Browsing by Subject "medication adherence"
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Item Association Between Medication Adherence and the Outcomes of Heart Failure(Wiley, 2018) Hood, Sarah R.; Giazzon, Anthony J.; Seamon, Gwen; Lane, Kathleen A.; Wang, Jane; Eckert, George J.; Tu, Wanzhu; Murray, Michael D.; Biostatistics, School of Public HealthBackground Previous studies of heart failure patients have demonstrated an association between cardiovascular medication adherence and hospitalizations or a composite end point of hospitalization and death. Few studies have assessed the impact of treatment adherence within large general medical populations that distinguish the health outcomes of emergency department visits, hospitalization, and death. Objective To determine the association of incremental cardiovascular medication adherence on emergency department visits, hospitalization, and death in adult heart failure patients in Indiana. Design Retrospective cohort study conducted using electronic health record data from the statewide Indiana Network for Patient Care (INPC) between 2004 and 2009. Methods Patients were at least 18 years of age with a diagnosis of heart failure and prescribed at least one cardiovascular medication for heart failure. Adherence was measured as the proportion of days covered (PDC) using pharmacy transaction data. Clinical end points included emergency department visits, hospital admissions, length of hospital stay, and mortality. Generalized linear models were used to determine the effect of a 10% increase in PDC on clinical end points adjusting for age, sex, race, Charlson comorbidity index, and medications. Results Electronic health records were available for 55,312 patients (mean age ± standard deviation [SD] 68 ± 16 years; 54% women; 65% white). Mean PDC for all heart failure medications was 63% ± 23%. For every 10% increase in PDC, emergency department visits decreased 11% (rate ratio [RR] 0.89; 95% confidence interval [CI] 0.89‐0.89), hospital admissions decreased 6% (RR 0.94; 95% CI 0.94‐0.94), total length of hospital stay decreased 1% (RR 0.99; 95% CI 0.99‐1.00), and all‐cause mortality decreased 9% (odds ratio 0.91; 95% CI 0.90‐0.92). Conclusion Incremental medication adherence was associated with reductions in emergency department visits, hospital admissions, length of hospital stay, and all‐cause mortality.Item Effect of Depression Treatment on Health Behaviors and Cardiovascular Risk Factors Among Primary Care Patients with Depression: Data from the eIMPACT Trial(2023-12) Schuiling, Matthew D.; Stewart, Jesse; Hirsh, Adam; Wu, WeiBackground. Although depression is a risk factor for cardiovascular disease (CVD), few clinical trials in people without CVD have examined the effect of depression treatment on CVD-related outcomes. It’s unknown if successful depression treatment improves indicators of CVD risk, such as CVD-relevant health behaviors, traditional CVD risk factors, and CVD events. Methods. We examined data from eIMPACT trial, a phase II randomized controlled trial conducted from 2015-2020. Depressive symptoms, CVD-relevant health behaviors (self-reported CVD prevention medication adherence, sedentary behavior, and sleep quality) and traditional CVD risk factors (blood pressure and lipid fractions) were assessed. Incident CVD events over four years were identified using a statewide health information exchange. Results. The intervention group exhibited greater improvement in depressive symptoms (p < 0.01) and sleep quality (p < 0.01) than the usual care group, but there was no intervention effect on systolic blood pressure (p = 0.36), low-density lipoprotein cholesterol (p = 0.38), high-density lipoprotein cholesterol (p = 0.79), triglycerides (p = 0.76), CVD prevention medication adherence (p = 0.64), or sedentary behavior (p = 0.57). There was an intervention effect on diastolic blood pressure that favored the usual care group (p = 0.02). CVD-relevant health behaviors did not mediate any intervention effects on traditional CVD risk factors. Twenty-two participants (10%) experienced an incident CVD event. The likelihood of an CVD event did not differ between the intervention group (12.1%) and the usual care group (8.3%; HR = 1.45, 95% CI: 0.62-3.40, p = 0.39). Conclusions. Successful depression treatment alone improves self-reported sleep quality but is not sufficient to lower CVD risk of people with depression. Alternative approaches may be needed reduce CVD risk in depression. Trial Registration: ClinicalTrials.gov Identifier: NCT02458690Item Impact of the Kenya post-election crisis on clinic attendance and medication adherence for HIV-infected children in western Kenya(2009-04) Vreeman, Rachel C.; Nyandiko, Winstone M.; Sang, Edwin; Musick, Beverly S.; Braitstein, Paula; Wiehe, Sarah E.Background: Kenya experienced a political and humanitarian crisis following presidential elections on 27 December 2007. Over 1,200 people were killed and 300,000 displaced, with disproportionate violence in western Kenya. We sought to