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Improving Medication Adherence Through Calendar Packaging: Results of A Randomized Controlled Trial among Hypertensive Patients in Malaysia
A868
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 – A 9 1 8
adjusted life years (QALYs). However, their incremental cost-effectiveness ratios were high above the willingness to pay. Compared with enoxaparin, dabigatran for THR/TKR lowered VTE complications but increased bleeding cases; dabigatran was cost-saving by reducing the costs (by THB 3,809.96 (USD 117.30) for THR) and producing more QALYs gained (by 0.00013 for THR). Dabigatran (vs. enoxaparin) had a 98% likelihood of being cost effective. Conclusions: Dabigatran is costsaving compared to enoxaparin for VTE prophylaxis after THR or TKR under the Thai context. However, both medications are not cost-effective compared to no thromboprophylaxis.
CARDIOVASCULAR DISORDERS – Patient-Reported Outcomes & Patient Preference Studies PCV33 Measurement of Adherence To Anti-Hypertensive Drugs in Asia Ma Q1, Kao C1, Miles G1, Chen G2 1Costello Medical Singapore Pte Ltd, Singapore, Singapore, 2Costello Medical Consulting Ltd, Cambridge, UK
Objectives: One in every three adults in Asia suffers from hypertension and the prevalence is increasing in many countries. Two-thirds of hypertension patients fail to successfully control blood pressure, mostly due to poor medication adherence. Therefore, improving medication adherence is crucial in the management of hypertension. The objective of this study is to investigate the adherence measurements used in hypertensive patients in Asia and the adherence level measured. Methods: A structured literature review was conducted in PubMed using search terms including “adherence”, “hypertension” and search terms for Asian countries. Studies that investigated adherence to anti-hypertensive drugs in Asian countries from 2006 to 2016 and reported the adherence measurements used were included. Results: A total of 388 articles were retrieved in the PubMed search, of which 54 studies were included for analysis. None of the studies used direct methods for adherence measurement. The most commonly used indirect method involved clinician assessment and self-report (61.1%); the most commonly used tools included self-administered questionnaire (SAQ, 31.5%), face-to-face interview (7.4%) and Morisky Medication Adherence Scale (MMAS, 9.3%). The second most commonly used indirect method involved secondary database analysis (33.3%); the scales used were medication possession rate (MPR, 20.4%) and cumulative medication adherence (CMA, 11.1%). Other studies used pill count (5.6%) to measure adherence indirectly. SAQ was mostly used in China and Korea. CMA was used only in Korea and MPR was only used in Hong Kong, Korea and Taiwan. On average, studies that used MPR reported a higher population adherence compared with studies that used MMAS. Further analyses will be performed to investigate other associations between adherence level measured and tools/scales used. Conclusions: Adherence to anti-hypertensive drugs has been measured using different tools in Asian studies. A gold standard needs to be established as guidelines for adherence measurements so that study results can be compared more easily.
PCV34 The Outcomes of A Pharmaceutical Care Assistance Program in A Romanian Community Pharmacy Mic OC1, Turcu-Stiolica A2 of Medicine and Pharmacy, Craiova, Romania, 2University of Medicine and Pharmacy Craiova, Craiova, Romania
1University
Objectives: Poor adherence diminishes the health benefits of pharmacotherapies. Implementation of a pharmaceutical care assistance program in community pharmacies could improve the medication adherence. First, it is very important to identify the potential adherence problems. The aim of this research is to evaluate the outcomes of a pharmacist adherence intervention for hypertensive patients. Methods: Two clinical pharmacists and 100 hypertensive patients from a community pharmacy in Craiova, Romania were involved in our study, in JanuaryDecember 2015. The patients were randomized to an intervention or control arm. The patients from intervention arm (50 patients) were included in a pharmaceutical assistance program that consists in motivational interviewing (MI) as the most useful tool that can easily identify potential medication adherence problems. These patients received from 3 to 5 interventions. The patients from control arm (50 patients) received traditional pharmaceutical assistance. All the patients from the two arms completed an adherence questionnaire at the start and the final of our study. The 25-items questionnaire computed the adherence indicator for every patient (low score indicates better adherence). The outcomes obtained for the two arms in December were compared using the Mann-Whitney Wilcoxon Test. The p-values shown are calculated on the two-tailed level. P< 0.05 was regarded as statistical significant. Results: The questionnaire identified from the start the adherence problems: 