• Adherence in Exercise Meta-Analyses: Assessment and Effect on Study Outcomes

      Slack, Marion; Bae, Jeffrey; Kobleski, Robert; College of Pharmacy, The University of Arizona (The University of Arizona., 2005)
      Objective: The purpose of this study was to explore whether current meta-analyses on exercise interventions assess adherence and/or compliance of the studies included in the meta-analyses and to determine if subject adherence had any effect on outcomes of the analyses. Methods: Data was collected through a search of the MEDLINE database using the key words exercise, adherence, compliance, clinical trials, and meta-analysis. Data on study title, author, number of studies screened, number in meta-analysis, range of sample sizes, total number of subjects, primary intervention, primary outcome, how study quality was assessed, how adherence was assessed, whether adherence was used as a control variable, and did adherence affect the outcome was recorded on a paper and pencil data extraction form. Data was analyzed by constructing a table describing the meta-analyses and calculating the number and percent of analyses that included adherence. The table allowed for the evaluation of the strength and methodology of each piece of literature with respect to acknowledging adherence as a significant variable in the strength and legitimacy of each analysis. Results: Nineteen meta-analyses met our search criteria and were evaluated. Five of the nineteen meta-analyses (26 percent) described a method for assessing adherence. It was found that none of these used adherence as a control variable. Four of the nineteen meta-analyses did not assess the quality of the studies contained within the analysis. One of these meta-analyses suggested that adherence may have confounded outcomes, but did not provide any data to address their concerns. Conclusions: In meta-analyses, adherence is unlikely to be addressed. Current meta-analyses frequently lack methods for assessing adherence, and do not use adherence as a control variable. Whether adherence to exercise regimens affects outcomes cannot be determined from current meta-analyses.
    • An Assessment of Medication Synchronization on Improving Medication Adherence

      Warholak, Terri; Badie, Shahene; Jing, Elizabeth; Fernandez, Carissa; Warholak, Terri; College of Pharmacy, The University of Arizona (The University of Arizona., 2015)
      Objectives: Our specific aim is to assess the changes in patient adherence in response to medication synchronization. Our working hypothesis is that medication synchronization will have a positive impact on patient adherence. Methods: This retrospective pre-post cohort study assessed medication adherence 365 days before and 365 days after enrollment into a prescription synchronization program. There were 5,994 patients included in the study. Seven medication classes and three demographic groups were chosen to assess for adherence. Adherence was determined by calculating mean proportion of days covered. A paired t-test was used to determine statistical significance for each drug class and demographic group. Exploratory analyses were done at 90 days and 180 days before and after the sync date to determine differences in terms of time. An alpha a-priori was set at 0.05 before analysis was started. Results: Current Fry’s Pharmacy patients greater than 18 years old that met the Centers for Medicare and Medicaid Services (CMS) for STARs rating criteria were included in the study. Results at 365 days showed a statistically significant decrease in PDC (p<0.0001), and was not affected by demographics. Conclusions: One year after the implementation of medication synchronization program at Fry’s Pharmacy, a statistically significance decrease in PDC is seen across all categories of chronic medications: statins, ACE-I/ARBs, beta-blockers, CCBs, metformin, thiazides, loop-diuretics, and inhaled corticosteroids. As such, medication synchronization may decrease patient adherence to the maintenance medications evaluated.
    • Effect of Adherence to the GOLD Guidelines on Chronic Obstructive Pulmonary Disease Related Readmissions in a Community Hospital

      Hall, Edina; Salek, Ferena; Glover, Jon; Binder, William; Clark, Scott; Hall, Edina; Salek, Ferena; Glover, Jon; College of Pharmacy, The University of Arizona (The University of Arizona., 2016)
      Objectives: To assess the relationship between adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for the management of chronic obstructive pulmonary disease (COPD) exacerbations and the corresponding 30-day, all-cause readmissions rate in a community hospital. Methods: A retrospective chart review was conducted on patients admitted with the primary diagnosis of a COPD exacerbation. Medications administration records relevant to the GOLD guidelines were examined as separate independent variables in relation to a readmission within 30 days of discharge. Additional factors examined included: demographic data, resident of a long-term care facility, pre-index hospitalization, pulmonary consult, vaccines, length of stay (LOS), discharge medications, and follow-up appointments. Results: Electronic health records of 120 patients were reviewed and divided into non-readmitted patients (n = 65, mean age 73.4 ± 10.1 years), all-cause readmissions (n = 55, mean age 70.15 ± 9.69 years), and COPD-related readmissions (n = 21, mean age 70.7 ± 11.1 years). Patients with heart failure (p = 0.024), a LOS >5 days (p = 0.045), a pre-index hospitalization (p = 0.001), or who were long-term care residents (p = 0.024) experienced more all-cause readmissions. Females experienced less all-cause readmissions (p = 0.035). Significantly more patients with a pre-index hospitalization had a COPD-related readmission (p = 0.027). Lastly, adherence to the GOLD treatment parameters was not significantly different across all groups. Conclusions: COPD is a complex disease and adherence to the GOLD guidelines during an exacerbation is unlikely to significantly impact 30-day readmission rates.
    • The impact of 90-day blister pack refill and patient education on compliance and blood pressure control in a Federally Qualified Health Center

