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.

scholarly journals Evaluating the Impact of Outpatient Multi-Dose Medication Packaging Service (MDMPS) on Medication Adherence and Clinical Outcomes

2020 ◽  
Vol 11 ◽  
pp. 215013272096508
Author(s):  
Pratibha Nair ◽  
Kok Wai Kee ◽  
Choon Siong Mah ◽  
Eng Sing Lee
Keyword(s):  
Blood Pressure ◽  
Medication Adherence ◽  
Clinical Outcomes ◽  
Low Density Lipoprotein ◽  
Medication Possession Ratio ◽  
Density Lipoprotein ◽  
Control Group ◽  
Improve Medication Adherence ◽  
Standard Medication ◽  
The Impact

Background: There is limited understanding on the impact of the multidose medication packaging service (MDMPS). Objectives: The main objective of this study was to evaluate changes in medication adherence in patients using MDMPS compared to patients receiving standard medication packaging (control group). The other objectives were to determine the association between medication adherence and clinical outcomes, and to assess patients’/caregivers’ perceptions toward MDMPS. Methods: A retrospective cohort study was conducted among primary care patients in Singapore enrolled into MDMPS between 2012 and 2017. Eligible patients were taking at least five chronic medications, diagnosed with Hypertension, Hyperlipidemia and/or Type 2 Diabetes, with prescription records for at least six months before and after the index period. They were matched to control patients based on the type of comorbidities and medication adherence status. Medication Possession Ratio (MPR), glycated hemoglobin (HbA1c), blood pressure and low-density lipoprotein-cholesterol (LDL-C) of both groups were compared between baseline and at least six months post-index period. Interviewer-administered questionnaires were also conducted for MDMPS patients. Results: The MPR of MDMPS patients (n = 100) increased by 0.37% ( P < .001) compared to the control group (n = 100). MDMPS patients with diabetes had reduced HbA1c by 0.1% after six months ( P = .022) but was not significant after 12 months. No significant changes were seen in blood pressure and LDL-C between both groups. At least 50% of patients were highly satisfied with MDMPS. Conclusion: MDMPS can improve medication adherence. Further studies are needed to understand its clinical impact.

scholarly journals Effects of Emotional Response on Adherence to Antihypertensive Medication and Blood Pressure Improvement

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Robert D. Keeley ◽  
Margaret Driscoll
Keyword(s):  
Blood Pressure ◽  
Medication Adherence ◽  
Emotional Response ◽  
Antihypertensive Medication ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
Behavioral Risk ◽  
Improve Medication Adherence ◽  
Pharmacy Refill ◽  
Adherence Score

Background. Developing interventions to improve medication adherence may depend upon discovery of novel behavioral risk factors for nonadherence.Objective. Explore the effects of emotional response (ER) on adherence to antihypertensive medication and on systolic blood pressure (SBP) improvement.Design. We studied 101 adults with diabetes and hypertension. The primary outcome, 90-day “percentage of days covered” adherence score, was determined from pharmacy refill records. The secondary outcome was change in SBP over 90 days. ER was classified as positive, negative, or neutral.Results. Average adherence was 71.6% (SD 31.4%), and negative and positive ER were endorsed by 25% and 9% of subjects, respectively. Gender moderated the effect of positive or negative versus neutral ER on adherence (interactionP=0.003); regardless of gender, negative and positive ER were associated with similarly high and low adherence, respectively, but males endorsing neutral ER had significantly higher adherence than their female counterparts (85.6% versus 57.1%,Fvalue = 15.3,P=0.0002). Adherence mediated ER's effect on SBP improvement: among participants with negative, but not positive or neutral, ER, increasing adherence and SBP improvement were correlated (Spearman’sr=0.49,P=0.02).Conclusions. Negative, but not positive or neutral, ER predicted better medication adherence and a correlation between medication adherence and improvement in SBP.

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.

