Which Educational Topics and Smartphone App Functions Are Prioritized by US Patients With Rheumatic and Musculoskeletal Diseases? A Mixed-Methods Study.

OBJECTIVE: We sought to identify (1) what types of information US adults with rheumatic and musculoskeletal diseases (RMD) perceive as most important to know about their disease, and (2) what functions they would use in an RMD-specific smartphone app. METHODS: Nominal groups with patients with RMD were conducted using online tools to generate a list of needed educational topics. Based on nominal group results, a survey with final educational items was administered online, along with questions about desired functions of a smartphone app for RMD and wearable use, to patients within a large community rheumatology practice-based research network and the PatientSpot registry. Chi-square tests and multivariate regression models were used to determine differences in priorities between groups of respondents with rheumatic inflammatory conditions (RICs) and osteoarthritis (OA), and possible associations. RESULTS: At least 80% of respondents considered finding a rheumatologist, understanding tests and medications, and quickly recognizing and communicating symptoms to doctors as extremely important educational topics. The highest-ranked topic for both RIC and OA groups was "knowing when the medication is not working." The app functions that most respondents considered useful were viewing laboratory results, recording symptoms to share with their rheumatology provider, and recording symptoms (eg, pain, fatigue) or disease flares for health tracking over time. Approximately one-third of respondents owned and regularly used a wearable activity tracker. CONCLUSION: People with RMD prioritized information about laboratory test results, medications, and disease and symptom monitoring, which can be used to create educational and digital tools that support patients during their disease journey.

Assessing the effectiveness of virtual reality to promote empathy for patients through a mixed-methods study.

OBJECTIVE: To describe the implementation and outcomes of EmpathyVR, an immersive experience using virtual reality (VR) to promote empathy for patients with physical limitations due to chronic diseases. METHODS: First-year student pharmacists participated in a learning experience that incorporated VR and stiff gloves to simulate physical limitations associated with color-blindness and arthritis, respectively. Students completed pre- and post-intervention surveys that included the Kiersma-Chen Empathy Scale and measures of immersion, user enjoyment, perceived usefulness for learning, and adverse effects of the experience. A focus group was also conducted with 6 students to obtain additional feedback on the learning experience. RESULTS: Of the 132 students who were enrolled in the program, 131 completed the assigned tasks; 117 of these agreed to participate in the study, and their data were included in the analyses. There was a significant improvement in empathy scores in the cognitive domain from pre- to post-intervention. Post-intervention survey results also demonstrated a high degree of immersion in the experience, high levels of self-reported enjoyment, and high levels of perceived usefulness of the activity to support learning. There was a low to moderate incidence of minor self-reported adverse effects from the activity. Focus group feedback was also positive. One student stated, "… it really allowed you to think and put yourself in their shoes." CONCLUSION: Implementation of a VR-based learning activity into the first semester of the PharmD curriculum was successful and resulted in improved student empathy scores and a positive learning experience.

Parent, child, and adolescent lived experience using the insulin-only iLet Bionic Pancreas.

OBJECTIVE: Automated insulin delivery (AID) systems show great promise for improving glycemic outcomes and reducing disease burden for youth with type 1 diabetes (T1D). The current study examined youth and parent perspectives after using the insulin-only iLet Bionic Pancreas (BP) during the 13-week pivotal trial. METHODS: Parents and youth participated in focus group interviews, with questions assessing participants' experiences in a variety of settings and were grounded in the Unified Theory of Acceptance and Use of Technology. Qualitative analysis was completed by 3 authors using a hybrid thematic analysis approach. RESULTS: Qualitative analysis of focus groups revealed a total of 19 sub-themes falling into 5 major themes (Diabetes Burden, Freedom and Flexibility, Daily Routine, Managing Glucose Levels, and User Experience). Participants' overall experience was positive, with decreased burden and improved freedom and flexibility. Some participants reported challenges in learning to trust the system, adjusting to the user interface, and the system learning their body. CONCLUSION: This study adds to the growing literature on patient perspectives on using AID systems and was among the first to assess caregiver and youth experiences with the BP system over an extended period (13 weeks). Patient feedback on physical experiences with the device and experiences trusting the device to manage glucose should inform future development of technologies as well as approaches to education for patients and their families.

Psychosocial Care for Youth with Type 1 Diabetes: Summary of Reviews to Inform Clinical Practice.

