Adherence

In November 2006, a panel of experts participated in a teleconference to discuss the issue of adherence to antihypertensive therapy. The panel was chaired by JoAnne M. Foody, MD, of the Yale University School of Medicine, Section of Cardiovascular Medicine, New Haven, CT. Also participating were Joshua S. Benner, PharmD, ScD, ValueMedics Research, Falls Church, VA, and William Frishman, MD, New York Medical College, Valhalla, NY.     

Specialized Adherence Counselors Can Improve Treatment Adherence

Abstract

Individuals living with HIV disease often have great difficulty adhering to drug treatment regimes. In order to improve treatment adherence clients were referred to a specialized adherence counselor for intensive adherence counseling and education. Instruments were developed which integrated research tools into on-going clinical assessments. The first 30 clients who received adherence counseling were tracked for at least one year in order to assess treatment adherence; 33% were discharged as adherent and 40% exhibited improved adherence; only 10% still had problems with adherence at the 12 month follow-up. This paper describes the role played by specialized adherence counselors and provides a summary of the guidelines that were developed throughout the course of this project. Strategies are offered for helping with diverse adherence problems describing how “to do” adherence counseling directed towards clinicians working on the front line to improve adherence.     

Micro-Immune Adherence

A micro-immune adherence assay is described, and some of the factors influencing the outcome of this reaction are discussed. A high degree of agreement is found between this technique and a micro-lymphocytotoxic assay based upon dye exclusion, both when non-selected sera and when specific HL-A antisera were used. It was concluded that micro-immune adherence is a simple and reliable technique also suitable for the demonstration of human HL-A antigens.     

Predictors of Statin Adherence

Statin therapy plays a central role in decreasing the morbidity and mortality associated with cardiovascular disease. However, prescribed statins are only effective if they are taken by patients on a regular basis, known as medication adherence. The factors that influence patient adherence to statin therapy can be categorized into patient factors, physician factors, and health system factors, often with interactions between the categories. Patient factors include demographics, socioeconomic status, comorbidities, and side effects. Physician factors include the physician’s own adherence to applying guideline recommendations, office visits, and their interactions with patients. Health system factors include issues such as cost and access to care. Physicians should be aware of the various elements that may influence a patient’s likelihood to take statin medications to improve adherence and provide the best possible patient outcomes.     

Adherence to Sublingual Immunotherapy

Adherence is a major issue in any medical treatment. Allergen immunotherapy (AIT) is particularly affected by a poor adherence because a flawed application prevents the immunological effects that underlie the clinical outcome of the treatment. Sublingual immunotherapy (SLIT) was introduced in the 1990s, and the early studies suggested that adherence and compliance to such a route of administration was better than the traditional subcutaneous route. However, the recent data from manufacturers revealed that only 13 % of patients treated with SLIT reach the recommended 3-year duration. Therefore, improved adherence to SLIT is an unmet need that may be achieved by various approaches. The utility of patient education and accurate monitoring during the treatment was demonstrated by specific studies, while the success of technology-based tools, including online platforms, social media, e-mail, and a short message service by phone, is currently considered to improve the adherence. This goal is of pivotal importance to fulfill the object of SLIT that is to modify the natural history of allergy, ensuring a long-lasting clinical benefit, and a consequent pharmaco-economic advantage, when patients complete at least a 3-year course of treatment.     

Adherence to HAART regimens

The problem of inadequate adherence to prescribed highly active antiretroviral therapy (HAART) drug regimens to treat HIV infection and AIDS is ubiquitous. Adherence can be inadequate despite both provider and patient understanding of the consequences of nonadherence. Successful long-term treatment of HIV/AIDS requires at least 95% adherence to HAART in order to prevent emergence of drug-resistant HIV variants that lead to regimen failure and limit options for future therapy. Despite the prevalence of inadequate adherence, many patients succeed, and HAART has transformed HIV infection into a chronic illness increasingly managed in primary care. The barriers to adherence observed in HIV treatment resemble barriers to the successful treatment of other chronic diseases: regimen complexity, side effects resulting in poor tolerability, patient lifestyle factors, and patient-provider relationships. Treatment of HIV infection has shown that patient-provider collaboration can result in the selection of a lifestyle-tailored regimen characterized by convenient dosing, low pill burden, and tolerable side effects that enhances adherence, effectiveness, and the patient's willingness to remain on anti-HIV therapy long term. This review focuses on the current understanding of adherence reporting, improvement of adherence, and, hence, improvement of treatment outcomes in HIV infection and AIDS.     

Medication Adherence and Heart Failure

Heart failure remains among the most prevalent and burdensome medical conditions in the United States. With increasing awareness regarding resource use and costs of care, there has been significant interest in the identification of factors that influence rates of hospitalization and readmission in individuals with heart failure. Medication adherence has been identified as one such modifiable factor. Many barriers to medication adherence have been identified and include factors related to the patient, those related to their medical condition, their medical regimen, the healthcare system and others that are social and socioeconomic in nature. Identification of these barriers has led to novel interventions for improving medication adherence with the goal of improving the care of individuals with heart failure.     

Reinforcing Adherence to Antihypertensive Medications

This pilot study evaluated a reinforcement intervention to improve adherence to antihypertensive therapy. Twenty‐nine participants were randomized to standard care or standard care plus financial reinforcement for 12 weeks. Participants in the reinforcement group received a cell phone to self‐record videos of adherence, for which they earned rewards. These participants sent videos demonstrating on‐time adherence 97.8% of the time. Pill count adherence differed significantly between the groups during treatment, with 98.8%±1.5% of pills taken during treatment in the reinforcement condition vs 92.6%±9.2% in standard care (P<.002). Benefits persisted throughout a 3‐month follow‐up, with 93.8%±9.3% vs 78.0%±18.5% of pills taken (P<.001). Pill counts correlated significantly (P<.001) with self‐reports of adherence, which also differed between groups over time (P<.01). Systolic blood pressure decreased modestly over time in participants overall (P<.01) but without significant time‐by‐group effects. These results suggest that reinforcing medication adherence via cellular phone technology and financial reinforcement holds potential to improve adherence.     

Relationship Dynamics are Associated with Self-Reported Adherence but not an Objective Adherence Measure in Malawi

AIDS and Behavior - Couple relationships can be leveraged to improve adherence to antiretroviral therapy (ART), but few studies have identified relationship factors to target in interventions in...