describe the immediate impact of this conflict on return to clinic and medication adherence for HIV-infected children cared for within the USAID-Academic Model Providing Access to Healthcare (AMPATH) in western Kenya. Methods: We conducted a mixed methods analysis that included a retrospective cohort analysis, as well as key informant interviews with pediatric healthcare providers. Eligible patients were HIV-infected children, less than 14 years of age, seen in the AMPATH HIV clinic system between 26 October 2007 and 25 December 2007. We extracted demographic and clinical data, generating descriptive statistics for pre- and post-conflict antiretroviral therapy (ART) adherence and post-election return to clinic for this cohort. ART adherence was derived from caregiver-report of taking all ART doses in past 7 days. We used multivariable logistic regression to assess factors associated with not returning to clinic. Interview dialogue from was analyzed using constant comparison, progressive coding and triangulation. Results: Between 26 October 2007 and 25 December 2007, 2,585 HIV-infected children (including 1,642 on ART) were seen. During 26 December 2007 to 15 April 2008, 93% (N = 2,398) returned to care. At their first visit after the election, 95% of children on ART (N = 1,408) reported perfect ART adherence, a significant drop from 98% pre-election (p < 0.001). Children on ART were significantly more likely to return to clinic than those not on ART. Members of tribes targeted by violence and members of minority tribes were less likely to return. In qualitative analysis of 9 key informant interviews, prominent barriers to return to clinic and adherence included concerns for personal safety, shortages of resources, hanging priorities, and hopelessness. Conclusion: During a period of humanitarian crisis, the vulnerable, HIV-infected pediatric population had disruptions in clinical care and in medication adherence, putting children at risk for viral resistance and increased morbidity. However, unique program strengths may have minimized these disruptions.Item Indiana Center for Intercultural Communication: Translating Health Discourse Research into Action(Office of the Vice Chancellor for Research, 2013-04-05) Connor, UllaThe Indiana Center for Intercultural Communication (ICIC) is a university-based research and service organization created to enhance links between the city of Indianapolis, the state of Indiana, and cultures/nations throughout the world. ICIC conducts internationally recognized research on language and intercultural communication and applies its expertise to benefit the wider community. The Center also offers group training programs and individualized tutoring in language for specific purposes and intercultural communication to students, faculty, medical residents, postdoctoral researchers, and business professionals in the community as well as international language educators. ICIC’s research focuses on health discourse from the perspective of intercultural rhetoric. The Center’s strong linguistic background provides a unique multimodal approach to the study of factors and forms of interaction and communication that impact medication adherence, risk comprehension, and patient disease management and decision-making. In keeping with the Signature Center Initiative mandate to conduct research that translates into practice, the results of ICIC’s research translate into action in the form of training to healthcare providers and guidelines for patient-tailored language and communication strategies. This poster features results from recent ICIC research projects, among them a study of linguistic indicators related to diabetes patient self-management and an intercultural analysis of sources of medical information in Spanish-speaking diabetes patients. Also featured are ongoing and future projects: a psychosociolinguistic study of patient voices to be applied to the development of patient-tailored messaging and the health-literacy oriented redesign of the Walther Cancer Center information portal for patients.Item The Medication Adherence Context and Outcomes Framework Image(2018-10-04) Bartlett Ellis, Rebecca J.; Ruppar, Todd M.Background: Adherence interventions have been largely ineffective, with most taking a "one-size-fits-all” approach without consideration of reasons for nonadherence. While the ABC Taxonomy clarified terminology and identified various outcomes measured along the process continuum, intervention design requires understanding the environments and contexts that contribute to nonadherence. A framework that combines the understanding of environment contextual influences, processes, and outcomes is needed to move forward with approaches to intervention design. Methods: Developed based on theory, practice, and research, the Medication-management and Adherence Contexts and Outcomes (MACO) framework describes the environmental contexts, the processes that occur within the contexts, and how these processes contribute to adherence outcomes. The MACO