The intensive demands of diabetes care can be difficult for youth with type 1 diabetes and their families to integrate into daily life. Standards of care in pediatric diabetes highlight the importance of evidence-based psychosocial interventions to optimize self-management behaviors and psychological well-being. The current review summarizes select systematic reviews and meta-analyses on evidence-based behavioral health interventions in pediatric diabetes. Interventions include strategies to strengthen youth psychosocial skills, improve family dynamics and caregiver mental health, enhance health and mental health equity, and address psychosocial factors related to diabetes technology use.

Effects of Framed Mobile Messages on Beliefs, Intentions, Adherence, and Asthma Control: A Randomized Trial.

We aimed to examine the effects of framed mobile messages (messages emphasizing losses or gains because of a behavior) on young adults' beliefs about their daily Inhaled Corticosteroids (ICS), intentions to take their ICS, adherence, and asthma control. College students (18-29 years) who owned a mobile phone and had a diagnosis of asthma with a prescription for an ICS were recruited. Participants (n = 43) were randomized to receive either gain- or loss-framed mobile messages three times per week for eight weeks. Engagement rates with messages were calculated. Outcomes included beliefs, intentions, adherence, and asthma control. Data collection was performed at baseline, week 4, and week 8. Mixed-design ANOVA assessed whether outcomes improved differentially from baseline to week eight between gain- and loss-framed groups. Twenty-two participants were randomly assigned to the gain-framed group and 21 to the loss-framed group. There was a 100% retention rate. The engagement rate with the text messages was 85.9%. There was a significant difference in participants' intentions to take medication and asthma control from baseline. There were no significant changes in other outcomes from baseline. There was no difference in changes in all outcomes between participants receiving gain- versus loss-framed messages. Framed mobile messages improved young adults' asthma control and intentions to take their medication as prescribed.

Activities to promote empathy for patients among pharmacy learners: A scoping review.

BACKGROUND: Provider empathy has been shown to be directly linked to improved patient outcomes. The objective of this scoping review of the literature was to identify and describe learning activities that promote empathy for patients among pharmacy learners. METHODS: This scoping review was conducted using the following inclusion criteria: publication in English, activities conducted in any academic pharmacy training program (professional degree program, experiential, residency, or fellowship), description of the learning activity(ies) provided, and focus on the experience of empathy/caring/compassion for patients, either human or animal. Articles were excluded if they focused only on skills such as empathic responding or if they did not describe the learning experience. All study designs other than reviews were included. RESULTS: The scoping review revealed 89 full-text articles that met the inclusion criteria. Included studies demonstrated a wide variety of approaches to the design of learning experiences as well as methods of measurement of empathy. Various types of learning modalities have been used to develop empathy in pharmacy learners, with reflection being the most common. A large proportion of studies that assessed empathy development used quasi-experimental or qualitative designs and did not report tests of statistical significance, which would make it difficult to compare the effectiveness of the different learning activities. IMPLICATIONS: A variety of approaches have been used among pharmacy learners to develop empathy for patients. Due to the high level of variability in approaches, more rigorous studies are needed to assess the effectiveness of these learning activities.

Medication use and contextual factors associated with meeting guideline-based glycemic levels in diabetes among a nationally representative sample.

Introduction: Based on the long-lasting diabetes management challenges in the United States, the objective was to examine glycemic levels among a nationally representative sample of people with diabetes stratified by prescribed antihyperglycemic treatment regimens and contextual factors. Methods: This serial cross-sectional study used United States population-based data from the 2015 to March 2020 National Health and Nutrition Examination Surveys (NHANES). The study included non-pregnant adults (≥20 years old) with non-missing A1C and self-reported diabetes diagnosis from NHANES. Using A1C lab values, we dichotomized the outcome of glycemic levels into <7% versus ≥7% (meeting vs. not meeting guideline-based glycemic levels, respectively). We stratified the outcome by antihyperglycemic medication use and contextual factors (e.g., race/ethnicity, gender, chronic conditions, diet, healthcare utilization, insurance, etc.) and performed multivariable logistic regression analyses. Results: The 2042 adults with diabetes had a mean age of 60.63 (SE = 0.50), 55.26% (95% CI = 51.39-59.09) were male, and 51.82% (95% CI = 47.11-56.51) met guideline-based glycemic levels. Contextual factors associated with meeting guideline-based glycemic levels included reporting an "excellent" versus "poor" diet (aOR = 4.21, 95% CI = 1.92-9.25) and having no family history of diabetes (aOR = 1.43, 95% CI = 1.03-1.98). Contextual factors associated with lower odds of meeting guideline-based glycemic levels included taking insulin (aOR = 0.16, 95% CI = 0.10-0.26), taking metformin (aOR = 0.66, 95% CI = 0.46-0.96), less frequent healthcare utilization [e.g., none vs. ≥4 times/year (aOR = 0.51, 95% CI = 0.27-0.96)], being uninsured (aOR = 0.51, 95% CI = 0.33-0.79), etc. Discussion: Meeting guideline-based glycemic levels was associated with medication use (taking vs. not taking respective antihyperglycemic medication classes) and contextual factors. The timely, population-based estimates can inform national efforts to optimize diabetes management.

