Impact of Post-Visit Outreach on Inhaled Corticosteroid Refill Persistence in Children and Young Adults With Asthma.

BACKGROUND: Inhaled corticosteroids (ICSs) are a fundamental pillar of most regimens for long-term control of persistent asthma. Poor adherence to ICS medication is a common problem in the asthma population that can lead to poor asthma control. We hypothesized that conducting a follow-up telephone call after general pediatric clinic visits for asthma would improve refill persistence. METHODS: We conducted a prospective cohort analysis of pediatric and young adult subjects followed in our pediatric primary care clinic for asthma on ICS medication found to have poor ICS refill persistence. This cohort received a follow-up telephone outreach call 5-8 weeks after the clinic visit. The primary outcome measure was refill persistence with regard to ICS therapy. RESULTS: There were 289 subjects who met the inclusion criteria and did not meet any exclusion criteria for the study (n = 131 in the primary cohort, n = 158 in the post-COVID cohort). The mean ICS refill persistence increased significantly for subjects in the primary cohort (39.4 ± 30.8% post intervention vs 32.4 ± 19.7% pre intervention) (P = .02) but not in the post-COVID cohort (36.4 ± 25.6% post intervention vs 38.9 ± 21.0% pre intervention) (P = .26). There was not a statistically significant change in hospitalizations after the intervention in either the primary or the post-COVID cohorts (P = .08 and .07, respectively). Systemic corticosteroid courses and emergency department visits decreased significantly post intervention (P = .01 and P = .004, respectively) in the primary group but not in the post-COVID group (P = .75 and P = .16, respectively). CONCLUSIONS: These results suggest that telephone outreach after out-patient clinic visits for asthma may have short-term benefit in ICS refill persistence; however, the effect size was small.

Elderly Population Has Higher Prevalence of Polypharmacy Associated with Poor Quality of Life and Low Compliance after Recovery from COVID-19.

Background: Long term effects of COVID are not fully understood yet. The geriatric population has been badly affected. The impact of COVID-19 on the health-related quality of life after recovery and patient compliance is a matter of concern especially in the geriatric population where polypharmacy is often prevalent. Aims and Objectives: This study intended to observe the occurrence of polypharmacy (PP) among COVID-19 recovered older patients with multimorbidity and explore its association with health-related quality of life and compliance in these patients. Materials and Methods: Total 90 patients, above 60 years of age having two or more co-morbidities and recovered from COVID-19 infection were included in this cross-sectional study. Number of pills taken daily by each patient was noted, to determine the occurrence of PP. WHO-QOL-BREF was used to assess the effect of PP on health-related quality of life (HRQOL). Medication adherence was measured using a self-reported questionnaire. Results: PP was found in 94.4% while hyper polypharmacy was found in 45.56% of patients. The overall mean score of HRQOL in patients with PP was 187.91 ± 32.98, indicating poor quality of life with PP (p value 0.0014) whereas the overall mean score of HRQOL in patients with hyper polypharmacy was 177.41 ± 26.11, showing poor quality of life with hyper polypharmacy (p value 0.0005). Increased number of pills corelated with poor quality of life (r =0.49). The medication adherence was found to be poor in patients who received mean number of pills 10.44 ± 2.62 whereas the adherence was good if the mean number of pills was 8.20 ± 2.63, (p value of 0.0001). Conclusion: Polypharmacy is highly prevalent among COVID-19 recovered patients and is associated with poor quality of life as well as poor medication adherence.

A scoping review of non-professional medication practices and medication safety outcomes during public health emergencies.

