Medication Adherence to Multidrug Regimens

The study aimed to develop and evaluate a medication diary for patients to report problems with medication use to enable shared-decision making and improve medication adherence.

Based on a search for existing diaries, a review of the content, and a list of medication self-management problems compiled from previous research, a paper and pencil version of a medication diary was developed. The diary was reviewed for clarity and overall presentation by five healthcare providers and nine patients. Afterwards, user-friendliness was evaluated by 69 patients with polypharmacy discharged from hospital during a quantitative prospective study.

The medication diary consists of several parts: (1) a medication schedule allowing patients to list their medicines, (2) information sheets allowing patients to write down specific medication-related information, (3) a monthly overview to indicate daily whether medication-related problems were experienced, (4) problem sheets elaborating on the problems encountered, (5) space for specific medication-related questions for healthcare providers to facilitate shared-decision making. The review phase resulted in minor textual adjustments and one extra problem in the problem sheet. Most participants, who tested the medication diary for two months, found the diary user-friendly (80%) and easy to fill in (89%). About 40% of participants reported problems with medication use. Half of the patients indicated that the diary can facilitate discussing problems with healthcare providers.

The medication diary offers patients the opportunity to report problems regarding their medication use in a proven user-friendly manner and to discuss these problems with healthcare providers. Reporting and discussing problems with medication use can serve as a first step towards making shared decisions on how to address the problems encountered.

In metabolic syndrome (MetS), cardiovascular disease (CVD) risk reduction relies on the complementary use of diet and lipid-lowering medication. Evidence suggests that initiating such medication may impede diet quality. The objective of this study was to evaluate the relationship between diet quality and statin use among adults with MetS and free of CVD from the Province of Québec.

This cross-sectional study included 2481 adults with MetS (40-69 years of age) from the CARTaGENE Québec population-based cohort, of whom 463 self-reported using statin monotherapy. Diet was assessed using the Canadian Dietary History Questionnaire II, a food- frequency questionnaire, and diet quality was assessed using the Alternative Healthy Eating Index (AHEI).

In multivariable-adjusted linear regression models, statin users had lower AHEI (%) compared with nonusers (users: 40.0; 95% confidence interval [CI], 38.9, 41.2 vs nonusers: 41.2; 95% CI, 40.4, 42.0; P = 0.03] because of a lower consumption of vegetables and whole grains. Stratified interaction analyses showed that the lower diet quality among statin users was mostly prevalent among men aged ≥ 50 years and women aged ≥ 60 years, among individuals with annual household incomes of < $50,000 and persons who self-reported history of high blood pressure.

In this cohort of adults with MetS from Quebéc, the use of statin monotherapy in primary prevention of CVD was associated with a slightly lower diet quality. These data suggest suboptimal complementarity between diet quality and use of cholesterol-lowering medication in primary prevention of CVD in MetS.

Dans le syndrome métabolique, la réduction du risque de maladie cardiovasculaire repose sur la complémentarité entre une saine alimentation et l'utilisation d’hypolipidémiants. Des évidences suggèrent que l'initiation d’un traitement médicamenteux hypolipémiant influencerait négativement la qualité de l'alimentation. Cette étude avait pour objectif de déterminer la relation entre la qualité de l’alimentation et l’utilisation de statines chez des adultes avec un syndrome métabolique, mais sans maladie cardiovasculaire, au Québec.

Cette étude transversale comptait 2481 adultes avec un syndrome métabolique (âgés de 40 à 69 ans) provenant de la cohorte CARTaGENE, représentative de la population du Québec, dont 463 sujets ayant autodéclaré qu’ils prenaient une statine en monothérapie. L’alimentation des sujets a été évaluée à l’aide du Canadian Dietary History Questionnaire II, un questionnaire de fréquence alimentaire, et la qualité de l’alimentation a été évaluée à l’aide de l’Alternative Healthy Eating Index (AHEI).

