This document discusses cardiovascular risk and adherence to treatment. It defines key terms like adherence, compliance, persistence, and non-adherence. It notes that poor adherence is a major reason for suboptimal clinical benefits. It also discusses factors that influence adherence like the medication, patient, and healthcare system. Non-adherence can increase risks of stroke, death, hospitalizations and costs. Long-term adherence to medications for conditions like hypertension and statins is often low, around 50%. Improving adherence requires addressing multiple barriers and ensuring patients are involved in treatment decisions.
Austin Ophthalmology is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Ophthalmology.
The journal aims to promote latest information and provide a forum for doctors, researchers, physicians, and healthcare professionals to find most recent advances in the areas of Ophthalmology. Austin Ophthalmology accepts research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Ophthalmology.
Austin Ophthalmology strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing.
Knowledge and Perceptions Related to Hypertension, Lifestyle Behavior Modific...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
Erectile Dysfunction and Risk Factors in Male Peruvian Hemodialysis Patientsasclepiuspdfs
Introduction: Erectile dysfunction (ED) is a common condition in patients with renal disease, but little is known about the prevalence of ED in some specific groups of patients such as Peruvian hemodialysis (HD) patients. Materials and Methods: A cross‑sectional study was conducted to determine the frequency of ED in HD patients (n = 390) in Lima, Peru. The prevalence and severity of ED were assessed using the International Index of Erectile Function with the validated Peruvian version. The dependence of ED on independent variables was evaluated by logistic regression. P ≤ 0.05 was regarded as statistically significant.
Matt Anstey is an intensivist from Sir Charles Gardiner hospital in Perth, Australia.
He gave this talk on outcomes after intensive care at an ICN WA meeting in Perth last year.
Update on the evidence to support deprescribing, a presentation by David Erskine, Director – London & South East Medicine Information Service (July 2017).
Colangiografie percutana transhepatica si drenaj biliar extern ALEXANDRU ANDRITOIU
colangiografie percutana transhepatica combinata cu drenaj biliar extern si drenaj peritoneal la un pacient cu ciroza hepatica atrofica, colangiocarcinom centrohilar si ascita refractara complicat a 5-a zi post-intervnetie cu colangita (angiocolita) si exitus
Austin Ophthalmology is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Ophthalmology.
The journal aims to promote latest information and provide a forum for doctors, researchers, physicians, and healthcare professionals to find most recent advances in the areas of Ophthalmology. Austin Ophthalmology accepts research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Ophthalmology.
Austin Ophthalmology strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing.
Knowledge and Perceptions Related to Hypertension, Lifestyle Behavior Modific...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
Erectile Dysfunction and Risk Factors in Male Peruvian Hemodialysis Patientsasclepiuspdfs
Introduction: Erectile dysfunction (ED) is a common condition in patients with renal disease, but little is known about the prevalence of ED in some specific groups of patients such as Peruvian hemodialysis (HD) patients. Materials and Methods: A cross‑sectional study was conducted to determine the frequency of ED in HD patients (n = 390) in Lima, Peru. The prevalence and severity of ED were assessed using the International Index of Erectile Function with the validated Peruvian version. The dependence of ED on independent variables was evaluated by logistic regression. P ≤ 0.05 was regarded as statistically significant.
Matt Anstey is an intensivist from Sir Charles Gardiner hospital in Perth, Australia.
He gave this talk on outcomes after intensive care at an ICN WA meeting in Perth last year.
Update on the evidence to support deprescribing, a presentation by David Erskine, Director – London & South East Medicine Information Service (July 2017).
Colangiografie percutana transhepatica si drenaj biliar extern ALEXANDRU ANDRITOIU
colangiografie percutana transhepatica combinata cu drenaj biliar extern si drenaj peritoneal la un pacient cu ciroza hepatica atrofica, colangiocarcinom centrohilar si ascita refractara complicat a 5-a zi post-intervnetie cu colangita (angiocolita) si exitus
Analiza lichidului pleural in vederea diferentierii intre transsudate si exsudate si cauzele posibile pentru prezenta unui exsudat. Modificari de aspect si biochimice ale lichidului pleural in diverse patologii.
The investigation (summarized in the attached slides) analyzed how at-risk obese/overweight patients interact with beneficial interventions (2013 AHA/ACC risk, cholesterol, obesity and lifestyle prevention guidelines). The study estimated the savings potential if overweight/obese patients in the ACC/AHA four statin benefit groups stepped-down one risk level.
Title: Cost Of Obesity-Based Heart Risk In The Context Of Preventive And Managed Care Decision-Making: An NHANES Cross-Sectional Concurrent Study
By: John Frias Morales
Designing Causal Inference Studies Using Real-World DataInsideScientific
In this webinar, experts provide an overview of causal inference, along with step-by-step guidance to designing these studies using real-world healthcare data.