OBJECTIVES: Public health emergencies (PHE) can disrupt personal medication practices and increase the risk of medication-related harm and other negative medication-related outcomes. Our aim was to examine the extent and nature of published research on this topic to guide future research and practice. STUDY DESIGN: Scoping review. METHODS: Standard electronic databases were searched. PRISMA-ScR guidelines were followed. Extracted data were organised in response to review questions and narrative accounts developed. RESULTS: A total of 129 studies were included, conducted across 32 countries, mostly in the USA (n = 42). Sixty-eight (53%) reported on infectious events, 49 (39%) climatological or ecological events and the remainder a mixture of terrorism, war or other disasters. The studies described several medication safety outcomes (medication-related harm, adherence, supply) and adaptive medication practices (self-altering prescribed medications, sharing medications and changing healthcare providers). Challenges to maintaining routine medication practices during a PHE included transport, finance, quarantine and knowledge-related issues. Twenty-eight studies (22%) examined health inequalities pertaining to adverse medication-related outcomes, with findings suggesting that gender, age, ethnicity, educational and socio-economic status may be related to inequalities. Research gaps identified included carers', children's and minority communities' experiences and intervention studies. CONCLUSIONS: There is considerable evidence of disruptions to routine personal medication practices during PHEs and of medication-related harm and other negative outcomes. Maintaining medication supply for the management of chronic conditions is a universal problem across all emergency types. Research is needed to address these disruptions, particularly amongst people who experience health inequalities who may need additional support.

Impact of the COVID-19 pandemic on patients with rheumatoid arthritis: data from the Ontario Best Practices Research Initiative (OBRI).

Objective: The coronavirus disease 2019 (COVID-19) pandemic created challenges for patients with RA. We examined the potential impact of the pandemic on patient-reported outcomes (PROs), disease activity and medication profiles, comparing the periods pre-pandemic and during the pandemic. Methods: Patients enrolled in the Ontario Best Practices Research Initiative were included if they had at least one visit to a physician or study interviewer within 12 months before and after the start of pandemic-related closures in Ontario (15 March 2020). Baseline characteristics, disease activity, PROs [i.e. health assessment questionnaire disability index, RA disease activity index (RADAI), European quality of life five-dimension questionnaire], medication use and changes were included. Student's paired two-sample t-tests and McNamar's tests were performed for continuous and categorical variables between time periods. Results: The sample for analysis consisted of 1508 patients, with a mean (s.d.) age of 62.7 (12.5) years, and 79% were female. Despite decreases in the number of in-person visits during the pandemic, there was no significant negative impact on disease activity or PRO scores. The DASs in both periods remained low, with either no clinically significant differences or slight improvement. Scores for mental, social and physical health were either stable or improved. There were statistically significant decreases in conventional synthetic DMARD use (P < 0.0001) and increased Janus kinase inhibitor usage (P = 0.0002). Biologic DMARD use remained stable throughout the pandemic. Conclusion: In this cohort, disease activity and PROs of RA patients remained stable during the COVID-19 pandemic. The longer-term outcomes of the pandemic warrant investigation.

Medication Adherence among Allogeneic Haematopoietic Stem Cell Transplant Recipients: A Systematic Review.

Recipients of a haematopoietic stem cell transplantation (HSCT) may experience issues in medication adherence (MA) when discharged. The primary aim of this review was to describe the oral MA prevalence and the tools used to evaluate it among these patients; the secondary aims were to summarise factors affecting medication non-adherence (MNA), interventions promoting MA, and outcomes of MNA. A systematic review (PROSPERO no. CRD42022315298) was performed by searching the Cumulative Index of Nursing and Allied Health (CINAHL), Cochrane Library, Excerpta Medica dataBASE (EMBASE), PsycINFO, PubMed and Scopus databases, and grey literature up to May 2022 by including (a) adult recipients of allogeneic HSCT, taking oral medications up to 4 years after HSCT; (b) primary studies published in any year and written in any language; (c) with an experimental, quasi-experimental, observational, correlational, and cross-sectional design; and (d) with a low risk of bias. We provide a qualitative narrative synthesis of the extracted data. We included 14 studies with 1049 patients. The median prevalence of MA was 61.8% and it has not decreased over time (immunosuppressors 61.5% [range 31.3-88.8%] and non-immunosuppressors 65.2% [range 48-100%]). Subjective measures of MA have been used most frequently (78.6%) to date. Factors affecting MNA are younger age, higher psychosocial risk, distress, daily immunosuppressors, decreased concomitant therapies, and experiencing more side effects. Four studies reported findings about interventions, all led by pharmacists, with positive effects on MA. Two studies showed an association between MNA and chronic graft-versus-host disease. The variability in adherence rates suggests that the issues are relevant and should be carefully considered in daily practice. MNA has a multifactorial nature and thus requires multidisciplinary care models.

