ARTICOLI DALLA LETTERATURA SCIENTIFICA

L’aderenza terapeutica nelle terapie metaboliche e cardiovascolari: una questione di genere?
Analisi condotta dal Prof. Andrea Lenzi “Sapienza” Università di Roma, Dipartimento di Medicina Sperimentale

Introduzione
L’aderenza terapeutica è un concetto complesso e multidimensionale, definito dalla Consensus internazionale promossa dalla Commissione Europea come “il processo attraverso il quale i pazienti assumono farmaci come prescritti”. E’ costituita da tre fondamentali elementi: l’iniziazione, il periodo tra la prescrizione e la prima somministrazione del farmaco; l’attuazione, il grado di aderenza del paziente al regime terapeutico prescritto; e la sospensione, l’interruzione del trattamento (1). Ognuna di queste tre componenti può essere significativamente ostacolata da importanti barriere. In particolare, si stima che una quota non trascurabile di pazienti non inizi mail la terapia prescritta (2). I principali limiti all’attuazione includono, invece, sia condotte non intenzionali, come la disattenzione e la dimenticanza, spesso legate a deficit cognitivi, sia condotte intenzionali volte a modificare le prestazioni mediche nei tempi e nei dosaggi. I termini “aderenza” e “persistenza” sono ampiamente usati come sinonimi. Tuttavia, la persistenza è strettamente definita come il periodo di tempo tra l’inizio della terapia e la somministrazione che precede l’interruzione, mentre la non persistenza è la causa…Continua a leggere

Medication adherence to direct anticoagulants in patients with non-valvular atrial fibrillation – a real world analysis
Catarina Brízido 1, António Miguel Ferreira 2, Pedro Lopes 2, Christopher Strong 2, Gustavo Sá Mendes 2, Francisco Fernandes Gama 2, Anaí Durazzo 2, Gustavo Rocha Rodrigues 2, Daniel Matos 2, Sara Guerreiro 2, Sérgio Madeira 2, Jorge Ferreira 2, Pedro Adragão 2, Miguel Mendes 2

Introduction and objectives: Direct oral anticoagulants (DOACs) changed the landscape of atrial fibrillation (AF) treatment, but also brought new challenges in terms of accessibility and compliance. The purpose of this study was to assess adherence to DOACs, and predictors of adherence in a population of AF patients.
Methods: Single-center retrospective study including all patients with non-valvular AF treated with a DOAC and followed in outpatient general cardiology, whose first DOAC prescription was between 1 April 2016 to August 2018. The number of pharmacy refills from the day of first prescription to 31 August 2018 was counted (by means of an electronic prescription platform). Medication refill adherence (MRA) was calculated by dividing the total days of supply by the number of days under therapy. Non-compliance was defined as MRA <90%.
Results: A total of 264 patients (120 men, mean age 74 [PLEASE INSERT SYMBOL] 12 years) met the inclusion criteria. The median CHA2DS2VASC score was 3 (interquartile range (IQR) 2-5)…Read more
 

Real-world Antihypertensive Treatment Patterns, Treatment Adherence, and Blood Pressure Control in the Elderly: An Italian Awareness-raising Campaign on Hypertension by Senior Italia FederAnziani, the Italian Society of Hypertension and the Italian Federation of General Practitioners
Rita Del Pinto 1, Giovambattista Desideri 2, Claudio Ferri 1, Enrico Agabiti Rosei 3 4

Introduction: Achieving hypertension control is beneficial regardless of age. Fixed-combination pills have the potential of increasing adherence to treatment, improving the benefit/risk ratio, and simplifying therapy, with resulting convenience especially in the elderly.
Aim: We examined real-world antihypertensive treatment adherence and hypertension control rates in a cohort of Italian elderly individuals, enrolled in a prospective, pragmatic awareness-raising campaign on blood pressure (BP).
Methods: 13196 treated hypertensive elderly (mean age 73.2±7.5 years, 55.5% women) were recruited through opportunistic sampling, answered a brief questionnaire on antihypertensive therapy, and were followed-up for 6 months, when BP was measured as per routine care. Controlled hypertension was defined as BP < 140/90 mmHg. Real-world treatment adherence and hypertension control rates were evaluated at 6 months according to different treatment patterns (fixed-dose versus free combinations), using Yates correction…Read more
 