65% were medication-related and 35% lifestyle-related. Motivational interviewing was represented by open-ended questions, affirmations, reflective listening and summaries for every patient in intervention arm. At the end of our study, we compared the adherence indicators from the two arms after the patients completed the questionnaires (p= 0.023< 0.05). Conclusions: Pharmacists and patients are increasingly involved in efforts to identify and improve patient medication adherence. The study showed the adherence’s increase in hypertensive patients by implementing a pharmaceutical assistance program with MI-centered method that was well accepted both by the pharmacists and the patients. PCV35 Effects Of Pharmacist Counseling on Outpatients Receiving Warfarin at Dr. Hasan Sadikin Bandung Hospital Putriana NA
Universitas Padjadjaran, bandung, Indonesia
Objectives: Warfarin has a narrow therapeutic index and is able to cause bleeding. Some efforts to improve knowledge, perseption and patients adherence to conduct warfarin therapeutics through counseling. This research aims to analysis the effects of counseling pharmacist on knowledge, perception, adherence behavior, and INR score recovery on warfarin management. Methods: Design this research used mixed method, qualitative data used for complete quantitative data. Qualitative used a content analysis with interview . Quantitative method used a quasi experimental method with control groups, pre test, and post test design. Data was collected by prospective method. The sample of this research were taken by consecutive sampling Data collection was conducted by doing interviews and completion of questionnaire before and after counseling. There were 80 respondents, observed for 3 month. Respondents were devided into two groups; treatment group and control group. Data were analysed by wilcoxon test and mann whitney test. Results: Data were collected on 80 patients with Rheumatic Heart Disease (42,5 %), Atrial Fibrilation (17,5 %), Deep Vein Thrombosis (10%), Rheumatic Mitral Valve Disease (10%), Prosthetic Heart (7,5%), other (22,5%). The numbers of patients whose International Normalized Ratio (INR) was in the therapeutic range for each indication were not statistically different between before and after receiving counseling (p> 0.05), Patients’ knowledge, perseption, and behavior compliance of warfarin therapy had increased after receiving the counseling service (p< 0.05). Conclusions: Pharmacist counseling can improve knowledge, perception, and adherence behavior, but not improve INR target. The Effect of warfarin to every individual not only affected by behavior compliance, but several factors can influenced effect of warfarin is clinical factors, nonclinical factors, and genetic factors. Clinical factors such as age, gender, pharmacokinethic and pharmacodynamic variability in patiens. Non clinical factors such as dose, interaction drugs, interactions with food, and intake of Vitamin K. PCV37 Improving Medication Adherence Through Calendar Packaging: Results of A Randomized Controlled Trial among Hypertensive Patients in Malaysia Tan BY, Shafie AA, Hassali MA, Saleem F Universiti Sains Malaysia, Penang, Malaysia
Objectives: Poor medication adherence may lead to complications related to uncontrolled hypertension. It is hypothesized that the use of calendar packaging (CP) can increase medication adherence in hypertensive patients. Thus, our objective was to investigate the effect of CP on medication adherence among hypertensive patients in Malaysia. Methods: This was a randomized controlled trial of CP (intervention group) versus normal pack (control group) for patients using daily dose of amlodipine. Patients were scheduled to refill their prescription every 28 days for 7 months. The primary outcome was adherence to amlodipine medication, assessed by medication possession ratio (MPR), percentage of refill on time and Malay Version Morisky medication adherence scales (MMMAS). Data were analysed using SPSS software version 22. Results: Eight two patients participated. The mean age (SD) was 55.85 (10.25) and 56.55 (10.42) for intervention and control group respectively. Intervention group showed better medication adherence than the control group in MPR (p< 0.05), percentage of patient refill on time and MMMAS. Intervention group have a significant improvement in systolic blood pressure (p < 0.05) compared to control group. Multiple linear regression reported an increase in adherence; MPR (β = 0.006, 95% CI 0.001-0.010) and MMMAS (β = 0.467, 95% CI 0.137-0.796) after controlling for age and duration of follow up. Intervention also reduced the systolic blood pressure (β = -4.355, 95% CI –8.419 to -0.291), but there was no significant effect on diastolic blood pressure. Conclusions: CP was associated with substantial and sustained improvements in medication adherence and systolic blood pressure. The association of improved medication adherence and reduced level of systolic blood pressure suggested that CP can lead to meaningful patient reported outcomes.
