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

2021 ◽  
Vol 62 (1) ◽  
Author(s):  
Maria Garcia-Cremades ◽  
Belen P. Solans ◽  
Natasha Strydom ◽  
Bernard Vrijens ◽  
Goonaseelan Colin Pillai ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Drug Development ◽  
Patient Adherence ◽  
Drug Distribution ◽  
Annual Review ◽  
Publication Date ◽  
Improve Medication Adherence ◽  
Resistance Development ◽  
Patient Nonadherence ◽  
The Impact

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.

Impact of Electronic Medication Reminder Caps on Patient Adherence and Blood Pressure

2021 ◽  
pp. 875512252110187
Author(s):  
Nicolette Mehas ◽  
Karen Suchanek Hudmon ◽  
Heather Jaynes ◽  
Steve Klink ◽  
Laura Downey ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Medication Adherence ◽  
Patient Adherence ◽  
Medication Possession Ratio ◽  
Self Report ◽  
Secondary Outcome ◽  
Control Group ◽  
Improve Medication Adherence ◽  
Electronic Reminder ◽  
The Impact

Background: Medication adherence is widely recognized as an essential component of chronic disease management, yet only 50% of patients take their medication as prescribed. Newer technologies have the potential to improve medication adherence. Objective: To conduct a pilot study estimating the impact of a pharmacy-dispensed electronic reminder cap (SMARxT cap), which also records cap openings, on medication adherence and blood pressure (BP). Methods: After a 30-day run-in period, 28 individuals were randomized to receive a SMARxT or placebo cap on each BP medication. The primary outcome was adherence measured via (1) the medication possession ratio, (2) number of cap openings, and (3) self-report. The secondary outcome was the average of 2 BP readings at 6 months. Mean changes from baseline to 6 months were compared between the 2 groups. Results: The medication possession ratio increased 2.7% in the SMARxT cap group and decreased 1.1% in the control group ( P = .13), and cap openings increased 11.9% in the SMARxT cap group and 9.9% in the control group ( P = .83). Self-reported adherence increased 1.1 points in the SMARxT cap group and 0.8 points in the control group ( P = .64). Systolic BP decreased 8.2 mm Hg in the SMARxT cap group and 2.8 mm Hg in the placebo cap group ( P = .35), and diastolic BP decreased to 6.2 mm Hg in the SMARxT cap group and was unchanged in the placebo cap group ( P = .06). Conclusions: Use of SMARxT cap showed nonsignificant improvement in medication adherence and BP lowering. This technology has potential to characterize and improve medication-taking behavior.

Abstract 113: Pharmacists' Perspectives of an Intervention to Improve Medication Adherence after ACS Hospitalization A Qualitative Analysis

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Kelty B Fehling ◽  
Anne Lambert-Kerzner ◽  
Ryan Davis ◽  
Jennifer Weaver ◽  
Casey Barnett ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Patient Education ◽  
Patient Adherence ◽  
Clinical Care ◽  
Qualitative Inquiry ◽  
Educational Process ◽  
Assessment Tools ◽  
Personal Contact ◽  
Improve Medication Adherence ◽  
Coronary Syndrome