Abstract P048: Effect of Hurricane Katrina on Medication Adherence and Blood Pressure among Hypertensive Veterans

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Angela M Thompson ◽  
M.A. Krousel-Wood ◽  
Hao Mei ◽  
Larry Webber ◽  
Jiang He ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Medication Adherence ◽  
Hurricane Katrina ◽  
New Orleans ◽  
Cardiovascular Events ◽  
Medication Possession Ratio ◽  
Group Differences ◽  
P Value ◽  
Antihypertensive Medications ◽  
The Impact

Background. An increase in cardiovascular events and blood pressure (BP) has been reported in the aftermath of major natural disasters. This increase may be due to acute psychological stress, physiologic suffering, or lack of appropriate healthcare services in these situations. Objectives. Using retrospective cohort data from the Veterans Administration, we examined the impact of Hurricane Katrina on medication adherence and BP control among 1000 hypertensive patients from New Orleans, Louisiana compared to 1000 patients from an area not affected by the hurricane, Alexandria, Louisiana. Methods. Antihypertensive medication refills were identified from electronic pharmacy records, and blood pressure readings recorded during routine examinations were extracted from electronic patient data. Adherence to antihypertensive medications was assessed using the medication possession ratio (MPR), a standard method of quantifying refills. MPR was classified as low (<0.80) or high (≥0.80). Multivariable-adjusted regression methods were used to examine change in BP from the 6 months before the hurricane to 6 months after the hurricane. Results. In the year before Hurricane Katrina, the proportion of patients with low MPR was similar for patients in New Orleans (11.8% [106 of 902]) and Alexandria (11.3% [105 of 931], p-value=0.75 for group differences). In the year following the hurricane, there was a significant increase in the proportion of New Orleans patients with low MPR (24.1% [155 of 643]), compared to Alexandria (11.2% [94 of 838], p-value<0.001 for group differences). The unadjusted mean (95% Confidence Interval) increase in BP from the pre-Katrina to post-Katrina period was 6.6 (4.7, 8.3) mmHg systolic/5.7 (4.6, 6.8) mmHg diastolic and 2.1 (0.8, 3.5) mmHg systolic/1.2 (0.4, 2.0) mmHg diastolic among patients in New Orleans and Alexandria, respectively (p-value<0.001 for group differences). After adjustment for age, race, pre-Katrina BP, and post-Katrina MPR as a continuous variable, the mean increase in BP remained significantly higher among patients in New Orleans at 5.9 (4.3, 7.6) mmHg systolic/4.5 (3.5, 5.5) mmHg diastolic, compared to those in Alexandria where mean increase was 2.0 (0.8, 3.2) mmHg systolic /1.5 (0.7, 2.2) mmHg diastolic (p-value < 0.001 for group differences). Conclusion. BP significantly increased among hypertensive veterans in New Orleans as compared to Alexandria after Hurricane Katrina. This increase was only in part explained by changes in medication adherence. Future disaster planning should provide veterans with a rapid and easily-available method of accessing medications and health services and should anticipate increased BP and potential cardiovascular events among patients with hypertension.

1200Changes in nocturnal blood pressure post-renal denervation: comparison of treatment versus control groups in SYMPLICITY HTN-3

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Kario ◽  
G Bakris ◽  
S Pocock ◽  
M Fahy ◽  
D L Bhatt
Keyword(s):  
Blood Pressure ◽  
Medication Adherence ◽  
Renal Denervation ◽  
Patient Adherence ◽  
Sympathetic Tone ◽  
Control Group ◽  
Control Groups ◽  
Sham Control ◽  
Night Time ◽  
And Control

