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The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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The 14th European Symposium on Patient Adherence,
COMpliance and Persistence
LODZ, POLAND
17-18.09.2010
Poznanski’s Palace - Museum of the City of Lodz.
Scientific Comittee:
Sabina de Geest
Eric Van Ganse
Rob Heerdink
Kurt Hersberger
Dyfrig Hughes
Przemyslaw Kardas
Marie P. Schneider
John Urquhart
Robert VanderStichele
Bernard Vrijens
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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About ESPACOMP
ESPACOMP is a non-profit association established to promote the science concerned with the quantitative assessment of what patients do with medicines they have been prescribed. Both the reasons for, and the clinical and economic consequences of, differences between caregivers‟ prescriptions and patients‟ execution of those prescriptions are principal topics of research with which the Society is concerned, along with facilitation of the translation of this research into information that is useful to patients, healthcare providers, healthcare policy makers, and pharmaceutical researchers.
Since 1996, a group of scientists from Belgium and the Netherlands organized the “Lowlands” symposium to share their research on patient compliance and persistence with prescribed therapy. This symposium has grown over the years reflecting the increased interest for adherence related issues across Europe. In order to reflect the international expansion of the symposium, in 2006, the organizing committee decided to rename the symposium as “European Symposium on Patient Adherence Compliance and Persistence” and to extend it to other European countries. In 2009, The European Society for Patient Adherence, Compliance, and Persistence was founded.
Today, the principal activity of ESPACOMP is to organize a yearly symposium. It has become the meeting place for an increasing number of international adherence researchers, pharmacoepidemiologists, statisticians and industry people interested in compliance and persistence.
Board of trustees 2010
President, Dr. Kardas Przemyslaw
Vice-predidents, Dr. Heerdink Rob & Dr. Hughes Dyfrig
Secretary, Dr. Schneider Marie-Paule
Treasurer, Dr. Vander Stichele Robert
Managing Director, Dr. Vrijens Bernard
Trustees 2010
Dr. Bouvy, Marcel, The Netherlands
Dr. De Geest, Sabina, Switzerland
Dr. Heerdink, Rob, The Netherlands
Dr. Hersberger, Kurt, Switzerland
Dr. Hughes, Dyfrig, UK
Dr. Kardas, Przemyslaw, Poland
Dr. Schneider, Marie-Paule, Switzerland
Dr. Urquhart, John, USA
Dr. Vander Stichele, Robert, Belgium
Dr. Van Ganse, Eric, France
Dr. Vrijens, Bernard, Belgium
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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WELCOME MESSAGE
Dear Colleagues and Friends,
It is a great pleasure for us to invite you to Lodz to attend 14th ESPACOMP meeting!
The ambitious aim of this conference is to encourage researchers from all over Europe to
conduct scientific research in the field of adherence, and share it with their peers. We hope
that this conference will be an excellent platform for such activities. Scientific programme is
loaded with a number of keynote lectures and multiple oral and poster presentations. The
thematic spectrum of these communications is wide ranging and interesting, thanks to a
large number of submissions received. We also invited excellent speakers, who will provide
the attendees with up-to-date information, which they may find useful in both their scientific
work, and clinical practice. Therefore, we are sure that this conference will be a really
unforgettably event. Last but not least, you will meet a lot of friends and colleagues from
around the world, and have a chance to relax during informal conference dinner. We hope
that you will enjoy this exceptional Conference.
While the programme is full of important presentations, you should not miss the opportunity
to discover Lodz, the second biggest town in Poland and one of the most beautiful and
dynamic cities in this country. Besides the vivid life of the large city, you will find a lot of
architectural and cultural highlights within.
We wish you a fruitful conference and an enjoyable stay in Lodz!
Przemyslaw Kardas,
President of ESPACOMP 2010
ESPACOMP 2010 Organising Comittee:
Justyna Gawrys
Przemyslaw Kardas
Pawel Lewek
Anna Piaszczynska
Michal Matyjaszczyk
Joanna Sawicka
LIST OF CONTENTS
PROGRAM _______________________________________________________________ 4
KEYNOTE SPEAKERS _____________________________________________________ 9
ORAL PRESENTATIONS _________________________________________________ 20
POSTER PRESENTATIONS _______________________________________________ 40
PRACTICAL INFORMATION ______________________________________________ 59
MAP OF LODZ ___________________________________________________________ 61
NOTES __________________________________________________________________ 62
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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PROGRAM
DAY1 - September 17th
09:00-09:15 Welcome and Introduction
09:15-10:00 Jean-Michel Métry Memorial Lecture
Improvement of drug adherence using single pill combinations: what is the evidence?
Michel Burnier
Service of Nephrology and Hypertension, CHUV, Lausanne, Switzerland
10:00-11:30 Session 1
What’s new in direct measurement of adherence
Measuring, Managing and Improving Adherence
Aunia Grogan
Global Head of Adherence, Novartis, Switzerland
Contributed papers
Adaptive analysis of electronic medication adherence data for african-american
patients with hypertension
Antoinette Schoenthaler, George Knafl, Gbenga Ogedegbe
Center for Healthful Behavior Change Department of Medicine NYU School of Medicine New
York, USA
Intervention and control care determines adherence intervention effects among
patients treated for HIV: A meta-analysis of randomized controlled trials
Marijn de Bruin, Herman Schaalma, Gerjo Kok, Charles Abraham, Harm J Hospers
(Assistant profession Intervention Design&Behavior Change) Department of Communication
Science, Wageningen University, the Netherlands
The growing market of adherence technologies. The challenges and implications of
implementing electronic medication reminders.
Pernille Dam, Hanne Herborg, Marianne Agergaard, Claus Møldrup, Charlotte Rossing
Pharmakon, Danish College of Pharmacy Practice
11:30-12:00 Break & Posters
12:00-13:30 Session 2
Use of electronic monitoring of drug intake to promote adherence
Improving adherence and treatment decision-making: the power of electronically compiled
drug-dosing histories
Marijn de Bruin
(Assistant profession Intervention Design&Behavior Change) Department of Communication Science,
Wageningen University, the Netherlands
Contributed papers
Persistence and execution to oral anticancer medications
Marie Paule Schneider, Leila Achtari Jeanneret , Silvia Domingues, Anne-Catherine Lange,
Bernard Vrijens, François Lüthi, Olivier Bugnon
Community pharmacy, Department of ambulatory care&community medicine, University of
Lausanne, Switzerland
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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Large scale monitoring program for hypertensive patients in a romanian community
pharmacy chain
Ana Maria Petculescu, Diana Simona Negru
S.C. S.I.E.P.C.O.F.A.R. S.A, Bucharest, Romania
Compliance to phosphate binders: a nurse' lead intervention made difference
Monique M. Elseviers, Yoleen Van Camp, Sofie Huybrechts
Department of Nursing Sciences, University of Antwerpen, Antwerp, Belgium
13:30-14:30 Lunch & Posters
14:30-15:40 Session 3
Use of e-health and telemedicine to improve adherence
eHealth in Europe: need, vision and practice
Pepijn van de Ven
Wireless Access Research Centre, Department of Electronic and Computer Engineering, University of
Limerick, Ireland
Contributed papers
Real-time Adherence data as input to an ICT based system for the treatment of
depression
Eric Tousset, Pim Cuijpers, Mark Hoogendoorn, Michel Klein
Aardex Group, Vise, Belgium
Real time medication monitoring with sms reminders improves adherence to oral
antidiabetic medication in patients with suboptimal adherence
Marcia Vervloet, Liset van Dijk, Arno Wormgoor, Jacqueline Santen-Reestman, Dinny de
Bakker, Marcel Bouvy
NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
15:40-16:00 Break&Posters
16:00-17:00 Session 4
Evolution of terminology and taxonomy of adherence in English and the other languages, and
medical practices
Contributed papers
A simple, robust taxonomy to describe deviations from prescribed drug therapy
Bernard Vrijens, For the ABC Project Team
AARDEX Group, Sion, Switzerland and Department of Biostatistics and Medical Informatics,
University of Liège, Belgium
Evolution of meaning and use of 'observance' / 'education thérapeutique' ('therapeutic
education patient') versus 'compliance' / 'adherence' in French and English languages
Marguerite Cognet, Emilie Adam, Rosane Braud
Researcher, teacher, UFR Social Sciences Université Paris 7 Diderot, Migrations and Society
Research Unit (URMIS) Paris, France
Differences and changes in attitude towards chronic medication between adherent and
non-adherent patients
Harm Geers, Eibert (Rob) Heerdink, Marcel Bouvy
Utrecht University, Faculty of Science Utrecht Institute for Pharmaceutical Sciences Division of
Pharmacoepidemiology&Pharmacotherapy Utrecht, the Netherlands
17:00-18:30 Meeting of the General Assembly
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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DAY 2 - September 18th
09:00-09:10 Introduction
09:10-10:20 Session 5
Miscellanea 1
Telemonitoring of Long Term Oxygen Therapy: Air Liquide Experience&Research
Marc Lemaire
Air Liquide Santé
Contributed papers
Application of health psychology and behavioural economics to explain adherence to
medicines in adult patients: a systematic review of empirical studies
Emily Fargher, Val Morrison, Todd Ruppar, Dyfrig Hughes
Bangor University, UK
Mobile phone SMS for optimizing asthma treatment outcome - a controlled trial
Claus Møldrup, Birthe Søndergaard, Jonathan Stein
University of Copenhagen Faculty of Pharmaceutical Sciences Department of Pharmacology
and Pharmacotherapy
10:20-11:30 Session 6
Miscellanea 2
Patient adherence in pre- and post-registration studies: different objectives, different
approaches
Ivo Abraham
University of Arizona, College of Nursing
Contributed papers
Factors associated with medication adherence among psychiatric outpatients with
substance abuse risk
Stephen Magura, Andrew Rosenblum, Chunki Fong
Western Michigan University
The heart foundation's "Improving cardiovascular adherence project": develoment of
an evidence-based training package for health care professionals
Parisa Aslani, Ines Krass, Beata Bajorek, Jill Thistlethwaite, Jeremy Bunker, Geoffrey Tofler
Faculty of Pharmacy, University of Sydney, Australia
11:30-12:00 Break & Posters
12:30-13:50 Session 7
Miscellanea 3
To Encourage or Coerce? The law's role in achieving patient compliance
Stewart Duffy
Contributed papers
Comparison of real life objective reliable compliance data assessed by an innovative
electronic system in patients recruited either by a pharmacist or a general practitioner
study: Differences and potential bias
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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Eric Leutenegger, Eric Vicaut, Bernard Bousquet
ABR Pharma, Paris; School of Medicine, University of Paris Lariboisière
The effect of a clinical trial on adherence and persistence to treatment
Hein A.W. van Onzenoort, Frederique E Menger, Cees Neef, Willem J Verberk, Peter W de
Leeuw, Paul-Hugo M van der Kuy
Department of Clinical Pharmacy, Radboud University Nijmegen Medical Centre, Nijmegen,
The Netherlands
Determinants of patient adherence to medical treatment: a systematic review of reviews
Przemyslaw Kardas, Pawel Lewek, ABC Project Team
Medical University of Lodz, First Department of Family Medicine, Lodz, Poland; ABC Project
www.abcproject.eu
13:50-14:00 Concluding remarks and the future of ESPACOMP
14:00-15:00 Lunch
Poster presentation
Impact of prolonged antihypertenive duration of action on predicted clinical outcomes in
imperfectly adherent patients: comparison of aliskiren, irbesartan and ramipril
Adam Lowy, Yvonne Brede, Deborah Keefe
Assessment of adherence of cinacalcet HCl in dialysed patients
Valentina Forni, Menno Pruijm, Carole Zweiacker, Michel Burnier
Evaluation of the medication compliance of liver transplant patients switched from a twice-
daily to a once-daily tacrlimus-based regimen
Marion Eberlin, Irene Kraemer
Improving patients' compliance - the role of pharmacists
Tatjana Crnjanski, Svetlana Stojkov-Rudinski, Ivana Tadic
Twelve-month persistence of COPD therapy after initiation in patients aged 50 and over: results
from the L777 study
Laurent Laforest, Mélanie Broquet, Gaëlle Désaméricq, Eric Van Ganse
Role of data-acquisition rate in defining salient patterns of drug exposure in ambulatory
pharmacotherapy
Bernard Vrijens, John Urquhart
Objective adherence measurement with an electronic blister: a feasibility study in primary care
Hein A.W. van Onzenoort, Cees Neef, Willem J Verberk, H Peter van Iperen, Peter W de Leeuw,
Paul-Hugo M van der Kuy
Studying the impact of medication counseling for patients starting a treatment with
antidepressant drugs: study design
Sophie Liekens, Tim Smits, Gert Laekeman, Veerle Foulon
Occurrence of prescriptions for noncurrent - changed or terminated - treatment and
prescription duplicates in electronic medical records and the Swedish national prescription
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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repository
Anders Ekedahl
Beliefs about medicines predict non-adherence with medication intended for chronic use
Harm Geers, Eibert (Rob) Heerdink, Marcel Bouvy
Impact of Drug Reminder Packaging on Compliance ? Where Are the Research Gaps?
Fabienne Boeni, Katja Suter, Isabelle Arnet, Kurt. E. Hersberger
Medication adherence in patients treated for COPD
Tamás Ágh, Ágnes Mészáros
Exploring ethnic differences in patient perspectives on medicines and medicine-taking: a
cross-cultural study in New Zealand
Beata Bajorek, Debbie Bassett-Clarke, Ines Krass
Achieving INR Target and Patient Satisfaction of Warfarinised Patients in HKL
Subramaniam Thanimalai, Agnes HSY, Chan BS, Chan CK, Nadrah N
A nationwide survey on medication adherence among polish patients and healthcare workers
Wojciech Kuzmierkiewicz
Involving patients in the development of a group-based educational intervention for a
randomised controlled trial to improve adherence to glaucome eye drops
Heather Waterman, Lisa Brunton, Cliff Richardson, Cecilia Fenerty, Fiona Spencer, David Henson
Medication Persistence in the Treatment of HIV Infection: A Review of the Literature and
Implications for Future Clinical Care and Research
Jason W. Bae, William Guyer, Kristy Grimm, Frederick L. Altice
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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KEYNOTE SPEAKERS
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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Prof. Michel Burnier Pr. Michel Burnier, MD, FASN, is Professor of Medicine and Head of the Division of Nephrology and Hypertension Consultation at the University Hospital of Lausanne, Switzerland. He has been trained in Internal Medicine and Nephrology in Lausanne, Switzerland and at the University of Colorado Health Science Centre, Denver, Colorado. He is a member of several Swiss and international societies in the field of nephrology and hypertension. He is a member of the Scientific Council of the European Society of Hypertension and member of the Committee of the Swiss Society of Hypertension. He is the president elect of the Swiss Society of Nephrology. Pr M. Burnier is also the president of the ethical review board of the Canton de Vaud and member of the board of Swissmedic, the Swiss Agency for Therapeutic Products. Pr Burnier participates in the Editorial Board of several journals including Hypertension and Blood Pressure. His research interests are the renal mechanisms of hypertension and the pathogenesis of disease progression in chronic kidney diseases with a special emphasis on the role of sodium. He has also worked on the clinical pharmacology of new antihypertensive drugs in humans with a special emphasis on drugs affecting the renin-angiotensin system and on drug adherence.