How asthmatic children dealt with the coronavirus pandemia? Adherence to Controller Medications and Level of Control among Children with Asthma Registered in Mashhad University of Medical Sciences

Background: Coronavirus disease 2019 pandemic had a great effect on the lives of asthmatic children. In this study we assessed changes in medication adherence and asthma control rate among our registered children with pediatric asthma.Methods: This cross-sectional study was conducted on 113 patients registered in our asthma and allergy clinic in Mashhad, Iran. We called them via phone and completed a questionnaire on the level of asthma medication adherence and the asthma control test (ACT) before and in the 6 months after COVID-19 emergence. We investigated the changes in medication adherence and asthma control due to COVID-19 pandemic.Results: A total of 113 asthmatic children in the age range of 1 to 15 (mean, 7.02 +/- 3.24 years) were included in the study. There were zero confirmed positive cases among them since COVID-19 introduction. The minority of patients (8.8%) had weak adherence, most of the children (35.4%) completed one course of prescribed medications, 33% had longer adherence, and only 25 patients (22.1%) had full adherence during the pandemic. Overall, our patients experienced better asthma control with a 1.51 rise in ACT score to arrive in 23.64 points out of 25. They had no asthma exacerbation and emergency visit. Over half of the families compiled the national preventive measures;as 85% of children had followed the stay-at-home order during the first peak of the pandemic.Conclusion: Our patients managed to come to a higher asthma control level despite their generally decreased adherence to medications during the pandemic. COVID-19 not only could not worsen asthma status in our children but surprisingly improved it. This shows that the preventive measures should be strongly applied for the asthmatic population.

Evaluation of Prevalence of Fatigue among Jordanian University Students and its Relation to COVID-19 Quarantine

BACKGROUND: The novel coronavirus outbreak (COVID-19) presented an opportunity to conduct an online survey to research the psychological fatigue as a mental health issue among the students of Jadara University, Jordan. AIM: This study aimed at assessing prevalence of fatigue in the student population of Jadara University (Irbid, Jordan) and its association with COVID-19 quarantine. METHODOLOGY: A cross-sectional study was conducted in Jadara University during a period of 2 months, extending from March to May, 2020. Two-hundred students (43.8% males and 56.2% females) participated in the study and filled forms of the fatigue assessment scale. RESULT(S): Psychologically-tired students constituted 59.0% of the participants whereas the remainder participants were normal students. Moreover, statistically-significant differences in fatigue between students of the various academic years (p = 0.04) were found. The highest proportion of students suffering from fatigue was observed in the fourth-, and 5th-year students (21 out of 42 and 9 out of 18, respectively, [i.e., 50.0%, each]). The lowest proportion of students suffering from fatigue was that of the 1st-year students (29.0%). Significant differences in fatigue were also found between working and non-working students (p = 0.001), where all the non-working students (92;100.0%) suffered from fatigue while most of the working students experienced no fatigue (82;69.0% of the working students). CONCLUSION(S): The current study adds to the growing body of knowledge available to policymakers and mental health practitioners throughout the world about the links between individual mental health and the COVID-19 quarantine.Copyright © 2022 Aiman Shoiab, Alia Khwaldeh, Ali Alsarhan, Ashraf Khashroum, Ayman Alsheikh, Sokiyna Ababneh.

Using the integrated theory of health behavior change to assess factors affecting diabetes medication adherence among black adults during COVID-19: an explanatory sequential mixed methods design.

