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Pharmaceutics
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Medication Adherence Assessed with Real-World Data: New Opportunities Provided by...
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Medication Adherence Assessed with Real-World Data: New Opportunities Provided by Big Data

A special issue of Pharmaceutics (ISSN 1999-4923). This special issue belongs to the section "Physical Pharmacy and Formulation".

Deadline for manuscript submissions: closed (3 December 2021) | Viewed by 46189

Special Issue Editor

Prof. Dr. Przemysław Kardas

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Guest Editor
Department of Family Medicine, Medical University of Lodz, Narutowicza 60, Lodz, Poland
Interests: medication adherence; big data; eHealth; pharmacoepidemiology; polypharmacy; chronic conditions

Special Issue Information

Dear Colleagues,

Medication adherence is the prerequisite for effective pharmacotherapy. Therefore, multiple interventions have been designed to improve it, addressing its major components of initiation, implementation, and discontinuation. Despite this, non-adherence remains a worldwide problem, which undermines the effectiveness of evidence-based therapies and jeopardizes the sustainability of healthcare systems. The rapid aging of the global population leads to a rise in the prevalence of multimorbidity and further aggravates this problem.

New opportunities to tackle this issue come with the availability of big data. Electronic health records, prescribing and dispensing databases, health insurance systems, and national health system records create an unprecedented opportunity to study medication adherence in millions of patients and/or in a longitudinal way. Identifying the major drivers of medication adherence and comparing the effectiveness of adherence interventions in real-world settings are just a couple of benefits of using large medical data repositories for adherence research.

This Special Issue aims to advance our understanding of medication adherence with the potential broader use of big data. A wide range of studies adopting this approach are welcome: from viewpoints describing new concepts and studies setting new standards, through pharmacoepidemiological studies in a regional, national, or international context, to pharmacoeconomical analyses.

Prof. Dr. Przemysław Kardas
Guest Editor

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Keywords

  • medication adherence
  • patient compliance
  • primary non-adherence
  • non-adherence
  • big data
  • eHealth
  • mHealth
  • pharmacoepidemiology
  • pharmacoeconomics

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Published Papers (5 papers)

