&lt;p&gt;Impact of Medication Regimen Simplification on Medication Adherence and Clinical Outcomes in Patients with Long-Term Medical Conditions&lt;/p&gt;

Elnaem, Mohamed Hassan; Irwan, Nor Afifah; Abubakar, Usman; Sulaiman, Syed Azhar Syed; Elrggal, Mahmoud E.; Cheema, Ejaz

doi:10.2147/ppa.s268499

Cited by 33 publications

(26 citation statements)

References 50 publications

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“…There a host of reasons to reduce polypharmacy in older adults, such as improving quality of life 29 and reducing the risk of adverse events. 30 Some reports have found that simplifying medication regimens does improve adherence (mostly in HIV infected adults), 31 but no regimen simplification interventions have been tested in people with COPD. Reducing complexity ought to be a goal of all clinicians when clinically indicated.…”

Section: Discussionmentioning

confidence: 99%

Associations of Medication Regimen Complexity with COPD Medication Adherence and Control

Federman¹,

O’Conor²,

Wolf³

et al. 2021

COPD

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Introduction Medication adherence is often low among people with chronic obstructive pulmonary disease (COPD) and medication regimen complexity may be a contributing factor. In this study, we sought to examine the role of medication regimen complexity in COPD medication adherence among patients with multimorbidity. Methods We performed cross-sectional analysis of data on COPD patients in primary care and pulmonary practices in New York City and Chicago (n=400). Regimen complexity was represented by the medication regimen complexity index (MRCI) and simple medication count. Adherence was measured by self-report and inhaler dose counts. Disease control measures included the COPD severity score (COPDSS) and the Medical Research Council (MRC) severity index. Results Mean age of study participants was 69 years, 66% had MRC grades 4 or 5, and 45% had low medication adherence. MRCI scores did not differ significantly between those with and without adequate medication adherence. Patients with higher MRCI scores were more likely to have severe COPD (OR 5.00, 95% CI 1.46–17.1, p=0.01) and dyspnea grades 3 or 4 (OR 2.27, 95% CI 1.03–5.03, p=0.04). Significant associations of medication count with COPD severity were also observed. Discussion These findings demonstrate that among patients with COPD and comorbid hypertension and diabetes, higher medication regimen complexity is associated with worse COPD control but not with COPD medication adherence.

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Section: Discussionmentioning

confidence: 99%

Associations of Medication Regimen Complexity with COPD Medication Adherence and Control

Federman¹,

O’Conor²,

Wolf³

et al. 2021

COPD

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“…Initially, and in contrast to the once-daily dosing of vadadustat [ 13 ], randomization to even twice weekly dosing has been reported with roxadustat [ 8 ]. There must be a pharmacodynamic reason for the thrice- or twice-weekly dose interval because it contrasts to the experience that medication adherence would be expected best with once-daily dosing [ 20 ]. However, in patients on hemodialysis, administration three times weekly would be suitable on the day of hemodialysis.…”

Section: Dosing and Formulationmentioning

confidence: 99%

Clinical Pharmacokinetics and Pharmacodynamics of Roxadustat

Czock

Keller

2021

Clin Pharmacokinet

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The pharmacokinetics of roxadustat are well characterized, with an apparent volume of distribution after oral administration of 22-57 L, apparent clearance of 1.2-2.65 L/h, and renal clearance of 0.030-0.026 L/h in healthy volunteers; the elimination half-life is 9.6-16 h. Plasma binding is 99% and the fraction eliminated by hemodialysis is 2.34%. As an interpretation of the pharmacodynamics of roxadustat, we proposed a concept with a hypothetical cascade of two subsequent effects, first on erythropoetin (EPO) and second on hemoglobin (delta Hb). The primary effect on EPO is observed within a few hours after roxadustat administration and can be modeled using the sigmoidal Hill equation. The concentration at half-maximum effect can be inferred at 10-36 µg/mL, the Hill coefficient at 3.3, and the effect bisection time at 10-17 h, corresponding to EPO half-life. The subsequent effect on hemoglobin (delta Hb) is observed after several weeks and can be interpreted as an irreversible, dose proportional, unsaturable effect, continuing in agreement with the lifespan of red blood cells of 63-112 days.

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“…Apart from these relatively special considerations, there is a generic need for community interventions to enforce a healthier lifestyle and pharmacotherapy optimization in most LMIC studies. Interventions that optimize pharmacotherapy which consider the simplifications of drug regimens are needed [ 66 ].…”

Section: Discussionmentioning

confidence: 99%

Disparities in Prevalence and Barriers to Hypertension Control: A Systematic Review

Elnaem

Mosaad²,

Abdelaziz

et al. 2022

IJERPH

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Controlling hypertension (HTN) remains a challenge, as it is affected by various factors in different settings. This study aimed to describe the disparities in the prevalence and barriers to hypertension control across countries of various income categories. Three scholarly databases—ScienceDirect, PubMed, and Google Scholar—were systematically examined using predefined search terms to identify potentially relevant studies. Original research articles published in English between 2011 and 2022 that reported the prevalence and barriers to HTN control were included. A total of 33 studies were included in this systematic review. Twenty-three studies were conducted in low and middle-income countries (LMIC), and ten studies were from high-income countries (HIC). The prevalence of hypertension control in the LMIC and HIC studies ranged from (3.8% to 50.4%) to (36.3% to 69.6%), respectively. Concerning barriers to hypertension control, patient-related barriers were the most frequently reported (n = 20), followed by medication adherence barriers (n = 10), lifestyle-related barriers (n = 8), barriers related to the affordability and accessibility of care (n = 8), awareness-related barriers (n = 7), and, finally, barriers related to prescribed pharmacotherapy (n = 6). A combination of more than one category of barriers was frequently encountered, with 59 barriers reported overall across the 33 studies. This work reported disparities in hypertension control and barriers across studies conducted in LMIC and HIC. Recognizing the multifactorial nature of the barriers to hypertension control, particularly in LMIC, is crucial in designing and implementing customized interventions.

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<p>Impact of Medication Regimen Simplification on Medication Adherence and Clinical Outcomes in Patients with Long-Term Medical Conditions</p>

Cited by 33 publications

References 50 publications

Associations of Medication Regimen Complexity with COPD Medication Adherence and Control

Associations of Medication Regimen Complexity with COPD Medication Adherence and Control

Clinical Pharmacokinetics and Pharmacodynamics of Roxadustat

Disparities in Prevalence and Barriers to Hypertension Control: A Systematic Review

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