Impact of a Multicomponent Educational Intervention on Community Pharmacy-Based Naloxone Services Implementation: A Pragmatic Randomized Controlled Trial.

BACKGROUND: Despite US naloxone access laws, community pharmacists lack training and confidence in providing naloxone. OBJECTIVE: To assess the impact of the Empowering Community Pharmacists program on pharmacists' knowledge, perceived barriers, attitudes, confidence, and intentions regarding naloxone services implementation, as well as naloxone prescriptions dispensed. METHODS: A 3-month pragmatic randomized controlled trial was conducted from December 2018 to March 2019. Alabama community pharmacists were recruited by mail, email, phone, and fax and randomized to intervention (monthly resources/reminders + educational webinar) or control (monthly reminders only). Outcome measures were assessed via online surveys at baseline (T1), immediately post-intervention (T2), and 3 months post-intervention (T3), including naloxone knowledge (%correct); perceived barriers, attitudes, confidence, and intention regarding naloxone services implementation (7-point Likert-type scale; 1 = strongly disagree, 7 = strongly agree); and number of naloxone prescriptions dispensed. Mean differences between control and intervention from T1 to T3 were assessed using 2-way mixed analysis of variance and adjusted analyses were conducted using generalized estimating equations with negative binomial distribution to assess associations between variables. RESULTS: Of 55 participants (n = 27 intervention, n = 28 control), most were female (80.3%), white (80.6%), in independently owned pharmacies (39.1%). Increases in mean [SD] confidence (5.52 [1.03]-6.16 [0.74], P < 0.0005) and intention (5.35 [1.51]-6.10 [0.96], P = 0.023) occurred from pre- to post-program within the intervention group and were statistically significant compared with control (confidence P = 0.016, intention P = 0.014). Confidence (exp(ß) = 1.46, P = 0.031) and perceived barriers (exp(ß) = 0.75, P = 0.022) were associated with number of naloxone prescriptions dispensed. CONCLUSION AND RELEVANCE: The Empowering Community Pharmacists program improved community pharmacists' confidence and intention regarding naloxone services implementation. Other states can adapt program elements according to their laws. CLINICALTRIALS.GOV IDENTIFIER: NCT05093309.

Optimizing chronic pain management through patient engagement with quality of life measures: a randomized controlled trial.

CONTEXT: Health-related quality of life (HRQOL) represents a new approach for guiding chronic pain management because it is patient-centered and more likely to be understood and accepted by patients. OBJECTIVES: To assess the value and utility of an eHealth intervention for patients with chronic low back pain (CLBP) that was primarily based on HRQOL measures and to measure the clinical outcomes associated with its use. METHODS: A randomized controlled trial was conducted within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION Pain Research Registry) using participants screened from November 2019 through February 2021. A total of 331 registry participants within the 48 contiguous states and the District of Columbia met the eligibility criteria, which included having CLBP and HRQOL deficits. Almost three-fourths of the participants were enrolled after onset of the COVID-19 pandemic. The participants were randomized to an eHealth intervention for HRQOL or wait list control. The primary outcome measures involved HRQOL based on the Patient-Reported Outcomes Measurement Information System (PROMIS), including the SPADE cluster (Sleep disturbance, Pain interference with activities, Anxiety, Depression, and low Energy/fatigue) and each of its five component scales. Secondary outcome measures involved low back pain intensity and back-related functioning. Changes over time for each outcome measure reported by participants in each treatment group were compared utilizing the student's t-test for statistical significance and Cohen's d statistic for clinical importance. Outcomes were reported as between-group differences in change scores and the d statistic, with positive values favoring the experimental treatment group. RESULTS: There were no significant differences between the experimental and control treatment groups for changes over time in any primary outcome measure. The d statistic (95% confidence interval) for the difference between the experimental and control treatment groups on the SPADE cluster was 0.04 (-0.18-0.25). The corresponding d statistics for the SPADE scales ranged from -0.06 (-0.27 to 0.16) for anxiety to 0.11 (-0.10 to 0.33) for sleep disturbance. There were also no significant or clinically important differences between the experimental and control treatment groups on the secondary outcome measures. Additionally, in subgroup analyses involving participants treated by osteopathic vs allopathic physicians, no significant interaction effects were observed. CONCLUSIONS: The eHealth intervention studied herein did not achieve statistically significant or clinically important improvements in any of the primary or secondary outcome measures. However, the validity and generalizability of the findings may have been limited by the unforeseen onset and impact of the COVID-19 pandemic shortly after beginning the trial.

