The full benefit of many effective medications will be achieved only if patients adhere to prescribed treatment regimens. Unfortunately, applying terms such as “noncompliant” and “nonadherent” to patients who do not consume every pill at the desired time can stigmatize them in their future relationships with health care providers. This article on medication adherence (or compliance) reviews strategies to assess and enhance this important aspect of patient care.

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Adherence to Medication

Summary
This report describes the epidemiology, burden, and treatment of osteoporosis in the 27 countries of the European Union (EU27).

/pdf/osteoporosis-in-the-european-union-medical-management-5gi5e439ck.pdf

Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA).

Adherence to therapies is a primary determinant of treatment success Failure to adherence is a serious problem which not only affects the patient but also the health care system Medication non adherence in patients leads to substantial worsening of disease, death and increased health care costs A variety of factors are likely to affect adherence Barriers to adherence could be addressed as patient, provider and health system factors, with interactions among them Identifying specific barriers for each patient and adopting suitable techniques to overcome them will be necessary to improve medication adherence Health care professionals such as physicians, pharmacists and nurses have significant role in their daily practice to improve patient medication adherence

/pdf/patient-medication-adherence-measures-in-daily-practice-5g5cs5p7gl.pdf

Patient medication adherence: measures in daily practice.

A review of 77 studies employing self-report measures of antiretroviral adherence published 1/1996 through 8/2004 revealed great variety in adherence assessment item content, format, and response options. Recall periods ranged from 2 to 365 days (mode=7 days). The most common cutoff for optimal adherence was 100% (21/48 studies, or 44%). In 27 of 34 recall periods (79%), self-reported adherence was associated with adherence as assessed with other indirect measures. Data from 57 of 67 recall periods (84%) indicated self-reported adherence was significantly associated with HIV-1 RNA viral load; in 16 of 26 (62%), it was associated with CD4 count. Clearly, the field would benefit from item standardization and a priori definitions and operationalizations of adherence. We conclude that even brief self-report measures of antiretroviral adherence can be robust, and recommend items and strategies for HIV research and clinical management.

/pdf/self-report-measures-of-antiretroviral-therapy-adherence-a-yg2a6d0h2l.pdf

Self-report measures of antiretroviral therapy adherence: A review with recommendations for HIV research and clinical management.

Osteoporosis, literally “porous bone”, is a disease characterized by weak bone. It is a major public health problem, affecting hundreds of millions of people worldwide, predominantly postmenopausal women. The main clinical consequence of the disease is bone fractures. It is estimated that one in three women and one in five men over the age of fifty worldwide will sustain an osteoporotic fracture. Hip and spine fractures are the two most serious fracture types, associated with substantial pain and suffering, disability, and even death. As a result, osteoporosis imposes a significant burden on both the individual and society. During the past two decades, a range of medications has become available for the treatment and prevention of osteoporosis. The primary aim of pharmacological therapy is to reduce the risk of osteoporotic fractures. The objective of this report is to review and describe the current burden of osteoporosis and highlight recent advances and ongoing challenges for treatment and prevention of the disease. The report encompasses both epidemiological and health economic aspects of osteoporosis and osteoporotic fractures with a primary geographic focus on France, Germany, Italy, Spain, Sweden, and the UK. Projections of the future prevalence of osteoporosis and fracture incidence, the total societal burden of the disease, and the consequences of different intervention strategies receive special attention. The report may serve as a basis for the formulation of healthcare policy concerning osteoporosis in general and the treatment and prevention of osteoporosis in particular. It may also provide guidance regarding the overall healthcare priority of the disease. The report is divided into six chapters: 1. Introduction to osteoporosis The first chapter provides a brief review of osteoporosis, how osteoporotic fractures are defined, a description of the most common osteoporotic fractures, the burden of fractures, as well as challenges in the delivery of health care to reduce the number of fractures. 2. Medical innovation and clinical progress in management of osteoporosis The second chapter reviews the measurement of bone mineral density, diagnosis of osteoporosis, methods for assessment of fracture risk, the development of interventions that reduce the risk of fractures, practice guidelines, and the cost-effectiveness of osteoporosis treatments. 3. Epidemiology of osteoporosis The third chapter reviews the epidemiology and consequences of osteoporosis and fractures, as well as different approaches for setting intervention thresholds ( i.e. at what fracture risk it is appropriate to initiate treatment ). 4. Burden of osteoporosis The fourth chapter presents a model estimation of the current burden of osteoporosis in the five largest countries in the European Union ( EU5 ) and Sweden. The burden is described in terms of fractures, costs, and quality-adjusted life years ( QALYs ) lost. 5. Uptake of osteoporosis treatments The fifth chapter provides a description of the current uptake of osteoporosis treatments, that is, how many patients of those eligible for treatment that actually can be treated in France, Germany, Italy, Spain, Sweden and the UK. International sales data from 1998 and forward was used to analyse international variations in treatment uptake. 6. The future burden of fractures and the consequences of increasing treatment uptake The last chapter presents projections of how the demographic changes in the five largest countries in the France, Germany, Italy, Spain, Sweden and the UK will impact the burden of osteoporosis up to 2025. Hypothetical projections of increments in treatment provision are also explored, and the impact of increased treatment on costs, fracture rates, and morbidity is estimated.

/pdf/osteoporosis-burden-health-care-provision-and-opportunities-53mj8depl1.pdf

Osteoporosis: burden, health care provision and opportunities in the EU: a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA).

Objective: To assess the contribution of the determination of concentrations of indinavir (IND) in plasma to the assessment of self-reported adherence and keeping of appointments to withdraw drugs from the hospital pharmacy. Patients and Methods: Adherence was assessed using three criteria: questionnaires, punctuality at appointments to withdraw drugs, and plasma concentrations of IND. Blood samples were obtained from 106 HIV-infected patients who had been receiving IND in combination with two nucleoside reverse transcriptase inhibitors for longer than 6 months. Logistic regression analysis was carried out, and receiver operating characteristic curves were drawn. Results: The kappa index showed a low concordance for the three measures. When pharmacy appointments and self-report are used together, the nondetection of drug levels is more reliably predicted (AUC = 0.75). With the viral load as the gold standard, plasma levels contribute nothing to the information given by the other two measures combined (AUC = 0.63, AUC = 0.64). Conclusion: Measurement of adherence to highly active antiretroviral therapy is complex. Because there is no gold standard for it, we demonstrated that each of three common adherence measures has shortcomings that can be minimized in a combined measurement system. Indinavir plasma levels appear to provide no additional information, so further studies are undoubtedly necessary.

Assessment of adherence to triple antiretroviral treatment including indinavir: role of the determination of plasma levels of indinavir.

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Assessment of adherence to triple antiretroviral treatment including indinavir: role of the determination of plasma levels of indinavir.