OBJECTIVES: (1) Evaluate changes in medication adherence and the role of psychosocial and interpersonal factors on adherence. (2) Explain the changes in medication adherence based on patient perceptions of adherence behaviors. DESIGN: We used an explanatory sequential mixed methods design for surveys at baseline and 1-year follow-up, followed by interviews. The Integrated Theory of Health Behavior Change guided the design of a questionnaire including self-reported measures of medication adherence, psychosocial factors such as illness and medication beliefs, self-efficacy, and depressive symptoms, interpersonal factors including social support and patient-provider communication, and socio-demographic and clinical factors. A convenience sample (n = 228) of adult patients with type 2 diabetes who self-identified as Black/African American completed the mail/telephone surveys. Nine semi-structured interviews were conducted with respondents of both surveys who had changes in medication adherence. Descriptive, mean differential, bivariate correlational analyses, and content analysis was conducted. Data integration merged quantitative and qualitative results as a joint display. RESULTS: Response rates for the baseline and follow-up survey were 28% and 47% respectively. Medication adherence scores were significantly correlated with illness perceptions (r = .30) and depression (r = .25) at baseline, and self-efficacy (r = -.51) and depression (r = .37) at follow-up. Qualitative themes included patient perceptions of adherence behaviors, impact of the COVID-19 pandemic, health literacy and self-efficacy. Mixed methods integration showed contrasting perceptions of the same themes including adherence behaviors, medication beliefs, social support, and patient-provider communication among participants whose medication adherence increased and decreased overtime. CONCLUSION: Self-efficacy, diabetes beliefs, and depressive symptoms were key psychosocial factors that affected medication adherence among Blacks/African Americans. Contrasting perceptions of beliefs in medicines, social support, provider relationships and communication among increased and decreased adherence participant groups explained the changes in adherence, which can be used to adapt existing interventions.

Continuity of care and medication adherence among youth with bipolar spectrum disorders enrolled in a large pragmatic study

This dissertation consists of two studies. Study one examined child-level predictors of mental health care service utilization among youth with bipolar spectrum disorders who were overweight/obese. Study two examined the differences in medication adherence and barriers to medication adherence among youth with bipolar spectrum disorders who were overweight/obese before and since the COVID-19 pandemic. Youth in this study were enrolled in Metformin for Overweight & OBese ChILdren and Adolescents with BIpolar Spectrum Disorders Treated with Second-Generation AntipsYchotics (MOBILITY), a prospective, large, pragmatic, randomized trial to study the impact of metformin and simple healthy lifestyle intervention (LIFE) vs. LIFE alone on patient-centered outcomes of body weight, second-generation antipsychotics (SGA) adherence, psychiatric symptom burden (e.g. mood/anxiety), and quality of life.Study One Introduction: The primary aim of this study was to examine variables, such as symptom severity and insurance status, related to continuity of care (follow-up visits, hospitalization) for youth with bipolar spectrum disorders who are overweight/obese. Methods: A secondary data analysis of data collected in MOBILITY was performed. All MOBILITY participants enrolled from November 5, 2015 through December 1, 2018 in the Midwest Region (N = 610) were included in analyses. Results: Participants enrolled from an inpatient hospital setting had fewer follow-up visits than those enrolled from an outpatient setting. Patients enrolled on an inpatient vs. outpatient setting were analyzed separately. Among patients enrolled from an outpatient setting, having public health insurance was associated with having higher numbers of psychiatric followup visits. Outpatients with lower CGI-S scores (less severe) at baseline had more follow-up visits. Higher CGI-S scores were associated with increased number of hospitalizations for those enrolled in outpatient settings. Outpatients with higher CGI-S scores and more follow-up visits had fewer hospitalizations than those with fewer follow-up visits. For participants enrolled on an inpatient setting, younger age was associated with higher number of hospitalizations. Conclusions: This study documented differences in continuity of care among the MOBILITY sample. Future studies are needed to determine if additional patient-level variables contribute to gaps in continuity of care so interventions can be targeted to those most vulnerable.Study Two The primary purpose of this study was to examine differences in SGA medication adherence among youth with bipolar spectrum disorders who were overweight/obese, before and iv since the COVID-19 pandemic. Methods: A secondary data analysis of data collected in MOBILITY was performed. All MOBILITY patient/caregiver dyads (N = 376) who completed tablet assessments for the Month 6 MOBILITY visit between March 1, 2019 and April 30, 2021 were included in analyses. Results: Before COVID-19, patients reported they missed 8.8% of prescribed doses/week, while caregivers reported patients missed 8.05% doses/week. Since COVID-19, patients reported missing 11.95% doses/week, and caregivers reported patients missed 4.63% doses/week. There were no significant differences in medication adherence rates before and since COVID-19 among patients or caregivers. The most frequently reported barrier to medication adherence among patients and caregivers in both time frames was forgetting to take medications. According to patients, caregiver assistance in taking medication may improve mediation adherence. Discussion: Patient and caregiver report of adherence rates since COVID19 differed, but reports of rates by both groups were similar before the pandemic. Future studies are needed to determine if adherence rates changed over time during the pandemic and to determine patient- and caregiver-acknowledged factors that facilitate adherence to medication regimens. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