Background: Despite the success of pharmacist-led interventions to improve medication adherence, pharmacists’ perspectives of these interventions are unknown. Our objective was to understand the pharmacists’ perspectives of a successful multifaceted intervention to improve medication adherence after acute coronary syndrome (ACS) hospitalization. Methods: We ascertained pharmacist perspectives’ through qualitative inquiry that included an open-ended survey, semi-structured interviews, and a focus group with the four pharmacists who participated in the intervention. Transcripts of surveys and interviews were analyzed using a content analysis approach. The intervention components included: 1) patient education; 2) assessment tools for potential medication adherence barriers; 3) collaborative care; and 4) automated medication refill reminders and educational messages. Pharmacists’ perspectives on each of these components were evaluated. Results: The pharmacists felt the intervention could be sustained in routine clinical care and identified key themes that facilitated intervention success. Pharmacists believed educating patients about their cardiovascular medications filled a gap in usual care. In addition, assessment tools that identified medication discrepancies and gaps in knowledge were helpful in tailoring patient education, while face-to-face conversations were more helpful in identifying mental and cognitive deficits that were barriers to adherence. Pharmacists also noted that the intervention led to the development of bi-directional relationships with patients through increased in-person and tele-health communication. As a result, poor adherence related to medication side effects was more readily addressed. Potential areas for improvement identified by the pharmacists included 1) emphasizing in-person visits to build relationships (begin the educational process while the patient is hospitalized and schedule both the follow-up clinic appointment and pharmacy visit at the same time); 2) utilizing the patient centered medical home concept to improve access to providers; 3) allowing sites to determine provider type to support the personal contact (i.e. pharmacist, nurse practitioner, registered nurse); and 4) employing interactive voice response (IVR) technology to facilitate communication. Conclusions: Pharmacists’ perspectives of a medication adherence intervention gave insights into reasons for the intervention success and suggestions for improvements and dissemination. We found that in-person meetings between pharmacists and patients led to bi-directional conversations and relationships with providers, which positively influenced patient adherence behavior. Future interventions designed to improve medication adherence should incorporate these pharmacist-identified factors.

Modeling Food Particle Systems: A Review of Current Progress and Challenges

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Lennart Fries
Keyword(s):  
Particle Systems ◽  
Model Systems ◽  
Annual Review ◽  
Publication Date ◽  
Food Particle ◽  
Adequate Model ◽  
Food Powders ◽  
Contact Models ◽  
Physical Phenomena ◽  
The Impact

For many years, food engineers have attempted to describe physical phenomena such as heat and mass transfer in food via mathematical models. Still, the impact and benefits of computer-aided engineering are less established in food than in most other industries today. Complexity in the structure and composition of food matrices are largely responsible for this gap. During processing of food, its temperature, moisture, and structure can change continuously, along with its physical properties. We summarize the knowledge foundation, recent progress, and remaining limitations in modeling food particle systems in four relevant areas: flowability, size reduction, drying, and granulation and agglomeration. Our goal is to enable researchers in academia and industry dealing with food powders to identify approaches to address their challenges with adequate model systems or through structural and compositional simplifications. With advances in computer simulation capacity, detailed particle-scale models are now available for many applications. Here, we discuss aspects that require further attention, especially related to physics-based contact models for discrete-element models of food particle systems. Expected final online publication date for the Annual Review of Chemical and Biomolecular Engineering, Volume 12 is June 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

The Justice Department's Pattern-or-Practice Police Reform Program, 1994–2017: Goals, Achievements, and Issues

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Samuel Walker
Keyword(s):  
Academic Research ◽  
Annual Review ◽  
Publication Date ◽  
Law Enforcement Agencies ◽  
Police Reform ◽  
Social Scientists ◽  
Reform Program ◽  
Or Practice ◽  
Consent Decrees ◽  
The Impact

The Department of Justice's pattern-or-practice police reform program has been an unprecedented event in American policing, intervening in local and state law enforcement agencies as never before and requiring a sweeping package of reforms. The program has reached reform settlements with forty agencies, including twenty with judicially enforced consent decrees. Academic research on the program, however, has been fairly modest. Social scientists have largely focused on a few selected issues. There is no study of the full impact of the program on one agency, and there is no comprehensive study of the impact of the program as a whole. Evaluations of individual agencies have been generally favorable, although with backsliding in some agencies. This review argues that the combination of several major goals and the various elements of specific consent decree reforms have created a web of accountability that is unmatched by any previous police reform effort. Expected final online publication date for the Annual Review of Criminology, Volume 5 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Virulence and Pathogenicity of Chytrid Fungi Causing Amphibian Extinctions

2021 ◽  
Vol 75 (1) ◽  
Author(s):  
Matthew C. Fisher ◽  
Frank Pasmans ◽  
An Martel
Keyword(s):  
Online Publication ◽  
Abiotic Factors ◽  
Amphibian Declines ◽  
Host Responses ◽  
Annual Review ◽  
Publication Date ◽  
Emerging Infections ◽  
Biological Methods ◽  
The Impact ◽  
Highly Virulent