Improvement of drug adherence using single pill combinations: what is the evidence? M. Burnier, Service of Nephrology and Hypertension, CHUV, Lausanne, Switzerland In all therapeutic areas, patients are asked to adhere to their therapeutic regimen as closely as possible in order to achieve the defined therapeutic goals. In some situations such as hypertension or the management of cardiovascular risks, patients need to take several therapeutic agents. It has been well recognized that increasing the pill burden and frequency leads to a reduction in persistence and a decline in drug adherence over time. To avoid a low persistence, it is increasingly recommended to prescribe single combinations rather than multiple single drug therapies. Among the arguments in favor of the use of single pill combinations, authors usually mention the improved drug adherence, a better tolerability and a better acceptation by the patients. The purpose of the presentation will be to review the actual evidence favoring the use of single pill combinations in clinical. If there are undoubtedly some advantages for the use of single pill combinations, the scientific evidence for a clear benefit remains relatively weak and carefully conducted prospective studies are still missing to support the general hypothesis.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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Aunia Grogan Aunia joined Novartis in 2009 from McKinsey & Company where she served a broad range of Fortune 500 companies on sales and marketing issues, with a special focus on Pharma clients and understanding consumer behaviour and decision making. Prior to joining McKinsey in 2003, Aunia was a market researcher for 15 years working across a diverse range of sectors including financial services, consumer packaged goods, travel/ leisure and publishing.
MEASURING, MANAGING AND IMPROVING ADHERENCE Global Head of Adherence, Novartis Pharma AG, Switzerland Email: aunia.grogan@novartis.com Aunia heads a new team within Novartis Pharma, tasked with building adherence capabilities across therapies. To that end the team are defining best practice for the organisation when designing adherence programmes: defining the barriers to adherence; exploring ways in which those barriers can be overcome; and finally defining how the measure adherence and the impact of programmes. In this session Aunia with give some background on why Novartis believes it is important to support patient adherence, and the specific challenges that presents. She will also review some of the areas Novartis is exploring to improve adherence and support patients.
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Marijn de Bruin Marijn de Bruin is assistant professor Intervention Design & Behavior Change, working at the Communication science department of Wageningen University. He graduated in Health Education and Health Promotion (Faculty of Health Sciences, Maastricht University, the Netherlands) and completed his PhD-thesis at the Faculty of Psychology of the same university. His primary expertise is the design, evaluation and comparison of behavior change interventions, and his focus is mainly on improving medication adherence in chronic diseases (and HIV specifically). For his research, Marijn combines qualitative and quantitative research methods to study the causes of behavior, conducts (randomized controlled) trials to assess the impact of interventions, and uses meta-regression analysis to synthesize the adherence intervention literature. For that purpose he also developed a Taxonomy of adherence intervention techniques suitable for designing, reporting and comparing the active content of adherence interventions. A recent additional focus in his research is on the adoption and implementation of evidence-based adherence care practices into routine clinical care, and cost-effectiveness evaluations of adherence interventions. His work is embedded in social psychological, communication, and innovation research and theories.
Improving adherence and treatment decision-making: The power of electronically compiled drug-dosing histories Although electronic monitoring (EM) has been used extensively as an adherence measurement instrument in research, electronically compiled drug dosing histories can also be a powerful tool to promote patients‟ medication intake. If used skillfully, the data can be used to apply a range of potent behavior change techniques directed at behavioral awareness, motivation, self-confidence, action planning, and behavioral maintenance. Such interventions are ideally suited for enhancing patients‟ self-management capacities. For health care providers, the availability of continuous and objective adherence data can guide medical decisions, raise awareness about the importance of dealing with non-adherence, and demonstrate the positive impact of efforts to support patients. Hence, drug dosing histories (the „hardware‟) combined with efficient adherence support programs (the „software‟) could have a notable impact on patient health and the cost-effectiveness of care. Future technologies, including the monitoring of adherence real-time, may provide additional possibilities for adherence self-management, alter the mode and costs of intervention delivery, and permit intervention delivery at the time adherence support can make the most difference. In this presentation these ideas will be illustrated with data from intervention trials to promote adherence among patients treated for HIV.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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Dr. Pepijn van de Ven Dr. Pepijn van de Ven is a Senior Research Fellow in the Wireless Access Research Centre at the University of Limerick (UL) and part time lecturer in the department of Electronic and Computer Engineering at UL. Pepijn received an MSc in Electrical and Electronic Engineering from the Eindhoven University of Technology in the Netherlands in 2000. He subsequently worked for Philips in the Eindhoven based Philips Research Laboratories as a research scientist investigating new RF front ends for 3rd generation telecommunication hand sets on experimental BiCMOS processes. In 2002 Pepijn obtained an IRCSET award to pursue a PhD at the University of Limerick on the „Identification and Control of Marine Vehicles Using Artificial Intelligence Techniques‟. After finalizing his PhD in 2005, Pepijn has had several postdoctoral positions in the area of wireless technologies and technologies for ambient assisted living. These include a role as Senior Research Fellow in the FP6 CAALYX project, co-Principal Investigator in MoSAiC, an Enterprise Ireland funded proof of concept project and co-Principal Investigator and lead researcher for the University of Limerick on the FP7 project ICT4Depression. Pepijn‟s research interests are wireless sensors for biomedical and ambient assisted living applications with a particular focus on falls and activity monitoring and smart user interfaces for wireless body area sensor networks.
eHealth in Europe: need, vision and practice Dr. Pepijn van de Ven, Dr. John Nelson Since its inception, the European Union (EU) has had welfare of its member states‟ citizens as one of its primary targets. In conjunction with medical and technological advances worldwide this has lead to a significant improvement in our wellbeing and lifestyle. The economic models supporting the various national health provision systems have led to widely accessible services that aim to look after the health and wellbeing of each and every individual within the state. Moreover, in a reaction to globalisation and the huge increase in human movement across the EU, these national health systems are indeed freely available to citizens of other member states. In the last decades the strain on the health care systems across the nations of the EU has increased significantly. For several nations, the initial reaction to the higher demand for healthcare staff was to employ health care professionals from outside the EU. However, this was never to be more than a short-term reaction to a problem requiring a far wider approach. As sustainability of the traditional health care systems is seriously threatened, eHealth has been embraced by the EU as an effective means of lowering the strain on the health systems to such an extent that these can be sustained into the future. As alluded to in the previous, the need for eHealth is largely driven by the fact that the resources are simply not available to sustain traditional health care systems given current demand and demographics. Of prime importance in this respect are the care for elderly people, the care for the chronically ill and the treatment of lifestyle induced diseases. To effectively target these, and other areas, the EU has developed a vision for eHealth endeavours within the EU. As stated in the Declaration on European Co-operation on eHealth which resulted from the eight High Level eHealth Conference in Barcelona (2010), the vision of the European Community is:
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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„That ICT for Health (eHealth) is a tool to improve quality and patient safety, to modernise national healthcare systems, to increase their efficiency and make them better adapted to the individual needs of citizens, patients, health professionals, and the challenges of an ageing society. The importance of ensuring that the deployment of ICT in healthcare, to be successful has to be accompanied by the necessary organisational reforms, driven by leadership and supported by adequate skills.‟ These words have not come without actions. Examples of use of eHealth in the EU are abundant. In the last two decades over 450 projects investigating ICT for health were funded by the European Commission with a total investment of over €1 billion. These projects focus on such diverse areas as remote monitoring, medication adherence, patient control / empowerment and integration of clinical information systems. In the presentation, the need, vision and practice of eHealth within the EU will be further discussed.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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Marc LEMAIRE Marc LEMAIRE is 54 years old, married, 2 children and he is currently AIR LIQUIDE R&D Healthcare Program Director Medical Doctor (1984) by training, he is awarded in Immunology (Pasteur Institute 1985) and in Hepatology-Gastro-Enterology (1986). Before joining Air Liquide, he was in charge of departments related to R&D (Hoechst) and Marketing (Parke-Davis-Pfizer) Marc LEMAIRE joined Air Liquide 12 years ago as Medical and Regulatory Affairs Director and since 2005 he is R&D Healthcare Program Director. Marc LEMAIRE is memberships of several scientific and strategic committees and the author of more 50 publications and 20 patents
Telemonitoring of Long Term Oxygen Therapy: Air Liquide Experience & Research Marc Lemaire, MD, R&D Air Liquide Healthcare Director VitalAire (Air Liquide group) is the European leader of homecare services particularly involved in main markets “Long Term Oxygen Therapy” (LTOT) for treating Chronic Obstructive Pulmonary Disease (COPD) and “Sleep Apnoea Disorder” as well. Due to the evolution of the population (in 2050, 2 billion will be over 60), the new technology in surgery (coelioscopy) and anaesthesia allowing to back home in one day, the improvement of devices interconnectivity, more and more patients will be treated at home. This Hospital cost reduction is counterbalanced by increasing cost of cares at home which have to be better managed in terms of patient (improvement of quality of life…) and also in terms of costs for the society. To answer these challenges, telemedicine is a very useful tool…if we are able to provide and manage the right information in the right timing. In COPD, the risk for the patient is to diagnose and treat too late an exacerbation leading often to the hospitalization in an emergency or Intensive Care Unit department. The consequences are to decrease the survival curve for the patient by reducing the lung functionality, and also to increase dramatically the cost of the treatment. In a unique European research program, Air Liquide (VitalAire) is proposing a global management based on telemonitoring (training, clinical monitoring, new monitoring LTOT device…) to improve the quality of life for the patient, to reduce the cost of the disease and to get information for the payer for reimbursing the cost of LTOT. This global approach will need to harmonize the payers‟ practices and could have also a significant regulatory impact for the development of new drugs or services.
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Ivo Abraham, PhD Ivo Abraham is Professor (part-time) in the Department of Pharmacy Practice and Science and Investigator in the Center for Health Outcomes and PharmacoEconomic Research at The University of Arizona College of Pharmacy. He has also served on the faculty of Case Western Reserve University (Cleveland, OH), University of Virginia (Charlottesville, VA), and (part-time) Katholieke Universiteit Leuven (Leuven, Belgium); and as Visiting Professor at Universiteit Maastricht (Maastricht, The Netherlands), University of Florida (Gainesville, FL), Rijksuniversiteit Groningen (Groningen, The Netherlands), University of Pennsylvania (Philadelphia, PA), and Chang Gung University (Kwei-Shan Tao-Yuan, Taiwan). He has lectured, consulted, and conducted research throughout the Americas, Europe, and the Asia-Pacific region. He divides his time between The University of Arizona and Matrix45, a biopharmaceutical research and consulting company, where he serves as Chief Scientist. Matrix45 offers two major service lines: (1) strategic, scientific, and clinical consulting for phase 4 and phase 5 studies; and (2) the development and promotion of evidence-based health care, from research synthesis, guidelines development and evaluation, and clinical support at the point of care. For the past decade or so, Ivo Abraham‟s research has focused mainly on how variability in (drug-centric) treatment regimens is associated with variability in patient outcomes. However, instead of merely evaluating effectiveness (“does the treatment work?”), his work addresses the equally important questions of “when does the treatment work, and when not?”, “what influences whether the treatment works?”, “why does the treatment work in some patients but not in others?”, “why does the treatment work with some clinicians but not with others?”, “why is the treatment tolerated by some patients but not by others?”, and “how much of patient outcomes is related to patient vs. clinician or treatment center.” With his colleagues, he has developed a comprehensive framework of treatment patterns and outcomes assessment, vulnerability profiling, hierarchical modeling, (non-)responder analysis, and pharmacovigilance; and drawing methodologies and statistical models from other disciplines into biomedical research. More recently, concerned about the abundance of evidence but clinicians‟ persistent low adoption of evidence-based guidelines, he started examining how practicing in accordance with evidence-based guidelines is directly associated with patient outcomes. He has (co-)authored 290+ articles and 60+ chapters, and has (co-)edited 29 books, monographs, and journal issues. His research has been funded continuously since 1984 by governmental funding agencies, foundations, and corporations. Ivo Abraham received the BS in nursing (equiv.) from Leuven University College, Associatie Katholieke Universiteit Leuven (Leuven, Belgium; 1979); and the MS in psychiatric-mental health nursing (1982) and the PhD in clinical research (1984) from the University of Michigan (Ann Arbor, MI, USA).
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Patient adherence in pre- and post-registration studies: different objectives, different approaches Ivo Abraham, PhD [1,2,3]; Christopher Lee, PhD [2,4]; Karen MacDonald, PhD [3]; Sabina De Geest, PhD [5,6]; Marie-Chisholm Burns, PharmD, MPH [1]; Stefaan Vancayzeele, MD, MSc [7]; Marie-Anne van Lierde, MD [7]; Christine Hermans, PharmD [7]; Kris Denhaerynck, PhD [3,8]; [1] Department of Pharmacy Practice and Science, The University of Arizona (Tucson, AZ, USA), [2] Center for Health Outcomes and Pharmacoeconomic Research, The University of Arizona (Tucson, AZ, USA), [3] Matrix45 (Earlysville, VA, USA), [4] School of Nursing, Oregon Health and Science University (Portland, OR, USA), [5] Institute of Nursing Science, University of Basel (Basel, Switzerland), [6] Center for Health Services and Nursing Research, Katholieke Universiteit Leuven (Leuven, Belgium), [7] Novartis (Vilvoorde, Belgium), [8] Department of Internal Medicine, University Hospital Basel (Basel, Switzerland) The premise of this lecture is that patient (non-)adherence, defined per the World Health Organization as the extent to which a person‟s behavior (e.g., taking medications) corresponds with the agreed recommendations of a health care provider, has different implications for pre-registration versus post-registration studies because of the different focus of both types of studies on, respectively, efficacy and effectiveness. In pre-registration trials, poor adherence is a behavioral confounder to be managed to assure the purest possible efficacy signal about a drug candidate. In post-registration trials, poor adherence is part of the clinical reality of drug-centric treatment in the “real world”. Here the emphasis is on detecting and managing adherence in ways that are clinically realistic within the context of routine patient care. Under this premise, we identify methodological principles for consideration in the design of controlled and non-controlled investigations for pre- and post-registration studies. Further, relying on a series of (mainly) multilevel modeling studies conducted within a novel comprehensive framework for effectiveness studies, we show conceptually how clinically feasible, rapid evaluations of adherence perceptions and behaviors are consistent determinants of clinical outcomes. We also release new findings from meta-analyses on the association between adherence perceptions and behaviors and blood pressure values, blood pressure control, and total cardiovascular risk following antihypertensive therapy.
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Stewart Duffy Stewart Duffy is an Irish born medical doctor and lawyer now living and working in London. Stewart graduated from Trinity College Dublin medical school in 1998. After three years in hospital practice Stewart took up a position as a post-doctoral research fellow at the University of Toronto‟s Department of Laboratory Medicine and Pathobiology. Based at Toronto General Hospital he spent two years researching the role of chemokines in the regulation of leukcocyte adhesion. He was awarded an M.D for his work by Trinity College Dublin in 2005. Stewart returned to hospital based surgical practice in Ireland in 2003. In 2004 he began an undergraduate law degree at University College Dublin graduating with an honours degree in law in 2007. Stewart was admitted to the New York State Bar in 2008. In September 2008 Stewart began work at the healthcare law department of Radcliffes Le Brasseur, a Westminster based law firm. Stewart‟s interest in healthcare law developed whilst living in Toronto during the SARS outbreak. He has been involved in research into Irish public health law including the history of its development and use. He has been the Irish rapporteur for the EU PH Law Flu project since 2008. He is a member of the EU PH Law Flu Network and has been an independent peer reviewer for a number of international journals.