Optimizing Oral Targeted Anticancer Therapies Study for Patients With Solid Cancer: Protocol for a Randomized Controlled Medication Adherence Program Along With Systematic Collection and Modeling of Pharmacokinetic and Pharmacodynamic Data
Carole Bandiera # 1 2 3, Evelina Cardoso # 4, Isabella Locatelli 3, Antonia Digklia 5, Khalil Zaman 5, Antonella Diciolla 5, Valérie Cristina 5, Athina Stravodimou 5, Aedo Lopez Veronica 5, Ana Dolcan 5, Apostolos Sarivalasis 5, Aikaterini Liapi 5, Hasna Bouchaab 5, Angela Orcurto 5, Jennifer Dotta-Celio 3, Solange Peters 5, Laurent Decosterd 6, Nicolas Widmer 2 6 7 8, Dorothea Wagner 5, Chantal Csajka # 2 4 7, Marie Paule Schneider # 1 2

Background: The strengthening or substitution of intravenous cytotoxic chemotherapy cycles by oral targeted anticancer therapies, such as protein kinase inhibitors (PKIs), has provided impressive clinical benefits and autonomy as well as a better quality of life for patients with cancer. Despite these advances, adverse event management at home and medication adherence remain challenging. In addition, PKI plasma concentrations vary significantly among patients with cancer receiving the same dosage, which could explain part of the observed variability in the therapeutic response.
Objective: The aim of this optimizing oral targeted anticancer therapies (OpTAT) study is to optimize and individualize targeted anticancer treatments to improve patient care and self-monitoring through an interprofessional medication adherence program (IMAP) combined with measurement PKI plasma concentrations.
Methods: The OpTAT study has two parts: (1) a 1:1 randomized medication adherence program in which the intervention consists of regular motivational interviewing sessions between the patient and the pharmacist, along…Read more

Understanding acceptability in the context of text messages to encourage medication adherence in people with type 2 diabetes
Y Kiera Bartlett 1, Cassandra Kenning 2, Jack Crosland 3, Nikki Newhouse 4, Lisa M Miles 3, Veronika Williams 5, Jenny McSharry 6, Louise Locock 7, Andrew J Farmer 4, David P French 3

Background: Acceptability is recognised as a key concept in the development of health interventions, but there has been a lack of consensus about how acceptability should be conceptualised. The theoretical framework of acceptability (TFA) provides a potential tool for understanding acceptability. It has been proposed that acceptability measured before use of an intervention (anticipated acceptability) may differ from measures taken during and after use (experienced acceptability), but thus far this distinction has not been tested for a specific intervention. This paper 1) directly compares ratings of anticipated and experienced acceptability of a text message-based intervention, 2) explores the applicability of the TFA in a technology-based intervention, and 3) uses these findings to inform suggestions for measuring acceptability over the lifespan of technology-based health interventions.
Methods: Data were obtained from a quantitative online survey assessing anticipated acceptability of the proposed text messages (n = 59) and a 12-week proof-of-concept mixed methods study assessing experienced acceptability…Read more

The correlation between self-related adherence, asthma-related quality of life and control of asthma in adult patients
Elida Zairina 1 2 3, Gesnita Nugraheni 1 2, Gusti Noorrizka Veronika Achmad 1 2, Arie Sulistyarini 1 2, Yunita Nita 1 2, Arief Bakhtiar 4 5, Muhammad Amin 4 5

Objectives: Medication non-adherence mostly occurs in patients with a wide range of disease severity, including asthma. The aim of the study was to assess the self reported adherence to asthma therapy and investigate the relationship between adherence, asthma control and asthma-related quality of life.
Methods: The study was a cross-sectional study in which participants were recruited from an outpatient department, in one hospital in Surabaya. Patients (aged≥18 years) with asthma who had used any regular asthma medications were included. Standardised questionnaires, including Juniper’s Asthma Control Questionnaire (ACQ), Adherence to Refills and Medications Scales (ARMS) and Juniper’s Asthma Quality of Life Questionnaire (AQLQ) were used.
Results: A total of 82 adults with asthma were recruited in the study. Male participants’ mean age was 49.13 ± 14.10 years (n = 23). Approximately 59 participants (72.0%) were females, 30 participants (36.5%) were using Budesonide inhaler, and 73 participants (89.0%) never smoked. The mean of ACQ, AQLQ, and ARMS scores were…Read more

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