Dans des modèles de régression linéaire multivariée, les utilisateurs de statines ont présenté un indice AHEI (%) plus faible en comparaison aux non-utilisateurs (utilisateurs : 40,0; intervalle de confiance [IC] à 95 % : 38,9-41,2 vs non-utilisateurs : 41,2; IC à 95 % : 40,4-42,0; p = 0,03), en raison d’une plus faible consommation de légumes et de grains entiers. Selon des analyses d’interaction stratifiées, la plus faible qualité nutritionnelle chez les utilisateurs de statines était particulièrement prévalente chez les hommes de ≥ 50 ans et les femmes de ≥ 60 ans, chez les personnes dont le revenu annuel du ménage était < 50 000 dollars et chez les personnes ayant autodéclaré des antécédents d’hypertension.

Dans cette cohorte d’adultes du Québec avec un syndrome métabolique, l’utilisation de statines en monothérapie dans la prévention des maladies cardiovasculaires était associée à une alimentation dont la qualité était légèrement plus faible. Ces données suggèrent une complémentarité sous-optimale entre la qualité de l’alimentation et l’utilisation d’hypocholestérolémiants en prévention des maladies cardiovasculaires chez les personnes avec un syndrome métabolique.

Management of high blood pressure (BP), a key feature of the metabolic syndrome (MetS), relies on diet and medication. Whether these modalities are used as complements has never been evaluated in real-world settings. This study assessed the relationship between diet quality and antihypertensive medication intensity among adults with MetS-associated high BP.

This cross-sectional study included 915 adults with MetS-associated high BP from the CARTaGENE cohort (Québec, Canada), of whom 677 reported using BP-lowering medication. Antihypertensive medication intensity was graded per the number of BP-lowering classes used simultaneously. Diet quality was assessed using the Dietary Approach to Stop Hypertension (DASH) score.

No evidence of a relationship between antihypertensive medication intensity and diet quality was found (β for each additional antihypertensive = –0.05; 95% CI, –0.35; 0.26 DASH score points). However, among men aged < 50 years and women aged < 60 years, the DASH score was inversely associated with medication intensity (β = –0.72; 95% CI, –1.24, –0.19), whereas this relationship tended to be positive among older participants (β = 0.32; 95% CI, –0.05, 0.69). Among participants with low Framingham risk score, the DASH score was inversely associated with medication intensity (β = –0.70; 95% CI, –1.31, –0.09), but no evidence of an association was found among individuals at moderate (β = 0.00; 95% CI, –0.45, 0.45) or high (β = 0.30, 95% CI, –0.24, 0.84) risk.

In this cohort of adults with MetS-associated high BP, there was an overall lack of complementarity between diet quality and BP-lowering medication, especially among younger individuals and those with a lower risk for cardiovascular disease for whom diet quality was inversely associated with intensity of medication.

La prise en charge de la pression artérielle (PA) élevée, l’une des caractéristiques principales du syndrome métabolique (SMet), repose sur une saine alimentation et l'usage de médicaments hypotenseurs. Il n’a jamais été évalué si ces modalités étaient utilisées de façon complémentaire en contexte réel. La présente étude portait sur la relation entre la qualité de l'alimentation et la médication antihypertensive au sein d'adultes ayant une PA élevée associée au SMet.

Cette étude transversale regroupait 915 adultes de la cohorte CARTaGENE (Québec, Canada) ayant une PA élevée associée au SMet, dont 677 ont rapporté prendre des médicaments abaissant la PA. L’intensité de la médication antihypertensive a été évaluée par le nombre de classes de médicaments abaissant la PA utilisées simultanément. La qualité du régime alimentaire a été évaluée à l’aide du score Dietary Approache to Stop Hypertension (DASH).

Aucune évidence d’une relation entre l’intensité des médicaments antihypertenseurs et la qualité de l'alimentation n’a été observée (β pour chaque antihypertenseur supplémentaire = –0,05 ; intervalle de confiance [IC] à 95 %, –0,35 ; 0,26 point au score DASH). Toutefois, chez les hommes âgés < 50 ans et chez les femmes âgées < 60 ans, le score DASH était inversement associé à l’intensité des médicaments (β = –0,72 ; IC à 95 %, –1,24, –0,19), alors que cette relation avait tendance à être positive chez les participants plus âgés (β = 0,32 ; IC à 95 %, –0,05, 0,69). Chez les participants qui avaient un score de risque de Framingham faible, le score DASH était inversement associé à l’intensité des médicaments (β = –0,70 ; IC à 95 %, –1,31, –0,09), mais aucune évidence d’une association n’a été observée chez les individus qui avaient un risque modéré (β = 0,00 ; IC à 95 %, –0,45, 0,45) ou élevé (β = 0,30, IC à 95 %, –0,24, 0,84).

