 2.50−3.57; p

Background/objectives Adherence is a major challenge in topical glaucoma therapy, particularly in an African context. We report a pilot study assessing adherence independently for the first time in an African context. Subjects/methods Participants with newly diagnosed open-angle glaucoma received a weighed bottle of Lumigan 0.01% with counselling on therapy. The bottles were returned monthly for renewal and weighed on return to estimate drops taken during the period. Data collection was for one year with a short compliance questionnaire. Results 11 patients participated. 5 (45%) failed to complete one full year of topical therapy. The overall mean number of drops per eye per day was 1.74 (SD 0.69) for the 6 with one year of monthly returned bottles and controlled IOPs at each visit. Self-perception of compliance in these patients was good. Conclusion The signs of poor adherence based on both self-report (previous literature), and in this small-scale study of an objective measure suggest medication may not be the first-line treatment of choice in this environment. Our report does, however, raise the possibility that those patients who return for repeat prescriptions and review are indeed adhering to their treatment regimens.

Kamban Hirasen,1,* Denise Evans,1,* Nelly Jinga,1 Rita Grabe,2 Julia Turner,2 Sello Mashamaite,2 Lawrence C Long,1,3 Matthew P Fox1,3,4 1Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 2Right to Care, Johannesburg, South Africa; 3Department of Global Health, Boston University School of Public Health, Boston, MA, USA; 4Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA*These authors contributed equally to this workCorrespondence: Denise Evans Tel +27 10 001 0637Email devans@heroza.orgIntroduction: The best method to measure adherence to antiretroviral therapy (ART) in resource-limited settings has not yet been established, particularly among adolescents and young adults (AYAs). The use of mobile technology may address the need for standardized tools in measuring adherence in this often marginalized population.Methods: We conducted a cross-sectional validation study among AYAs (18– 35 years) attending a South African HIV clinic between 07/2015-09/2017. We determine the diagnostic accuracy of two modes of delivering an adherence questionnaire (self-administered electronic vs interviewer-administered paper-adherence questionnaire) comprising two self-reported adherence tools (South African National Department of Health (NDoH) adherence questionnaire and the Simplified Medication Adherence Questionnaire (SMAQ)) to identify poor adherence compared to; 1) a detectable viral load (≥ 1000 copies/mL) and 2) a sub-optimal concentration of efavirenz (EFV) (EFV ≤ 1.00 μg/mL) measured by therapeutic drug monitoring (TDM).Results: Of 278 included participants, 7.1% and 7.3% completing the electronic- and paper-questionnaires had a detectable viral load, while 14.7% and 16.5% had a sub-optimal concentration of EFV, respectively. According to viral load monitoring, the electronic-adherence questionnaire had a higher sensitivity (Se) in detecting poor adherence than the paper-based version across the NDoH adherence questionnaire (Se: 63.6% vs 33.3%) and SMAQ (Se: 90.9% vs 66.7%). In contrast, when using blood drug concentration (EFV ≤ 1.00 μg/mL), the paper-adherence questionnaire produced a higher sensitivity across both adherence tools; namely the NDoH adherence questionnaire (Se: 50.0%vs 38.1%) and SMAQ (Se: 75.0% vs 57.1%).Conclusion: When using more accurate real-time measures of poor adherence such as TDM in this young adult population, we observe a higher sensitivity of an interviewer-administered paper-adherence questionnaire than an identical set of self-administered adherence questions on an electronic tablet. An interviewer-administered questionnaire may elicit more accurate responses from participants through a sense of increased accountability when engaging with health care workers.Keywords: antiretroviral therapy, adherence, adolescents, virologic suppression, therapeutic drug monitoring, South Africa

Objective: Poor adherence to asthma therapy is a major problem in the management of asthma. We aimed to assess if a designed coaching program in children with asthma, coming from low socioeconomic ...

Aims: Among patients with schizophrenia, poor adherence and persistence with oral atypical antipsychotics (OAA) often results in relapse and hospitalization. Second-generation antipsychotic...

Funeral services sector personnel are at risk of contracting infectious diseases and have poor adherence to universal safety precautions. More work needs to be done to understand this industry; however, there is limited information on conducting research within this sector. This manuscript draws on experiences and observations of funeral services study describing lessons learned in the field, particularly emphasizing attempts to engage funeral homes in research and the impact of this work on the research team. Factors to be considered before researching in this sector: obtaining approvals, identification as researchers, and in-house emotional support for the research team.