REMICARE—Medicine Intake Tracker and Healthcare Assistant

An automated reminder mechanism is built in this Android-based application. It emphasizes the contact between doctors and patients. Patients can set a reminder to remind them when it is time to take their medicine. Multiple medications and timings, including date, time, and medicine description, can be programmed into the reminder by using image processing. Patients will be notified through a message within the system, as preferred by the patients. They have the option of looking for a doctor for assistance. In this COVID-19 pandemic situation where nurses have to remind the patients in the hospitals to take their medications, our application can be useful, alerting the patient every time of the day when he/she has to take the medicine and in what amounts. Also, all the necessary tests report and prescriptions can be saved on the cloud for later use. Patients will be provided with doctor contact information based on their availability. Also, patients will be notified of the expiry date of the medicine, and the former history of the medicines can be stored for further reference. The proposed system prioritizes a good user interface and easy navigation. Image processing will be accurate and efficient with the help of powerful CNN-RNN-CTC algorithm. It also emphasizes on a secure storage of the user's data with the help of the RSA algorithm for encryption and the gravitational search algorithm for secure cloud access. We attempted to create a Medical Reminder System that is cost-effective, time-saving, and promotes medication adherence. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Medication adherence among adult kidney transplant recipients: A mixed methods examination

Kidney transplantation remains the best and most cost-effective treatment for patients with end stage kidney disease, and the number of kidney transplants performed in the U.S. annually has increased steadily since 2015. To ensure transplant success, kidney transplant recipients (KTRs) are often prescribed lifelong, complex medication regimens that include immunosuppressants, anti-infectives, and medications to control comorbid chronic conditions. Taking these medications as prescribed is essential, as nonadherence can lead to significant complications. Overall, KTRs face significant health burdens, and must be confident, and competent, in their ability to manage a range of conditions and self-care behaviors, including medication-taking.Using data and accessing participants from a large clinical trial, we applied mixed methods to address gaps in the transplant literature related to medication regimen adherence and self-management of health among adult KTRs. In doing so, we sought to (1) characterize medication nonadherence among KTRs;(2) understand KTR experiences of medication-taking;and (3) evaluate the impact of the COVID-19 pandemic on KTRs' ability to self-manage their health. We found evidence of both immediate and downstream barriers to regimen adherence, patient- and health system-level barriers to adherence, and barriers to which minority KTRs might be particularly vulnerable. Importantly, our findings indicated that adherence to medications taken for comorbid conditions might prove more difficult for KTRs than adherence to immunosuppressants. We also found that the pandemic might have challenged KTRs' ability to manage their health by compromising access to necessary care, including vaccination in the early stages of eligibility, and by exacerbating rates of anxiety. Based on our findings, we provide recommendations - both within and outside the context of the ongoing pandemic - to support KTRs in engaging in critical health behaviors like appropriate medication-taking. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Medication Adherence in Children with Down Syndrome with Autoimmune Thyroid Disease During the Covid-19 Pandemic: Indonesian Study