PCV38 Assessment of Utility for Heart Failure using Visual Analogue Scale(VAS), Time-Trade off(TTO) and Euroqol-5 Dimension(EQ-5D) in the Korean General Population Lee JY, Lee E School of Pharmacy, Sungkyunkwan university, Suwon, South Korea
Objectives: The aim of this study was to assess and analyze the utility values for Heart Failure (HF) using different generic health status measuring instruments in the Korean general population. Methods: Through literature review and interview with cardiologists, 5 scenarios related to the health status of HF were developed: Stable Chronic Heart Failure (SCHF), hospitalization due to acute exacerbation, SCHF+cough, SCHF+hypotention and SCHF+hyperkalemia. To elicit the utilities for HF, face-to-face interview was carried out for 200 people selected from the general population through proportional allocation by age and gender. The utilities for HF were assessed using VAS, TTO and EQ-5D. Subjects were divided into two groups according to questionnaires: one questionnaire consisting of VAS, TTO and EQ-5D 3 Level (EQ-5D-3L) and the other questionnaire consisting of VAS, TTO and EQ-5D 5 Level (EQ-5D-5L). To compare the utilities among different instruments, Wilcoxon rank sum test and Repeated Measure Analysis of Variance (RMANOVA) were conducted. Results: The utilities for SCHF measured by VAS, TTO, EQ-5D-3L and EQ-5D-5L were 0.626 (±0.09), 0.815 (±0.104), 0.892 (±0.09) and 0.871 (±0.088), respectively. The utilities assessed using each instruments decreased in the order of SCHF, SCHF+cough, SCHF+hypotention, SCHF+hyperkalemia and hospitalization for all instruments. When comparing among health statuses, the lowest utilities were measured in the hospitalization status (VAS:0.215 (±0.101), TTO:0.360 (±0.164), EQ-5D-3L:-0.034 (±0.188), EQ-5D-5L:0.215 (±0.173)). The utility
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 – A 9 1 8
adjusted life years (QALYs). However, their incremental cost-effectiveness ratios were high above the willingness to pay. Compared with enoxaparin, dabigatran for THR/TKR lowered VTE complications but increased bleeding cases; dabigatran was cost-saving by reducing the costs (by THB 3,809.96 (USD 117.30) for THR) and producing more QALYs gained (by 0.00013 for THR). Dabigatran (vs. enoxaparin) had a 98% likelihood of being cost effective. Conclusions: Dabigatran is costsaving compared to enoxaparin for VTE prophylaxis after THR or TKR under the Thai context. However, both medications are not cost-effective compared to no thromboprophylaxis.
CARDIOVASCULAR DISORDERS – Patient-Reported Outcomes & Patient Preference Studies PCV33 Measurement of Adherence To Anti-Hypertensive Drugs in Asia Ma Q1, Kao C1, Miles G1, Chen G2 1Costello Medical Singapore Pte Ltd, Singapore, Singapore, 2Costello Medical Consulting Ltd, Cambridge, UK
Objectives: One in every three adults in Asia suffers from hypertension and the prevalence is increasing in many countries. Two-thirds of hypertension patients fail to successfully control blood pressure, mostly due to poor medication adherence. Therefore, improving medication adherence is crucial in the management of hypertension. The objective of this study is to investigate the adherence measurements used in hypertensive patients in Asia and the adherence level measured. Methods: A structured literature review was conducted in PubMed using search terms including “adherence”, “hypertension” and search terms for Asian countries. Studies that investigated adherence to anti-hypertensive drugs in Asian countries from 2006 to 2016 and reported the adherence measurements used were included. Results: A total of 388 articles were retrieved in the PubMed search, of which 54 studies were included for analysis. None of the studies used direct methods for adherence measurement. The most commonly used indirect method involved clinician assessment and self-report (61.1%); the most commonly used tools included self-administered questionnaire (SAQ, 31.5%), face-to-face interview (7.4%) and Morisky Medication Adherence Scale (MMAS, 9.3%). The second most commonly used indirect method involved secondary database analysis (33.3%); the scales used were medication possession rate (MPR, 20.4%) and cumulative medication adherence (CMA, 11.1%). Other studies used pill count (5.6%) to measure adherence indirectly. SAQ was mostly used in China and Korea. CMA was used only in Korea and MPR was only used in Hong Kong, Korea and Taiwan. On average, studies that used MPR reported a higher population adherence compared with studies that used MMAS. Further analyses will be performed to investigate other associations between adherence level measured and tools/scales used. Conclusions: Adherence to anti-hypertensive drugs has been measured using different tools in Asian studies. A gold standard needs to be established as guidelines for adherence measurements so that study results can be compared more easily.