Liguo Wang,1,* Peng Chen,2,* Chao Zheng3 1Department of Infectious Diseases, First Affiliated Hospital of Xiamen University, Fujian Province, China; 2Department of Emergency, Xinglin Hospital, First Affiliated Hospital of Xiamen University, Fujian Province, China; 3Department of Respiratory, First Affiliated Hospital of Xiamen University, Fujian Province, China *These authors contributed equally to this work Objective: The objective of this study was to explore the risk factors of poor adherence of nucleoside analogs (NUC) treatment in chronic hepatitis B (CHB) patients and the virological changes in patients with poor adherence. Subjects and methods: A total of 205 CHB patients were enrolled. The patients’ demographic data and family history were collected. NUC adherence was calculated every 12 weeks as follows: number of NUC tablets taken by the patients was divided by the number of NUC tablets prescribed. NUC adherence> 90% was defined as good adherence of NUC treatment. Results: NUC adherence of male patients was significantly lower than that of female patients. Adherence among patients with previous NUC treatment was poorer than that of patients without previous NUC treatment. Multivariate analysis indicated that female gender (OR =0.367,P=0.013) was the protective factor for NUC adherence in CHB patients, while pretreatment with NUC was the risk factor for NUC adherence (OR =3.209,P=0.002). A total of six patients in the good adherence group experienced virological breakthroughs while 15 of 77 patients in the poor adherence group experienced virological breakthroughs (P=0.001). Similar trends were observed in NUC resistance. Four of the 128 patients with good adherence developed NUC resistance while nine of the 77 patients with poor adherence developed resistance (P=0.015). Multivariate analysis suggested that pretreatment with NUC (OR =3.133,P=0.031), NUC drugs (OR = 3.951,P=0.010), and adherence (OR =2.749,P=0.046) were independent risk factors associated with virological breakthroughs and that NUC drugs (OR =7.083, P=0.005) and poor adherence (OR =4.951,P=0.009) were independent risk factors for NUC resistance. Conclusion: Male gender and pretreatment with NUC were risk factors associated with NUC adherence. Poor NUC adherence is more likely to induce virological breakthroughs and NUC resistance. For patients with poor NUC adherence, it is necessary to give timely education to improve treatment adherence. Keywords: chronic hepatitis B, adherence, nucleoside analogs, virological breakthroughs, risk factors

Poor adherence to psychiatric treatment is a common clinical problem, leading to unfavourable treatment outcome and increased healthcare costs.The aim of this study was to investigate the self-reported adherence and attitudes to outpatient visits and pharmacotherapy in specialized care psychiatric patients.Within the Helsinki University Psychiatric Consortium (HUPC) pilot study, in- and outpatients with schizophrenia or schizoaffective disorder (SSA, n = 113), bipolar disorder (BD, n = 99), or depressive disorder (DD, n = 188) were surveyed about their adherence and attitudes towards outpatient visits and pharmacotherapy. Correlates of self-reported adherence to outpatient and drug treatment were investigated using regression analysis.The majority (78.5%) of patients reported having attended outpatient visits regularly or only partly irregularly. Most patients (79.2%) also reported regular use of pharmacotherapy. Self-reported non-adherence to preceding outpatient visits was consistently and significantly more common among inpatients than outpatients across all diagnostic groups (p .001). Across all groups, hospital setting was the strongest independent correlate of poor adherence to outpatient visits (SSA β = -2.418, BD β = -3.417, DD β = -2.766; p .001 in all). Another independent correlate of non-adherence was substance use disorder (SSA β = -1.555, p = .001; BD β = -1.535, p = .006; DD β = -2.258, p .000). No other socio-demographic or clinical factor was significantly associated with poor adherence in multivariate regression models.Irrespective of diagnosis, self-reported adherence to outpatient care among patients with schizophrenia or schizoaffective disorder, bipolar disorder, and depression is associated strongly with two factors: hospital setting and substance use disorders. Thus, detection of adherence problems among former inpatients and recognition and treatment of substance misuse are important to ensure proper outpatient care.

