Adherence to osteoporosis medications amongst Singaporean patients

Cheen, McVin Hua Heng; Kong, Ming; Zhang, R. F.; Tee, F. M. H.; Chandran, Manju

doi:10.1007/s00198-011-1635-9

Cited by 27 publications

(19 citation statements)

References 33 publications

(48 reference statements)

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“…However, as MPR is a measure of medication possession, it does not reflect actual medication consumption and may thus overestimate our cohort’s actual compliance to ULT. High MPRs seem to be a consistent observation in our country, as demonstrated in other local studies of patients with diabetes49 and osteoporosis 50. In Singapore, the convenience of on-site pharmacies within hospitals and clinics may account for the higher likelihood of prescriptions being filled after each doctor’s visit.…”

Section: Discussionsupporting

confidence: 88%

Utility of the Morisky Medication Adherence Scale in gout: a prospective study

Tan¹,

Teng²,

Chong³

et al. 2016

PPA

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BackgroundThe outcomes of any chronic illness often depend on patients’ adherence with their treatment. A tool is lacking to assess adherence in gout that is standardized, allows real-time feedback, and is easy to understand.ObjectiveWe set out to evaluate the utility of the 8-item Morisky Medication Adherence Scale (MMAS-8) in monitoring medication adherence in a multiethnic Asian gout cohort on urate-lowering therapy (ULT).MethodsThis cohort study recruited patients with gout where baseline and 6-monthly clinical data, self-report of adherence, and health status by Gout Impact Scale (GIS) and EuroQoL-5 dimension 3 levels were collected. Those who received at least 9 months of ULT were analyzed. Convergent and construct validities of MMAS-8 were evaluated against medication possession ratio (MPR) and known groups, clinical outcomes, and patient-reported outcomes. Internal consistency and test–retest reliability were assessed using Cronbach’s alpha and intraclass correlation coefficient (ICC), respectively.ResultsOf 91 patients, 92.3% were male, 72.5% Chinese with mean age 53.5 years. MMAS-8 (mean 6.17) and MPR (mean 96.3%) were poorly correlated (r=0.069, P=0.521). MMAS-8 did not differ between those who did or did not achieve target serum urate (SU) <360 µmol/L (P=0.852); or among those whose SU improved, stagnated, or worsened during follow-up (P=0.777). Adherence was associated with age (β=0.256, P=0.015) and education level (P=0.011) but not comorbidities, polypharmacy, or flare frequency. Concerns for medication side effects and anxiety or depression were associated with lower MMAS-8 (P<0.005). Internal consistency was acceptable (α=0.725) and test–retest reliability was satisfactory (ICC =0.70, 95% confidence interval [CI] 0.36–0.88).ConclusionMMAS-8 had limited construct validity in assessing medication adherence to ULT in our gout patients. Nevertheless, it identified patients bothered or worried about ULT side effects, and those with underlying anxiety or depression, for whom targeted education and coping support may be useful.

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Section: Discussionsupporting

confidence: 88%

Utility of the Morisky Medication Adherence Scale in gout: a prospective study

Tan¹,

Teng²,

Chong³

et al. 2016

PPA

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“…That could depend on the fact that the participants did not find taking long-term medication difficult to perform, once they had developed routines for taking their medications. That is in contrast to large quantitative studies that describe adherence with medications to be around 50-70% [43-45]. However, quantitative studies focusing on adherence use more precise measurements and definitions for medication adherence than in this study where we relied on the participants’ own descriptions of their medication taking.…”

Section: Discussionmentioning

confidence: 87%

The over time development of chronic illness self-management patterns: a longitudinal qualitative study