Ancient enzootic associations between wildlife and their infections allow evolution to innovate mechanisms of pathogenicity that are counterbalanced by host responses. However, erosion of barriers to pathogen dispersal by globalization leads to the infection of hosts that have not evolved effective resistance and the emergence of highly virulent infections. Global amphibian declines driven by the rise of chytrid fungi and chytridiomycosis are emblematic of emerging infections. Here, we review how modern biological methods have been used to understand the adaptations and counteradaptations that these fungi and their amphibian hosts have evolved. We explore the interplay of biotic and abiotic factors that modify the virulence of these infections and dissect the complexity of this disease system. We highlight progress that has led to insights into how we might in the future lessen the impact of these emerging infections. Expected final online publication date for the Annual Review of Microbiology, Volume 75 is October 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Biomolecular Modeling and Simulation: A Prospering Multidisciplinary Field

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Tamar Schlick ◽  
Stephanie Portillo-Ledesma ◽  
Christopher G. Myers ◽  
Lauren Beljak ◽  
Justin Chen ◽  
...  
Keyword(s):  
Modeling And Simulation ◽  
Annual Review ◽  
Publication Date ◽  
Long Term Effects ◽  
Short Term ◽  
Biomolecular Modeling ◽  
Productive Phase ◽  
The Impact ◽  
New Algorithms

We reassess progress in the field of biomolecular modeling and simulation, following up on our perspective published in 2011. By reviewing metrics for the field's productivity and providing examples of success, we underscore the productive phase of the field, whose short-term expectations were overestimated and long-term effects underestimated. Such successes include prediction of structures and mechanisms; generation of new insights into biomolecular activity; and thriving collaborations between modeling and experimentation, including experiments driven by modeling. We also discuss the impact of field exercises and web games on the field's progress. Overall, we note tremendous success by the biomolecular modeling community in utilization of computer power; improvement in force fields; and development and application of new algorithms, notably machine learning and artificial intelligence. The combined advances are enhancing the accuracy and scope of modeling and simulation, establishing an exemplary discipline where experiment and theory or simulations are full partners. Expected final online publication date for the Annual Review of Biophysics, Volume 50 is May 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

scholarly journals Medication adherence in cardiovascular medicine

BMJ ◽  
2021 ◽  
pp. n1493
Author(s):  
Steven T Simon ◽  
Vinay Kini ◽  
Andrew E Levy ◽  
P Michael Ho
Keyword(s):  
Cardiovascular Disease ◽  
Medication Adherence ◽  
Behavioral Interventions ◽  
Healthcare Team ◽  
Improve Medication Adherence ◽  
Team Members ◽  
Medication Costs ◽  
Dosing Regimens ◽  
Cognitive Behavioral Interventions ◽  
The Impact

AbstractCardiovascular disease is the leading cause of death globally. While pharmacological advancements have improved the morbidity and mortality associated with cardiovascular disease, non-adherence to prescribed treatment remains a significant barrier to improved patient outcomes. A variety of strategies to improve medication adherence have been tested in clinical trials, and include the following categories: improving patient education, implementing medication reminders, testing cognitive behavioral interventions, reducing medication costs, utilizing healthcare team members, and streamlining medication dosing regimens. In this review, we describe specific trials within each of these categories and highlight the impact of each on medication adherence. We also examine ongoing trials and future lines of inquiry for improving medication adherence in patients with cardiovascular diseases.

scholarly journals A systematic overview of systematic reviews evaluating medication adherence interventions

2020 ◽  
Vol 77 (2) ◽  
pp. 138-147 ◽  
Author(s):  
Laura J Anderson ◽  
Teryl K Nuckols ◽  
Courtney Coles ◽  
Michael M Le ◽  
Jeff L Schnipper ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Systematic Reviews ◽  
Financial Incentives ◽  
English Language ◽  
Patient Adherence ◽  
Measurement Tool ◽  
Improve Medication Adherence ◽  
Study Characteristics ◽  
Adherence Interventions ◽  
Grade Methodology