Au sein de cette cohorte d’adultes qui avaient une PA élevée associée au SMet, aucune évidence de complémentarité entre la qualité de l'alimentation et l'intensité de la médication antihypertensive n'a été observée, particulièrement chez les individus plus jeunes et chez ceux exposés à un risque plus faible de maladies cardiovasculaires pour qui la qualité du régime alimentaire était inversement associée à l’intensité des médicaments.

In the Medication Adherence In Glaucoma To Improve Care trial, 200 veterans with medically-treated glaucoma were randomized to an intervention designed to improve glaucoma medication adherence or to usual care. In the 6 months after intervention, the mean proportion of doses taken on schedule was higher for participants in the intervention group compared with controls (0.85 vs. 0.62, P < 0.001). The purpose of this study was to use a mixed-methods approach to compare barriers and facilitators with adherence among participants through qualitative analysis of structured interviews.

This is an analysis of interviews conducted from patients participating in a clinical trial.

Participants from the intervention arm were separated into quartiles based on medication adherence according to the electronic monitor to sample from high and low responders to the intervention. We interviewed 23 participants; 11 participants with low adherence and 12 with high adherence.

Interviews were conducted over telephone and transcribed. Staff members used grounded theory to conduct content analysis and code the transcribed interviews. The iterative process produced categories of common barriers and facilitators for medication adherence.

The frequency of responses addressing common barriers and facilitators were compared between participants with high and low adherence.

In the lowest- and highest-adherence groups, a difficult schedule was the most cited barrier for regular drop usage (63.6% and 58.3%, respectively). In the lowest and highest-adherence groups, the most cited facilitator for adherence was use of the smart bottle (100% and 91.7%, respectively). In the lowest-adherence group, 72.7% of participants cited that improved ability to administer drops was a benefit from the intervention. In the highest-adherence group, 75% of participants cited increased disease knowledge and formation of habits as facilitators from the intervention. Of the 22 of 23 participants who mentioned the smart bottle, 100% cited that they had increased adherence and would continue using the smart bottle.

Using dosing reminders and personalized patient education may be important avenues for addressing difficulties with adhering to an eye drop schedule to improve glaucoma self-management.

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Polypharmacy is commonly related to poor drug adherence, decreased quality of life and inappropriate prescribing in eldery. Furthermore, this condition also leads to a higher utilization of health services resources, due to the increased risk of adverse drug events, length of stays in hospitals and readmissions rates after discharge.

This Systematic Review aimed to synthesize the current evidence that evaluates pharmaceutical services on polymedicated patients, from an economic perspective.

Systematic searches were conducted in MEDLINE, SCOPUS and Cochrane Library databases to identify studies that were published until January 2021. Experimental and observational studies were included in this review, using strict inclusion/exclusion criteria and were assessed for quality using the following tools: RoB and ROBINS-I. Two independent reviewers selected the articles and extracted the data.

3,662 articles were retrieved from the databases. After the screening, 18 studies were included: 9 experimental and 9 observational studies. The studies reported that the integration of the pharmacist as a member of the healthcare team provides an optimized use of pharmacotherapy to polymedicated patients and contributes to health promotion, providing reduction of spending on medication, reduction of expenses related to emergency care and hospitalizations and other medical expenses. The ECRs made cost-effectiveness or cost-benefit analysis, and most of the Non Randomized studies had statistically significant cost savings even considering the expenses of pharmaceutical assistance. Experimental studies reported a cost reduction varying between US$ 193 to US$ 4,966 per patient per year. Furthermore, observational studies estimated a cost reduction of varying from US$ 3 to US$ 2,505 per patient per year. The cost savings are related to decrease in emergency visits and hospitalizations, through pharmacist intervention (medication review and pharmacotherapy follow-up).

Considering the set of studies included, pharmaceutical care services directed to polymedicated patients may cooperate to save financial resources. Most of the interventions showed positive economic trends and also contributed to improving clinical parameters and quality of life. However, due to the majority of the studies having exploratory or qualitative methodology, it is essential to carry out more robust studies, based on full economic evaluation.