To Encourage or Coerce? The Law’s role in achieving patient compliance Stewart Duffy M.D. Attorney-at-Law (New York) The idea of a Medical Police (“Medicinal Polizie”) became popular in Europe in the mid-nineteenth century arising out of concerns about the adverse health effects of poor sanitation, food adulteration, the unregulated sale of medicines and an unregulated medical profession. This was also the era in which many jurisdictions embarked on large scale legislative regulation for public health much of which survived essentially unchanged into the twenty-first century. Medical „Police‟ powers still exist in most jurisdictions. These include powers to compel vaccination or treatment, to require compliance or to detain patients in the context of infectious diseases or mental illness. Indeed the European Convention on Human Rights (ECHR) expressly permits the detention of individuals of unsound mind or for the control of the spread of infectious disease. Non-compliance with anti-infective therapy poses a direct threat to others through the spread of infection or the development of drug resistant organisms. Modern public health statutes have developed powers to facilitate compliance whilst retaining the older coercive powers. The traditional paternalistic attitudes of the State and medical professionals has radically diminshed since the second half of the twentieth century. That period was marked by the rise in the concept of patient autonomy and the development of the legal doctrine of informed consent. Whilst the right to personal autonomy, protected by Article 8 of the ECHR and by many national constitutions, clearly entitles a patient with capacity to decline treatment, even where it is irrational to do so, social and legal norms have also shifted to make health
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professionals accountable for patient outcomes through the doctrine of medical negligence or its civil law equivalent. The tension between these norms can create real difficulties for healthcare professionals. The use of prescription medications has become more pervasive. Long term therapy for the control of blood pressure, cholesterol and coagulation are widespread. Compliance is a significant concern with many such interventions for asymptomatic conditions. The cost of non-compliance are borne by both the individual patient and the wider community. If individual and population benefit is to be maximised, and significant waste of resources avoided, strategies to improve compliance are essential. The law should facilitate, or at least not obstruct the development and implementation of such strategies yet at a time when the delivery of health care is becoming increasingly systematised controls on the exchange of personal information have become more exacting. The law, though a neglected tool, continues to have a symbolic and instrumental potential to contribute to improvements in individual and population health by regulating healthcare professionals and influencing their conduct as well as the conduct of their patients and by facilitating evidenced-based interventions to improve health.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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ORAL PRESENTATIONS
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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ADAPTIVE ANALYSIS OF ELECTRONIC MEDICATION ADHERENCE
DATA FOR AFRICAN-AMERICAN ATIENTS WITH HYPERTENSION
Antoinette Schoenthaler1, George Knafl3, Gbenga Ogedegbe2
(1) Center for Healthful Behavior Change Department of Medicine NYU School of Medicine New York,
NY USA antoinette.schoenthaler@nyumc.org, (2) Center for Healthful Behavior Change Department
of Medicine NYU School of Medicine New York, NY USA gbenga.ogedegbe@nyumc.org, (3) The
University of North Carolina at Chapel Hill School of Nursing Chapel Hill, NC USA gknafl@unc.edu
BACKGROUND: Electronic monitoring devices (EMD) are regarded as the 'gold standard' for
assessing rates of medication adherence in clinical research, allowing researchers to evaluate the
longitudinal nature of patient medication adherence. However, most analyses focus on simple
summary adherence measures based on an implicit assumption of constant adherence over time,
which often does not hold, and thus, does not account for the complex patterns that often characterize
medication-taking behaviors.
AIM: To employ Adaptive Statistical Modeling (ASM) methods on EMD data from Medication Event
Monitoring System (MEMS) devices to assess: (1) individual-subject adherence patterns, (2) clustering
of individual-subject adherence patterns, (3) the relationship between membership in adherence
clusters and subject characteristics, and (4) the effect of membership in adherence clusters and in
treatment groups on psychosocial outcomes over time in a sample of 141 hypertensive African-
American patients participating in a 12-month RCT.
METHODS: ASM methods were used to analyze grouped EMD data and to evaluate consistency
between subjects' actual and prescribed adherence. Generated adherence patterns were adaptively
clustered and related to patient demographic characteristics (e.g., age, insurance status, gender) and
treatment group membership (intervention vs. usual care). Adherence cluster and treatment group
membership were also used to predict psychosocial outcomes (e.g., self-efficacy, depression,
knowledge) over time.
RESULTS: EMD data were available for 141 patients consisting of from 0.0 to 1.0 (median 0.52)
openings per day for subjects and combining to over 18,000 openings for over 40,000 days of MEMS
usage. There were 7 adherence clusters: (1) consistently high mean adherence, (2) consistently near-
zero adherence, (3) improving adherence, (4) gradually deteriorating adherence, and (5-7) early
consistent adherence (at 3 different levels) with late deterioration. The chance of having consistently
high adherence (cluster 1) changed with type of insurance in a way (89% for HMO, 35% for Medicare,
27% for Medicaid, 9% for self-insured) that was significantly different than for the chance of being in
adherence clusters 2-7 (Fisher's exact test, p<0.001). No other characteristics were significantly
associated with adherence cluster membership. Mean self-efficacy changed differently post-baseline
for patients in the intervention/control groups. Mean self-efficacy increased for both groups from a
common baseline value, but to higher levels for intervention group subjects. Mean self-efficacy
changed in a similar manner for subjects with consistently high adherence as compared to the other
clusters. It was highest for subjects in the intervention group with high adherence, lowest for control
group subjects in the other clusters, and in between for control group subjects with high adherence
and intervention group subjects in the other clusters.
CONCLUSIONS: Type of insurance was significantly related to having consistently high adherence in
a sample of hypertensive African-American primary care patients participating in a 12-month
behavioral intervention study. Self-efficacy was higher for subjects in the intervention group and/or
with having consistently high adherence. Alternate methods for modeling EMD data can provide novel
insights into patients' medication-taking behaviors and their relationships with subject characteristics
and clinical outcomes.
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Intervention and control care determines adherence intervention
effects among patients treated for HIV: A meta-analysis of
randomized controlled trias
Marijn de Bruin1, Herman Schaalma1, Gerjo Kok1, Charles Abraham1, Harm J Hospers1
(1) PhD
Background: Poor adherence limits the effectiveness of HIV-treatments. Systematic reviews have the
potential to identify practical and effective interventions. Meta-analyses that control for variability in
standard care provided to comparison groups may produce more accurate estimates of intervention
effects and a better understanding of effective intervention ingredients.
Objectives: To examine whether viral load and adherence success rates could be accurately
explained by the active content of adherence interventions when controlling for variability in care
delivered to controls.
Methods: Databases were searched for randomized controlled trials of Highly Active Antiretroviral
Therapy adherence interventions published from 1996 to January 2009. A total of 1342 records were
retrieved, and 52 articles were examined in detail. Directly observed therapy and interventions
targeting specific patient groups (ie, psychiatric or addicted patients) were excluded, yielding a final
sample of 31 trials. A comprehensive Taxonomy of behavior change techniques to promote treatment
adherence was developed and reliably used by two coders to determine the active
content of care provided to intervention and control groups. Authors were contacted to complete
missing data.
Results: The capacity (the number of active ingredients to support adherence, weighted for tailoring
and repetition) of standard care provided to control groups varied considerably between studies. The
active content of adherence care provided to both the control and intervention groups predicted viral
load and adherence success rates in the respective conditions (P<.001 for all comparisons), with an
estimated total impact of optimal adherence care of 55 percentage points. After controlling for
variability in care delivered to controls, the capacity of the interventions accurately predicted the viral
load and adherence effect sizes (R2 = 0.78, P = .02; R2 = 0.28, P<.01). Although interventions were
generally beneficial, their effectiveness reduced noticeably with increasing levels of standard care.
Conclusions: Intervention and control patients were exposed to effective adherence care. Future
meta-analyses of adherence interventions should assess and control for variability in care delivered to
active controls. At present, clinical practice may be best served by implementing current best practice.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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The growing market of adherence technologies. The challenges and
implications of implementing electronic medication reminders.
Pernille Dam 4, 5, Hanne Herborg2, 5, Marianne Agergaard3, 5, Claus Møldrup6, 7, Charlotte
Rossing1, 5
(1) e-mail: cr@pharmakon.dk, (2) e-mail: hh@pharmakon.dk, (3) e-mail: mag@pharmakon.dk, (4) e-
mail: pd@pharmakon.dk, (5) Pharmakon, Danish College of Pharmacy Practice, Milnersvej 42, DK-
3400 Hillerod, Denmark, (6) Universitetsparken 2, DK-2100 Copenhagen, cm@farma.ku.dk, (7)
University of Copenhagen, Faculty of Pharmaceutical Sciences, Department of Pharmacology and
Pharmacotherapy
Background Adherence technologies constitute a rapidly growing market where several actors are
interested in acting as distribution channels. Community pharmacies have an opportunity to become
the chosen channel for delivery of adherence technology services in primary health care. Pharmacies
may be an independent distributor of adherence technologies in relation to the companies that
promote the technologies.
• To identify and categorize relevant adherence technologies suited for a pharmacy product selection
• To test selected adherence technologies with medicine users in order to gain qualitative experience
about the devices, outline which type of medicine users they may be suited for and identify counselling
needs
• To develop indicators for technical quality, safety&usability
Methods A search was made in Medline (Pubmed) and Google for adherence
technologies/medication reminders/AIDS and similar terms. Adherence technologies were identified
and categorized according to their technology level and characteristics. The selection of adherence
technologies were field-tested on 20 voluntary medicine users for 2 weeks as part
of a pilot study. A semi-structured questionnaire and qualitative interviews were used to collect data.
Results 83 different medication reminder devices were identified from the literature and internet
search. Devices could be categorized from a user perspective (non-electronic reminders, electronic
reminders, one room electronic reminders, 'dosette-like' electronic reminders, automated dose
dispensing devices and 'other') as well as from a technology level point of view (low tech, intermediate,
high tech). The field test showed that technologies matching the user?s needs were accepted and
implemented when introduced with relevant counselling. Five medicine users failed to implement the
adherence technology. Reasons for not implementing the adherence technologies were no need for
technology, technical difficulties or other practical problems. Seventeen medicine users returned the
sent questionnaire. Eight medicine sers reported an improvement, seven reported no change, and
none reported a decrease in adherence after implementing the adherence technology. Four themes
were identified as the most important (either positively og negatively) for the medicine users:
'Flexibility&applicability in daily use', 'adherence support', 'visual reminding', 'audio reminding'.
Indicators for technical quality, safety & usability were developed under the following main categories:
'materials & medicine', 'patient safety', 'service operation', 'user friendliness' and 'documentation'.
Conclusion The market of adherence technologies is large. The products available vary in terms of
quality and level of technology. When field-tested, the adherence technologies benefitted some, but
not all users. Half of the medicine sers stated that their adherence was improved while it was
unchanged for the rest. To implement adherence technologies in the community pharmacy supply, it is
recommended that quality criteria are outlined, and that counselling including a matching procedure
between product and user is carried out in each individual case.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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PERSISTENCE AND EXECUTION TO ORAL ANTICANCER
MEDICATIONS
Marie Paule Schneider1, Leila Achtari Jeanneret 3, Silvia Domingues1, 2, Anne-Catherine Lange4,
Bernard Vrijens4, François Lüthi3, Olivier Bugnon1, 2
(1) Community pharmacy, Department of ambulatory care & community medicine, University of
Lausanne, Switzerland, (2) Community pharmacy, School of pharmaceutical sciences, University of
Geneva, University of Lausanne, Switzerland, (3) Multidisciplinary oncology center, University
Hospital, Lausanne, Switzerland, (4) Pharmionic research center, Aardex group, Visé, Belgium
Background
Oral anti-cancer treatments have expanded rapidly over the last years. While managing oral tablets at
Home ensures better quality of life, it also exposes patients to the risk of sub-optimal adherence.
Aim
To assess persistence and execution to oral anticancer medications.
Methods
A 12-month nonrandomized, longitudinal, on-going study. Consecutive patients starting an oral
treatment (tyrosine kinase inhibitors (TKI) (imatinib/sunitinib); aromatase inhibitors (AI)
(letrozole/exemestane); capecitabine; temozolomide) are proposed to enter the study by the
oncologist. Then, patients are referred to the pharmacy, where oral anticancer treatment is dispensed
in the Medication Event Monitoring System (MEMS). Electronically compiled dosing history data from
the MEMS bottles are summarized and used as feedback during semi-structured interviews with the
pharmacist, which are dedicated to prevention of nonadherence and management of side effects.
Interviews are scheduled before each medical visit. Report of the interview is available to the
oncologist via an on-line secured portal. Adherence was described as: persistence (length of time
between the first-taken and the last-taken doses) and execution (proportion of days with correct
dosing).
Results
Study started in March 2008 and 36 patients (19 men, median age 63 yrs (range 29-80)) have been
included. Fifteen patients were prescribed a TKI, 10 an IA, 10 capecitabine, 1 temozolomide.
Administration was continuous in 30 patients and cyclic in 6 patients. Regimens were QD or BID.
Length of follow-up was 221 days (range 90-457). Persistence at 365 days was 58.2% and execution
90.6%. Reasons for nonpersistence were: adverse effects (4), death (2), progression of cancer (2),
psychosocial issues (2), and patient own
decision to stop treatment (1).
Conclusion
The 12-month execution of the prescribed dosing regimens was high. However, persistence was lower
and reasons for nonpersistance were diverse. Modelization of persistence should discriminate
between Real patients nonpersistence and nonpersistence due to clinical circumstances. Further
research in this area is needed as more oral cancer drugs will be available in the future. Published
data on long term persistence and execution are scarce. These parameters need to be explored.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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LARGE SCALE MONITORING PROGRAM FOR HYPERTENSIVE
PATIENTS IN A ROMANIAN COMMUNITY PHARMACY CHAIN
Ana Maria Petculescu1, Diana Simona Negru2
(1) S.C. S.I.E.P.C.O.F.A.R. S.A, Bucharest, Romania, antsuky2005@gmail.com, (2) S.C.
S.I.E.P.C.O.F.A.R. S.A, Bucharest, Romania, di_negru@yahoo.com
Background: Involving the hypertensive patients in their therapeutic plan, gaining blood pressure
(BP) control and adopting a healthier lifestyle will increase the adherence and will delay cardiovascular
complication onset. Due to prescription refill visits, community pharmacists are in contact with most of
the chronic patients. Thus, they are able to implement and use complex monitoring programs that can
help hypertensive patients to better achieve their therapy goals.
Aim: The researchers' aims were: (1) to assess hypertensive patients for personal and medical data
and to record in an especially designed "Personal Cardio Logbook" (PCL) repetitive BP
measurements, during the study period, (2) to investigate patient's awareness on lifestyle
modifications, and (3) to evaluate program's benefits and effectiveness on patient's adherence to
therapy.
Methods: This program was developed for Dona Chain community pharmacies and it runs since
November 2007. The data analysis provided below refers to recordings made over 24 months of
research (till November 2009). During the initial visit in community pharmacies, designated
pharmacists and physicians, co-workers for this study, assessed the hypertensive patients (record all
relevant data in an electronic Patient Data Sheet (e-PDS)), and request their acceptance for
participation in program. After the e-PDS was filled in and the initial BP measurement was taken, the
patient received her/his PCL, meant to serve both the patient and her/his family or specialist physician
to closely monitor patient's evolution. The patients were invited to come back for regular BP values
measurements (taken in the pharmacy and recorded in PCL).
Results: At the beginning of the study, the total number of registered participants was 4,539
(distributed as 3,245 women - 71.5%, and 1,294 men - 28.5%) and most of them agreed to participate
in the program and to receive PCL. A single exception was accepted for 293 hypertensive patients
(6.5%) that did not agree to share medial data or to receive PCL, but insisted to be part of the
monitoring program, as they considered being more motivated in following their therapy and
recommended lifestyle regimen. Unfortunately, less than half (2,028 patients) choose to come back in
pharmacies for regular BP measurements. From all subjects (n = 4,539) included in the study, 56.0%
had (initially) hypertension under control.