Background: Statin treatment is often associated with poor adherence, which may be due to the onset of adverse drug reactions (ADRs). We investigated on potential risk factors related to preventable cases of statin-induced ADRs and to the discontinuation of statin therapy. Methods: We performed a study using the database of Italian spontaneous reporting. The target population for the preventability assessment was all patients with suspected statin-induced ADRs deriving from Campania Region (a territory of Southern Italy) between 2012 and 2017. Additionally, a local sentinel surveillance site involving General Practitioners was selected to countercheck in routine clinical practice the role of ADRs for statin discontinuation. Results: In total, 34 of 655 (5.19%) regional cases were preventable and among detected risk factors 90.0% was related to healthcare professionals’ practices and 10.0% to patient behaviour. In 81.4% (533/655) of cases, statin therapy was discontinued due to ADRs, mainly classified as not serious and associated with a positive prognosis. These results were also confirmed in the active sentinel site. Conclusions: Our findings suggest an inappropriate use of statins among the identified preventable cases and a potential inappropriate statin discontinuation due to ADRs. These factors may be useful for targeting interventions to improve statin adherence.

Outpatient care is critical in the management of chronic diseases, including sickle cell disease (SCD). Risk factors for poor adherence with clinic appointments in SCD are poorly defined. This exploratory study evaluated associations between modifying variables from the Health Belief Model and missed appointments.We surveyed adults with SCD (n = 211) and caregivers of children with SCD (n = 331) between October 2014 and March 2016 in six centres across the U.S. The survey tool utilized the framework of the Health Belief Model, and included: social determinants, psychosocial variables, social support, health literacy and spirituality.A majority of adults (87%) and caregivers of children (65%) reported they missed a clinic appointment. Children (as reported by caregivers) were less likely to miss appointments than adults (OR:0.22; 95% CI:(0.13,0.39)). In adults, financial insecurity (OR:4.49; 95% CI:(1.20, 20.7)), health literacy (OR:4.64; 95% CI:(1.33, 16.15)), and age (OR:0.95; 95% CI:(0.91,0.99)) were significantly associated with missed appointments. In all participants, lower spirituality was associated with missed appointments (OR:1.83; 95%CI:(1.13, 2.94)). The most common reason for missing an appointment was forgetfulness (adults: 31%, children: 26%). A majority thought reminders would help (adults: 83%, children: 71%) using phone calls (adults: 62%, children: 61%) or text messages (adults: 56%, children: 51%).Our findings demonstrate that modifying components of the Health Belief Model, including age, financial security, health literacy, spirituality, and lacking cues to action like reminders, are important in missed appointments and addressing these factors could improve appointment-keeping for adults and children with SCD.

Poor adherence is a main challenge to successful second-line ART in South Africa. Studies have shown that patients can re-suppress their viral load following intensive adherence counselling. We identify factors associated with failure to re-suppress on second-line ART. The study was a retrospective cohort study which included HIV-positive adults who experienced an elevated viral load ≥400 copies/ml on second-line ART between January 2013–July 2014, had completed an adherence counselling questionnaire and had a repeat viral load result recorded within 6 months of intensive adherence counselling. Log-binomial regression was used to evaluate the association between patient characteristics and social, behavioral or occupational factors and failure to suppress viral load (≥400 copies/ml). A total of 128 patients were included in the analysis, and of these 39% (n = 50) failed to re-suppress their viral load. Compared to those who suppressed, far more patients who failed to suppress reported living with family (44.2% vs. 23.7%), missing a dose in the past week (53.3% vs. 30.0%), using traditional/herbal medications (63.2% vs. 34.3%) or had symptoms suggestive of depression (57.7% vs. 34.3%). These patient-related factors could be targeted for interventions to reduce the risk for treatment failure and prevent switching to expensive third-line ART.

Alcohol use is prevalent among HIV-positive individuals or people living with HIV/AIDS (PLWHA). Alcohol abuse is associated with poor adherence to antiretroviral therapy (ART) [1], which in turn ca...

Poor adherence to medication is a serious problem in the United States, leading to complications and preventable hospitalizations, particularly for patients with chronic diseases. Interventions hav...