PCV34 The Outcomes of A Pharmaceutical Care Assistance Program in A Romanian Community Pharmacy Mic OC1, Turcu-Stiolica A2 of Medicine and Pharmacy, Craiova, Romania, 2University of Medicine and Pharmacy Craiova, Craiova, Romania
1University
Objectives: Poor adherence diminishes the health benefits of pharmacotherapies. Implementation of a pharmaceutical care assistance program in community pharmacies could improve the medication adherence. First, it is very important to identify the potential adherence problems. The aim of this research is to evaluate the outcomes of a pharmacist adherence intervention for hypertensive patients. Methods: Two clinical pharmacists and 100 hypertensive patients from a community pharmacy in Craiova, Romania were involved in our study, in JanuaryDecember 2015. The patients were randomized to an intervention or control arm. The patients from intervention arm (50 patients) were included in a pharmaceutical assistance program that consists in motivational interviewing (MI) as the most useful tool that can easily identify potential medication adherence problems. These patients received from 3 to 5 interventions. The patients from control arm (50 patients) received traditional pharmaceutical assistance. All the patients from the two arms completed an adherence questionnaire at the start and the final of our study. The 25-items questionnaire computed the adherence indicator for every patient (low score indicates better adherence). The outcomes obtained for the two arms in December were compared using the Mann-Whitney Wilcoxon Test. The p-values shown are calculated on the two-tailed level. P< 0.05 was regarded as statistical significant. Results: The questionnaire identified from the start the adherence problems: 65% were medication-related and 35% lifestyle-related. Motivational interviewing was represented by open-ended questions, affirmations, reflective listening and summaries for every patient in intervention arm. At the end of our study, we compared the adherence indicators from the two arms after the patients completed the questionnaires (p= 0.023< 0.05). Conclusions: Pharmacists and patients are increasingly involved in efforts to identify and improve patient medication adherence. The study showed the adherence’s increase in hypertensive patients by implementing a pharmaceutical assistance program with MI-centered method that was well accepted both by the pharmacists and the patients. PCV35 Effects Of Pharmacist Counseling on Outpatients Receiving Warfarin at Dr. Hasan Sadikin Bandung Hospital Putriana NA
Universitas Padjadjaran, bandung, Indonesia
Objectives: Warfarin has a narrow therapeutic index and is able to cause bleeding. Some efforts to improve knowledge, perseption and patients adherence to conduct warfarin therapeutics through counseling. This research aims to analysis the effects of counseling pharmacist on knowledge, perception, adherence behavior, and INR score recovery on warfarin management. Methods: Design this research used mixed method, qualitative data used for complete quantitative data. Qualitative used a content analysis with interview . Quantitative method used a quasi experimental method with control groups, pre test, and post test design. Data was collected by prospective method. The sample of this research were taken by consecutive sampling Data collection was conducted by doing interviews and completion of questionnaire before and after counseling. There were 80 respondents, observed for 3 month. Respondents were devided into two groups; treatment group and control group. Data were analysed by wilcoxon test and mann whitney test. Results: Data were collected on 80 patients with Rheumatic Heart Disease (42,5 %), Atrial Fibrilation (17,5 %), Deep Vein Thrombosis (10%), Rheumatic Mitral Valve Disease (10%), Prosthetic Heart (7,5%), other (22,5%). The numbers of patients whose International Normalized Ratio (INR) was in the therapeutic range for each indication were not statistically different between before and after receiving counseling (p> 0.05), Patients’ knowledge, perseption, and behavior compliance of warfarin therapy had increased after receiving the counseling service (p< 0.05). Conclusions: Pharmacist counseling can improve knowledge, perception, and adherence behavior, but not improve INR target. The Effect of warfarin to every individual not only affected by behavior compliance, but several factors can influenced effect of warfarin is clinical factors, nonclinical factors, and genetic factors. Clinical factors such as age, gender, pharmacokinethic and pharmacodynamic variability in patiens. Non clinical factors such as dose, interaction drugs, interactions with food, and intake of Vitamin K. PCV37 Improving Medication Adherence Through Calendar Packaging: Results of A Randomized Controlled Trial among Hypertensive Patients in Malaysia Tan BY, Shafie AA, Hassali MA, Saleem F Universiti Sains Malaysia, Penang, Malaysia