Abstract Purpose To systematically summarize evidence from multiple systematic reviews (SRs) examining interventions addressing medication nonadherence and to discern differences in effectiveness by intervention, patient, and study characteristics. Summary MEDLINE, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects were searched for papers published from January 2004 to February 2017. English-language SRs examining benefits of medication adherence interventions were eligible. Inclusion was limited to adult patients prescribed medication for 1 of the following disease conditions: diabetes and prediabetes, heart conditions, hypertension and prehypertension, stroke, and cognitive impairment. Non–disease-specific SRs that considered medication adherence interventions for older adults, adults with chronic illness, and adults with known medication adherence problems were also included. Two researchers independently screened titles, abstracts, and full-text articles. They then extracted key variables from eligible SRs, reconciling discrepancies via discussion. A MeaSurement Tool to Assess systematic Reviews (AMSTAR) was used to assess SRs; those with scores below 8 were excluded. Conclusions regarding intervention effectiveness were extracted. Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methodology was applied to assess evidence quality. Results Of 390 SRs, 25 met the inclusion criteria and assessed adherence as a primary outcome. Intervention types most consistently found to be effective were dose simplification, patient education, electronic reminders to patients, and reduced patient cost sharing or incentives. Of 50 conclusions drawn by the SRs, the underlying evidence was low or very low quality for 45 SRs. Conclusion Despite an abundance of primary studies and despite only examining high-quality SRs, the vast majority of primary studies supporting SR authors’ conclusions were of low or very low quality. Nonetheless, health system leaders seeking to improve medication adherence should prioritize interventions that have been studied and found to be effective at improving patient adherence, including dose simplification, education, reminders, and financial incentives.

The effect of medical home enrollment on cardiometabolic medication adherence among Medicaid-insured cancer patients.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 279-279
Author(s):  
Lisa Spees ◽  
Stephanie B. Wheeler ◽  
Xi Zhou ◽  
Krutika B Amin ◽  
Chris Baggett ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Medication Adherence ◽  
Cancer Patients ◽  
Care Coordination ◽  
Medical Home ◽  
Metastatic Breast ◽  
Treatment Phase ◽  
Cancer Type ◽  
Improve Medication Adherence ◽  
The Impact

279 Background: Medical homes, developed to increase care coordination among vulnerable patient populations, have been successful in improving outcomes of patients with multiple chronic comorbidities, but have not been evaluated among cancer survivors. We determined the impact of medical home enrollment on adherence to anti-diabetics, anti-lipidemics, and anti-hypertensives among Medicaid patients diagnosed with non-metastatic breast, colorectal, or lung cancer. Methods: Using linked cancer registry and claims data from North Carolina, we included Medicaid-insured adults diagnosed from 2004-2012 with breast, colorectal, or lung cancer who had at least one cardiometabolic condition (i.e., hyperlipidemia, hypertension, and diabetes mellitus). For each cardiometabolic condition, we measured medication adherence using ambulatory proportion of days covered (PDC). We examined the impact of medical home enrollment on PDC across the phases of cancer care (i.e., pre-cancer diagnosis, treatment, and survivorship phases) using a differences-in-differences model. All models adjusted for age, sex, race/ethnicity, dual enrollment, cancer type, comorbidity index, and number of cardiometabolic conditions. Results: We included, respectively, 765, 1079, and 1634 cancer patients with diabetes, hyperlipidemia, and hypertension. Overall, adherence to anti-lipidemics was lower than adherence to anti-diabetics and anti-hypertensives. In the pre-diagnosis phase, mean PDC across all cardiometabolic conditions was slightly lower for cancer patients enrolled in a medical home than those not enrolled in a medical home. However, medication adherence improved 3-5% in the treatment phase and 7% in the survivorship phase for cancer patients in a medical home compared to cancer patients not in a medical home during the pre-diagnosis phase. Conclusions: These results provide evidence that enrollment in a medical home can improve medication adherence, even among vulnerable cancer patients with complex health needs. The medical home model is an effective healthcare system intervention through which to provide better care coordination and improve patient outcomes.

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