Predictors of adherence among Alzheimer's disease patients receiving oral therapy

Borah, Bijan J.; Sacco, Patricia; Zarotsky, Victoria

doi:10.1185/03007995.2010.493788

Cited by 60 publications

(73 citation statements)

References 38 publications

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“…62,64 In the study by Amuah et al, 44 patients with AD paying for a greater proportion of their total prescription costs were significantly more likely to discontinue ChEI therapy. Studies of other drug classes have shown strong associations between worse adherence and (or) persistence and financial barriers in older, vulnerable patient groups.…”

Section: Patient-level Factorsmentioning

confidence: 99%

“…44,50 This seemingly paradoxical finding may reflect an opportunity for more interactions with prescribers, with enhanced continuity of care leading to improved treatment persistence. Two other studies from the Netherlands 43 and the United States 62 reported lower persistence and adherence to ChEI therapy among patients with greater comorbidity. While a higher pill burden (that is, number of pills, tablets, or capsules taken on a regular basis) appeared to be unrelated to ChEI persistence, there may be a positive association between the number of medications and greater adherence to dementia pharmacotherapy.…”

Section: Patient-level Factorsmentioning

confidence: 99%

“…An association with advanced age may reflect the impact of more advanced disease severity, 31 a perceived lack of therapeutic benefit, or concerns about a heightened risk for adverse effects. The few reports of greater ChEI persistence 44 or adherence 62 with increased age could be explained by modifying factors such as greater caregiver involvement in medication management, which has been linked with both higher ChEI use 69 and better adherence. 29,71 Unfortunately, information on the degree of caregiver involvement is generally not available in these studies.…”

Section: Patient-level Factorsmentioning

confidence: 99%

“…61 Comparisons across studies are challenging, given potentially incongruent methodology and differences in the measures and time periods employed. 35,40,52,[61][62][63][64] Adherence estimates may vary, both between and within patients with AD, illustrating the importance of capturing the dynamic nature of adherence behaviour. 66 Among patients with AD, the 1-year discontinuation rate for ChEIs ranges between 40% and 65%, with up to 90% stopping after 2 to 3 years.…”

Section: Overview Of Studies Examining Persistence and Adherencementioning

confidence: 99%

“…We identified 27 English-language observational studies on persistence and 7 reporting measures of adherence with dementia pharmacotherapy. 35,40,52,[61][62][63][64] Several studies further considered the likelihood and related predictors of switching between medications and formulations. 35,36,39,47,64,65 Estimates of adherence range from 34% 35 to 94%.…”

Section: Overview Of Studies Examining Persistence and Adherencementioning

confidence: 99%

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Persistence and Adherence with Dementia Pharmacotherapy: Relevance of Patient, Provider, and System Factors

et al. 2014

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This paper provides a comprehensive review of studies examining adherence and (or) persistence with dementia pharmacotherapy during the past decade, including a summary of the key patient-, drug-, system-, and provider-level factors associated with these measures. Estimates of adherence and 1-year persistence to these drugs have ranged from 34% to 94% and 35% to 60%, respectively. Though many studies reported nonsignificant associations, there are data suggesting that patient age, sex, ethnoracial background, socioeconomic status, and region-specific reimbursement criteria, as well as the extent and quality of interactions among patients, caregivers, and providers, may influence persistence with pharmacotherapy. As many studies relied on administrative data, limited information was available regarding the relevance of patient's cognitive and functional status or the importance of caregiver involvement or assistive devices to adherence or persistence. W W WPersistance et observance de la pharmacothérapie de la démence : pertinence des facteurs liés au patient, au fournisseur, et au système Cet article offre une revue détaillée des études examinant l'observance et (ou) la persistance de la pharmacothérapie de la démence au cours des dix dernières années, dont un résumé des principaux facteurs au niveau du patient, du médicament, du système et du fournisseur qui sont associés à ces mesures. Les estimations de l'observance et de la persistance d'un an à ces médicaments allaient de 34 % à 94 % et de 35 % à 60 %, respectivement. Même si de nombreuses études faisaient état d'associations non significatives, des données suggèrent que l'âge, le sexe, les origines ethnoraciales, le statut économique des patients et leurs critères de remboursement régionaux, ainsi que l'étendue et la qualité des interactions entre patients, soignants, et fournisseurs peuvent influencer la persistance de la pharmacothérapie. Comme bon nombre d'études s'appuyaient sur des données administratives, l'information disponible était limitée en ce qui concerne la pertinence de l'état cognitif et fonctionnel du patient, ou l'importance de l'implication du soignant ou des dispositifs d'assistance à l'observance ou à la persistance. In 2008, the estimated number of people with dementia in Canada was nearly half a million.2 Ensuring appropriate pharmacotherapy is an important component of care for people with dementia.3,4 ChEIs (for example, donepezil, rivastigmine, and galantamine) and the N-methyl-daspartate receptor antagonist memantine are approved for the symptomatic treatment of AD. 3,4 Recommendations made at the fourth CCCDTD (in 2012) included offering all people with AD a trial of a ChEI unless there are contraindications, using these agents for Parkinson disease dementia, and considering memantine for AD at a moderateto-severe stage. 5Investigating adherence and persistence with dementia pharmacotherapy is important in understanding both the therapeutic benefits and the cost-effectiveness of these medications. As symptomatic therapies, trea...