Audulv

2013

BMC Public Health

103

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BackgroundThere currently exists a vast amount of literature concerning chronic illness self-management, however the developmental patterns and sustainability of self-management over time remain largely unknown. This paper aims to describe the patterns by which different chronic illness self-management behaviors develop and are maintained over time.MethodTwenty-one individuals newly diagnosed with chronic illnesses (e.g., diabetes, rheumatism, ischemic heart disease, multiple sclerosis, chronic renal disease, inflammatory bowel disease) were repeatedly interviewed over two-and-a-half years. The interviews were conducted in Sweden from 2006 to 2008. A total of 81 narrative interviews were analyzed with an interpretive description approach.ResultsThe participants’ self-management behaviors could be described in four different developmental patterns: consistent, episodic, on demand, and transitional. The developmental patterns were related to specific self-management behaviors. Most participants took long-term medications in a consistent pattern, whereas exercise was often performed according to an episodic pattern. Participants managed health crises (e.g., angina, pain episodes) according to an on demand pattern and everyday changes due to illness (e.g., adaptation of work and household activities) according to a transitional pattern. All of the participants used more than one self-management pattern.ConclusionThe findings show that self-management does not develop as one uniform pattern. Instead different self-management behaviors are enacted in different patterns. Therefore, it is likely that self-management activities require support strategies tailored to each behavior’s developmental pattern.

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“…To avoid underestimating true persistence, the treatment was considered to be persistent if the oral BP was switched to another oral BPs or the dose of drugs was changed within a permissible gap [19, 24, 25]. Study subjects who discontinued BPs for a duration longer than permissible gap were considered to be non-persistent, even if BPs were subsequently restarted [20]. Reasons for non-persistence with oral BPs were identified and classified as adverse events, poor health literacy and cost.…”

Section: Methodsmentioning

confidence: 99%

Compliance and persistence with oral bisphosphonates for the treatment of osteoporosis in female patients with rheumatoid arthritis

Park

Koo

et al. 2017

BMC Musculoskelet Disord

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BackgroundPoor adherence with oral bisphosphonates (BPs) can mitigate their therapeutic benefit for osteoporosis and is a significant clinical burden. Most previous studies regarding adherence with oral BPs have focused on postmenopausal osteoporosis, but little attention has been given to patients with rheumatoid arthritis (RA). Thus, we investigated compliance and persistence with oral BPs in the treatment of osteoporosis and analyzed risk factors for poor adherence in female patients with (RA) in real setting.MethodsThis is a retrospective longitudinal study including 396 female patients with RA in whom oral BPs were newly initiated from Aug 2004 to Aug 2014 at a university rheumatology center in South Korea. Compliance was quantified using the 1-year medication possession ratio (MPR), while persistence was defined as duration from the initiation to the end of BPs therapy without interruption exceeding 56 days. Seropositve RA was defined as having a positive test result for the presence of either rheumatoid factor or anti-cyclic citrullinated peptide antibody.ResultsOf 396 RA patients, 221 (55.8%) were prescribed risedronate 35 mg weekly; 17 (4.3%) received alendronate 70 mg weekly; and 158 (39.9%) received ibandronate 150 mg monthly. The 1-year MPR was 70.1% and the proportion of RA patients with the 1-year MPR ≥ 0.8 was 60.1%. A total of 274 (69.2%) patients discontinued oral BPs during the study period and persistence with BPs was 63.3% at 1 year, 50.7% at 2 years and 33.3% at 3 years. The most common cause of non-persistence was adverse events (47.5%), followed by poor health literacy (40.5%) and cost (12%). Both compliance and persistence with monthly oral BPs were significantly lower than those with weekly regimens (OR: 2.48, 95% CI: 1.59–3.89, P < 0.001 and HR: 2.19, 95% CI: 1.69–2.83, P < 0.001, respectively). Additionally, patients with seropositive RA showed better compliance and persistence with BPs compared with their seronegative counterparts.ConclusionsCompliance and persistence with oral BPs in RA patients were suboptimal in real practice, thereby limiting the efficacy of osteoporosis treatment. Extending the dosing interval of BPs may improve medication adherence in RA patients.

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Adherence to osteoporosis medications amongst Singaporean patients

Abstract: In contrast to studies conducted in the US and Europe that show poor adherence, our study suggests higher adherence rates to bisphosphonate therapy amongst Singaporean patients.

Cited by 27 publications

References 33 publications

Utility of the Morisky Medication Adherence Scale in gout: a prospective study

Utility of the Morisky Medication Adherence Scale in gout: a prospective study

The over time development of chronic illness self-management patterns: a longitudinal qualitative study

Compliance and persistence with oral bisphosphonates for the treatment of osteoporosis in female patients with rheumatoid arthritis

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