Causal inference is used to answer cause and effect research questions and yield estimates of effect. Causal study design considerations and statistical methods address the effects of confounding variables and other potential biases and allow researchers to answer questions such as, “Does treatment A produce better patient outcomes compared to Treatment B?”
Causal study interpretations have traditionally been restricted to randomized controlled trials; however, causal inference applied to observational healthcare data is growing in importance, driven by the need for generalizable and rapidly delivered real-world evidence to inform regulatory, payer, and patient/provider decision making. The application of causal inference methods leads to stronger and more powerful evidence. When these techniques are applied to observational data, the results generated are both from and for the real world.
Presenters walk through several real-world case studies including the PCORI-funded BESTMED study and a collaborative study with a prominent pharmacy payer.
Chair and Presenter, Sumanta Kumar Pal, MD, FASCO, Pedro C. Barata, MD, MSc, Toni K. Choueiri, MD, and Cristina Suarez, MD, PhD, prepared useful Practice Aids pertaining to renal cell carcinoma for this CME/MOC/NCPD/AAPA activity titled “Fine-Tuning the Wave of Innovation in RCC: Personalized Management Across the Disease Spectrum.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD/AAPA information, and to apply for credit, please visit us at https://bit.ly/3yGnLnD. CME/MOC/NCPD/AAPA credit will be available until July 2, 2024.
This study uses consecutive National Health and Nutrition Examination Surveys (NHANES) data from 2003-2012 to concurrently model obese body size (c.f., normal weight) main effects, moderated by nondiabetic moderate 10-year ASCVD risk (c.f., 30-year and diabetic), on total medical cost outcomes.
• Minors, seniors 76+, outlier diseases, and pregnant women were excluded, resulting in 192,447,424 weighted or 22,510 unweighted participants.
Diagnosticul si tratamentul TVP nu sunt intotdeauna usor de realizat. Din constelatia de antitrombotice, alegerea schemei si dozajului terapeutic pentru liza trombusului si/sau preventia secundara, pune serioase probleme in practica medicala
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
4. Riscul CVRiscul CV
• Total (global)
-absolut
-relativ
• Formule de calcul probabilistic intr-o
populatie tinta
5. Riscul global-CADRiscul global-CAD
• Riscul global este un calcul al riscului absolut
de a avea un eveniment coronarian (deces,
IMA) intr-un interval de timp specificat (10
ani).
• Cunoasterea RCV permite medicului sa
prescrie terapii tintite in copul reducerii
riscului (antihipertensive, statine, aspirina).
6. Permite aflarea raspunsului la intrebarilePermite aflarea raspunsului la intrebarile
• Cine va beneficia de interventiile terapeutice?
• Cand trebuie inceput tratamentul farmacologic
si non-faramacologic?
• La cine, aceste interventii sunt cost-eficiente?.
• Calculul risului CV poate ajuta in luarea celei
mai bune decizii de management.
7. Calcululul Riscului Global
Calculul riscului CV global este recomandat in toate
ghidurile nationale ca punct de plecare in decizia
terapeutica
• Framingham CardioVascular Risk Score
(Framingham Heart Study)-USA
• Prospective Cardiovascular Munster Heart Study
(PROCAM)
• Systematic Coronary Risk Evaluation system (SCORE)
• United Kingdom Prospective Diabetes Study
(UKPDS) for diabetics,
• Reynolds Risk Score
• NHANES (include the obesity as a risk factor)
17. Controlul FRCVControlul FRCV
• HTA-stil de viata, dieta, medicatie;
• Colesterol-dieta, medicatie (statine);
• Fumatul- consiliere, medicatie;
• Diabet-dieta, medicatie;
• Istoric familial (ereditate)-……
• Sexul Masculin-…..
FR influentabili/neinflentabili
18. Definitii, termeni si concepteDefinitii, termeni si concepte
The World Health Organization:The World Health Organization:
Adherence:
- the degree to which the person’s behavior corresponds with the agreed
recommendations from a healthcare provider.
Compliance:
- the degree to which a patient correctly follows medical advice.
- patient is passively following the physician’s orders, while adherence
acknowledges that the patient is part of the decisionmaking process,
making this the preferred term.
Persistence:
the duration of time over which a patient continues to fill the prescription.
Non-acceptance:
- some patients may never start treatment (a type of non-adherence)
Concordance:
- the degree of accordance of therapeutic goals of patient and therapist is
defined as ‘concordance
19. Non-AderentaNon-Aderenta
OMS/WHO:
• ,,poor adherence is the primary reason for suboptimal
clinical benefit in many circumstances.
• ,,medication non-adherence has been associated with
increased hospitalizations, loss of productivity,
premature deaths, and increased treatment costs”.