Traditionally, ointments were the vehicle of choice for psoriasis. Poor adherence of traditional vehicles limits the use of topical corticosteroids. Alternative formulations have gained popularity due to their ease of application, improved adherence and efficacy.To evaluate the efficacy of topical desoximetasone 0.25% spray formulation in extensive psoriasis.This multicenter, double-blinded, randomized trial compared twice daily topical 0.25% desoximetasone spray to placebo in subjects ≥18 with moderate to severe plaque psoriasis. Primary outcome of the study was the proportion of subjects in each group that achieved clinical success (Physician Global Assessment [PGA] of 0 or 1) and/or treatment success at (target lesion score of 0 or 1) day 28.One-hundred-and-twenty subjects were enrolled. At baseline, 75.0% and 73.3% of the treatment and placebo group had at least moderate PGA, respectively. Clinical success in the intended-to treat and placebo group was 30% and 5% (p = .0003), respectively; treatment success was 39% and 7% (p .0001), respectively.The lack of standardized outcomes for topical psoriasis treatments limits the ability to compare the results to other treatments.Topical desoximetasone spray provides rapid control of moderate to severe psoriasis lesions and may be considered for patients awaiting approval of biologicals.Clinical Trial was registered at clinicaltrial.gov: NCT01206387.

Club drugs and alcohol abuse are prevalent among methadone maintenance treatment (MMT) patients. However, little is known about the association between these abuse and treatment outcomes among MMT patients. The aim of this study is to examine the prevalence of club drugs and alcohol abuse among MMT patientsand to investigate the associations between these abuse and treatment outcomes – drop-out and poor adherence. In this one-year cohort study conducting in Guangzhou, China, data including background characteristics, club drugs use in the last six months, alcohol use history and treatment-related information was collected. Cox regression analyses and log-binomial regression analyses were applied to identify the associations between these abuse and drop-out and poor adherence respectively. Thirty-seven participants (9.2%) admitted to the use of at least one type of club drugs in the last six months and eighty-eight (21.9%) were identified as alcohol abusers. Of all participants, 21.0% had dropped out of treatment and 27.7% exhibited poor adherence during the study period. Adjusting for significant background variables, use of at least one type of club drugs [hazards ratio (HR) = 1.90, 95% confidence Interval (CI) = 1.01–3.56] and use of methamphetamine in the last six months (HR = 2.26, 95%CI = 1.15–4.43) significantly predicted drop-out. Frequency of having six or more drinks on one drinking occasion when drinking [risk ratio (RR) = 1.87, 95% CI = 1.16–2.95] significantly predicted poor adherence. Our findings indicated that club drugs and alcohol abuse predicted drop-out and poor adherence among MMT patients. Early identification and intervention for the abuse should be taken into consideration when developing interventions tailored to improve treatment outcomes among MMT patients.

Cardiovascular disease (CVD) is currently the leading cause of mortality among individuals living with chronic spinal cord injury (SCI). The purpose of this study is to: 1) Describe the prevalence of CVD risk factors including dyslipidemia (DYS), hypertension (HTN) and type II diabetes mellitus (DM) in patients with chronic SCI; 2) Report the frequency of individuals recommended for diagnostic testing, as per current Canadian CVD diagnostic guidelines; and 3) Report the frequency of individuals receiving guideline-derived appropriate therapy for these risk factors.Adults with a chronic, stable SCI (n = 91) were included in this study. Medical histories, current medications, blood serum analyses and blood pressures were collected and compared to current Canadian CVD diagnostic guidelines to assess for DYS, HTN and DM.Of the 81 participants with blood serum analyses, 10 (14.7%) of 23 (28.4%) individuals meeting diagnostic criteria for DYS were not taking appropriate statin medication and 2 (2.5%) of 7 (8.6%) individuals meeting diagnostic criteria for DM were not taking appropriate DM medication. Of the 91 participants having BP measurements, 13 (14.3%) of 26 (28.6%) individuals meeting diagnostic criteria for HTN were not taking appropriate BP medication.In addition to a high prevalence of CVD risk factors among individuals with chronic SCI, there is also evidence of poor adherence to diagnostic and treatment guidelines for DYS, HTN and DM. The study results highlight an important gap between the observed prevalence of disease and the low rates of screening and guideline adherence in the SCI population.