      Hall-Lipsy, Elizabeth; Lopez, Dania; Flores, Randall; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Purpose: The purpose of this study is to examine and evaluate the impact of: 1) a pharmacy managed 90-day blister package refill on adherence and 2) educational intervention on medication adherence plus blood pressure outcomes. Introduction: Hypertension is one of the most common health condition amongst adults in the US. It is most often managed with the use of antihypertensive medications. Non-compliance to medication is often one of the biggest barriers in the management of hypertension and impacts health and increased health care costs. Community health centers like Mariposa Community Health Center in rural locations often have difficulty improving their patients’ medication adherence. Different strategies have been developed in order address medication adherence and improve health outcomes. Methods: A prospective, randomized controlled trial study that measured and compared adherence and blood pressure (BP) values of patients enrolled in a 90-day blister pack refill who participated in an educational workshop about hypertension. Participants completed a knowledge test survey before and after the educational workshop as well as an ASK-12 survey in order to identify potential barriers that affect medication adherence. Randomization was done utilizing a block randomization method. Adherence was calculated utilizing portion of days covered (PDC) formula. BP was analyzed utilizing a paired T-test. Knowledge and ASK-12 surveys were analyzed utilizing Wilcoxon signed-rank test. Results: In the first 90-day period, systolic blood pressure (SBP) was significantly decreased by mean of 6.84mmHg (p=0.05, 95% CI -.078-13.77). Diastolic had a similar decreasing trend but was not statistically significant (p=23 95% CI -2.42-9.04). 93.3% of the participants were adherent to their antihypertensive medications (PDC>80%). Pre and post knowledge surveys did not show any significant difference in the first 90 days. Questions 3 and 7 of the ASK-12 survey had a significant difference (p=0.021, p=0.15, 95% CI) in the first 90-day period. CONCLUSION: The number of patients vs those who consented yielded a less than desirable turnout limiting the intervention and making all those who consented assigned to the 90-day refill group limiting our data and having a comparison group. A significant decrease in SBP from their baseline BP was observed.
    • Medication Adherence Education in U.S. Schools and Colleges of Pharmacy

      Lee, Jeannie; Nguyen, Danielle; Lee, Jeannie; College of Pharmacy, The University of Arizona (The University of Arizona., 2014)
      Specific Aims: Medication adherence is the extent to which patients take their medications correctly and consistently as prescribed.1 The objective of this study was to assess Accreditation Council for Pharmacy Education (ACPE)- preaccredited and accredited schools and colleges of pharmacy for adherence course content in their curricula. Methods: The survey link was sent via email to the Department of Pharmacy Practice Chair, or equivalent, at each institution. The data collected via the online survey included information regarding the details of medication adherence curriculum present at the program. All data remained confidential. Chi-square statistical test was used for analysis to compare hours of adherence education taught in older (in existence ≥ 20 years) versus newer (< 20 years) programs. Main Results: Twenty-eight programs responded among 130 inquiries (22% response rate). Of the respondents, only two colleges of pharmacy offered a course on medication adherence, one as an elective and one as required. Common adherence principles were incorporated into other pharmacy courses with the most common topics being counseling, patient education and communication skills. Older programs taught more hours (> 20 hours) focused on adherence compared to the newer programs, but they did not differ significantly (p = 0.39). Conclusion: Despite the low response rate, the findings show a lack of curricular focus on medication adherence, particularly as an individual course. Further studies are needed to identify adherence training received by student pharmacists, and to evaluate the impact of adherence-focused curriculum components on provision of patient care centered on medication adherence by pharmacy practitioners.