Objectives: Poor medication adherence may lead to complications related to uncontrolled hypertension. It is hypothesized that the use of calendar packaging (CP) can increase medication adherence in hypertensive patients. Thus, our objective was to investigate the effect of CP on medication adherence among hypertensive patients in Malaysia. Methods: This was a randomized controlled trial of CP (intervention group) versus normal pack (control group) for patients using daily dose of amlodipine. Patients were scheduled to refill their prescription every 28 days for 7 months. The primary outcome was adherence to amlodipine medication, assessed by medication possession ratio (MPR), percentage of refill on time and Malay Version Morisky medication adherence scales (MMMAS). Data were analysed using SPSS software version 22. Results: Eight two patients participated. The mean age (SD) was 55.85 (10.25) and 56.55 (10.42) for intervention and control group respectively. Intervention group showed better medication adherence than the control group in MPR (p< 0.05), percentage of patient refill on time and MMMAS. Intervention group have a significant improvement in systolic blood pressure (p < 0.05) compared to control group. Multiple linear regression reported an increase in adherence; MPR (β = 0.006, 95% CI 0.001-0.010) and MMMAS (β = 0.467, 95% CI 0.137-0.796) after controlling for age and duration of follow up. Intervention also reduced the systolic blood pressure (β = -4.355, 95% CI –8.419 to -0.291), but there was no significant effect on diastolic blood pressure. Conclusions: CP was associated with substantial and sustained improvements in medication adherence and systolic blood pressure. The association of improved medication adherence and reduced level of systolic blood pressure suggested that CP can lead to meaningful patient reported outcomes.
PCV38 Assessment of Utility for Heart Failure using Visual Analogue Scale(VAS), Time-Trade off(TTO) and Euroqol-5 Dimension(EQ-5D) in the Korean General Population Lee JY, Lee E School of Pharmacy, Sungkyunkwan university, Suwon, South Korea
Objectives: The aim of this study was to assess and analyze the utility values for Heart Failure (HF) using different generic health status measuring instruments in the Korean general population. Methods: Through literature review and interview with cardiologists, 5 scenarios related to the health status of HF were developed: Stable Chronic Heart Failure (SCHF), hospitalization due to acute exacerbation, SCHF+cough, SCHF+hypotention and SCHF+hyperkalemia. To elicit the utilities for HF, face-to-face interview was carried out for 200 people selected from the general population through proportional allocation by age and gender. The utilities for HF were assessed using VAS, TTO and EQ-5D. Subjects were divided into two groups according to questionnaires: one questionnaire consisting of VAS, TTO and EQ-5D 3 Level (EQ-5D-3L) and the other questionnaire consisting of VAS, TTO and EQ-5D 5 Level (EQ-5D-5L). To compare the utilities among different instruments, Wilcoxon rank sum test and Repeated Measure Analysis of Variance (RMANOVA) were conducted. Results: The utilities for SCHF measured by VAS, TTO, EQ-5D-3L and EQ-5D-5L were 0.626 (±0.09), 0.815 (±0.104), 0.892 (±0.09) and 0.871 (±0.088), respectively. The utilities assessed using each instruments decreased in the order of SCHF, SCHF+cough, SCHF+hypotention, SCHF+hyperkalemia and hospitalization for all instruments. When comparing among health statuses, the lowest utilities were measured in the hospitalization status (VAS:0.215 (±0.101), TTO:0.360 (±0.164), EQ-5D-3L:-0.034 (±0.188), EQ-5D-5L:0.215 (±0.173)). The utility