© 2015 Informa Healthcare USA, Inc.Objective: Poor adherence to the National Institute of Health (NIH) Asthma Guidelines may result in unnecessary admissions for children presenting to the emergency department (ED) with exacerbations. We determine the effect of implementing an evidence-based ED clinical pathway on corticosteroid and bronchodilator administration and imaging utilization, and the subsequent effect on hospital admissions in a US ED. Methods: A prospective, interventional study of pediatric (≤21 years) visits to an academic ED between 2011 and 2013 with moderate-severe asthma exacerbations has been conducted. A multidisciplinary team designed a one-page clinical pathway based on the NIH Guidelines. Nurses, respiratory therapists and physicians attended educational sessions prior to the pathway implementation. By adjusting for demographics, acuity and ED volume, we compared timing and appropriateness of corticosteroid and bronchodilator administration, and chest radiograph (CXR) utilization with historical controls from 2006 to 2011. Subsequent hospital admission rates were also compared. Results: A total of 379 post-intervention visits were compared with 870 controls. Corticosteroids were more likely to be administered during post-intervention visits (96% vs. 78%, adjusted OR 6.35; 95% CI 3.17-12.73). Post-intervention, median time to corticosteroid administration was 45 min faster (RR 0.74; 95% CI 0.67-0.81) and more patients received corticosteroids within 1 h of arrival (45% vs. 18%, OR 3.5; 95% CI 2.50-4.90). More patients received > 1 bronchodilator dose within 1 h (36% vs. 24%, OR 1.65; 95% CI 1.23-2.21) and fewer received CXRs (27% vs. 42%, OR 0.7; 95% CI 0.52-0.94). There were fewer admissions post-intervention (13% vs. 21%, OR 0.53; 95% CI 0.37-0.76). Conclusion: A clinical pathway is associated with improved adherence to NIH Guidelines and, subsequently, fewer hospital admissions for pediatric ED patients with asthma exacerbations.

We explored parents', children's and physiotherapists' experiences of regular CoughAssist® use, along with their perceptions of its value as an adjunct to in their daily, home respiratory management.All children in the care of a specialist neuromuscular service who regularly used a CoughAssist® device at home participated. Qualitative case study methods involved semi-structured interviews with three children with neuromuscular disorders (NMD), their parents and physiotherapist. Data were analysed using thematic content analysis.Participants (n = 9) perceived the CoughAssist® held benefits for physical, social and emotional aspects of living with NMD. Poor adherence was identified as the major barrier to effective use, governed by factors including child's resistance, time constraints, treatment preference, practitioner support and fear of pressure trauma.Barriers to regular CoughAssist® use must be identified and individually addressed to enable uptake into respiratory care, accurately measure its effectiveness and realise its perceived benefits to children with NMD.

Objective: To compare the Inhaler Compliance Assessment(TM) (INCA(TM)), a novel audio-recording device objectively measuring timing and proficiency of inhaler use, against established adherence measures, and explore its discriminant and predictive validity.Design: Prospective observational study; 184 chronic obstructive pulmonary disease (COPD) patients used an INCA(TM)-enabled salmeterol/fluticasone inhaler for one-month post-hospital discharge.Main outcome measures: INCA(TM) (Attempted, Attempted Interval, Actual) adherence correlated with Doses Used Rate, self-reported adherence and prescription refill for concurrent validity. Discriminant validity for reason for admission, cognition and lung function; predictive validity for health status and quality-of-life.Results: Rates of Attempted, Attempted Interval and Actual adherence were 59, 47 and 23%, respectively. Only 7% of participants had Actual adherence>80%. INCA(TM) variables significantly correlated with Doses Used Rate but not with self-report; Attempted and Attempted Interval were weakly associated with prescription refill. Higher cognitive and lung functioning groups had better INCA(TM) adherence. Attempted and Attempted Interval predicted health status, while Doses Used Rate predicted quality-of-life.Conclusion: INCA(TM) did not strongly correlate with self-report or prescription refill data. Discriminant and predictive validity demonstrated by INCA(TM) suggests the potential utility of the INCA(TM) as a method to identify intentional and unintentional adherence to inhaled medication and facilitate targeted intervention.

In people with Coronary Heart Disease (CHD), poor adherence to medication, exercise, and dietary recommendations can compromise prognosis. This study investigated respective associations of the Com...