Background: The coronavirus disease-19 (COVID-19) pandemic has significantly affected healthcare systems. Down syndrome (DS) is a chronic disease caused by trisomy of chromosome 21 which is associated with a variety of medical problems such as autoimmune thyroid disease (AITD) that necessitate comprehensive routine treatment. During the COVID-19 pandemic, there was an increasing an unavailability, which became an impediment to chronic disease patients' drug consumption. Objective(s): The purpose of this study was to examine the barriers to medication adherence faced by DS patients during the COVID-19 pandemic. Method(s): An observational analytic study was conducted from January to July 2021 among parents of DS patients who registered in the pediatric endocrinology outpatient clinic of Dr. Soetomo General Hospital. Inclusion criteria include: The parents of DS with AITD patients aged 1-18 years who came to the pediatric endocrinology polyclinic, routinely took oral medication before March 2020, can fill out questionnaire forms independently, and signed the informed consent. Exclusion criteria were parents of DS patients who did not take regular medication, or started treatment after March 2020. Data were collected and analyzed using the Wilcoxon comparison test Results: There are 31 DS patients responded and completed the questionnaires. Adherence to hospital visits in DS with AITD patients before and during the COVID-19 pandemic showed significant differences (P = 0.001). The main barriers to follow-up visits during the pandemic were lockdown protocol which made travel difficult (28%). The compliance for taking medication was still high although 13 (41.9%) obtained the medicine without a prescription. Conclusion(s): Changes in terms of medication adherence during the pandemic have highlighted the importance of improving DS patient's access to healthcare. Shifting medication counseling to the nearest primary health care provider with supervision from a tertiary referral specialist appears to be a reasonable and potentially cost-effective strategy in improving treatment adherence especially in a pandemic setting.Copyright © 2023, Author(s).

Changes in Clinical Management of Patients with Schizophrenia Treated with Long-Acting Injectable Antipsychotics (LAIs), Including Telepsychiatry Use, During the COVID-19 Pandemic.

Purpose: The COVID-19 pandemic substantially impacted care of patients with schizophrenia treated with long-acting injectable antipsychotics (LAIs). This study (OASIS-MAPS) examined how clinical sites adapted operations and used telepsychiatry to maintain standard of care for these patients during the pandemic. Methods: Two online surveys (initial: October-November 2020, N = 35; follow-up: July-September 2021, N = 21) were completed by a principal investigator (PI) or PI-appointed designee at sites participating in the OASIS study (NCT03919994). Survey responses were analyzed descriptively. Results: At the time of the initial survey, all 35 participating sites were using variants of telepsychiatry, with 20 sites adopting it after the pandemic started. Most sites reported no negative impacts of the pandemic on medication adherence, although approximately 20% of sites reported decreased adherence for LAIs. Twelve sites (34%) reported switching patients with schizophrenia from LAIs to oral antipsychotic medications, while 11 sites (31%) reported switching patients from shorter to longer injection interval LAIs during the pandemic. Most sites did not experience difficulties in implementing or expanding telepsychiatry services, although lower reimbursement rate for telepsychiatry and patients' lack of access to and training on relevant technologies were the most frequently reported barriers. Conclusion: Changes made by sites after the pandemic onset were viewed by almost all participants as satisfactory for maintaining standard of care. Almost all participants thought that the use of telepsychiatry services would continue after the pandemic in a hybrid manner combining telepsychiatry and office visits. Ensuring that patients have equitable access to telepsychiatry will be important in the post-pandemic future.

Hypertension care during the COVID-19 pandemic in an integrated health care system.

Retention in hypertension care, medication adherence, and blood pressure (BP) may have been affected by the COVID-19 pandemic. In a retrospective cohort study of 64 766 individuals with treated hypertension from an integrated health care system, we compared hypertension care during the year pre-COVID-19 (March 2019-February 2020) and the first year of COVID-19 (March 2020-February 2021). Retention in hypertension care was defined as receiving clinical BP measurements during COVID-19. Medication adherence was measured using prescription refills. Clinical care was assessed by in-person and virtual visits and changes in systolic and diastolic BP. The cohort had a mean age of 67.8 (12.2) years, 51.2% were women, and 73.5% were White. In 60 757 individuals with BP measurements pre-COVID-19, 16618 (27.4%) had no BP measurements during COVID-19. Medication adherence declined from 86.0% to 80.8% (p < .001). In-person primary care visits decreased from 2.7 (2.7) to 1.4 (1.9) per year, while virtual contacts increased from 9.5 (12.2) to 11.2 (14.2) per year (both p < .001). Among individuals with BP measurements, mean (SD) systolic BP was 126.5 mm Hg (11.8) pre-COVID-19 and 127.3 mm Hg (12.6) during COVID-19 (p = .14). Mean diastolic BP was 73.5 mm Hg (8.5) pre-COVID-19 and 73.5 mm Hg (8.7) during COVID-19 (p = .77). Even in this integrated health care system, many individuals did not receive clinical BP monitoring during COVID-19. Most individuals who remained in care maintained pre-COVID BP. Targeted outreach may be necessary to restore care continuity and hypertension control at the population level.