As per their statement, only some of them have adopted at least one lifestyle changing measure:
2,660 patients (58.6%) follow a low-sodium diet, 1,808 patients (39.8%) have a diet enriched in fruits
and vegetables and even lesser participate in regular physical activities (1,462 patients, 32.2%). After
the initial visit, the 2,028 patients generated a number of 10,929 come-back (monitoring) visits, for
regular BP measurements. In 24 months of study duration, 148 patients actively participating in the
monitoring program gained control of BP values, showing an increase rate of 7.3% for controlled
hypertension patients.
Conclusion: Hypertension monitoring programs in community pharmacies, along with designated
instruments to regularly collect and record BP measurements, such as the PCL, have shown to
contribute to patients' beneficial by increasing their adherence to hypertensive therapy and lifestyle
regimen.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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COMPLIANCE TO PHOSPHATE BINDERS: A NURSE' LEAD
INTERVENTION MADE THE DIFFERENCE
Monique M Elseviers2, Yoleen Van Camp2, Sofie Huybrechts1, 2
(1) Department of Clinical Pharmacology, University of Ghent, (2) Department of Nursing Sciences,
University of Antwerpen, Antwerp, Belgium
Background Phosphate binders (PBs) are commonly prescribed in hemodialysis (HD) patients to
control serum levels of phosphorus. Compliance to PBs is complicated by the high pill burden and the
irregular pattern of intake.
Aim
This study aims to compare the compliance to phosphate binders blindly controlled by the Medication
Event Monitoring System (MEMS) to the results obtained by a nurse lead intervention focusing on
medication knowledge and personalized support.
Methods
Baseline compliance to PBs was evaluated in 3 Belgian and 1 Dutch dialysis centre. All adult patients
treated with PBs, in chronic HD for more than 3 months and without mental disorders, were asked for
participation. Compliance was measured during a period of 14 weeks using MEMS-V Track-Cap
devices (Aardex Ltd, CH). Non-compliance was defined as a registered intake <80% of prescribed
doses. Patients' characteristics and lab results (phosphorus, calcium, PTH) were collected using a
structured questionnaire. An interventional study was set up in an additional Belgian centre using
identical inclusion and observation methods. In the latter centre, 4 weeks after the start of the
observation period, a nurse visited all participating patients, offering an information chart and an
individualized explanation about PBs. Thereafter, she contacted all participants bi-weekly for a
personalized talk about compliance.
Results
In the total cohort of 257 patients (including 216 baseline and 41 intervention patients), mean age was
67.5 years (range 21-90), 59% were males, mean HD treatment was 47 months (range 3-267).
Patients had a mean pill burden of 14 pills per day (range 2-35) with 33% of patients taking more than
one PB. PBs studied were calcium carbonate, sevelamer and lanthanum in 46, 42 and 12% of
patients, respectively with a mean intake of 3.9 (range 1-9) PB pills per day. Patients of the
intervention study did not differ from the Basic cohort except for a higher number of lanthanum users.
During the first week of observation, non-compliance was observed in 23.3% of patients in the
baseline cohort compared to 24.4% in the intervention study (p=0.875). In the baseline cohort,
compliance decreased from a mean of 85.5% (SD 24.4) in week 1 to 75.9% (SD 30.5) in week 14. In
contrast, in the intervention group compliance increased from a mean of 82.5% (SD 22.9) to 94.4%
(SD 13.5). Interrupted time series analysis revealed that the decreasing trend of compliance per week
in the baseline cohort with a slope of -0.782 (95% CI -1.07 - -0.489) significantly differed from the
slope of 0.672 (95% CI -0.13 - 1.40) in the intervention group. During the intervention study, serum
phosphorus levels decreased accordingly (from 4.8 to 4.6 mg/dL - p=0.110) and knowledge about PBs
increased from a mean score of 53 to 75%.
Conclusion
Although non-compliance to PBs was frequently observed in HD patients, a nurse lead program of
education and close follow-up of PB intake is worth considering to improve compliance.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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Real-time Adherence data as input to an ICT based system for the
treatment of depression
Eric Tousset3, Pim Cuijpers2, Mark Hoogendoorn1, Michel Klein 1
(1) Computer Science department, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, (2)
Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The netherlands, (3)
Pharmionic Systems, Vise, Belgium
Major depression is currently the fourth disorder worldwide in terms of disease burden, and is
expected to be the disorder with the highest disease burden in high-income countries by 2030.
Estimated costs of depression are annually 177 and 147 million euro per 1 million inhabitants for major
and minor depression respectively.
The increasing needs for individualised therapies and the scarcity of human resources put a
tremendous pressure on the healthcare system. The emerging concept of Ambient Assisted Living
(AAL) provides a natural approach to this important issue. By combining methods, electronic systems,
devices as well as services in an integrated framework, AAL set the stage for a individualised support
based on the situation of the person in need. AAL are also able to broadly deliver health care services
at the point of need.
In this R&D project, funded by the 7th framework of the European Union, 5 research organisations and
2 SME companies at the forefront of Artificial and Ambient Intelligence and Clinical Psychology have
joined their efforts to tackle the challenge of building an AAL system for the self-management of
depression in a highly collaborative framework. The convergence between new ultra-light devices
such as smart-phone and non invasive and wearable systems for the monitoring of bio-signals
provides the technological basis of the
system.
Several therapeutic modules will be used to support and improve the state of the patient via a smart-
phone and/or web-based communication. Those modules will be driven by an artificial reasoning
system: in this context, monitored data will be used as input to judge the current state of the patient
and push the adequate therapy module. Adherence to the prescribed medication is one of the
essential components of an effective therapy. This project will explore, beyond the current state-of-the-
art, technologies in monitoring medication adherence, exploiting patient's drug dosing history in
combination with other bio-signals, and communicating effectively the individualized information and
messages about medication intakes to the patient. Several scenarios In this advanced technological
setting will be developed to identify the appropriate information to be provided to each stakeholder in
managing patient adherence to the prescribed medication.
The AAL system under construction requires the use of modular and interoperable concepts
supporting the sharing of relevant information between sub-systems and services. An overview of the
system and the principles of its architecture will be presented. The use of adherence to the prescribed
anti-depressive medication in the system will be highlighted.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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REAL TIME MEDICATION MONITORING WITH SMS REMINDERS
IMPROVES ADHERENCE TO ORAL ANTIDIABETIC MEDICATION IN
PATIENTS WITH SUBOPTIMAL ADHERENCE
Marcia Vervloet2, Liset van Dijk2, Arno Wormgoor1, Jacqueline Santen-Reestman1, Dinny de
Bakker2, 3, Marcel Bouvy4
(1) Mediq Apotheken, Utrecht, The Netherlands, (2) NIVEL, Netherlands Institute for Health Services
Research, Utrecht, The Netherlands, (3) Tranzo, Scientific Centre for Transformation in Care and
Welfare, Tilburg University, The Netherlands, (4) Utrecht Institute for Pharmaceutical Sciences (UIPS),
Division of Pharmacoepidemiology and Pharmacotherapy, University Utrecht, The Netherlands
Background Poor adherence to antidiabetics has a negative influence on glycemic control in type 2
diabetes patients. Real Time Medication Monitoring (RTMM) aims to improve adherence. RTMM offers
the combination of monitoring patients' medication use in real time with an electronic medication
dispenser and reminding patients of their medication intake through SMS. These reminders are
tailored to the patients' needs: the SMS is only sent if the medication has not been taken.
Aim Evaluate the effect of RTMM with tailored SMS reminders on patients' adherence to oral
antidiabetics.
Methods Randomised Controlled Trial with two intervention and one control arm, in which a total of
161 diabetes type 2 patients with suboptimal levels of adherence to oral antidiabetics (less than 80%
based on pharmacy refill data) participated. Patients were randomly assigned to one of the three arms.
Patients in the first intervention arm (n=56) used RTMM including tailored SMS reminders and a
personal webpage where they could monitor their medication use (SMS group). Patients in the second
intervention arm (n=48) used RTMM without SMS reminders or internet access (non-SMS group).
Patients in the control arm (n=57) were not exposed to any intervention. The intervention lasted for six
months. Pharmacy refill data of all patients were available from 11 months before, and until 11 months
after the start of the intervention. Detailed data on medication use registered by RTMM were available
for patients in the intervention groups (comparison between these groups is discussed elsewhere). To
compare the adherence in the intervention groups with the control group, pharmacy refill data is used.
Primary outcome measure is refill adherence to oral antidiabetics calculated from pharmacy data by
taking the number of days for which oral antidiabetics are dispensed during the study period divided
by the total number of days of the study period. Differences In adherence between the intervention
and control group were tested with Students' T-tests.
Preliminary results Average refill adherence at baseline of included patients in the SMS group, non-
SMS group and control group was respectively 61.5% (SD=14.1), 62.2% (SD=12.8), and 61.7%
(SD=13.5) and did not differ significantly between the three groups. At present, pharmacy refill data
were available for 40 patients in the SMS group, 40 patients in the non-SMS group and 34 patients in
the control group. Patients receiving SMS reminders had an average refill adherence of 86.7%
(SD=22.3). Average refill adherence of patients not receiving reminders was lower: 78.5% (SD=20.2).
With an average of 73.5% (SD=20.7), patients in the control group had the lowest refill adherence.
The differences in refill adherence were significant between the SMS and control group (p<0.01), and
between the SMS and the non-SMS group (p<0.05). The adherence did not differ significantly
between the non-SMS group and the control group.
Conclusion These preliminary results suggest that RTMM with SMS reminders are effective in
improving adherence to oral antidiabetics. Since not only patients with diabetes experience difficulties
in following prescribed therapy, RTMM can also provide opportunities for increasing adherence to
medication for Rother chronic diseases.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
29
A simple, robust taxonomy to describe deviations from prescribed
drug therapy
Bernard Vrijens1, For the ABC Project Team
(1) AARDEX Group, Sion, Switzerland and Department of Biostatistics and Medical Informatics,
University of Liège, Belgium
Background
The ABC project, sponsored by the 7th Framework program of the European Union, started in January
2009, as an international collaboration of European research groups in the field of patient adherence.
One of the main objectives of this project is to conduct a systematic review to assess the terminology
used in the literature and, based on that review, to propose a sound taxonomy for medication-taking
behavior that will support adequate measurements. The purpose of this paper is to retrace the steps
by which the ABC Project Team proceeded.
Methods
A systematic review was conducted, searching MEDLINE, EMBASE, CINAHL, the Cochrane Library,
and PsycINFO for all English-language papers addressing the taxonomy/terminology of describing
deviations from prescribed drug treatment in ambulatory patients. Internal and external meetings were
organized to reach a consensus.
Results
142 papers were identified for this review. Over ten different terms were used to describe medication-
taking behaviour, often with differing conceptual definitions, resulting in methodological weakness. The
term most currently used and widely accepted is 'medication adherence'. It is the process by which
patients Take prescribed medications. It is composed of three parts: 'initiation', 'execution' and
'discontinuation'. 'Medication Management' is an over-arching construct for naming the practice and
processes of monitoring and supporting medication adherence by patients.
Conclusions
The outcome of this collaborative project is a new conceptual foundation and transparent taxonomy. It
provides researchers and caregivers with a sound logical structure and coherent language to
measure, interpret, study, and improve medication-taking behavior.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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Evolution of meaning and use of 'observance' / 'education
thérapeutique' ('therapeutic education patient') versus 'compliance'
/ 'adherence' in French and English languages
Marguerite Cognet3, Emilie Adam1, Rosane Braud2
(1) Ph.D candidate, Anthropology Université Paris 7 Diderot, Migrations and Society Research Unit
(URMIS) Paris, France, (2) Ph.D candidate, Sociology Université Paris 7 Diderot, Migrations and
Society Research Unit (URMIS) Paris, France, (3) Researcher, teacher, UFR Social Sciences
Université Paris 7 Diderot, Migrations and Society Research Unit (URMIS) Paris, France
The notion of 'observance', which first emerged in the French healh system in the 1980's, spread
widely over the following decade. Although heavily influenced by anglo-saxon scientific circles, the
notion would go on to evolve differently in francophone academic literature, as well as in medical
practice.
While the notion of 'compliance' in anglophone countries competes with that of 'adherence' in the
francophone world the notion of 'therapeutic education patient' ('éducation thérapeutique') is becoming
the most commonly used term.
Basing ourselves on critical reviews of medical and social sciences literature in both languages over a
period spanning the late sixties to the first decade of the 21st century, we will show how the notions of
'compliance' versus 'observance' have evolved in quantitative and qualitative terms and how their
applications in medical practice have changed.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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Differences and changes in attitude towards chronic medication
between adherent and non-adherent patients
Harm Geers2, Eibert (Rob) Heerdink1, 2, Marcel Bouvy2
(1) University Medical Center Utrecht Department of Clinical Pharmacy, division of Laboratory and
Pharmacy PO Box 85 500, 3508 GA Utrecht, the Netherlands, (2) Utrecht University, Faculty of
Science Utrecht Institute for Pharmaceutical Sciences Division of Pharmacoepidemiology &
Pharmacotherapy PO Box 80 082, 3508 TB Utrecht, the Netherlands
Background
It is unclear whether necessity and concerns about chronic medication change over time and how
possibile changes are related to adherence. We studied the difference and changes in attitude
towards chronic medication and the association with adherence.
Methods
Patients with a first prescription for a drug intended for chronic use were identified in 9 pharmacies. All
patients received the Believes about Medicines Questionnaire specific (BMQs) at the start (t0) and
after one (t1) month. Dispensing records were extracted from the pharmacies after at least 10 months
and ta king compliance defined as a continuous measure of medication acquisition (CMA) <80% and
persistence were assessed. A patient was non-persistent if a gap in which no medication was
available to the patient of 90 days or longer emerged. Patients' believes were classified as either
ambivalent (high necessity, high
concerns), skeptical (low necessity, high concerns), indifferent (low necessity, low concerns) and
accepting (high necessity, low concerns), based on their BMQs scores.
Results
Included were 376 patients. Response rates were 50% and 39% at t0 and t1. Of the responders at t0
39 (22%) had poor taking compliance, and 51 (29%) were non-persistent. No significant difference in
believes between patients with good and poor taking compliance was observed. A trend however was
observed towards less indifference at t1 in the group with good taking compliance (23%), compared to
the group with poor taking compliance (32%). In the non-persistent group were less accepters (15%
vs. 23%) and more skeptical (28% vs. 9%) users compared to the persistent group. In persistent
users, acceptance increased significantly from 15% to 23% and indifference decreased significantly
from 14% to 9% at t1.
Conclusion
Accepting users are more likely to continue their medication, while skeptical users are more likely to
discontinue treatment. Changes in attitude towards chronic medication take place early in the
treatment course. Pharmacists should address concerns and necessity with patients during the early
course of treatment to prevent non-persistence and possibly poor taking compliance.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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ECONOMICS TO EXPLAIN ADHERENCE TO MEDICINES IN ADULT
PATIENTS: A SYSTEMATIC REVIEW OF EMPIRICAL STUDIES
Emily Fargher1, Val Morrison1, Todd Ruppar2, Dyfrig Hughes1
(1) Bangor University, UK., (2) K.U.Leuven, Belguim.
Background: Health psychology and economic models of patient behaviour may be used to explain
adherence to medicines. Aims: As part of the ABC project, we aim to examine the contribution of
Heath psychology and behavioural economic models to the understanding of adherence to medicines
in adults; then to consolidate this evidence in a conceptual framework of determinants of adherence.
Methods: A systematic review was conducted using MEDLINE, EMBASE, the Cochrane Library,
CINAHL, PsychINFO, and EconLit (1990-2010, no language restrictions), with additional studies
identified by experts and bibliographic scrutiny. Search terms relating to adherence, medicines, theory,
and behavioural models were combined in two separate searches of the health psychology and
economic literature. All study types containing empirical data on adherence determinants were
included. Independent extraction of articles by two reviewers using predefined data fields.