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10 pages, 782 KiB  
Article
Trends in the Prescription of Strong Opioids for Chronic Non-Cancer Pain in Primary Care in Catalonia: Opicat-Padris-Project
by Aina Perelló-Bratescu, Christian Dürsteler, Maria Asunción Álvarez-Carrera, Laura Granés, Belchin Kostov and Antoni Sisó-Almirall
Pharmaceutics 2022, 14(2), 237; https://doi.org/10.3390/pharmaceutics14020237 - 20 Jan 2022
Cited by 6 | Viewed by 3983
Abstract
In chronic non-cancer pain (CNCP), evidence of the effectiveness of strong opioids (SO) is very limited. Despite this, their use is increasingly common. To examine SO prescriptions, we designed a descriptive, longitudinal, retrospective population-based study, including patients aged ≥15 years prescribed SO for [...] Read more.
In chronic non-cancer pain (CNCP), evidence of the effectiveness of strong opioids (SO) is very limited. Despite this, their use is increasingly common. To examine SO prescriptions, we designed a descriptive, longitudinal, retrospective population-based study, including patients aged ≥15 years prescribed SO for ≥3 months continuously in 2013–2017 for CNCP in primary care in Catalonia. Of the 22,691 patients included, 17,509 (77.2%) were women, 10,585 (46.6%) were aged >80 years, and most had incomes of <€18,000 per year. The most common diagnoses were musculoskeletal diseases and psychiatric disorders. There was a predominance of transdermal fentanyl in the defined daily dose (DDD) per thousand inhabitants/day, with the greatest increase for tapentadol (312% increase). There was an increase of 66.89% in total DDD per thousand inhabitants/day for SO between 2013 (0.737) and 2017 (1.230). The mean daily oral morphine equivalent dose/day dispensed for all drugs was 83.09 mg. Transdermal fentanyl and immediate transmucosal release were the largest cost components. In conclusion, there was a sustained increase in the prescription of SO for CNCP, at high doses, and in mainly elderly patients, predominantly low-income women. The new SO are displacing other drugs. Full article
(This article belongs to the Special Issue Medication Adherence Assessed with Real-World Data: New Opportunities Provided by Big Data)
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13 pages, 5898 KiB  
Article
Delta T, a Useful Indicator for Pharmacy Dispensing Data to Monitor Medication Adherence
by Pascal C. Baumgartner, Bernard Vrijens, Samuel Allemann, Kurt E. Hersberger and Isabelle Arnet
Pharmaceutics 2022, 14(1), 103; https://doi.org/10.3390/pharmaceutics14010103 - 2 Jan 2022
Cited by 2 | Viewed by 2197
Abstract
Introduction: Calculating patients’ medication availability from dispensing or refill data is a common method to estimate adherence. The most often used measures, such as the medication possession ratio (MPR), average medication supplies over an arbitrary period. Averaging masks the variability of refill behavior [...] Read more.
Introduction: Calculating patients’ medication availability from dispensing or refill data is a common method to estimate adherence. The most often used measures, such as the medication possession ratio (MPR), average medication supplies over an arbitrary period. Averaging masks the variability of refill behavior over time. Goal: To derive a new absolute adherence estimate from dispensing data. Method: Dispensing histories of patients with 19 refills of direct oral anticoagulants (DOAC) between 1 January 2008 and 31 December 2017 were extracted from 39 community pharmacies in Switzerland. The difference between the calculated and effective refill day (ΔT) was determined for each refill event. We graphed ΔT and its dichotomized version (dΔT) against the MPR, calculated mean ΔT and mean dΔT per refill, and applied cluster analysis. Results: We characterized 2204 refill events from 116 DOAC patients. MPR was high (0.975 ± 0.129) and showed a positive correlation with mean ΔT. Refills occurred on average 17.8 ± 27.9 days “too early”, with a mean of 75.8 ± 20.2 refills being “on time”. Four refill behavior patterns were identified including constant gaps within or at the end of the observation period, which were critical. Conclusion: We introduce a new absolute adherence estimate ΔT that characterizes every refill event and shows that the refill behavior of DOAC patients is dynamic. Full article
(This article belongs to the Special Issue Medication Adherence Assessed with Real-World Data: New Opportunities Provided by Big Data)
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11 pages, 706 KiB  
Article
Development and Validation of a Questionnaire to Measure Medication Adherence to Direct-Acting Agents in Patients with Hepatitis C
by Adina Turcu-Stiolica, Irina Paula Doica, Bogdan Silviu Ungureanu, Ion Rogoveanu, Dan Nicolae Florescu, Mihaela-Simona Subtirelu and Dan Ionut Gheonea
Pharmaceutics 2021, 13(10), 1683; https://doi.org/10.3390/pharmaceutics13101683 - 14 Oct 2021
Cited by 3 | Viewed by 1922
Abstract
This study aims to develop a new self-report tool (HCV-AD) measuring adherence factors, intentional or unintentional, during Hepatitis C Virus (HCV) treatment with direct-acting antivirals (DAA) aiming to achieve high efficacy, otherwise resulting in drug resistance and treatment failure. Two phases were conducted: [...] Read more.