Treatment Adherence in Dermatology During the COVID-19 Pandemic: A Review.

The coronavirus disease 2019 (COVID-19) pandemic raised many challenges for dermatology. Safety is a principal concern for many patients, particularly those on medications that affect the immune system. Understanding how the pandemic affects patients' treatment adherence may be informative for counseling or other interventions to assure that treatment plans are not inappropriately interrupted, or for future pandemics. The purpose of this review was to investigate the extent to which the COVID-19 pandemic affected medication adherence in dermatology. A literature search of PubMed was performed using the search terms: adherence, compliance, dermatology, COVID-19, SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), and pandemic. Eleven primary research studies met the inclusion criteria and were included in the review. During the COVID-19 pandemic, non-adherence in dermatology patients was primarily linked to concern about the risk of COVID-19 infection with long-term use of immunomodulatory and immunosuppressive medications. In some cases, non-adherence was associated with feelings of depression, anxiety, or perceived stress. High adherence was attributed to regular and convenient communication between patients and dermatology providers through the effective use of telemedicine and electronic messaging. Frequent communication with providers to address patient concerns and provide continuity of care improved adherence. An integrated virtual approach to patient care facilitated this, particularly through the use of telemedicine. Implementation of routine virtual questionnaires was, to some extent, effective in replacing limited in-person patient-provider interactions during the pandemic. Finally, the added threat of the pandemic presented an additional mental health component to consider for patients, supporting the need for a multidisciplinary approach to patient care.

Impact of COVID-19 Pandemic on Adherence to Chronic Therapies: A Systematic Review.

The spread of the coronavirus disease 2019 (COVID-19) pandemic caused a sudden and significant disruption in healthcare services, especially for patients suffering from chronic diseases. We aimed at evaluating the impact of the pandemic on adherence to chronic therapies through a systematic review of available studies. PubMed, EMBASE, and Web of Science were searched since inception to June 2022. Inclusion criteria were: (1) observational studies or surveys; (2) studies on patients with chronic diseases; (3) reporting the effects of COVID-19 pandemic on adherence to chronic pharmacological treatment, as a comparison of adherence during the pandemic period vs. pre-pandemic period (primary outcome) or as rate of treatment discontinuation/delay specifically due to factors linked to COVID-19 (secondary outcome). Findings from 12 (primary outcome) and 24 (secondary outcome) studies showed that many chronic treatments were interrupted or affected by a reduced adherence in the pandemic period, and that fear of infection, difficulty in reaching physicians or healthcare facilities, and unavailability of medication were often reported as reasons for discontinuation or modification of chronic therapies. For other therapies where the patient was not required to attend the clinic, continuity of treatment was sometimes ensured through the use of telemedicine, and the adherence was guaranteed with drug stockpiling. While the effects of the possible worsening of chronic disease management need to be monitored over time, positive strategies should be acknowledged, such as the implementation of e-health tools and the expanded role of community pharmacists, and may play an important role in preserving continuity of care for people with chronic diseases.

Barriers and facilitators of antiretroviral therapy (ART) adherence habit formation in Sub-Saharan Africa: Evidence from a qualitative study in Kampala, Uganda.

RATIONALE: In 2020, nearly 40 million people lived with HIV/AIDS (PLWHA) worldwide, of whom 70% were receiving antiretroviral therapy (ART). Two-thirds of PLWHA reside in Sub-Saharan Africa (SSA), where rates of viral load suppression are often suboptimal and frequently attributed to low ART adherence. Strong pill-taking habits are often reported as a key strategy among those who successfully maintain medication adherence, yet not enough is known about the barriers and facilitators in SSA to pill-taking in response to the same contextual cue, which is a necessary step in the habit formation process. OBJECTIVE: To address this knowledge gap and to inform a subsequent intervention to promote context-dependent repetition, called anchoring, we used a formative qualitative approach to collect in-depth narratives about barriers and facilitators of the anchoring intervention for establishing ART pill-taking habits at the Mildmay Hospital in Kampala, Uganda. METHODS: We conducted interviews with 25 randomly selected patients starting ART, 5 expert patients, and 10 providers at Mildmay, and performed a rapid analysis to inform the intervention in a timely manner. RESULTS: We found that pill taking in response to the same contextual cue, or anchor, was threatened by stigma and food insecurity and that the COVID-19 pandemic exacerbated these barriers. We also determined that important linguistic changes were needed to the instructional materials and reminder messages in the subsequent intervention to avoid words and phrases with negative connotations for this target population. CONCLUSIONS: Several important barriers and facilitators to context-dependent pill taking in Uganda were identified through our formative research that helped to inform important revisions to our subsequent intervention. These findings underscore the importance of understanding local barriers and facilitators when designing and planning interventions, particularly when implementing theory-based intervention approaches that have yet to be tested in a new setting.