framework differentiates the processes, defined as medication management, within and across contexts that affect adherence outcomes. Results: Three distinct yet interrelated contexts identified in the MACO framework include 1.) clinic, 2.) pharmacy, and 3.) home. Conclusions: The MACO framework is a useful heuristic to understand at which point people experience problems with managing medications in the medication management continuum. This information can then be used for designing and delivering context-specific interventions and selecting appropriate outcome measures of adherence based on the contexts.Item Medication Adherence Prediction Through Online Social Forums: A Case Study of Fibromyalgia(JMIR, 2019) Haas, Kyle; Ben Miled, Zina; Mahoui, Malika; Electrical and Computer Engineering, School of Engineering and TechnologyBackground: Medication nonadherence can compound into severe medical problems for patients. Identifying patients who are likely to become nonadherent may help reduce these problems. Data-driven machine learning models can predict medication adherence by using selected indicators from patients’ past health records. Sources of data for these models traditionally fall under two main categories: (1) proprietary data from insurance claims, pharmacy prescriptions, or electronic medical records and (2) survey data collected from representative groups of patients. Models developed using these data sources often are limited because they are proprietary, subject to high cost, have limited scalability, or lack timely accessibility. These limitations suggest that social health forums might be an alternate source of data for adherence prediction. Indeed, these data are accessible, affordable, timely, and available at scale. However, they can be inaccurate. Objective: This paper proposes a medication adherence machine learning model for fibromyalgia therapies that can mitigate the inaccuracy of social health forum data. Methods: Transfer learning is a machine learning technique that allows knowledge acquired from one dataset to be transferred to another dataset. In this study, predictive adherence models for the target disease were first developed by using accurate but limited survey data. These models were then used to predict medication adherence from health social forum data. Random forest, an ensemble machine learning technique, was used to develop the predictive models. This transfer learning methodology is demonstrated in this study by examining data from the Medical Expenditure Panel Survey and the PatientsLikeMe social health forum. Results: When the models are carefully designed, less than a 5% difference in accuracy is observed between the Medical Expenditure Panel Survey and the PatientsLikeMe medication adherence predictions for fibromyalgia treatments. This design must take into consideration the mapping between the predictors and the outcomes in the two datasets. Conclusions: This study exemplifies the potential and limitations of transfer learning in medication adherence–predictive models based on survey data and social health forum data. The proposed approach can make timely medication adherence monitoring cost-effective and widely accessible. Additional investigation is needed to improve the robustness of the approach and extend its applicability to other therapies and other sources of data. [JMIR Med Inform 2019;7(2):e12561]Item Medication Management: The Macrocognitive Workflow of Older Adults With Heart Failure(JMIR Publications Inc., 2016-10-12) Mickelson, Robin S.; Unertl, Kim M.; Holden, Richard J.; Department of BioHealth Informatics, School of Informatics and ComputingBACKGROUND: Older adults with chronic disease struggle to manage complex medication regimens. Health information technology has the potential to improve medication management, but only if it is based on a thorough understanding of the complexity of medication management workflow as it occurs in natural settings. Prior research reveals that patient work related to medication management is complex, cognitive, and collaborative. Macrocognitive processes are theorized as how people individually and collaboratively think in complex, adaptive, and messy nonlaboratory settings supported by artifacts. OBJECTIVE: The objective of this research was to describe and analyze the work of medication management by older adults with heart failure, using a macrocognitive workflow framework. METHODS: We interviewed and observed 61 older patients along with 30 informal caregivers about self-care practices including medication management. Descriptive qualitative content analysis methods were used to develop categories, subcategories, and themes about macrocognitive processes used in medication management workflow. RESULTS: We identified 5 high-level macrocognitive processes affecting medication management-sensemaking, planning, coordination, monitoring, and decision making-and 15 subprocesses. Data revealed workflow as occurring in a highly collaborative, fragile system of interacting