The aim of this study was to examine the experience of individuals diagnosed with schizophrenia in the low-income country of Nigeria. A phenomenological approach was adopted to explore the relationship of poverty and poor adherence to antipsychotics. Semi-structured interviews were conducted with 11 individuals diagnosed with schizophrenia. The interviews were audiotaped, transcribed verbatim and analysed. A reiterative process allowed the development of two major categories. It was found that the experience of taking medication was associated with both wellness and side-effects, which could affect the ability to function. Poverty was associated with poor adherence to antipsychotics. The results show that poverty and poor adherence to antipsychotics significantly overlap and result in lack of money to purchase antipsychotics, food insecurity, feelings of vulnerability and social exclusion. Respondents' in this study experienced significant poverty, which impacted negatively on health and wellbeing, and th...

Poor adherence to treatment is a significant problem throughout medicine and particularly in the treatment of dermatologic conditions with topical medications, which present unique barriers to adherence.We reviewed the literature to assess whether timing of office visits can be used to improve adherence.Studies examining adherence and office visits were identified using two search engines. PubMed was searched using the terms "medication adherence" OR "medication compliance" AND "visits." A Web of Science cited reference search was performed to identify articles referencing the paper "On white-coat effects and the electronic monitoring of compliance" by Alvan R. Feinstein, MD.Fifteen studies were identified, three of which were on dermatologic conditions. Thirteen studies found a positive correlation between adherence and office visits. Three of these studies demonstrated increased adherence with increased visit frequency. One study reported adherence was unaffected by office visits.Our review was limited in that none of the studies identified looked at the effect timing of office visits had on adherence in the long term.Strategic scheduling of office visits can be a valuable tool to improve adherence, particularly in the management of dermatologic conditions, and may help spare patients unnecessary exposure to more toxic systemic therapies.

Little is known about the attitudes of doctors and patients to the use of home blood pressure monitoring (HBPM) and its relationship with compliance to exercise, diet, and antihypertensive medication and blood pressure (BP) control. We conducted a cross-sectional internet survey in treated patients with hypertension in Japan. Overall, 500 questionnaires were returned; 292 respondents (58.4%) reported that their doctor had recommended HBPM and among them 106 (36.3%) reported satisfactory adherence to HBPM. Compared to patients with poor adherence to HBPM, patients with satisfactory adherence to HBPM were more likely to have satisfactory compliance with exercise, diet and medication but no significant difference in BP control.

To review the literature on the prevalence, potential causes, and consequences of medication nonadherence in adult attention-deficit/hyperactivity disorder (ADHD).Attention-deficit/hyperactivity disorder is a common, chronic, and impairing neuropsychiatric disorder, affecting 4.4% of the US adult population. Medications alleviate many aspects of the disorder, but associated difficulties with disorganization and planning can lead patients to have poor adherence and subsequent treatment failure. This review will examine the scope and consequences of medication nonadherence in children and adults with ADHD.Comprehensive literature reviews via PubMed searches were conducted for continuity of medication and medication adherence (and related terms) in ADHD (and ADD). The studies were reviewed and classified regarding prevalence, measure of adherence or continuity, etiology, and consequences of medication nonadherence in childhood/adolescent and adult ADHD.Studies of pharmacy claims databases and treatment studies have shown that the prevalence of medication discontinuation or nonadherence is between 13.2% to 64%. More studies have focused on medication adherence in children/adolescents than in adult ADHD. Medication nonadherence is more prevalent in immediate-release versus extended-release psychostimulants in childhood/adolescent ADHD, but differences in the formulations have not been studied extensively in adults. Current studies have almost exclusively relied on patient reports. Possible etiologies of medication nonadherence have not been examined with formal rating instruments in adult ADHD. The long-term consequences of medication nonadherence, in terms of impairments, have not been examined.Studies have documented that medication nonadherence is common in childhood/adolescent ADHD. Further prospective studies are necessary to document the scope of the problem in adult ADHD and to examine the potential benefits of utilizing extended-release medications in adult ADHD. Studies correlating the impact of medication nonadherence on symptoms and impairments in adult ADHD are needed. Future studies should consider utilizing technology to document medication nonadherence, such as MEMS caps.

New guidelines for the diagnosis and management of asthma were released in 2007. Separate recommendations are presented for three separate age groups (ages 0-4, 5-11 andor= 12). Six pharmacologic steps of therapy are defined for each age group. Severity is assessed in patients not on long-term control medication as a guide to initiating therapy. Control is assessed in patients on long-term control therapy to determine whether a step up, no change or a step down in therapy is indicated. Before increasing pharmacologic therapy in patients with uncontrolled asthma, adverse environmental exposure, poor adherence and inadequately treated comorbidities should be considered as targets of therapy. Guidelines for the management of asthma exacerbations are also presented.