Managing Medications and Medication Adherence Among US Adults During the Early Phase of the COVID-19 Pandemic.

Purpose: Before the COVID-19 pandemic and the disruptions it brought, medication adherence was already a challenging and complex health behavior. The purpose of this study was to describe patients' interactions in clinic, pharmacy, and home contexts and associated medication management and adherence during the early phase of the COVID-19 pandemic. Patients and Methods: A survey questionnaire was developed using the Medication Adherence Context and Outcomes framework and distributed via social media between May and July 2020 targeting adults taking a daily prescribed medication. Survey questions assessed sociodemographics, interactions with healthcare providers, clinics, pharmacies, medication management experiences, habit strength, and life chaos perceptions during the pandemic. Medication adherence was assessed by the self-report BAASIS© scale to measure implementation, discontinuation, and overall nonadherence. Results: A total of 134 adults from the United States, mean age 50.0 (SD 16.1) years were included in this analysis. Respondents took a median of 3.50 (interquartile range 4) daily medications. Delays in seeing a provider were reported by 47 (35.1%). Pharmacy encounters were impacted; 25 (18.7%) indicated their method for obtaining medication changed. Medication nonadherence was reported among 62 (46.3%) and was significantly greater among those who delayed prescription refills (p=0.032), pillbox users (p=0.047), and those who experienced greater life chaos (p=0.040) and lower habit strength (p<0.001) in the early phase of the pandemic. Conclusion: Although the early phase of the pandemic affected access to care for nearly one-third of the sample, distance-accessible care options and strategies to obtain needed services without being in-person supported respondents medication management. Helpful strategies included provider accessibility, telehealth, home delivery/mail-order, drive-thru's, 90-day supplies, and online/automatic refills. Methods to develop and reestablish habits are critical. Care providers in clinic and pharmacy settings can educate and remind patients about services like distance-accessible technologies and online ordering of medications and establishing routines to support medication adherence.

A pragmatically before-after trial of tele-visits vs face-to-face visits for chronic patients during the COVID-19 pandemic: patient-reported adherence.

BACKGROUND: During the COVID-19 pandemic, chronic patients are at a higher risk of contamination with the virus. Specific strategies are required to restrict these patients' exposure to contaminated areas and improve medication adherence. One suggested strategy is tele-visiting, which is effective for the continuity of care and medication adherence during the pandemic. OBJECTIVE: The present study aimed to explore the effect of tele-visiting services via telephone on chronic patients' medication adherence before and after implementing a tele-visit program during the COVID-19 pandemic. METHODS: All patients received the tele-visit twice on the phone during the study. To compare patients' medication adherence in face-to-face visits and tele-visit, an adapted version of the Morisky Medication Adherence Scale-8 was used. Paired-samples T-test was run to measure participants' medication adherence before and after the tele-visit program. RESULTS: The tele-visit was run for 314 patients. The participants' adherence score before the intervention was 60.02, and after the intervention was 59.9. As the paired-sample T-test results showed, the difference between these two was not statistically significant. Moreover, medication adherence was not significantly associated with any of these variables: BMI, occupation, comorbidities, duration of disease, age, gender, marital status, and education level. CONCLUSIONS: The present findings showed that chronic patients' medication adherence did not differ significantly in face-to-face visits and tele-visiting. During the Covid-19 pandemic, due to the effectiveness of tele-visiting services, they can be used effectively to lower the transmission rate of the disease and reduce healthcare providers' burden.