Results: 2308 publications were identified, 1605 were excluded following title and abstract screening.
703 full papers were assessed and 203 included in the review.
Conclusions: Health psychology models derived from social cognitive theory, self-regulation theory or
social learning theory; and, economic theories of consumer demand and time preference have been
used to explain adherence to medicine. Self-report was the most common measure of adherence. The
extent to which individual components of the relevant model were tested varied. Conclusions:
Identifying the determinants of non-adherence may help guide the development of interventions to
improve adherence by targeting the factors that influence intentional non-adherence to long-term
treatment. Consolidation of behavioural models may provide a theoretical basis for the development
and assessment of effective adherence-enhancing interventions.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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Mobile phone SMS for optimizing asthma treatment outcome – a
controlled trial.
Claus Møldrup2, Birthe Søndergaard2, Jonathan Stein1
(1) Privat consultant, (2) University of Copenhagen Faculty of Pharmaceutical Sciences
Department of Pharmacology and Pharmacotherapy
Background: A pilot study by Anhoj and Moldrup on the feasibility of collecting asthma diary data
from asthma patients via mobile phones and text messaging, or Short Messaging Service (SMS),
concluded that it isfeasible, and that SMS may be a useful tool for supporting the self-management of
asthma.
Objective: The objective of this study is to assess the health-related effects of a SMS compliance and
monitoring system for optimized asthma treatment.
Methods: In total 244 asthmatics participated in a prospective controlled randomized trial (114
intervention,130 control). The intervention consisted of sequences of SMS messages sent to the
intervention group, each containing 2 or 3 monitoring questions and one reminder to take the
preventive medication. Both the intervention and control group received questionnaires on days 0, 45,
and 90.Primary outcome measures were self assessed outcome questionnaire included the 5 question
asthma control test, EQ-5D, use of health services and use of preventive medicine questions.
Results: The use of SMS monitoring yields no health-related effects, no decrease in the use of
healthcare services, and no change in the use of medicine between the control and intervention
groups. The lack of outcomes for the intervention is not due to recruitment or the randomizing of
participants, not due to dropout. This study furthermore supports other findings concerning the lack of
asthma control in the asthma population.
Discussion: SMS is a reliable, convenient, affordable, secure, widespread and a feasible technology
for communication between the patient and healthcare system. However, even given the poor level of
asthma control determined at baseline, this study clearly documents that a SMS compliance and
monitoring intervention design like the one presented in this paper does not improve asthma control,
nor does it generate fewer contacts with the healthcare system or improve the use of medicines.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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FACTORS ASSOCIATED WITH MEDICATION ADHERENCE AMONG
PSYCHIATRIC OUTPATIENTS WITH SUBSTANCE ABUSE RISK
Stephen Magura2, Andrew Rosenblum1, Chunki Fong1
(1) National Development and Research Institutes, U.S.A. (2) Western Michigan University, U.S.A.
Background: Recognizing predictors of medication adherence among patients with psychiatric and
substancje abuse problems is important because poor medication adherence is associated with
relapse and hospitalization. Aims: (1) To determine the extent of psychiatric medication non-
adherence among a sample of psychiatric outpatients with a high rate of substance abuse, and (2) the
factors associated with non-adherence which could suggest means for improving adherence in this
population.
Methods: Consecutive new admissions to an urban continuing psychiatric day treatment program
were recruited Turing 2003-2005. The analysis involves patients who were prescribed psychiatric
medication from different providers during the prior six months (N=131). Confidential research
interviews were conducted at admission that included a modified Medication Adherence Rating Scale
(MARS). All results reported are statistically
significant at p<.05.
Results: Age (mean) 39 y; male 61%; Hispanic 60%; Black 36%; White 18%; public
assistance/disability 73%; DSM-IV diagnoses: major depression 26%, schizoaffective 21%, bipolar,
16%, schizophrenia 13%, other mood 9%, psychotic NOS 7%, other 8%; substance abuse history
(93%); drug/alcohol abuse within past 90 days (74%). At least one non-adherence item on an 8-item
MARS was endorsed by 78%, with a mean of 3.3 items endorsed, e.g., forgot to take (31%); careless
at times (44%); stopped when felt better (44%); stopped when felt worse (32%). Lower medication
adherence was associated
more psychiatric symptoms, which supports the construct validity of the MARS in this sample. Factors
related to lower MARS adherence scores during the past six months in bivariate analysis were: lower
satisfaction with medication, lower friends? support for drug/alcohol abstinence, higher engagement in
processes of change, more medication side effects, lower self-efficacy for drug avoidance and lower
social support for recovery. In multivariate regression analysis with backward elimination, only the last
three factors remained as significant predictors of adherence. One-third of the patients said their
psychiatrists did not spend enough time with them to explain side effects or were rushed, although this
was not directly associated with non-adherence.
Conclusion: Low medication adherence was associated with side effects, a cognitive factor
and a social factor. This suggests that technical aids such as pill dispensers with alarms, while
potentially useful, may be insufficient since low adherence is not attributable solely to forgetting to take
medication. Our previous work with dually-diagnosed patients has documented that self-help groups
providing social suport for recovery can increase medication adherence. Strengthening adherence
should also include better education about side effects and the importance of adherence to sustain the
benefits of medication. This education, which might also involve assertiveness training, should
encourage patients to discuss their symptoms and side effects with their psychiatrists, rather than
simply to stop taking medication. Psychiatrists should also be encouraged to address patients?
adherence strategies, since the time devoted to ad dressing that during treatment may prevent serious
adverse events such as relapse, treatment drop-out and hospitalization.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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THE HEART FOUNDATION'S 'IMPROVING CARDIOVASCULAR
ADHERENCE PROJECT': DEVELOPMENT OF AN EVIDENCE-
BASED TRAINING PACKAGE FOR HEALTH CARE
PROFESSIONALS
Parisa Aslani2, Ines Krass2, Beata Bajorek2, Jill Thistlethwaite3, Jeremy Bunker4, Geoffrey Tofler1
(1) Department of Cardiology, Royal North Shore Hospital, NSW Australia, (2) Faculty of Pharmacy,
University of Sydney, Australia, (3) Institute of Clinical Education, University of Warwick, United
Kingdom, (4) Sydney Institute of General Practice Education & Training, NSW Australia
Introduction
The expanding burden of cardiovascular disease has emphasised the importance of ongoing
adherence and persistence to prescribed therapy for effective disease prevention and management,
including the treatment of symptomless risk factors (e.g., hypertension, dyslipidaemia). Research has
shown that during long-term therapy for chronic illnesses, adherence to medication averages only
50%, highlighting the need for targeted practice interventions. However, most interventions usually
target barriers to adherence that are under the patients' control, whereas barriers related to the health
care system and health care professionals (HCPs) have received less attention.
Yet, these HCP-related barriers are particularly important in vulnerable patients and/or acute situations
(e.g.,after periods of hospitalisation resulting in treatment changes, such as after an acute
cardiovascular event), especially where inadequate discharge planning and follow-up with primary
health care practitioners (e.g. GP, community pharmacist, community nurse) can compromise
adherence to therapy. These problems are further compounded by the fact that HCPs are often poor
judges of patient medication-taking behaviours and, rather than using systematic approaches to
identify non-adherence, they tend to rely on personal intuition. Thus, there is a clear need to educate
and upskill HCPs in the issues surrounding medication adherence as well as the implementation of
systems to identify, address and monitor non-adherence and non-persistence to therapy. For optimal
impact, this also requires systems support, multiprofessional collaboration, and an in-depth
understanding how to support patient self-management behaviour.
Aim
The aim of this project was to develop an evidence-based training package for HCPs, high lighting
interprofessional and collaborative strategies, to promote medication-taking in patients on
cardiovascular therapy. The project is supported by the Heart Foundation's (Australia) 'Improving
cardiovascular adherence project'.
Method
Using an iterative feedback process and consultation from an expert panel, a versatile training
package, which can be delivered as a face-to-face workshop, self-directed learning program, or an
interactive on-line course, was designed. The package was structured to demonstrate how HCPs
based in primary care (i.e., general practitioners, pharmacists, nurses) can facilitate appropriate
intervention. Its specific objectives were to help HCPs achieve a comprehensive understanding of the
issues related to: the importance of adherence to medicines; adherence in cardiovascular drug
therapy; and appropriate management strategies.
Outcome
The final training package comprises a series of six educational modules focusing on:
Module 1: Adherence to Cardiovascular Medicines, the Principles
Module 2: Identifying Patients' Non-Adherence
Module 3: Creating Concordance and Making Shared Treatment Decisions
Module 4: Aiding Patient Self-Management in Cardiovascular Treatment
Module 5: Interventions to Improve Your Patients' Adherence
Module 6: Specific Roles of Health Care Professionals
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
36
Each module provides an overview of the topic (referring to the evidence-based literature), a selection
of resources to support learning, presentation of practice tools, and facilitated discussion and
interaction with other participants. Importantly, self-directed learning is integral to each module,
providing examples of worked patient cases (6 in total) with accompanying scripted dialogue,
demonstrating the identification of non-adherence and the practical application of evidence-based
strategies and selected tools to promowe adherence, highlighting areas where interprofessional
collaboration is warranted.
Summary
This training package not only provides a unique and comprehensive resource for practitioners, but
specifically targets issues in adherence by addressing barriers presented by the health system and/or
health care professionals. Through a better understanding of the issues in adherence, and
development of skills In identifying and addressing adherence, health care professionals will be able to
work more collaboratively to optimise medication use and provide appropriate patient support.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
37
Comparison of real life objective reliable compliance data assessed
by an innovative electronic system in patients recruited either by a
pharmacist or a general practitioner study : Differences and
potential bias.
Eric Leutenegger1, 2, Eric Vicaut2, Bernard Bousquet1
(1) ABR Pharma, Paris, (2) School of Medicine, University of Paris Lariboisière
Objective
An innovative electronic compliance measurement system has been developed. This system allow to
obtain quantitative data however it may induce bias in patients, pharmacists (PHs) or general
practitioner (GPs). The data from 2 studies conducted either with PHs or GPs give us the opportunity
to explore the potential differences and bias.
Method
29 GPs and 40 PHs in France selected consecutively, over a 4-week period, all patients receiving
rosuvastatin 5 or 10 mg, clopidrogel 75 mg or sitagliptine 100 mg. 132 HPs' patients and 69 GPs' one
returned at least one blister. We compare for each drug the main compliance criteria in each
population.
Results
For rosuvastatin, GPs' patients show a similar range of taking/prescribed dose ratio than PH's ones
(95 vs 86%, NS). GP's patients show higher level of days in accordance with the prescription (76 vs
67%, p<0,05) and lower level of skipped days defined as days without intakes (14 vs 24 %, p=0,01).
Conclusion
First comparison of data compliance between GPs' patients and PHs' one show a better compliance in
the GP's group. These results could reflect slight bias from the GPs' patients' selection in a Real life
compliance study due to their willingness to obtain positive feed back on compliance.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
38
THE EFFECT OF A CLINICAL TRIAL ON ADHERENCE AND
PERSISTENCE TO TREATMENT
Hein A.W. van Onzenoort4, Frederique E Menger6, Cees Neef2, Willem J Verberk5, Peter W de
Leeuw1, Paul-Hugo M van der Kuy3
(1) Cardiovascular Research Institute Maastricht (CARIM), Maastricht University and, Department of
Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands, (2) Department of
Clinical Pharmacy and Toxicology, University Hospital Maastricht, Maastricht, The Netherlands, (3)
Department of Clinical Pharmacy, Orbis Medical Centre, Sittard, The Netherlands, (4) Department of
Clinical Pharmacy, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands, (5)
Microlife Corporation, Taipei, Taiwan, (6) Utrecht Institute for Pharmaceutical Sciences, Division of
Pharmacoepidemiology and Pharmacotherapy, Utrecht, The Netherlands
Background Although it is generally acknowledged that poor adherence to treatment is one of the
major determinants of an uncontrolled blood pressure, results of clinical trials show much better
figures for adherence, suggesting that the degree of adherence found in clinical trials does not
represent a 'real-life' situation.
Aim To investigate adherence and persistence profiles in patients with hypertension who had
participated in a clinical trial by collecting refill data before, during, and after participation in a clinical
trial. Methods Two-hundred-and-twenty-eight patients who participated in the HOMERUS trial between
2001-2005 and whose adherence to treatment had been monitored electronically and by pill count
were invited to participate in this study. After signing informed consent, patients' filled prescriptions
from computerized pharmacy systems were obtained from 1999 until 2010. Refill adherence was
calculated for each ATC code as the theoretical duration divided by the period between the start date
and the date of the last prescription
filled. The theoretical duration was calculated by dividing the number of units dispensed by the
prescribed daily dose.
Results In total, 182 patients agreed to participate in this study. Refill data were available of 22,600
prescriptions. The monitored periods covered 993 (standard deviation (SD) 517 days), 250 (SD 71)
days, and 1695 (SD 475) days for the corresponding period before, during, and after the trial,
respectively. Participation into the trial significantly increased refill adherence: 90.6% versus 95.6%
(p<0.001). After the trial period refill adherence decreased significantly to 91.8% (p<0.001), which was
non-significantly different from the adherence before the start of the trial (p=0.45). After termination of
the trial, median duration of continuation of the trial medication was 1424 days.
Conclusions Participation in a clinical trial significantly increases adherence to treatment. The long
persistence of trial medication and the high refill adherence rates might suggest that patients are more
involved with their condition and treatment, and therefore more willing to participate in a trial in which
adherence is monitored.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
39
Determinants of patient adherence to medical treatment: a
systematic review of reviews.
Przemyslaw Kardas
1,2, Pawel Lewek
1,2, ABC Project Team
2
1Medical University of Lodz, First Department of Family Medicine, Lodz, Poland, e-mail:
family@csk.umed.lodz.pl; 2 ABC Project www.abcproject.eu, e-mail: info@abcproject.eu
Background: Patients' non-adherence to medical treatment is a rising problem worldwide. Many
interventions to improve patient adherence were found to have their effectiveness far from the
expectations. This may be partly explained by the lack of a theoretical foundations for these
interventions. Innovations in theory and practice are badly needed. To lay a solid foundation for future
interventions, a systematic review of publication on determinants of patient adherence was conducted.
Aim: The aim of this study was to perform a systematic review of recent publication on determinants
on patient adherence.
Methods: Electronic literature searches were performed in January, 2010 in Medline (through
PubMed), Psychinfo, Embase, Cinahl, International Pharmaceutical Abstracts (IPA) and the Cochrane
Library. Major inclusion criteria were 1) adherence to medication as a major topic of publication 2) type
of publication - systematic review 3) determinants of compliance provided 4) publication date
01/01/2000 or later. Studies primarily focusing on adherence-enhancing interventions were excluded.
All the identified abstracts were assessed against the inclusion and exclusion criteria by at least one of
the authors. With inconsistent result of the assessment, publications were accepted for full text
assessment.
Results: Out of 833 abstract screened, 100 were selected for full text evaluation, and finally, 53 were
found to fulfil all study criteria. The scope of the identified publications covered wide range of chronic
treatment, with HIV being the most frequent topic. Noticeably, no publication with the major focus on
the short-term treatment was identified. A large number of factors affecting adherence was listed,
including patient-, condition-, therapy-, healthcare system-related factors, as well as social and
economic factors. Only several studies differentiated factors related to execution, and persistence.