Abstract Background Renal denervation (RDN) impacts blood pressure (BP) differently than anti-hypertensive medications by providing a non-reversible 24-hour change in sympathetic tone that is independent of patient adherence. This might lead to differences in the pattern of BP reduction over the 24-hour period related to diurnal variations in sympathetic tone compared with the timing of drug dosing on BP. This “always on” impact of RDN on BP was observed in the 24-hour Ambulatory BP (ABPM) measurements in the SPYRAL HTN-ON MED and OFF MED trials and raises the question of whether this might also be seen in prior studies of RDN. Purpose It is hypothesized that SYMPLICITY HTN-3 did not meet its primary efficacy endpoint, in part, due to improved medication adherence and subsequent BP reductions in the control group. We hypothesized that examination of 24-hour ABPM in HTN-3 would illustrate the effects of improved medication adherence in the control group and reveal differences in the pattern of BP reduction between RDN and control groups, thereby demonstrating an impact on sympathetically mediated BP. Methods 24-hour ABPM measurements were obtained at baseline and 6 months post-randomization per protocol. ABPM was measured and recorded every 30 minutes and a minimum of 21 daytime and 12 night-time acceptable measurements were required for inclusion in the analysis. Mean and standard error of BP were calculated at each timepoint. Night-time was defined as 1:00–6:00AM. Results The figure shows hourly mean ABPM at baseline and 6 months for RDN (A) and sham-control groups (B). Changes in ABPM from baseline to 6 months for RDN and sham control groups are shown in (C). Both the RDN and control groups experienced lower mean hourly BP during the day. In contrast, BP reductions from baseline were greater at night and during the pre-awakening morning hours (1:00–6:00AM) in the RDN group compared with the sham control group. ANCOVA baseline BP-adjusted treatment difference for night-time SBP between RDN and control groups was −3.4 mmHg [95% confidence intervals: −6.7, −0.2; p=0.039]. One possible explanation may be that plasma levels of some antihypertensive medications (such as hydralazine and furosemide) may be lower during night-time hours, lessening the effect of BP reduction in the control group. Conclusions Analysis of 24-hour ABPM measurements in the RDN group of HTN-3 demonstrate a consistent separation of curves at 6 months compared with baseline. This separation is also seen in the control group in HTN-3 but is minimal at night-time and in the early morning periods, a time when some medications' impact on BP is lessened. Analyses of ABPM data in additional studies (SYMPLICITY HTN-Japan and SPYRAL First-In-Man trials) are planned to further investigate the role of medication adherence in BP reduction after RDN. Acknowledgement/Funding The SYMPLICITY HTN-3 trial is funded by Medtronic.

Impact of a mobile hypertension program in four rural Dominican bateyes

2018 ◽  
Author(s):  
◽  
Tammie M. Conley
Keyword(s):  
Blood Pressure ◽  
Medication Adherence ◽  
Blood Pressure Control ◽  
Migrant Workers ◽  
Repeated Measures ◽  
Large Population ◽  
Pressure Control ◽  
Academic Community ◽  
Self Report ◽  
The Impact

[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT AUTHOR'S REQUEST.] Hypertension contributes significantly to cardiovascular risk and overall mortality worldwide. Among Haitians, uncontrolled hypertension is a leading contributing cause of death. The Dominican Republic is home to a large population of Haitian migrant workers who are living in poverty in sugar cane villages called bateyes. Like other rural impoverished communities, batey residents often lack access to basic health and education services which can result in poor cardiovascular health outcomes. This dissertation examined the impact of the first 12 months of an ongoing mobile hypertension program. The program, developed via an academic-community partnership, was delivered by a local Dominican non-governmental organization (NGO) in four rural bateyes. A ‘promotora’ (lay health promoter) who is a resident of each batey works closely with the team to enhance community participation in the program. Descriptive statistics were used to describe the study sample (n=70). A within-group, repeated-measures, pre-/post design examined the impact of the program on the main outcome measure of blood pressure control. Other outcome measures of interest were body mass index (BMI) and self-reported salt, alcohol, and smoking behaviors, and medication adherence (measured by self-report and pill counts). Results from analyses of 5 visits over a 12-month period showed a decrease in mean systolic and diastolic blood pressure over time (p less than .005). Of note, 68% of the participants were >80% adherent to their antihypertensive medications. A Pearson’s correlation showed that individuals with increased medication adherence also had clinically and statistically significant reductions in SBP and DBP. Findings from this analysis of the first 12 months of the program indicate that the mobile hypertension screening and treatment program has a positive impact on blood pressure control. Evaluation of the program is ongoing and could serve as a model that has widespread implication in other isolated communities worldwide.

scholarly journals Hypertensive Patient Compliance with Pharmacist Intervention: A Systematic Review