Non-adherence to medications is widely recognized as a major public health
concern and contributes to patient morbidity, mortality and healthcare costs
20. Ce este aderenta pe termen lungCe este aderenta pe termen lung
(long-time adherence)?(long-time adherence)?
• 12 luni dupa externare
• 24 luni
21. Non-Non-AderenAderenta pe termen lungta pe termen lung
Greater prescribing/filling complexity was associated with lower levels of adherence.
Some studies suggest that long-term adherence of chronically prescribed CV medications such as anti-hypertensives or statins may
be as low as 50%.
22. • 1996-primul simpozion
• 2006-primul simpozion
european
• 2009 ESPACOMP
ESPACOMP is a non-profit association
established to promote the science concerned with the quantitative assessment of what
patients do with medicines they have been prescribed.
23.
24.
25. Cum masuram aderenta?
• Nu este o metoda gold-standard
• Criterii directe:
- conc. medicamentului sau metabolitilor sai in
prodise biologice (sange/urina)
• Criterii indirecte:
- chestionare, met. electronice, contabilizare Rp,
masurarea unor markeri biologivie (LDL-Col),
etc.
26.
27.
28. Consecintele nonaderentei la pacientii
cu RCV inalt
Gehi AK, Ali S, Na B, Whooley MA. Self-reported medication adherence and cardiovascular events in patients with stable
coronary heart disease: the heart and soul study. Arch Intern Med. 2007;167(16):1798–1803.
• 1.015 pts. CAD
• chestionar-aderenta
Follow-up 4 ani
• 4.4x risc de stroke
• 3.8x risk de deces
32. • In SUA numai 50% dintre pts. continua
tratamentul cu statine la 6 luni, si doar 30-
40% la 1 an!
• Beneficiile tratamentului cu statine este pus
sub semnul intrebarii in populatia generala.
• Riscurile intreruperii tratamentului cu statine
sunt devastatatoare, in ciuda beneficiilor certe
demonstrate in trial-urile clinice.
Aderenta la statine
33. 9.014 patients with previous CAD
Results:
monitoring of cholesterol concentration had modest ability for
detecting complete non-adherence and non-persistence.
BMJ 2011;342:d12
34. Diabetes Care 28:595–599, 2005
CONCLUSIONS:
• Adherence to statin therapy, (as reflected by MPR), is closely related to LDL
cholesterol goal attainment in patients with diabetes and dyslipidemia.
• The probability of goal achievement appears to increase substantially when
the MPR is 0.80.
• Pharmacy records can be used to identify patients who are poorly compliant
with statin therapy and at high risk for failure to attain LDL cholesterol
goals.
35. Motivele intreruperii tratamentuluiMotivele intreruperii tratamentului
cu statine-o dilema actuala?cu statine-o dilema actuala?
• Efectele adverse (diabet?, rabdomioliza)
• Costuri (original vs generic)
• Lipsa de incredere in produs
• Campania anti-statine in mediul on-line
• Comunicare, educatie, follow-up
• Unii pts intrerup o perioada, dupa care reiau
tratamentul!
36. Riscurile terapiei cu statine suntRiscurile terapiei cu statine sunt
determinate genetic!determinate genetic!
37. Results
• Statins were prescribed for 67% patients, but only 41% used the
drug
• In spite of being indicated, statins were not prescribed in 33%
patients
• Of 26% patients, nonadherent to statins,
- 67% did not use the drug due to its high cost,
- 31% due to the lack of instruction,
- 2% due to side effects.
Arq Bras Cardiol, volume 76 (nº 2), 115-8, 2001
38. Adherence With Statin Therapy in Elderly
Patients With and Without Acute Coronary
Syndromes
Cynthia A. Jackevicius, Muhammad Mamdani, Jack V. Tu
JAMA. 2002;288(4):462-467.
Conclusions:
Elderly patients with and without recent ACS have low rates of adherence
to statins.
This suggests that many patients initiating statin therapy may receive no
or limited benefit from statins because of premature discontinuation.
39. Adherence With Statin Therapy in Elderly Patients With and Without Acute Coronary Syndromes
JAMA. 2002;288(4):462-467. doi:10.1001/jama.288.4.462
All curves are based on a Cox proportional hazards model adjustedfor covariates. The median follow-up was 494 days for acute coronary
syndrome,430 days for coronary artery disease, 235 days for primary prevention, and303 days for overall.
40.
41. Aderenta la statine este diferita de aAderenta la statine este diferita de a
celorlate medicamente CV?celorlate medicamente CV?
• (1) Aspirina: 71%
• (2) B-blocante: 46%
• (3) Statine: 44%
• 1+2+3: 21%
Duke University
42. 28 studies were included:
• 19 studies evaluating outcomes associated with statin adherence
• 6 studies with statin discontinuation
• 3 studies with statin persistence
The included studies consistently reported
increased risks of CVD and mortality
associated with poor adherence with respect
to both execution of regimen and stopping of
therapy.