people, artifacts, time, and space. Process breakdowns were common and patients had little support for macrocognitive workflow from current tools. CONCLUSIONS: Macrocognitive processes affected medication management performance. Describing and analyzing this performance produced recommendations for technology supporting collaboration and sensemaking, decision making and problem detection, and planning and implementation.Item Medication-taking behaviours in chronic kidney disease with multiple chronic conditions: a meta-ethnographic synthesis of qualitative studies(Wiley, 2017-03) Bartlett Ellis, Rebecca J.; Welch, Janet L.; IU School of NursingAims and objectives To identify behaviours associated with taking medications and medication adherence reported in qualitative studies of adults with chronic kidney disease and coexisting multiple chronic conditions. Background To inform medication adherence interventions, information is needed to clarify the nature of the relationships between behaviours that support medication-taking and medication adherence in multiple chronic conditions. Design Meta-ethnographic review and synthesis. Methods CINAHL Complete, MEDLINE and PsycINFO databases were searched. Five qualitative studies met the inclusion criteria. A meta-ethnographic approach was used for synthesis. Medication-taking behaviours were abstracted from study findings and synthesised according to the contexts in which they occur and interpreted within a new developing framework named the Medication-taking Across the Care Continuum and Adherence-related Outcomes. Results Twenty categories of medication-taking behaviours occurred in three main contexts: (1) patient–provider clinical encounters, (2) pharmacy encounters and (3) day-to-day management. These behaviours are distinctly different, multilevel and interrelated. Together they represent a process occurring across a continuum. Conclusions Future medication adherence research should consider using a multilevel ecological view of medication management. Clinical practice and policy development can benefit from further understanding socio-contextual behaviours that occur across the continuum. Nurses should have greater presence in chronic disease management and be positioned to support the day-to-day home management of patients' medications.Item Nonadherence to Oral Antihyperglycemic Agents: Subsequent Hospitalization and Mortality among Patients with Type 2 Diabetes in Clinical Practice(IOS, 2015) Zhu, Vivienne J.; Tu, Wanzhu; Rosenman, Marc B.; Overhage, J. Marc; Department of Biostatistics, Fairbanks School of Public HealthUsing real-world clinical data from the Indiana Network for Patient Care, we analyzed the associations between non-adherence to oral antihyperglycemic agents (OHA) and subsequent diabetes-related hospitalization and all-cause mortality for patients with type 2 diabetes. OHA adherence was measured by the annual proportion of days covered (PDC) for 2008 and 2009. Among 24,067 eligible patients, 35,507 annual PDCs were formed. Over 90% (n=21,798) of the patients had a PDC less than 80%. In generalized linear mixed model analyses, OHA non-adherence is significantly associated with diabetes related hospitalizations (OR: 1.2; 95% CI [1.1,1.3]; p<0.0001). Older patients, white patients, or patients who had ischemic heart disease, stroke, or renal disease had higher odds of hospitalization. Similarly, OHA non-adherence increased subsequent mortality (OR: 1.3; 95% CI [1.02, 1.61]; p<0.0001). Patient age, male gender, income and presence of ischemic heart diseases, stroke, and renal disease were also significantly associated with subsequent all-cause death.Item Pillbox intervention fidelity in medication adherence research: A systematic review(Elsevier, 2017-07) Bartlett Ellis, Rebecca J.; Knisely, Mitchell R.; Boyer, Kiersten; Pike, Caitlin; School of NursingBackground Pillboxes are widely available, have evidence of effectiveness, but translating pillboxes in self-management interventions requires an understanding of intervention components. Purpose To review components of intervention design, interventionist training, delivery, receipt, enactment, and targeted behaviors in adherence studies. Methods Five multidisciplinary databases were searched to find reports of controlled trials testing pillboxes and medication adherence interventions in adults managing medications. Details of treatment fidelity, that is, design, training, delivery, receipt, and enactment, were abstracted. Findings A total of 38 articles reporting 40 studies were included. Treatment fidelity descriptions were often lacking, especially reporting receipt and enactment, important for both control and intervention groups. Clearly reported details are needed to avoid making assumptions when translating evidence. Conclusion These findings serve as a call to action to explicitly state intervention details. Lack of reported intervention detail is a barrier to translating which components of pillboxes work in influencing medication adherence behaviors and outcomes.