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.

Fundamento y objetivo: Ensayar la contribucion de las concentraciones plasmaticas de efavirenz y nevirapina en la valoracion de la adhesion al tratamiento antirretroviral. Pacientes y metodo: Estudio observacional transversal. La adhesion se valoro utilizando cuestionarios, recogida de farmacos y concentraciones plasmaticas de efavirenz y nevirapina. Se estudio a 45 pacientes que recibian efavirenz o nevirapina en combinacion con dos inhibidores de la transcriptasa inversa analogos de nucleosidos (ITIAN). Resultados: De los 45 pacientes, 7 fueron considerados no adherentes de acuerdo con los cuestionarios, 17, segun farmacia y 5, utilizando las concentraciones plasmaticas de efavirenz y nevirapina. El 33,3% tenia carga viral detectable. Conclusion: La asociacion de adherencia autodeclarada y citas en farmacia puede mejorar la validez de la medida de adhesion al tratamiento antirretroviral. Las concentraciones plasmaticas de efavirenz y nevirapina son relativamente estables, y no aportan ninguna informacion.

Valoración de la adhesión al tratamiento antirretroviral: papel de la determinación de la concentración plasmática de los fármacos no análogos de nucleósidos

Fundamento y objetivo Conocer las variables predictoras de carga viral detectable (CVD) en pacientes en tratamiento antirretroviral de gran actividad Pacientes y metodo Estudio observacional (cross-sectional) en pacientes en tratamiento antirretroviral con 2 inhibidores de la transcriptasa inversa analogos de nucleosidos y un inhibidor de la proteasa. Se recogieron diversas variables sociodemograficas y clinicas. Para la valoracion de la adherencia se establecieron los modelos I, que reune los criterios autodeclarado y farmacia, y II, que incluye las concentraciones plasmaticas en sujetos adherentes con los 2 criterios anteriores y CVD. Se realizo un analisis de regresion logistica con las variables asociadas con la presencia de CVD en el analisis univariado y se disenaron un algoritmo diagnostico y las curvas de eficacia diagnostica para seleccionar el modelo que mejor predice la presencia de CVD Resultados De 136 pacientes estudiados, 39 (28,7%) presentaban CVD. Los menores de 35 anos ( odds ratio [OR] = 2,68), los infectados por compartir jeringuillas o por relaciones heterosexuales (OR = 6,42), aquellos no totalmente convencidos de la capacidad de mutacion del virus de la inmunodeficiencia humana (VIH) por mala adhesion (OR = 3,25) y los clasificados como no adherentes con el modelo que incluia concentraciones plasmaticas (OR = 6,91) presentaban con mayor frecuencia CVD. El modelo que mejor predijo la CVD incluiria a pacientes clasificados como no adherentes con cualquiera de los 2 modelos que ademas presentaban otro de los factores de riesgo detectados; la prevalencia de CVD en estos fue del 10% frente al 43% Conclusiones La adhesion al tratamiento antirretroviral de gran actividad es un factor muy importante en la prediccion de CVD, especialmente en pacientes jovenes, los infectados por compartir jeringuillas o via heterosexual y aquellos no convencidos de la importancia de la adhesion

Factores predictores de carga viral detectable en pacientes en tratamiento antirretroviral de gran actividad

Trabajo presentado en el Experts Workshop to discuss the terms of reference a new fib Special Activity, celebrado en Torino (Italia) en octubre de 2009

Manual REHABCON on concrete repair and rehabilitation

The use of antimicrobials is high in general surgery units. In order to optimize antimicrobials used in the treatment of intra-abdominal infection, ertapenem was included in 2007 in the formulary of the Complejo Asistencial Universitario de Leon. It was restricted for patients with high-severity community-acquired intra-abdominal infection or with risk factors for poor outcome, as a strategy to save antibiotics with greater spectrum (carbapenems, piperacillin/tazobactam) or as strategy of therapeutic de-escalation. Antibiotic consumption in the surgery unit was analyzed from 2006 to 2011. Defined daily doses per 100 bed-days (DBD) were calculated. We also analyze the clinical histories of patients treated with ertapenem admitted to this unit during 2011. The surgery unit has a high rate of use of antibiotics (average consumption 64.97 ± 3.98 DBD). The group of penicillins is the most consumed (average consumption 24.45 ± 2.18 DBD). It highlights the increased use of piperacillin/tazobactam and a significant decrease in the use of amiglycosides and imidazoles, parallel to the increase in the use of all carbapenems since ertapenem was introduced in the formulary. In 2011, at least in 47,4 % of cases ertapenem was used out off protocol

/pdf/estudio-de-utilizacion-de-antimicrobianos-en-un-servicio-de-10v2pyf1io.pdf

Estudio de utilización de antimicrobianos en un servicio de cirugía general tras modificaciones en la guía farmacoterapéutica

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