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Section: Patient-level Factorsmentioning

confidence: 99%

Section: Patient-level Factorsmentioning

confidence: 99%

Section: Patient-level Factorsmentioning

confidence: 99%

Section: Overview Of Studies Examining Persistence and Adherencementioning

confidence: 99%

Section: Overview Of Studies Examining Persistence and Adherencementioning

confidence: 99%

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Persistence and Adherence with Dementia Pharmacotherapy: Relevance of Patient, Provider, and System Factors

et al. 2014

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Factors associated with medication adherence in older patients: A systematic review

et al. 2018

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Objective Medication adherence is a major challenge in the treatment of older patients; however, they are under‐represented in research. We undertook a systematic review focused on older patients to assess the reasons underlying non‐adherence in this population. Methods We searched multiple electronic databases for studies reporting reasons for non‐adherence to medication regimens in patients aged 75 years and over. Our results were not limited to specific diseases, health‐care settings, or geographical locations. The quality of eligible studies was assessed using the Newcastle‐Ottawa Scale. A narrative synthesis of findings was performed. Results A total of 25 publications were included, all of which were in community settings. Frequent medication review and knowledge regarding the purpose of the medication were positively associated with adherence. Factors associated with poor adherence were multimorbidity, cognitive impairment, complex regimens with multiple prescribing physicians, and problems with drug storage or formulation. Conclusion These findings suggest that interventions to improve adherence could focus on medication review aimed at simplifying regimens and educating patients about their treatment. Groups with poor adherence that may benefit most from such a model include patients with multiple comorbidities and cognitive impairment.

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Highlighting Differences Between Conditional and Unconditional Quantile Regression Approaches Through an Application to Assess Medication Adherence

2013

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The quantile regression (QR) framework provides a pragmatic approach in understanding the differential impacts of covariates along the distribution of an outcome. However, the QR framework that has pervaded the applied economics literature is based on the conditional quantile regression method. It is used to assess the impact of a covariate on a quantile of the outcome conditional on specific values of other covariates. In most cases, conditional quantile regression may generate results that are often not generalizable or interpretable in a policy or population context. In contrast, the unconditional quantile regression method provides more interpretable results as it marginalizes the effect over the distributions of other covariates in the model. In this paper, the differences between these two regression frameworks are highlighted, both conceptually and econometrically. Additionally, using real-world claims data from a large US health insurer, alternative QR frameworks are implemented to assess the differential impacts of covariates along the distribution of medication adherence among elderly patients with Alzheimer’s disease.

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Predictors of adherence among Alzheimer's disease patients receiving oral therapy

Cited by 60 publications

References 38 publications

Persistence and Adherence with Dementia Pharmacotherapy: Relevance of Patient, Provider, and System Factors

Persistence and Adherence with Dementia Pharmacotherapy: Relevance of Patient, Provider, and System Factors

Factors associated with medication adherence in older patients: A systematic review

Highlighting Differences Between Conditional and Unconditional Quantile Regression Approaches Through an Application to Assess Medication Adherence

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