The Moderating Power of Impulsivity: A Systematic Literature Review Examining the Theory of Planned Behavior.

The theory of planned behavior (TPB) states that behavioral intention is the best predictor of actual behavior change. However, intention explains only a portion of the variance in behavior. Of specific interest is the question of which moderating or mediating variables can be leveraged to aid health promotion interventions utilizing the tenets of behavioral economics (delay discounting and commitment contracts) in the intention-behavior pathway. Impulsivity has been postulated to fill this role and may be applied to multiple behaviors. We aim to determine if impulsivity moderates the association between intention and actual behavior in the TPB, to discover what other variables may moderate or mediate this association, and to apply the findings to future studies in the field of behavioral economics. To this end, a systematic review was conducted using the PubMed, PsychINFO, and Embase online databases. Eligible studies in peer-reviewed journals published prior to November 2021 were selected. Thirty-three studies were included in the final review, examining physical activity, diet, preventive health, mental health, addiction, and medication adherence behaviors. Three main concepts emerged: (1) impulsivity moderates the association between intention and behavior change; (2) self-efficacy moderates the association between intention and behavior change; and (3) planning and self-efficacy contribute to moderated mediation. This review demonstrates a gap in the literature regarding the application of the TPB to the intention-behavior pathway for health behaviors. Future studies in behavioral economics may leverage the variables of impulsivity, self-efficacy, and planning to predict follow-through in this area and to develop targeted change initiatives.

How to inform college students about meningitis B vaccine? Comparative effectiveness of an online theory-based text and video intervention.

Objective The purpose of this study was to compare the effect of text and video formats of an online theory-based Meningitis B (MenB) health message intervention on college students. Participants: College freshmen and transfer students admitted at a Southern U.S. University. Methods: In a 2-arm randomized study, knowledge, perceptions, and intention to receive the vaccine were compared pre- and post-intervention. Results: Post intervention, participants in both the written and video interventions had significantly higher scores of knowledge, perceptions, and intentions. Upon comparing the change in scores pre- to post-intervention between both text and video groups, no significant differences were found between both groups. Conclusions: This study, a first in using a theory-based MenB online education intervention and questionnaire to compare text and video formats, suggests that both text and video formats are equally effective in raising young adults' awareness about the MenB vaccine.

Mental Health and Psychotropic Stigma Among Student Pharmacists.

Objective: To gain a better understanding of student pharmacists' stigma toward mental health and psychotropic medications. Methods: A cross-sectional study was conducted via paper and online surveys amongst all student pharmacists enrolled in a Doctor of Pharmacy program in the Southeastern United States (n = 501). The Perceived Devaluation and Discrimination (PDD) Scale was used to measure mental health stigma. The Beliefs about Medicines Questionnaire (BMQ) was modified to measure psychotropic stigma. MANOVAs were conducted to investigate relationships between student pharmacists' characteristics with mental health and psychotropic stigma. A paired t-test was used to determine if there was a difference between degree of mental health stigma and psychotropic stigma. Results: A total of 390 participants completed the survey (65%). The sample was mostly female (67%), white (79%), and non-Hispanic (96%). Ages were predominantly within the 19-24-year range (80%), and the majority of respondents reported previous interactions with patients who have mental health conditions (55%) or patients on psychotropic medications (65%). Student personal preferences for mental health treatment were primarily psychologic (42%) or both psychologic and psychotropic (40%). Degree of psychotropic stigma was significantly greater than that of mental health stigma. A statistically significant association was found between student personal preference for treatment and the psychotropic stigma. No difference was found in degree of either type of stigma across cohorts. Conclusions: Student pharmacists demonstrated both mental health and psychotropic stigmas. Future research should be performed to determine what effects these stigmas have on care of patients with mental health conditions.

Individuals' preference for financial over social incentives for medication adherence.