This study aims to develop a new self-report tool (HCV-AD) measuring adherence factors, intentional or unintentional, during Hepatitis C Virus (HCV) treatment with direct-acting antivirals (DAA) aiming to achieve high efficacy, otherwise resulting in drug resistance and treatment failure. Two phases were conducted: in the first phase, items were generated based on an extensive literature review, and, in the second phase, a prospective cohort study was conducted using HCV patients from Gastroenterology Department from University County Hospital of Craiova, Romania (n = 222), to evaluate the validity and reliability of the questionnaire. A number of 19 items were generated following a systematic review and through expert opinion. The internal consistency reliability was evaluated using Cronbach’s alpha. The construct validity was assessed using correlations with two other instruments: visual analog scale (VAS) and medication possession ratio (MPR). The final questionnaire (HCV-AD10) was derived through exploratory factor analysis, with 82% of total variance explained. This instrument appeared as a reliable and valid measure for medication adherence, with Cronbach’s alpha (0.867) and significant high positive correlations between adherence scores calculated with HCV-AD10 and VAS (ρ = 0.61, p < 0.001) or with HCV-AD10 and MPR (ρ = 0.75, p < 0.001). This research would make a worthwhile contribution to HCV management. Full article
(This article belongs to the Special Issue Medication Adherence Assessed with Real-World Data: New Opportunities Provided by Big Data)
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14 pages, 845 KiB  
Article
The Potential to Reduce Patient Co-Payment and the Public Payer Spending in Poland through an Optimised Implementation of the Generic Substitution: The Win-Win Scenario Suggested by the Real-World Big Data Analysis
by Przemysław Kardas, Aneta Lichwierowicz, Filip Urbański, Beata Szadkowska-Opasiak, Ewa Karasiewicz, Paweł Lewek, Dominika Krupa and Marcin Czech
Pharmaceutics 2021, 13(8), 1165; https://doi.org/10.3390/pharmaceutics13081165 - 28 Jul 2021
Cited by 4 | Viewed by 2772
Abstract
High medication costs are one of the major barriers to patient adherence. Medication affordability might be improved by generic substitution. The aim of this study was to assess the effectiveness of the implementation of generic substitution mechanisms in Poland. This was a retrospective [...] Read more.
High medication costs are one of the major barriers to patient adherence. Medication affordability might be improved by generic substitution. The aim of this study was to assess the effectiveness of the implementation of generic substitution mechanisms in Poland. This was a retrospective analysis of nationwide real-world big data corresponding to dispensation of metformin preparations in 2019 in Poland. Relevant prescription and dispensation data were compared to assess the prevalence of generic substitution and its economic consequences. Among the 1,135,863 e-prescriptions analysed, a generic substitution was found in only 4.81% of the packs dispensed, based on e-prescriptions issued for metformin under its originator version and 2.73% under generic drugs. It is estimated that if these values were applied to the total Polish drug market, patients could lose the opportunity to lower their co-payment by 15.91% and the national payer to reduce its reimbursement expenditures by 8.31%. Our results point at the suboptimal implementation of generic substitution in Poland. Therefore, relevant actions need to be taken in order to maximise the benefits provided by this mechanism. It could not only lead to the win-win scenario in which both patients and the national payer are secured substantial savings, but it could also have a positive impact on patient adherence. Full article
(This article belongs to the Special Issue Medication Adherence Assessed with Real-World Data: New Opportunities Provided by Big Data)
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41 pages, 1313 KiB  
Systematic Review
Factors Contributing to Medication Adherence in Patients with a Chronic Condition: A Scoping Review of Qualitative Research
by Kirsi Kvarnström, Aleksi Westerholm, Marja Airaksinen and Helena Liira
Pharmaceutics 2021, 13(7), 1100; https://doi.org/10.3390/pharmaceutics13071100 - 20 Jul 2021
Cited by 136 | Viewed by 33710
Abstract
Introduction: Medication adherence continues to be a significant challenge in healthcare, and there is a shortage of effective interventions in this area. This scoping review studied the patient-related factors of medication adherence. Methods: We searched Medline Ovid, Scopus, and Cochrane Library from January [...] Read more.
Introduction: Medication adherence continues to be a significant challenge in healthcare, and there is a shortage of effective interventions in this area. This scoping review studied the patient-related factors of medication adherence. Methods: We searched Medline Ovid, Scopus, and Cochrane Library from January 2009 to June 2021 to find the most recent original qualitative studies or systematic reviews that addressed the patient-related factors of medication adherence in treating chronic conditions. We used the PRISMA-ScR checklist to ensure the quality of the study. Results: The initial search revealed 4404 studies, of which we included 89 qualitative studies in the scoping review. We inductively organized the patient-related factors causing barriers, as well as the facilitators to medication adherence. The studies more often dealt with barriers than facilitators. We classified the factors as patient-specific, illness-specific, medication-related, healthcare and system-related, sociocultural, as well as logistical and financial factors. Information and knowledge of diseases and their treatment, communication, trust in patient-provider relationships, support, and adequate resources appeared to be the critical facilitators in medication adherence from the patient perspective. Discussion and conclusions: Patients are willing to discuss their concerns about medications. Better communication and better information on medicines appear to be among the critical factors for patients. The findings of this scoping review may help those who plan further interventions to improve medication adherence. Full article
(This article belongs to the Special Issue Medication Adherence Assessed with Real-World Data: New Opportunities Provided by Big Data)
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