2021 ◽  
pp. 85-97
Author(s):  
Abdullah M. Alshahrani ◽  
Marzoq S. Al-Nasser ◽  
Saif T. Alhawashi ◽  
Saad Alqahtani ◽  
Ali A. Alqahtani ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Medication Adherence ◽  
Hypertensive Patient ◽  
Patient Compliance ◽  
Intervention Group ◽  
Pressure Control ◽  
Pharmacist Intervention ◽  
Control Group ◽  
Improve Medication Adherence ◽  
Significant Difference

Background: Pharmacists and physicians can work together to improve patient compliance especially for the management of hypertension. Medication adherence leads to advance health and reduces hospitalizations (morbidity), death (mortality) and healthcare costs. Objectives: Involvement of pharmacist in treatment intervention can result in improved understanding about hypertension and it can increase medication adherence to antihypertensive therapy which ultimately advance overall quality of life. Study design and methods: A comprehensive research study was conducted using two eminent databases i.e. PUBMED and EMBASE. The research articles from 1996 to 2015 were analyzed. All the selected articles were about pharmacist intervention, hypertensive patient compliance and hypertension medication adherence. Results: Some studies show no control in BP; however, there was significant difference in the systolic and diastolic BP pre and post pharmacist intervention (Systolic from 158.1±14.4 to 143.8 ± 10.7, Diastolic from 100.6 ±11.5 to 89.8 ± 9.7). Conversely, in some studies BP was controlled in about 29.9% of control group and in 63% of the intervention group. Conclusion: Results showed many methods can improve medication adherence and blood pressure including counseling patients in person, collaboration between pharmacists and physicians, and using technology like telecommunication to intensify patients counseling. Pharmacist intervention can significantly increase disease-related knowledge, blood pressure control and medication adherence in patients with hypertension.

scholarly journals Improved adherence with Medicines Use Review service in Slovenia: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Urška Nabergoj Makovec ◽  
Igor Locatelli ◽  
Mitja Kos
Keyword(s):  
Medication Adherence ◽  
Controlled Trial ◽  
Test Group ◽  
Multiple Linear Regression Model ◽  
Relative Difference ◽  
Control Group ◽  
Adherence Support ◽  
Medicines Use ◽  
The Impact ◽  
Medicines Use Review

Abstract Background Based on several existing patient-oriented activities, Medicines Use Review (MUR) service was standardized and officially adopted in Slovenia in 2015. Service aims to provide adherence support and ensure safe and effective medicines use. Therefore, the aim of the study was to evaluate the benefits of MUR in Slovenia, primarily the impact on medication adherence. Methods A randomised controlled trial was performed in community pharmacies to compare MUR with standard care. Patients were randomised into either the test (patients received MUR by a certified MUR provider at visit 1), or control group. The study primary outcome was self-reported adherence to multiple medications, assessed by electronic ©Morisky Widget MMAS-8 Software at the first visit (V1) and after 12 weeks (V2). A sub-analysis of intentional and unintentional non-adherence was performed. MUR impact was defined as the relative difference in ©MMAS-8 score after 12 weeks between the test and control group. A multiple linear regression model was used to predict MUR impact based on baseline adherence (low versus medium and high). Several secondary outcomes (e.g. evaluation of drug-related problems (DRPs)) were also assessed. Results Data from 153 (V1) and 140 (V2) patients were analysed. Baseline adherence was low, moderate and high in 17.6, 48.4 and 34.0% patients, respectively. In the low adherence subpopulation, test group patients showed a 1.20 point (95% CI = 0.16–2.25) increase in total ©MMAS-8 score (p = 0.025) compared to control group patients. A 0.84 point (95% CI = 0.05–1.63) increase was due to intentional non-adherence (p = 0.038), and a 0.36 point (95% CI = − 0.23-0.95) was due to unintentional non-adherence (p = 0.226). Additionally, statistically significant decrease in the proportion of patients with manifested DRPs (p < 0.001) and concerns regarding chronic medicines use (p = 0.029) were revealed. Conclusion MUR service in Slovenia improves low medication adherence and is effective in addressing DRPs and concerns regarding chronic medicines use. Trial registration ClinicalTrials.gov - NCT04417400; 4th June 2020; retrospectively registered.