Community supervision has been an integral part of cor- rections since the establishment of probation more than 100 years ago. It has commonly been assumed that offenders benefit from community supervision much more than if they were incarcerated. However, empiri- cal evidence in support of the effectiveness of community supervision in reducing recidivism questions this assumption. A detailed examination of audio taped interviews between 62 probation officers and their clients found relatively poor adherence to some of the basic principles of effec- tive intervention-the principles of Risk, Need and Responsivity. For the most part, probation officers spent too much time on the enforcement aspect of supervision (i.e., complying with the conditions of probation) and not enough time on the service delivery role of supervision. Major criminogenic needs such as antisocial attitudes and social supports for crime were largely ignored and probation officers evidenced few of the skills (e.g., prosocial modeling, differential reinforcement) that could influence behavioral change in their clients. As a snapshot of present practices, this study begins a path to a systematic and structured training agenda to help probation officers become more effective agents of change.

The adherence to topical corticosteroid therapy in atopic dermatitis is very poor, although this remains the mainstay of treatment in this disease. This fact is very well known, but has been studie...

Psoriasis is closely associated with cardiovascular comorbidities. Poor adherence can affect both psoriasis outcomes and the effectiveness of treatment for cardiovascular comorbidities. We discuss a case of psoriasis medication nonadherence resulting in admission to the dermatology inpatient service for erythrodermic psoriasis. Administration of the patient's prescribed home antihypertensive regimen on admission resulted in a severe hypotension requiring transfer to the medical intensive care unit (ICU). This case illustrates the role of poor adherence in an erythrodermic flare of psoriasis; this case also illustrates how new-onset regimented adherence, in a formerly nonadherent patient, may result in life-threatening iatrogenic disease.

Poor communication can lead to misunderstandings about the importance of different diagnostic tests, underreporting of key symptoms and side-effects and poor adherence to treatment regimens or will...

Yeying Wang,1,2 Alan F Geater,3 Yanling Chai,1 Jiahong Luo,2 Xiaoqun Niu,1 Bing Hai,1 Jingting Qin,1 Yongxia Li1 1Department of Respiratory Medicine, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, People’s Republic ofChina; 2Department of Epidemiology and Biostatistics, School of Public Health, Kunming Medical University, Kunming, Yunnan Province, People’s Republic of China; 3Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand Objectives: To identify patterns of adherence to nasal continuous positive airway pressure (nCPAP) use in the first 3 months of therapy among newly diagnosed adult patients with obstructive sleep apnea/hypopnea syndrome (OSAS) and their predictors. To develop pretherapy and in-therapy scores to predict adherence pattern. Methods: Newly diagnosed adult OSAS patients were consecutively recruited from March to August 2013. Baseline clinical information and measures such as Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), Zung’s Self-Rating Depression Scale (SDS), and The Pittsburgh Sleep Quality Index (PSQI) at baseline and at the end of 3rd-week therapy were collected. Twelve weeks’ adherence data were collected from the nCPAP memory card, and K-means cluster analysis was used to explore adherence patterns. Predictive scores were developed from the coefficients of cumulative logit models of adherence patterns using variables available at baseline and after 3 weeks of therapy. Performance of the score was validated using 500 bootstrap resamples. Results: Seventy six patients completed a 12-week follow-up. Three patterns were revealed. Patients were identified as developing an adherence pattern that was poor (n=14, mean ± SD, 2.3±0.9 hours per night), moderate (n=19, 5.3±0.6 hours per night), or good (n=43, 6.8±0.3 hours per night). Cumulative logit regression models (good → moderate → poor) revealed independent baseline predictors to be ESS (per unit increase) (OR [95% CI], 0.763 [0.651, 0.893]), SDS (1.461 [1.238, 1.724]), and PSQI (2.261 [1.427, 3.584]); and 3-week therapy predictors to be ESS (0.554 [0.331, 0.926]), PSQI (2.548 [1.454, 4.465]), and the changes (3rd week–baseline data) in ESS (0.459 [0.243, 0.868]), FSS (3.556 [1.788, 7.070]), and PSQI (2.937 [1.273, 6.773]). Two predictive score formulas for poor adherence were developed. The area under the curve (AUC) of the receiver operating characteristics (ROC) curves for baseline and 3-week formulas were 0.989 and 0.999, respectively. Bootstrap analysis indicated positive predictive values of baseline and 3-week predictive scores in our patient population of 0.82 (95% CI [0.82, 0.83]) and 0.94 (95% CI [0.93, 0.94]), respectively. Conclusion: A high level of prediction of poor adherence pattern is possible both before and at the first 3 weeks of therapy. The predictive scores should be further evaluated for external validity. Keywords: OSAS, adherence, nCPAP, predictive model, K-means cluster analysis, bootstrap analysis

