Glossary of Adherence Related Terminology
Adherence to Psychotropic and Nonpsychotropic Medication Among Patients With Bipolar Disorder and General Medical Conditions
Jennifer B. Levin, Ph.D., Michelle E. Aebi, M.A., Curtis Tatsuoka, Ph.D., Kristin A. Cassidy, M.A., Martha Sajatovic, M.D. Psychiatric Services, 2015.
Objective: This study assessed the relationship between nonadherence to psychotropic and nonpsychotropic medications for 88 patients nonadherent to medication treatment for bipolar disorder.
Methods: This descriptive study was part of a clinical trial promoting medication adherence. Nonadherence was de- fined as $20% of days with missed doses.
Results: A majority of the sample was female and had type I bipolar disorder; 49% had hypertension, 39% had hyperlipidemia, and 69% smoked; average body mass index was 34, and 65% were obese. The median proportion of days with missed doses was 53.6% (interquartile ratio [IQR]538.10%273.40%) for psychotropic medications and 33.93% (IQR513.81%2 51.91%) for nonpsychotropic medications. There was a significant difference between nonadherence to psychotropic and nonpsychotropic medication for the past week (z524.11, p,.001) and past month (z524.19, p,.001). More global psychopathology was associated with nonpsychotropic nonadherence.
Conclusions: Psychotropic adherence was worse than nonpsychotropic adherence, yet both were poor. Improving adherence to cardiovascular medications is a reasonable pathway to improve cardiovascular health in this population.
Effect of Financial Incentives to Physicians, Patients, or Both on Lipid Levels: A Randomized Clinical Trial
Asch DA, Troxel AB, Steward WF, Sequist TD, Jones JB, Hirsch AG, Hoffer K, Zhu J, Wang W, Hodlofski A, Frasch AB, Weiner MG, Finnerty DD, Rosenthal MB, Gangemi K, Volpp KG. JAMA. 2015;314(18):1926-1935.
Importance: Financial incentives to physicians or patients are increasingly used, but their effectiveness is not well established.
Objective: To determine whether physician financial incentives, patient incentives, or shared physician and patient incentives are more effective than control in reducing levels of low-density lipoprotein cholesterol (LDL-C) among patients with high cardiovascular risk.
Interventions Primary care physicians were randomly assigned to control, physician incentives, patient incentives, or shared physician-patient incentives. Physicians in the physician incentives group were eligible to receive up to $1024 per enrolled patient meeting LDL-C goals. Patients in the patient incentives group were eligible for the same amount, distributed through daily lotteries tied to medication adherence. Physicians and patients in the shared incentives group shared these incentives. Physicians and patients in the control group received no incentives tied to outcomes, but all patient participants received up to $355 each for trial participation.
Conclusions and Relevance In primary care practices, shared financial incentives for physicians and patients, but not incentives to physicians or patients alone, resulted in a statistically significant difference in reduction of LDL-C levels at 12 months. This reduction was modest, however, and further information is needed to understand whether this approach represents good value.
Reviews and Meta-analyses
A New Taxonomy for Describing and Defining Adherence to Medications
Vrijens B, De Geest S, Hughes D, Przemyslaw K, Demonceau J, Ruppar T, Dobbels F, Fargher E, Morrison V, Lewek P, Matyjaszczyk M, Mshelia C, Clyne W, Aronson J, Urquhart J. British Journal of Clinical Pharmacology 2012, 73(s5); 691-705.
This paper proposes a new taxonomy, in which adherence to medications is conceptualized, based on behavioral and pharmacological science, and will support quantifiable parameters. A systematic literature review was performed to identify the different conceptual approaches to adherence research. As a result, authors of this paper hav eproposed a new taxonomy for medication taking behavior that will support relevant measures.
Impact of Health Literacy on Medication Adherence: A Systematic Review and Meta-analysis
Annals of Pharmacotherapy. Zhang, N., Terry A., McHorney C. 2014, 48(6): 741-751.
This article reviews and synthesizes published literature to determine the association between health literacy, the degree to which an individual has the capacity to understand health information, and medication adherence. The authors concluded that there is an association, but further research is needed to explore these associations.
Interventional Tools to Improve Medication Adherence: A Review of Literature
Costa E, Giardini A, Savin M, Menditto E, Lehane EA, Laosa O, Pecorelli S, Monaco A, Marengoni A. Patient Preference and Adherence 2015, 9: 1303-1314.
This paper reviews the importance of the role of medication adherence in the management of chronic diseases; particularly in the aging population. The majority of studies are focused on short-term adherence, and no consistent results were presented for long-term evidence; suggesting that future research should focus on new, innovative strategies to improve adherence for long term.
mHealth SMS Text Messaging Interventions and to Promote Medication Adherence: An Integrative Review
DeKoekkoek T., Given B, Given CW, Ridenour K, Schueller M, Spolestra SL. Journal of Clinical Nursing. 2015, 24: 19-20.
This review provides clinicians with the state of the science with regard to text messaging interventions that promote medication adherence. A description of intervention components are provided to aid nurses in development of text messages and in translating evidence into practice.
Commentaries and Editorials
Selecting, Adapting, and Sustaining Programs in Healthcare Systems
Zullig, L and Bosworth, HB. Journal of Multidisciplinary Healthcare. 2015, 8: 199-203.
Numerous effective programs have been developed to address specific health problems, but most have been confined to the research setting. This article describes important factors to consider when attempting to scale-up and implement programs in large healthcare settings.