43. J Manag Care Pharm. 2014;20(1):51-57
Conclusion:
• patients adherence levels tend to decline over time
• a transition to levels of adherence lower than a PDC of 80% was
associated with increased risk of CV events
47. • The good adherence (89%) in
this study may be based on
the systematic feedback of
treatment results.
• the percentage side effects
(27 %) is much higher than
the incidence of adverse
effects of statins in RCT’s
(5-10%)
49. • Statin therapy for patients with cardiovascular
conditions (first-year measure)
• Statin therapy for patients with diabetes (first-year
measure).
The Healthcare Effectiveness Data andThe Healthcare Effectiveness Data and
Information Set (HEDIS)Information Set (HEDIS)
50. Proposed New Measure for HEDIS 2016:Proposed New Measure for HEDIS 2016:
Statin Therapy for Patients WithStatin Therapy for Patients With
Cardiovascular DiseaseCardiovascular Disease
• Received Statin Therapy. The percentage of members
who were identified as having clinical ASCVD and were
dispensed at least moderate intensity statin therapy
during the measurement year.
• Statin Adherence 80 percent. The percentage of
members who were identified as having clinical ASCVD
and were dispensed at least moderate-intensity statin
therapy that they remained on for at least 80 percent of
the treatment period.
51.
52. The CMA was better for patients with
increasing CV risk.
CMA at 15 months varied from an average of 56%
(67% with a CMA ≤ 80%) for those with one risk factor
to 72% (43.3% with a CMA ≤ 80%) for patients with
three or more risk factors
53. Aderenta in tratamentul HTAAderenta in tratamentul HTA
• Controlul TA optim-un deziderat neatins in
populatie
• Nonaderenta-cauza de falsa HTA rezistenta
Medicatia antihipertensiva
• Aderenta buna-Ca bloc, IECA
• Aderenta scazuta-Beta bloc, diuretic
54. Patient adherence and the treatment of
hypertension
• Nonadherence to antihypertensive medication is common.
• The latest National Health and Nutrition Examination Survey
(NHANES) found that about 74 percent of hypertensive
patients in the United States are being treated, and
72 percent of those being treated have their blood
pressure well controlled (which was defined as a pressure
below 140/90mmHg)
• In a study of 149 hypertensive patients who were monitored with
electronic pill boxes, 42 percent were nonadherent,
defined as taking less than 80 percent of prescribed
antihypertensive medication .
Kaplan N et al. UpToDate 2015
55.
56. Adherence to diabetes medication:Adherence to diabetes medication:
a systematic reviewa systematic review
Conclusions
• Adherence to diabetes medication remains an ongoing problem.
• Of the 27 studies included in the present review, the prevalence of adherence
ranged from 38.5 to 93.1%.
• Only six out of 27 studies (22.2%) reported prevalence of adherence of ≥ 80%
among their study population.
• Depression and medication cost were found to be consistent and
potentially modifiable predictors for diabetes medication-taking behaviour.
Krass I et al. 2015, 32,6:725-737
57. Aderenta la dieta mediteraneanaAderenta la dieta mediteraneana
• Dieta mediteraneana reduce RCV
• Efectele aderentei crescute:
-reduce LDL-Col. oxidat
-reduce RLO
-reduce procesele inflamatorii
-imbunatateste controlul TA
-previne sdr. metabolic
Pitsavos C et al. . Am J Clin Nutrition (The ATTICA Study) 2005
58. Spania, Grecia, Italia
Adherence to the Mediterranean diet was mainly poor in
roughly half of the populations investigated.
Major determinants of adherence were social and demographic
factors
NFS Journal 3 (2016) 13–19
59.
60. Ann Pharmacother 2010;44:1905-13.
• The pharmaceutical care program (frequent counseling
sessions - every 3 months) resulted in a significantly
lower rate of discontinuation within 6 months after
initiating therapy versus usual care.
• Median MPR was very high (>99%)!
Some studies suggest that long-term adherence of chronically prescribed CV medications such as anti-hypertensives or statins may be as low as 50%.
All we know about the value of these chronic medications in reducing untoward outcomes are usually based on rigorous RCT that involve frequent visits, free medications, and pill counts to verify adherence.
The actual benefit of CV medications when they are taken only intermittently or for a short period of time and then stopped is not known for sure, but is thought to be worse based on observational studies in routine practice.
As would be hypothesized, not taking one’s chronic medications has important clinical consequences.
In this observational study in a high-risk cohort of patients with established but stable coronary artery disease, a single question was asked to examine the extent to which they were taking their medications as prescribed (adherence). Patients were followed for an average follow-up period of four years.
Those taking their medications as prescribed only 75% of the time, or less, had a more than four times the increased risk of stroke and almost a four-fold increased risk of death.