Psoriasis plaques that have very thick adherent scale (so-called coral reef or rupioid psoriasis) tend to be resistant to topical treatment. We present a case of coral reef psoriasis that responded to topical clobetasol 0.05% spray without concomitant use of moisturizers or keratolytic agents. We propose that coral reef psoriasis is resistant to topical corticosteroids because of poor adherence to treatment, not because of poor penetration of applied agents.

As the prevalence of chronic obstructive pulmonary disease (COPD) continues to grow, management of the disease still faces considerable challenges. Despite the existence of effective pharmacological treatments, patient adherence is often poor. Side effects of medications and patients’ concerns about potential side effects may contribute to poor adherence. Situated as they are at the frontline of patient care in the clinic, nurse practitioners play an important role in the management of COPD. This review discusses the current literature on medications available for management of COPD, focusing primarily on their safety and tolerability. This information can be particularly important for nurse practitioners, who can be invaluable in identifying side effects, and providing education to patients with COPD on the available treatments and the associated side effects. By helping patients to understand the balance of benefits and risks of treatment, nurse practitioners may be able to help improve adherence and thereby improve patient outcomes.

Norio Watanabe,1,2 Keiko Yamamura,3 Yusuke Suzuki,4 Hiroyuki Umegaki,4 Katsuro Shigeno,5 Ryo Matsushita,1 Yoshimichi Sai,1 Ken-ichi Miyamoto,1 Kiyofumi Yamada61Department of Clinical Pharmacy, Graduate School of Natural Science and Technology, Kanazawa University, Kanazawa, Ishikawa, Japan; 2Department of Pharmacy, Hashima Municipal Hospital, Hashima, Gifu, Japan; 3Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan; 4Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; 5Department of Pharmacy Practice and Sciences, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan; 6Department of Neuropsychopharmacology and Hospital Pharmacy, Nagoya University Graduate School of Medicine, Nagoya, Aichi, JapanAim: Donepezil is widely used to delay the progression of cognitive dysfunction in patients with Alzheimer's disease (AD), but the efficacy of pharmacotherapy is often reduced by poor adherence to medication. In order to improve adherence by providing information about AD and the significance of pharmacotherapy, the Donepezil Outpatient Consultation Service (DOCS) was set up. The influence of this service on medication persistence was assessed in the present study.Methods: Among outpatients starting donepezil therapy, we enrolled 59 patients between April 2008 and September 2010 before establishment of the DOCS (non-DOCS group) and 52 patients between October 2010 and March 2012 who attended the DOCS (DOCS group). Each patient's and their caregiver's understanding about the clinical features of AD and pharmacotherapy with donepezil were also assessed. Their understanding was compared before and after the DOCS, and the 1-year medication persistence rate and the reasons for discontinuation were also investigated.Results: The 1-year medication persistence rate was significantly higher in the DOCS group than in the non-DOCS group (73.1% vs 49.2%, P = 0.008). We examined the association of medication persistence with age, sex, clinical dementia rating, living alone, and attending the DOCS. As a result, medication persistence was significantly higher in patients attending the DOCS. The main reasons for discontinuation of donepezil were transfer elsewhere (11) and gastrointestinal side effects (5) in the non-DOCS group, and transfer (9) and gastrointestinal side effects (3) in the DOCS group. The overall score for understanding was 2.5 ± 1.7 before attending the DOCS and it increased significantly to 5.7 ± 0.7 afterward (P < 0.001).Conclusion: The DOCS consultation provided by hospital pharmacists for AD patients and their caregivers improved understanding about the clinical features of dementia and provided pharmacological knowledge about antidementia drugs, leading to better adherence to pharmacotherapy that could maximize its effect.Keywords: Alzheimer's disease, cholinesterase inhibitors, consultation, donepezil, patient knowledge, pharmacists