Conclusion: An extensive literature search provided updated review on the determinants of patient
adherence. Further studies in this field could benefit from implementing rigorous scientific terminology,
and particularly, making clear distinction between factors affecting execution, and persistence.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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POSTER PRESENTATIONS
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
41
POSTER No 1
IMPACT OF PROLONGED ANTIHYPERTENSIVE DURATION OF
ACTION ON PREDICTED CLINICAL OUTCOMES IN IMPERFECTLY
ADHERENT PATIENTS: COMPARISON OF ALISKIREN,
IRBESARTAN AND RAMIPRIL
Adam Lowy1, Yvonne Brede1, Deborah Keefe2
(1) Novartis Pharma AG, Basel, Switzerland, (2) Novartis Pharmaceuticals Corporation, East Hanover,
NJ, USA
Background. Most patients miss occasional doses of antihypertensive treatment. The consequent
loss of BP control may be mitigated by prescribing forgiving drugs (i.e. prolonged BP-lowering action
beyond 24h), but the clinical consequences of gaps in dosing and the impact of drug duration of action
have not been evaluated quantitatively.
Aim. To estimate the effects of adherence and drug duration of action on mean systolic BP (SBP)
reduction and predicted cardiovascular disease (CVD) risk.
Methods. We simulated 256-day dosing histories for 1250 subjects, incorporating realistically
distributed gaps in dosing based on a published study of electronically monitored dosing records from
4783 patients with hypertension in clinical trials. Adherence was set to 90%, 75% and 60% by altering
the proportion of doses missed. SBP reductions were averaged over time and subject to estimate
population mean reductions In SBP. Ten-year CVD risk was predicted using the Framingham Risk
Equation with baseline characteristics from NHANES 2005-2006 (average data: age 65.2 years;
52.9% women; SBP 155.95 mmHg; Total cholesterol 5.41 mmol/L); baseline absolute 10-year CVD
risk was 27.0%. Mean office SBP-lowering effect (mmHg; aliskiren 300 mg -14.1, irbesartan 300 mg -
13.3, ramipril 10 mg -10.1) and the rate of SBP increase after stopping treatment (mmHg/day; aliskiren
1.0, irbesartan 3.6, ramipril 4.0) were taken from a randomized, double-blind trial in patients with
hypertension. The rate of decrease in SBP upon resuming treatment after a gap in dosing was fixed at
5 mmHg/day.
Results. With adherence set at 90% (typical of randomized trials of antihypertensives), predicted
population average SBP reductions were larger for aliskiren (13.7 mmHg) than irbesartan (12.3
mmHg) or ramipril (9.3 mmHg), as were predicted absolute reductions in 10-year CVD risk (aliskiren
4.1%, irbesartan 3.7%, ramipril 2.8%). Adherence in real-world use is typically much lower; with
adherence reduced to 60%, the predicted SBP-lowering effect of aliskiren (12.7 mmHg) was
diminished less than that of irbesartan (9.8 mmHg) or ramipril (7.1 mmHg). For aliskiren, the decrease
in adherence predicted a rise in SBP of 1.0 mmHg and 3 additional CVD events per 1000 patients;
larger differences were predicted for irbesartan (2.5 mmHg; 7.5 events/1000) and ramipril (2.2 mmHg;
6.7 events/1000). The number needed to treat to avoid 1 CVD event was 26 for aliskiren, 34 for
irbesartan and 47 for ramipril.
Conclusion. Occasional non-adherence to antihypertensive medication - the rule rather than the
exception In real-world practice - has a clinically relevant impact on BP reduction and CVD risk. This
may be mitigated In part by prescribing regimens based on forgiving drugs (i.e. prolonged BP-lowering
action beyond 24h).
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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POSTER No 2
ASSESSMENT OF ADHERENCE OF CINACALCET HCL IN
DIALYSED PATIENTS WITH SECONDARY
HYPERPARATHYROIDISM: A EUROPEAN SURVEY
Valentina Forni1, Menno Pruijm¹, Carole Zweiacker¹, Michel Burnier¹
¹Service of Nephrology and Hypertension, CHUV Lausanne, Switzerland
Background: In the treatment of secondary hyperparathyroidism (sHPT) in dialysis patients, a lack of
responsiveness to drug therapy may be due to pharmacological and biological
factors as well as to non-adherence to the complex prescribed regimens. Low adherence to drugs
used in the treatment of sHPT is particularly worrisome, since high PTH values have been associated
with elevated morbidity and mortality rates. The calcimimetic cinacalcet-HCl (Mimpara®) is an
effective treatment of sHPT approved for dialysis patients. When Ipoh values do not improve despite
an initial dose of 30mg/day, an increase up to a maximum of 180mg/day is recommended. Suboptimal
adherence to cinacalcet is difficult to identify In clinical practice, but it may be crucial to recognize it in
order to prevent costs and dosedependent side-effects. Therefore, a European multinational survey of
drug adherence to Cinacalcet-HCL using an electronic monitor was performed in dialysis patients.
Aim: We monitored and described drug history of Cinacalcet-HCL in a large longitudinal international
survey, involving five European countries (Switzerland, France, Germany, Austria, Italy).
Methods: Medication adherence was compiled using the MEMS® system. Several aspects of drug
history were considered:
- the adherence, used as blanket term to subsume persistence and execution
- the persistence, defined as the time elapsed (in days) between entry in the monitoring period and the
time of discontinuation;
- the execution, which refers to the comparison between the prescribed drug dosing
regimen and the patient‟s drug history while on treatment. The latter definition includes: the
percentage of skipped days (= 1 or 2 days without intake), the percentage of „drug holidays‟ (3 or more
consecutive days without drug intake), the “day of the week effect” (the compliance of one day of the
week is significantly lower, p < 15 %, than the average compliance).
Results: The drug history of 157 patients was analyzed (Switzerland: 58 pts., France 21 pts, Germany
and Austria 55 pts., Italy 23 pts.). The adherence and persistence were found to decline substantially
over 200 days, with 22% classified as “non-adherent” at 200 days and 18% interrupting their
treatment. There were some differences between countries (persistence 76% in Italy vs. 90% in
France at 200 days), however statistically not significant (p=0.078). Concerning execution, the drug
history of 121 patients with single daily tablet regimen was available for analysis: more than 21%
(n=26) missed more than 10% of their doses, corresponding to more than 36 days without medication
during a year; more than 71% (n = 86) experienced at least one “drug holiday” during their monitoring
period. Finally almost 50% of the patients (n=57) had a “day of the week effect”, for all countries
mostly on week end.
Conclusions: Assessment of drug adherence to Cinacalcet-HCL allowed to detect problems both in
the persistence and execution indices, with some countries specific differences, but also with
international analogies.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
43
POSTER No 3
EVALUATION OF THE MEDICATION COMPLIANCE OF LIVER
TRANSPLANT PATIENTS SWITCHED FROM A TWICE-DAILY TO A
ONCE-DAILY TACROLIMUS-BASED REGIMEN
Pharm. D. Marion Eberlin1, Ph. D. Irene Kraemer2
(1) Department of Pharmacy, University Medical Center, Langenbeckstrasse 1, 55131 Mainz,
Germany, eberlinm@uni-mainz.de, (2) Department of Pharmacy, University Medical Center,
Langenbeckstrasse 1, 55131 Mainz, Germany, kraemer@unimedizin-mainz.de
Background: Compliance with the immunosuppressive therapy plays a major role in the long-term
success and outcome of liver transplantation. Thus, the development of strategies to promote
compliance of liver transplant patients and the evaluation of compliance over time are of particular
interest.
Aim: The main objective of this study is to compare medication compliance rates in liver transplant
patients with increasing time intervals after transplantation, switched from a twice-daily to a once-daily
Tacrolimus-based regimen (Prograf® vs. Advagraf®).
Methods: 65 liver-transplant patients with Tacrolimus-based therapy were included in a non-
interventional, prospective trial. Patients were assigned to 3 groups with regard to months or years
post transplantation (p.t.): Group 1: > 6 months < 2 years p.t., Group 2: > 2 years < 5 years p.t., Group
3: > 5 years p.t. in order to study the relationship of compliance rates and time interval after
transplantation. Medication compliance with the immunosuppressive therapy was measured over a 12
months period (each patient taking 6 months Prograf®, consecutive 6 months Advagraf®) with
medication event monitoring systems (MEMS®), AARDEX Ltd., Switzerland). Dosing (DC)-, Taking
(TC)-, Timing (TIC). Compliance and Drug Holidays were calculated for each patient by using the data
collected with MEMS®. Medians of compliance were compared between the 3 subgroups.
Results: According to a per protocol-analysis, the data of 63 patients were eligible both after the first
and the second period of 6 months (Prograf®: Group 1: 15 patients (pat.), Group 2: 23 pat., Group 3: >
5 years: 22 pat., drop-outs: 3 pat., Advagraf®: Group 1: 16 pat., Group 2: 23 pat., Group 3: 23 pat.,
drop-outs: 1 pat.). While taking Prograf® twice-daily the median of DC was 97% for group 1, 97% for
group 2 and 98% for group 3 (p=0.931). While taking Advagraf® once-daily the median of DC was
99% for group 1, 98% for group 2 and 97% for group 3 (p=0.158). Compliance rates of patients with
the once-daily regimen were higher than with the twice-daily regimen in nearly all measured
parameters. Differences in the compliance rates with the immunosuppressive drug therapy were
respectively not significant between the 3 groups assigned. Compliance with the immunosuppressive
medication was better the shorter transplantation was dated back. In all patient groups the resulting
DC- and TC-rates were higher than the TIC-rate. Patients seemed to Lack awareness for TIC, i.e.
patients did not take the drugs in the correct time interval. The correct timing of the evening dose
turned out to be more difficult than the correct timing of the morning dose.
Conclusion: Patients are aware of the importance of taking their immunosuppressive medication.
Measured compliance rates are high and do not vary significantly between the subgroups. Better
compliance with the once-daily regimen was observed.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
44
POSTER No 4
IMPROVING PATIENTS' COMPLIANCE - THE ROLE OF
PHARMACISTS
Tatjana Crnjanski3, Svetlana Stojkov-Rudinski2, Ivana Tadic1
(1) Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University
of Belgrade, Serbia, ivanak@pharmacy.bg.ac.rs, (2) The Public Pharmacy Subotica, Subotica,
Republic of Serbia, direktor@apotekasubotica.rs, (3) The Public Pharmacy Subotica, Subotica,
Republic of Serbia, tatjanacrnjanski@yahoo.com
Background: Low compliance may reduce the benefits of pharmacotherapy. There are many factors
which may affect the compliance. Recognizing these factors by the pharmacist at the primary health
care level provides the proper approach to patients. On the other hand, pharmacists' knowledge and
attitude also do not necessarily contribute to better compliance.
Aim: To assess the pharmacists' knowledge and attitude toward compliance.
Methods: Prospective, cross-sectional study was conducted in 25 different community pharmacies
from different regions of Serbia. In total, 356 pharmacists participated in the study. The study lasted
four months (January - April 2010). Knowledge and opinions about compliance were collected through
a self-reported questionnaire which had been designed to meet the purpose of this study. Descriptive
statistics and correlation analyses were used to summarize the results. The results of the pilot study
will be presented AT the 70th FIP World Congress of Pharmacy/Pharmaceutical Sciences. In this
abstract we will present the results of the complete study.
Results: One quarter of pharmacists (25%) know what compliance means. There is no significant
relationship (chi-square test; p>0.05) and no positive correlation (r=-0.44; p>0.05) between years in
service and knowledge about compliance. The largest number of pharmacists thinks that their
pharmacotherapy education, rather than: education of patients on health topics, cooperation with
physicians, installing electronic patients' records, pharmacists' education in psychology and
communication (respectively), May affect the proper and regular use of medication by patients.
Pharmacists believe that the lack of time, due to the large number of patients, is the major problem for
adequate counseling of patients. Other problems that pharmacists are stated as the cause of
inadequate counseling of patients were: patients' impatience, the Lack of conditions for confidential
conversation with patients, poor communication with patients and lack of pharmacists' self-confidence.
The attitude of the largest number of pharmacists is that the main reason for poor patients' compliance
is dosing frequency and polypharmacy. Other reasons were: medication's cost, patients' forgetfulness
to take medicines, expression of drug's side effects and patients' lack of confidence In the therapy
outcome.
Conclusion: Pharmacists can play a vital role in counseling and educating patients in an effort to
improve compliance. Conducted study has shown that the education of pharmacists may affect the
improvement of compliance. The years of service have no impact of pharmacists' knowledge. Lack of
time during working hours is one of the major problems for adequate counseling of patients.
Pharmacists believe that polypharmacy is one of the causes for bad patients' compliance. Further
research needs more specific questionnaire to determine precisely what the attitudes of patients are
which impact the compliance.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
45
POSTER No 5
TWELVE-MONTH PERSISTENCE OF COPD THERAPY AFTER
INITIATION IN PATIENTS AGED 50 AND OVER: RESULTS FROM
THE L777 STUDY
Laurent Laforest1, Mélanie Broquet1, Gaëlle Désaméricq1, Eric Van Ganse1
(1) Unité de Pharmacoépidémiologie, CHU Lyon, Hopital Pierre Wertheimer, Bron, France
Background: Tiotropium, a specific therapy for COPD, was launched in France in May 2006. Early
persistence under tiotropium is poorly documented.
Aims: To determine the 12-month persistence under tiotropium and to identify its predicting factors.
Methods: Health insurance's claims databases from the French Rhône-Alpes region were used.
Patients aged 50 and over, with at least 3 prescriptions of a respiratory drug (ATC R03) in 2006 were
pre-selected. Those to whom tiotropium was dispensed at least once between May 2006 and April
2007 and with at least a 12-month follow-up in the database after the drug initiation were studied.
Persistence was defined as the definitive interruption of therapy within 12 months following the drug
initiation.
Results: 1,341 patients (mean age 68 yrs, 34% women) were studied. 75% remained under
tiotropium therapy over 5 months and 61% remained at least 12 months after the initiation. A better
persistence to tiotropium was observed in males (p=0.01), patients with long-term disease status
(p=0.0001) and those with associated respiratory drugs (p=0.002). Conversely no difference was
observed according to age or past hospital admissions. Persistence was significantly better for
tiotropium compared to salmeterol-fluticasone fixed combination (p<0.0001), also in patients taking
both drugs simultaneously.
Conclusions: In real-life settings, persistence was inadequate for COPD patients under therapy, even
though better results were observed for tiotropium. Our data suggest a better persistence in case of
more severe disease.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
46
POSTER No 6
Role of data-acquisition rate in defining salient patterns of drug
exposure in ambulatory pharmacotherapy
Bernard Vrijens3, 4, John Urquhart1, 2
(1) AARDEX group, Zug, CH, (2) Department of Bioengineering and Therapeutic Sciences, Center for
Drug Development Science, UCSF, San Francisco CA USA, (3) Pharmionic Systems, Visé, Belgium,
(4) University of Liège, Belgium
Studies of patients' drug exposure patterns during ambulatory pharmacotherapy divide into two
methodologic categories: pre-electronic and electronic methods for compiling ambulatory patients'
drug dosing histories. Pre-electronic methods include diaries, histories, questionnaires, counts of
returned untaken doses, and audits of prescription refill data. Diaries were discredited by the finding,
via electronic time-stamping of diary entries, of a high incidence of long intervals between events and
times of their recording (1). The Rother pre-electronic methods are subject to a variety of uncertainties,
but all have rates of data acquisition that are inked to frequencies of clinic visits or prescription refills,
i.e., 1-24 data points/year. In contrast, electronic medication-event monitoring, in which package
opening times are automatically time-stamped by electronic means, has a data-acquisition rate of 4
data points/hr. The link between package opening times and drug ingestion is robust, shown by
measured concentrations of drug in plasma compared to those projected on the assumption that
package opening times signify the time of ingestion of the prescribed dose (2). The 4/hr rate of
sampling, ~3 orders of magnitude richer than pre-electronic methods can achieve, has defined the
following temporal patterns of drug exposure: (a) time-of-day effects, with dose-omission rates 1.5-2x
more frequent with PM than with AM dosing; (b) day-of- week effects, with patient-specific clustering of
dose-omissions on particular days of the week; (c through i) precise definition of (c) when dosing
starts, (d) when missed doses occur, (e) when multi-day lapses in dosing start and stop, (f) when
dosing halts permanently; (g) when white-coat effects occur; (h) the temporal sequence of dosing halts
and putative rebound effects - does dosing-cessation trigger harm, or does harm trigger dosing-
cessation? (i) coincidence of drug non-response with dosing history data - does non-response arise
from PK/PD or non-adherence? (j) comparative effectiveness of different methods of medication
management. Clinical correlates of the foregoing confirm the early prediction (3) that variable
adherence vies with PK as the leading source of variance in drug response. Richly sampled dosing
history data lay the foundation for pharmacometrically sound interpretation of variations in drug
response in ambulatory care, including exposure-informed safety assessment.