The Impact of Domestic Violence on Women’s Self-Attitude in Kazakhstan

2020 ◽  
pp. 77-83
Author(s):  
Zhanna Kalmatayeva
Keyword(s):  
Domestic Violence ◽  
Quantitative Research ◽  
Self Esteem ◽  
Self Report ◽  
Control Group ◽  
Personality Research ◽  
Attitude Test ◽  
The Difference ◽  
Student’S T ◽  
The Impact

The purpose of the article was to study the problems of domestic violence of women and its consequences in Kazakhstan. The analysis of the results of the study of self-attitude and self-esteem of women subjected to domestic violence. Revealed there is a correlation between the level of self-attitude of domestic violence victims and the non-differentiated I-concept. 140 women participated in the present study, 70 women are control group which not subjected to domestic violence and 70 women of them who have currently reported domestic violence in the Crisis Center "Umit" in Nur-Sultan in the period from November 2017 to October 2019. Quantitative research method was used in terms of survey model by implementing a psychological test “The self-attitude test questionnaire (SA)” that assesses self-relation, differentiated by self-esteem, self-sympathy, self-interest, and expectations of self-reliance of participants. Also, during the study was used personal questionnaire “Who am I?” a variant of non-standardized self-report, approaching the projective methods of personality research. Descriptive statistics were used to analyze the answers in terms of their levels of the participants’ self-esteem and self-relation and further, since it was revealed according to the results reflect the difference in the two groups by the values obtained from these scales, the Student's t-test for independent groups was used [2] was used to reveal whether there is any correlation between the components of the scale. The obtained results can be used to interventions and training of family for counselors in order to promote women's self-esteem and self-relation.

Optimizing patient adherence to stroke rehabilitation: A mixed method telerehabilitation trial (Preprint)

2021 ◽  
Author(s):  
Isabelle Gaboury ◽  
Michel Tousignant ◽  
Hélène Corriveau ◽  
Matthew Menear ◽  
Guylaine Le Dorze ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Stroke Rehabilitation ◽  
Patient Adherence ◽  
Interprofessional Collaboration ◽  
Interdisciplinary Collaboration ◽  
Control Group ◽  
Shared Decision ◽  
The Impact

BACKGROUND Strong evidence supports beginning stroke rehabilitation as soon as the patient’s medical status has stabilized and continuing following discharge from acute care. However, adherence to rehabilitation treatments over the rehabilitation phase has been shown to be suboptimal. OBJECTIVE Objective: The aim of this study is to assess the impact of a telerehabilitation platform on stroke patients’ adherence to a rehabilitation plan and on their level of reintegration to normal social activities, in comparison with usual care. The primary outcome is patient adherence to stroke rehabilitation (up to 12 weeks), which is hypothesized to influence reintegration to normal living. Secondary outcomes for patients include functional recovery and independence, depression, adverse events related to telerehabilitation, use of services (up to 6 months), perception of interprofessional shared decision making, and quality of services received. Interprofessional collaboration as well as quality of interprofessional shared decision making will be measured on clinicians. METHODS In this interrupted time series with a convergent qualitative component, rehabilitation teams will be trained to develop rehabilitation treatment plans that engage the patient and family, while taking advantage of a telerehabilitation platform to deliver the treatment. The intervention will entail 220 patients to receive stroke telerehabilitation with an interdisciplinary group of clinicians (telerehabilitation) versus face-to-face, standard of care (n = 110 patients). RESULTS Results: Our Research Ethics Board has approved the study in June 2020. Data collection for the control group is underway, with another year planned before we begin the intervention phase. CONCLUSIONS This study will contribute to minimize both knowledge and practice gaps, while producing robust, in-depth data on the factors related to the effectiveness of telerehabilitation in a stroke rehabilitation continuum. Findings will inform best practices guidelines regarding telecare services and the provision of telerehabilitation, including recommendations regarding effective interdisciplinary collaboration regarding stroke rehabilitation. CLINICALTRIAL ClinicalTrials.gov NCT04440215

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