References:
1. Stone AA, Shiffman S, Schwartz JF, Broderick JF, Hufford MR. Patient noncompliance with paper
diaries. BMJ 2002; 324:1193-4.
2, Vrijens B, Tousset E, Rode R, Bertz R, Mayer S, Urquhart J. Successful projection of the time-
course of drug concentration in plasma during a one-year period from electronically compiled dosing-
time data used as input to individually parameterized pharmacokinetic models. J Clin Pharmacol 2005;
45:461-7.
3. Harter JG, Peck CC. Chronobiology: suggestions for integrating it into drug development. Ann NY
Acad Sci 1991;618:563-71.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
47
POSTER No 7
OBJECTIVE ADHERENCE MEASUREMENT WITH AN ELECTRONIC
BLISTER: A FEASIBILITY STUDY IN PRIMARY CARE
Hein A.W. van Onzenoort4, Cees Neef2, Willem J Verberk6, H Peter van Iperen5, Peter W de
Leeuw1, Paul-Hugo M van der Kuy3
(1) Cardiovascular Research Institute Maastricht (CARIM), Maastricht University and, Department of
Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands, (2) Department of
Clinical Pharmacy and Toxicology, University Hospital Maastricht, Maastricht, The Netherlands, (3)
Department of Clinical Pharmacy, Orbis Medical Centre, Sittard, The Netherlands, (4) Department of
Clinical Pharmacy, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands, (5)
DSM-THC, Veldhoven, The Netherlands, (6) Microlife Corporation, Taipei, Taiwan
Background Although several methods are available for measuring adherence to treatment, no
method fulfils all requirements for valid adherence measurement. The electronic blister (e-blister)
could be a valuable tool for adherence measurement.
Aim The investigate the feasibility of the e-blister
Methods The feasibility, the functionality, robustness, and adherence to treatment determined by the
e-blister were investigated in 115 patients. Functionality was determined by variables that could
influence the interpretation of registered events, and as a result the interpretation of adherence rates.
The robustness of the e-blister was determined by calculating the percentage of blisters that registered
multiple events at the same time as a consequence of breaking multiple conductive tracks. Adherence
was expressed as ta king and timing adherence, and days of correct dosing.
Results In total, 245 e-blisters were used during a mean period of 60 days (standard deviation [SD] 29
days). The registration of handing-out date and time of the e-blister took place in 72% of all e-blisters.
Registration of patient number or name, identification number of the e-blister, identification of the event
(i.e. date and time of pushing the pill through the e-blister), and handing-in date and time of the e-
blister was 100%. Forty-two e-blisters (17%) registered multiple events at the same time as a
consequence of breaking multiple conductive tracks. Mean taking and timing adherence, and days of
correct dosing were 97.6% (SD 11%), 86.9% (SD 29%), and 94.3% (SD 14%).
Conclusions The e-blister may be a valuable tool for measuring adherence to treatment. However,
functionality and robustness of the e-blister need further development.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
48
POSTER No 8
STUDYING THE IMPACT OF MEDICATION COUNSELING FOR
PATIENTS STARTING A TREATMENT WITH ANTIDEPRESSANT
DRUGS: STUDY DESIGN
Sophie Liekens2, Tim Smits1, 3, Gert Laekeman2, Veerle Foulon2
(1) Faculty of Business and Economics, K.U. Leuven, (2) Research centre for pharmaceutical care
and pharmaco-economis, K.U.Leuven, Leuven, (3) Research group Marketingmanagement, Lessius
University College
Background
Depressive disorders have a global impact on health-related quality of life as well as on socio-
economic parameters. Treatment with antidepressant drugs has shown to be effective if executed
correctly for an appropriate period of time. However, recent data suggest that only a minority of
patients ta king antidepressant drugs adhere to treatment recommendations.
Aim
I. The overall aim of this project is to study the impact of adherence- supporting counseling by
community pharmacists. The counseling will focus on new users of antidepressant drugs and the
impact will be measured on adherence as well as clinical, economic and humanistic parameters.
The project will also investigate
II. Attitude and stigma of community pharmacists towards patients with mental disorders
III. Impact of an education program involving consumer educators on stigma and attitudes
IV. Usage patterns of antidepressant drugs, including adherence (pharmaco- epidemiological study)
Methods
To answer the main research question (I), a randomized controlled trial will be set up. Pharmacists in
the intervention arm will be trained to counsel patients with a new prescription for an antidepressant
drug. Pharmacists in the control arm will deliver standard care. Four telephone-based surveys (0 to 6
months post-intervention) will be used to gather information on different parameters. In the pharmaco-
epidemiological study (IV), the database of a pharmacy-network containing patient-level data will be
analysed. To investigate stigma and attitudes of pharmacists (II) and to study the impact of an
education program (III) on these parameters, a mental health survey will be used that was previously
tested on pharmacy students.
Results
A survey of attitude and stigma by community pharmacists towards patients with depression was the
first step in the realization of this project and shows that in spite of pharmacists' positive attitude
towards depression and their willingness to play a role in depression care, current practice is far from
ideal. In the near future, interventions will be planned in order to improve pharmacists' competencies
in the care for depressive patients. The first results of the analysis of the dataset of the pharmacy-
network (still on-going), suggest that almost 40% of patients who use antidepressant drugs buy only 1
package (within the pharmacy network), which may point to non-adherence.
Conclusion
This project focuses on the impact of an underused group of healthcare professionals on an important
aspekt in the treatment of depressive disorders, i.e. non-adherence to treatment recommendations.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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POSTER No 9
Occurrence of prescriptions for noncurrent - changed or terminated
- treatment and prescription duplicates in electronic medical
records and the Swedish national prescription repository.
Anders Ekedahl,
Associate professor, Department of Drug Use (Social Pharmacy), Medical Product Agency, Sweden
Patient adherence to prescribed treatment for chronic conditions has been estimated to be on average
about 50% [1] and drug related problems may cause as much as 30% of acute admittances to hospital
care [2]. Discrepancies between medical records and patients‟ actual current medication are common
[3-5]. The objective of the present study was to compare current prescribed treatment stated by
patients with the printouts from the electronic medical record (EMR) and the Swedish national
prescription repository (NPR) with regard to (1) prescriptions for noncurrent (previously changed or
terminated) treatment, (2) prescription duplicates and (3) missing prescriptions.
Design: Cross-sectional study. Patients over 18 years of age with 5 or more prescriptions stored in
the NPR or the EMR, with follow-up visit at a health care centre or visiting a pharmacy, were invited to
the study. Patients giving written informed consent to participate were interviewed. The stated
prescribed current, ongoing treatment was compared with printouts of prescribed medication from the
EMR and of the stored prescriptions in the NPR.
Main Outcome Measures: Proportions of prescriptions for (a) noncurrent treatment (changed or
terminated), (b) prescription duplicates and (c) missing prescriptions in the EMR and the NPR.
Results: 216 patients with altogether 2515 prescriptions were included. In total, 71% were unique
prescriptions for current ongoing treatment, 17% were prescriptions for noncurrent treatment (changed
or terminated therapy) and 11% were prescription duplicates. Of 2195 prescriptions in the EMR, 75%
were unique prescriptions for current treatment, 13% were noncurrent, 11% were prescription
duplicates and 8% of the current prescriptions were missing. Of 1904 prescriptions in the NPR, 75%
were unique prescriptions for current ongoing medication, 13% were noncurrent prescriptions, 11%
were prescription duplicates and 20% of the current prescriptions were missing. The EMR and the
NPR contained _1 noncurrent prescription or duplicate for 76% and 69% of patients.
Conclusion: Prescriptions for noncurrent treatment and prescription duplicates as well as missing
prescriptions are common in both EMR and the Swedish NPR. Consequently, claims data based on
data of prescribed medicines in the EMR or the stored prescriptions in NPR contain many errors.
Adherence estimates measured as “claims data” for prescriptions in the EMR and NPR may deviate
significantly from true figures.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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POSTER No 10
Beliefs about medicines predict non-adherence with medication
intended for chronic use.
Harm Geers2, Eibert (Rob) Heerdink1, 2, Marcel Bouvy2
(1) University Medical Center Utrecht Department of Clinical Pharmacy, division of Laboratory and
Pharmacy PO Box 85 500, 3508 GA Utrecht, the Netherlands, (2) Utrecht University, Faculty of
Science Utrecht Institute for Pharmaceutical Sciences Division of Pharmacoepidemiology &
Pharmacotherapy PO Box 80 082, 3508 TB Utrecht, the Netherlands
Introduction
Many patients discontinue chronic medication early. It is unclear if non-adherence can be predicted at
the start of therapy.
Objective
To investigate whether poor taking compliance or non-persistence of chronic medication can be
predicted from patients' beliefs about medicines.
Methods
A prospective follow study. Patients were included in nine pharmacies in The Netherlands and were
eligible for inclusion if they filled a first prescription for a drug intended for chronic use. All patients
received a questionnaire at the time of the first prescription (t0), one month (t1) and six months (t6)
after the first prescription. The questionnaire consisted of both the Believes about Medicines
Questionnaire general and specific (BMQ) and the Satisfaction about Information on Medicines Scale
(SIMS). Electronic dispensing records were extracted from the pharmacies 10 months after inclusion.
Poor taking compliance was defined as a medication possession rate (CMA) less than 80% and non-
persistence was defined after a 90 day medication gap had emerged. Multivariable logistic regression
models were constructed with either taking compliance or non-persistence as a dependent variable,
using the questions at t0, t1 and t6 as covariates. The best predictive model was selected and a risk
score was calculated from the remaining significant covariates. Sensitivity and specificity were
calculated for each risk score to determine the optimal cutoff value for each model.
Results
Response rates at t0, t1 and t6 were 50%, 39% and 34% respectively. Medication histories of 355
patients were extracted, 21 patients were lost to follow-up or excluded. At t0 no predictive model could
be constructed. The areas under the Receiver Operator Characteristic (ROC) curve for the best
predicting model (t1) were 0.840 [95% CI 0.760-0.920] for taking compliance and 0.799 [95% CI
0.709-0.889] for non-persistence. At the optimal cutoff values of the risk scores sensitivity and
specificity were 0.80 and 0.71 for non-persistence and 0.79 and 0.69 for poor taking compliance.
Conclusions
Predicting non-adherence from patients' beliefs and knowledge about medicines is possible using the
multivariate risk model from this study.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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POSTER No 11
Impact of Drug Reminder Packaging on Compliance? Where Are the
Research Gaps?
Fabienne Boeni2, Katja Suter1, Isabelle Arnet2, Kurt. E. Hersberger2
(1) Clinical Pharmacy & Epidemiology, University Hospital, Spitalstrasse 26 & Hebelstrasse 2, CH-
4031 Basel, (2) Pharmaceutical Care Research Group, University of Basel, Klingelbergstr. 50, CH-
4056 Basel
Background: Non compliance is a common problem occurring in all age classes, long- and short-term
treatment, and all medical conditions with rates around 50%. Reasons for non compliance are
manifold. Various authors have assumed drug reminder packaging to be a solution for forgetful and
elderly patients with complex therapeutic regimens. Such drug reminder packaging is widely used in
practice, but the effect on compliance and patient relevant endpoints has not been established yet.
Previous reviews applied rather rigid selection criteria for literature inclusion.
Aims: To analyse the impact of drug reminder packaging through comprehensive literature search, to
compile an evidence map, to uncover research gaps, and to support the rationale for future study
approaches.
Methods: In a systematic review PubMed, Embase, Cinhal, and PsychInfo were searched until May
2010, using 16 different terms for "drug reminder packaging". Studies were included if they used a
prospective controlled setting, if the intervention involved a specific unit-of-use drug packaging
intended to serve as a reminder system, if patients took one or more medications without the
assistance of a healthcare professional and if at least one of the following four parameters was
measured: taking compliance, economic, clinical, or humanistic outcomes. To map evidence, articles
were analysed with respect to methodological quality and outcomes. Methodological analysis was
based on a quality assessment tool for quantitative studies (Effective Public Health Practice Project)
and on additional criteria to evaluate specific points of interest.
Results: A total of 1559 references were identified, of which 29 studies fulfilled the inclusion criteria
(24 randomized controlled trials and 5 prospective cohort studies). Taking compliance was measured
in 28 studies. All studies demonstrated improved compliance, but only 15 showed a significant
difference between intervention and control group, and few studies included economic (2 studies),
clinical (16 studies), and humanistic outcomes (6 studies). Although most of the studies chose a
design of high quality, they lacked of methodological exactness. Major methodological weak points
were low patient number, inadequate description of intervention, insufficient information about
potential confounders, short study duration, high dropout rates, and poorly presented results. Mapping
the evidence revealed that main efforts has been put into study design and compliance measurement.
Eminent gaps were poorly tailored interventions, applicability in daily life, sufficient reporting as well as
humanistic and economic outcomes.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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POSTER No 12
MEDICATION ADHERENCE IN PATIENTS TREATED FOR COPD
Tamás Ágh1, Ágnes Mészáros1
(1) University Pharmacy Department of Pharmacy Administration, Semmelweis University. Hungary.
aghtamas@t-email.hu
Background: Many factors that influence adherence to therapy with respiratory drugs are directly
related to patient characteristics and treatment regimen. It is necessary to identify these factors for the
development of more effective strategies to improve medicine taking behaviour.
Aim: The objectives of the study were: (1) to estimate adherence to complex pulmonary therapy and
(2) to identify factors that influence adherence in COPD.
Methods: In the cross-sectional study the following information were obtained: adherence (4-item self-
reported Morisky Medication Adherence Scale), age, gender, disease severity (post-bronchodilator
spirometry: FEV1), smoking, number of drugs and number of daily doses. We did not demarcate the
drugs as inhaled or oral medications. Differences in patient characteristics between adherence stages
were tested using Pearson Chi-square test for categorical variables, and Kruskal-Wallis test for
continuous variables.
Results: Data were obtained from 170 patients (mean age: 63,83 (SD=11,24) years). Seven out of ten
participants did not adhere completely to the medication treatment (32% (n=55) high, 26% (n=44)
medium and 42% (n=71) low adherent). There were significant differences between the median score
of age in the different groups of adherence (Chi-square=53,854, p=0,000). Adherence was correlated
with smoking (Chi-square=14,66, p=0,001), number of drugs (Chi-square=81,061, p=0,000) and
number of daily doses (Chi-square=169,694, p=0,000). Adherence to medication was not related to
gender or disease severity.
Conclusion: Non-adherence represents a significant problem of realizing the optimal disease
management in COPD. Middle age, smoking patients should be heeded with special attention by the
clinicians, because the non-adherent rate is very high in this population. The present study indicates
that number of drugs and doses per day are inversely related to drug taking behaviour. Treatment for
COPD is based on general medical condition and disease severity. Patients with moderate to severe
COPD are treated with complex therapy, so in many cases the number of drug substances can not be
reduced. Using fix combination and/or low dosing-frequency drugs can be expected to be as effective
way to enhance adherence in routine clinical practice. Patient cooperation with medication was low
over six daily doses, therefore it would be necessary to apply less frequent dosing regimens.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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POSTER No 13
EXPLORING ETHNIC DIFFERENCES IN PATIENT PERSPECTIVES
ON MEDICINES AND MEDICINE-TAKING: A CROSS-CULTURAL
STUDY IN NEW ZEALAND
Beata Bajorek2, Debbie Bassett-Clarke1, Ines Krass2
(1) Faculty of Health and Environmental Science, Auckland University of Technology, New Zealand,
(2) Faculty of Pharmacy, University of Sydney, Australia
Introduction
The literature identifies many barriers to medicines use, including bio-psycho-social issues, but less is
known regarding the ethno-cultural barriers, which are important in culturally diverse nations such as
Australia and New Zealand (NZ). The aim of this study is to explore ethnic differences in medicine-
taking, focussing on the NZ population, comprising NZ Maori, NZ European, Pacific Island (Pasifika)
and Asian immigrants. The results will help inform the development of resources and communication
tools to assist pharmacists in providing pharmaceutical care to diverse patient populations.
Method
A qualitative study involving a series of focus groups (4 per population stratum for each of Maori,
Pacific Islanders, European, and Asian populations) was conducted. Focus groups were chosen
mainly because they are appropriate to the social context of the various ethnic groups involved, as
storytelling is important in oral and/or indigenous cultures. Participants over the age of 55 years and
taking medicines were recruited from various community-based groups (eg local health services,
community groups). The group discussions were transcribed verbatim and then analysed for key
themes via manual inductive coding. The validity of the findings was confirmed through respondent
(participant)-checking and independent researcher review.
Results
Twenty focus groups involving 100 participants (aged >=55 years) were conducted. Overall, three key
common themes emerged across the various groups:
1. Conception of a medicine
2. Issues about medicines information
3. The degree of engagement in self-management of medicines
In general, the NZ European participants had a very narrow view of what a medicine is, were
motivated to source medicines information independently, and were very proactive in medicines
management. At the other end of the spectrum, Pasifika peoples expressed a broad view of what
constitutes a medicine, were not motivated to source medicines information independently, and were
not proactive in medicines management, tending to instead rely on the health care professional to
supply the answers. The findings from the various Ethnic groups highlight differences in attitudes to
medicines per se and medicines-taking, and these influences on medication-taking behaviour need to
be considered in the provision of pharmaceutical care.
Conclusion
Ethnic differences in attitudes to medicines and medicine-taking are apparent, although there are
some commonalities in terms of needs regarding support and advice around medicines use.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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POSTER No 14
Achieving INR Target And Patient Satisfaction of Warfarinised
Patients in HKL
Subramaniam Thanimalai, Agnes HSY1, Chan BS1, Chan CK1, Nadrah N1
(1) none
All patients receiving warfarin therapy should achieve the recommended INR targets to reduce the risk
of thromboembolic events or bleeding. In 2008, only 50% of the time Hospital Kuala Lumpur (HKL)
atrial fibrillation patients met the INR targets. This quality assurance project aims to improve the
percentage of time patients were within their INR targets and patients satisfaction towards the services
provided by identifying the contributing factors and implementing remedial actions.
To provide a shorter clinic waiting time and to improve patient knowledge, which will contribute to the
increase in percentage of time patients are within their INR targets.
An initial study was done to identify the percentage of time patients were within their INR targets and
this was conducted from January to April 2008. A brainstorming session was held to identify the
contributing factors. Remedial actions were implemented continuously from April 2008. Evaluation of
the effectiveness of remedial action in terms of percentage of time patients were within their INR
targets, clinic waiting time and patient warfarin knowledge took place from April to July 2009.
Atrial fibrillation patients constituted the majority (85%) of patients on warfarin therapy in HKL. The
long waiting time, poor knowledge, non-adherence and reduced opportunity to discuss drug related
issues were the major contributors to the non-achievement of INR targets.
The remedial actions involved were based on 3 aspects, which are Process, Knowledge and Attitude.
Process based remedial actions included introduction of Point of Care Testing (POCT) Coagulometer,
on the spot warfarin dispensing and INR monitoring by pharmacist. Implementation of problem solving
approach during Warfarin Medication Therapy Adherence Clinic(WMTAC), continuous education
sessions, provision of standard counseling checklist and introduction of a new Patient Information
Handbook were part of Knowledge based remedial actions. As for the attitude based remedial actions,
patients were given Warfarin Calendar to record their warfarin consumption.
After remedial action, it was found that the percentage of time patients within their INR targets improve
from 50% to 66%. There was a reduction of clinic waiting time by 51.5%. 90% of the patients were
also satisfied with the remedial actions implemented.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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POSTER No 15
A NATIONWIDE SURVEY ON MEDICATION ADHERENCE AMONG
POLISH PATIENTS AND HEALTHCARE WORKERS
Wojciech Kuzmierkiewicz1
(1) The Foundation for the Development of Polish Pharmacy and Medicine, Starogard Gdanski,
Poland, e-mail: wojciech.kuzmierkiewicz@polpharma.com
Background: In Poland, research in the field of patient adherence started only recently. Therefore,
little is known about the attitudes of both patients, and healthcare workers toward adherence.
Aim: The aim of this study was to assess patients' and healthcare workers' attitudes toward
adherence in chronic conditions. The survey consisted of two phases. The qualitative phase aimed at
identifying the barriers to adherence, as well as the factors motivating them to adhere to the therapy.
The goal of the quantitative phase was to determine the scale and reasons for not following the
doctor's instructions in the Polish society.
Methods: A qualitative phase was designed in the form of focus group discussions with both
healthcare workers (cardiologists, diabetologists, psychiatrists, GPs, community nurses, and
pharmacists), as well as patients (those suffering from cardiovascular diseases, schizophrenia,
mothers of children diagnosed with asthma, or allergy, and elderly). A quantitative phase was carried
out in the form of a multi-theme opinion poll on a sample of 1006 respondents aged 15 and over, of
which 228 declared to be diagnosed with one or more of chronic conditions.
Results: Survey results indicate that the healthcare workers are aware of the importance of patient
adherence, but they do not perceive this problem as an important social and medical issue, and they
feel helpless against the real behaviour of patients. Results confirm that many Polish patients
discontinue or modify the prescribed treatment. Only 65% of chronically ill patients declare that they
always take the prescribed doses. Every fourth chronically ill patient failed to follow the doctor's
instructions, either using only a part of the prescribed package, or some or only one of the prescribed
medicines. The survey revealed three key barriers to good adherence:
• The patients' knowledge is limited mainly to the most serious risks - which are the easiest not to treat
seriously since they seem too distant and occur only in extreme cases,
• The knowledge of less serious consequences is lacking, this leads to disregarding one's state of
health or the need for regular treatment;
• Lack of awareness of the positive results of compliance.
It was also observed, that the smaller the trust in the doctors, the more often the patients modify the
therapy on their own.
Conclusion: The results of the survey indicate that Polish patents' compliance with the therapeutic
instructions in the treatment of chronic diseases is far from perfect. At the same time, healthcare
workers are not fully aware of the problem, and often find themselves helpless when facing it. In such
a situation it is worth considering the introduction of changes into the curriculum of medical students
and graduates concerning communication, motivation and negotiations in the context of the chronically
ill patients. It also seems essential to build a strong coalition toward improved compliance, with the
participation of all the relevant stakeholders.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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POSTER No 16
INVOLVING PATIENTS IN THE DEVELOPMENT OF A GROUP-
BASED EDUCATIONAL INTERVENTION FOR A RANDOMISED
CONTROLLED TRIAL TO IMPROVE ADHERENCE TO
GLAUCOMA EYE DROPS
Heather Waterman3, Lisa Brunton3, Cliff Richardson3, Cecilia Fenerty1, Fiona Spencer1, David
Henson2
(1) Manchester Royal Eye Hospital, (2) School of Medicine, University of Manchester, (3) School of
Nursing, Midwifery and Social Work, University of Manchester
Background
Glaucoma is the leading permanent cause of blindness worldwide. Glaucoma eye drops have been
shown to slow down or prevent loss of sight yet, as in other long term conditions, patients do not instil
them as prescribed. Health policy in the UK identifies that education is important to improve adherence
to glaucoma medicines. A recent Cochrane review could not recommend any particular interventions
for patients with glaucoma due to poor quality research. Evidence from other long term conditions
suggests that group-based education might be a successful and cost-effective alternative method and
the involvement of patients could lead to more relevant programmes.
Aim
The aim of this study, therefore, is to work with people with glaucoma and health professionals to
determine the delivery, content, frequency and duration of a group-based glaucoma education
programme. This study is an important forerunner to future research to conduct a randomized
controlled trial comparing individual education with group-based education.
Methods
The selected research design was action research. An action research group was formed with five
patients with glaucoma, seven health professionals and the research team. The purpose of the ARG
was to critically review literature on group-based education models, identify local organisational
facilities and constraints, and discuss their own prejudices and experiences of education. Meanwhile,
30 people with established and newly diagnosed glaucoma were interviewed. Open-ended questions
focussed on understanding adherence patterns, and needs and preferences for an educational
programme. Data from the interviews and the ARG meetings were analysed qualitatively to identify
barriers or facilitators of adherence. These were taken as potential indicators of what should be
included in an educational programme and thus were reconfigured into learning outcomes. Data was
also searched and categorised according to patients expressed preferences for the length, frequency
and delivery of the programme. A literature review of group-based education models was also
conducted by a research assistant and the components of the models were compared with the
learning outcomes.
Results
Theory: The constituent parts of the Information, Motivation and Behavioural Theory most closely
matched the learning outcomes of the group based education programme thus developed.
Content: Ten learning outcomes were identified for inclusion in the group-based educational
intervention, for example, understanding the diagnosis of glaucoma and the implications of eye drops,
feeling confident to instil their drops, and being able to ask questions of health professionals.
Frequency/Duration: Two sessions lasting no longer than two hours each time, were considered
optimal to be able to deliver the proposed content and to ensure patient acceptability of duration (to
increase attendance).
Delivery: There was strong patient preference for the intervention to be provided by health
professionals and opposition to a layperson led intervention. This is in contrast to recent NHS
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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initiatives such as the Expert Patient Programme. A facilitative method of delivery was favoured over
didactic teaching methods.
Conclusion
The participatory methodology used for this study has proved particularly suited to developing a group-
based education programme.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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POSTER No 17
Medication Persistence in the Treatment of HIV Infection: A Review
of the Literature and Implications for Future Clinical Care and
Research
Jason W. Bae, William Guyer, Kristy Grimm, Frederick L. Altice
Yale University School of Medicine, email: Frederick.altice@Yale.edu
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PRACTICAL INFORMATION
TRANSFER FROM FOCUS HOTEL TO CONFERENCE VENUE AND BACK
There will be shuttle buses to the conference venue departing from Focus Hotel at 8.15 on
17th and 18th September.
After the conference on the 17th , there will be a shuttle bus from the conference venue to
Focus Hotel at 17:00.
Or... you may like to take a walk around the Manufaktura Shopping and Leisure Centre
neighbouring the Poznanski‟s Palace (located in former industrial buildings belonging to
Israel Poznanski‟s cotton empire. http://www.wirtualnafabryka.com/ )
CONFERENCE VENUE AND REGISTRATION DESK
The conference pack and registration will be available from 08:00 in the mornings of 17th
and 18th September. There will be a place to leave your luggage if required – please enquire
at the desk.
The conference will take place at Israel Poznanski’s Palace - Museum of the City of Lodz
located at 15, Ogrodowa Str. In 70s and 80s, of the 19th century, Izrael Poznanski became
the “King of cotton” in Lodz. He was the owner of the biggest palace and the textile factory in
Lodz in the 19th century. The Poznanski Palace has been listed as one of the largest and
greatest residence of its type.
The palace was functionally connected with a huge cotton production plant, a housing estate
for workers and other accompanying buildings. Former industrial buildings have been
revitalized and adapted into the 4-star deluxe hotel, as well as shopping, entertainment and
cultural centre Manufaktura – one of the most interesting in Europe.
CONFERENCE LUNCH
Tea & coffee breaks and lunch will be provided at the conference venue on 17th and 18th
September.
PRESENTERS
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
60
The conference venue will be open from 08:00 on 17th and 18th September. Poster
presenters are asked to set up their posters as early as possible on 17th September.
Adhesives accessories will be made available.
Paper presenters are asked to send their slides by email at the latest on 15th September to
family@csk.umed.lodz.pl. If you are bringing your slides with you, a technician will assist
you with uploading them between 08:00 and 9:00 in the mornings of 17th and 18th September
or during coffee breaks.
CONFERENCE GALA DINNER
The conference dinner will be organized at “U Fabrykanta” Restaurant. The address is 2,
Plac Zwycięstwa. There will be shuttle buses departing from Focus Hotel at 19.45; and
returning from 23:00 onwards.
TRANSFER FROM LODZ TO WARSAW AIRPORT ON 18th SEPTEMBER
Conference participants who marked an option “require transfer to Warsaw airport on 18th
September” during registration are free to take a bus shuttle provided by the organizers at
15.00 o’clock. The bus will leave from the conference venue.
Alternative ways of getting to Warsaw airport:
- A taxi to the airport. The fare would be 400-450 zloty (100-120 Euro). Corporate taxis
(the ones having a company name and phone number on them) are less expensive.
We can book a taxi for you on request.
- Train from Lodz Fabryczna Station to Warsaw Central Station and a taxi to the
airport. Trains leave app. every 80 minutes. The journey lasts about 90 minutes. The
timetable in English is available at http://rozklad-pkp.pl/. Tickets are available at cash
desks in the main hall of the train station and credit cards are accepted.
Please note that due to construction work, the Warsaw airport will be partially closed
in the evening of 17th, on the 18th (morning to evening) and on the morning of 19th
September. Some departures will be on schedule, some will be redirected to other
airports, mostly to Lodz (which is good news). Please, check with your airlines if your
arrival/departure will be from Warsaw or will be redirected to a different airport.
ADDITIONAL INFORMATION FOR ESPACOMP BOARD
The dinner for Board Members and Invited Speakers on 16th September will be organized at
FOCUS hotel at 20:00. FOCUS hotel is located in Lodz, at 23/25 Lakowa Str.
The ESPACOMP Board Meeting will take place on 17th September from 17.00:18.30 at the
conference site.
ADDITIONAL INFORMATION FOR INVITED SPEAKERS
The hotel rooms for you have been booked at FOCUS hotel, located in Lodz at 23/25
Lakowa Str.
The dinner for Invited Speakers and Board Members on 16th September will be organized at
FOCUS hotel at 20:00.
CONTACTS
Contact telephone numbers: Anna +48 509 686 431, Pawel + 48 501 183 148
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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MAP OF LODZ
Legend:
1. Poznanski‟s Palace -
Museum of the City of
Lodz (Conference venue),
15, Ogrodowa Str.
2. Focus Hotel, 25, Łąkowa
Str.
3. “U Fabrykanta”
Restaurant, 2, Plac
Zwycięstwa Sq.
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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NOTES
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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NOTES
The 14th European Symposium on Patient Adherence, COMpliance and Persistence, Lodz, Poland, 17-18.09.2010
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NOTES
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