BACKGROUND: Patients with chronic conditions continue to face financial and system-related barriers to medication adherence. Pharmacy, provider, and payer-based financial and social incentive-based interventions may reduce these barriers and improve adherence. However, it is unclear how patient demographics and clinical characteristics influence the type of incentives preferred by patients. OBJECTIVES: To examine individuals' preference for financial versus social incentives and to explore the association between patient demographic and clinical characteristics with preferences for financial or social incentives. METHODS: A cross-sectional survey of a nationally representative sample of patients was conducted with Qualtrics panelists (N = 909). U.S. adults taking at least 1 prescription medication for a chronic condition were included. Survey items elicited participants' demographic characteristics, preference for financial or social incentives, self-reported medication adherence, number of prescribed medications, and number of chronic conditions. Bivariate associations between patient characteristics and incentive preferences were tested using t and chi-square tests. Logistic regression was performed to determine patient characteristics associated with participants' preference for incentives. RESULTS: When compared with those who were adherent to medications, individuals who were nonadherent were less likely to prefer financial incentives over social incentives (adjusted odds ratio [OR] 0.55 [95% CI 0.31-0.98]). Patient income, sex, and ethnicity were also associated with preferences for financial incentives. Those earning less than $50,000 per year were less likely to prefer financial incentives compared with social incentives (adjusted OR 0.44 [0.24-0.79]). Females were more likely to prefer financial incentives (adjusted OR 1.98 [1.16-3.37]). Hispanic/Latinos were less likely to prefer financial incentives compared to non-Hispanics/non-Latinos (adjusted OR 0.51 [0.29-0.89]). CONCLUSION: Preferences for medication adherence incentives differed on the basis of adherence status and patients' demographic characteristics. Findings have implications for how incentive-based interventions can be structured to target certain patient groups.

Evaluation of a Capped Dosing Telavancin Regimen Compared to Standard Dosing at a Large Community Teaching Hospital.

Telavancin, a lipoglycopeptide antibiotic, is traditionally dosed at 10 mg/kg based on total body weight but is associated with toxicities that limit its use. This study supports the use of a capped dosing regimen of 750 mg in obese patients, which is associated with equal efficacy and fewer adverse effects compared to traditional dosing.

Patients' Preferences for Sodium-Glucose Cotransporter 2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists.

Purpose: To determine patients' preferences for sodium-glucose cotransporter 2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs). Patients and Methods: A cross-sectional, web-based discrete choice experiment was conducted among US adults with type 2 diabetes mellitus (T2DM) in May 2021. Six attributes-the route and frequency of administration, the chance of reaching target HbA1c in six months, the percentage reduction in the risk of major adverse cardiovascular events (MACE), the chance of gastrointestinal side effects, the chance of genital infection, and out-of-pocket cost per month-were identified from literature review and consultation with patients and clinicians. A Bayesian efficient design was used to generate choice sets. Each choice set contained two hypothetical SGLT-2i and GLP-1 RA alternatives described by the attributes and an opt-out alternative. A total of 176 patients were asked to select the most preferred option from each choice set. Mixed logit (ML) and latent class (LC) models were developed. The conditional relative importance of each attribute was determined. Results: The ML model showed the out-of-pocket cost had the highest conditional relative importance, followed by the chance of reaching the target HbA1c. The best LC model revealed two patient classes. All attributes were significantly important to the patients in both classes, except the chance of genital infection in class 2. Compared to the patients in class 2, the patients in class 1 were older (approximately 65 vs 56 years) and had a higher number of comorbidities (approximately three vs two). Conclusion: T2DM patients placed different preference weights or importance across SGLT-2i and GLP-1 RA attributes. Preference heterogeneity was found among patients with different ages and numbers of comorbidities.

Disparities in Cognitive Impairment With Anticholinergic Drug Use: A Population-Based Study.

OBJECTIVES: We aim to evaluate the association between anticholinergic drug (ACH) use and cognitive impairment and the effect of disparity parameters (sex, race, income, education, and rural or urban areas) on this relationship. METHODS: The analyses included 13,623 adults aged ≥65 years from the REasons for Geographic And Racial Differences in Stroke study (recruited 2003-2007). The ACH use was defined by the 2015 Beers Criteria, and cognitive impairment was measured by the Six-Item Cognitive Screener. Multivariable logistic regression models assessed disparities in cognitive impairment with ACH use, iteratively adjusting for disparity parameters and other covariates. The full models included interaction terms between ACH use and other covariates. A similar approach was used for class-specific ACH exposure and cognitive impairment analyses. RESULTS: Approximately 14% of the participants used at least 1 ACH listed in the Beers Criteria. Antidepressants were the most frequently prescribed ACH class. A significant sex-race interaction illustrated that females compared with males (in Blacks: odds ratio [OR] = 1.28, 95% confidence interval [CI] 1.10-1.49 and in Whites: OR = 1.96, 95% CI 1.74-2.20), especially White females (Black vs White: OR = 0.71, 95% CI 0.64-0.80), were more likely to receive ACHs. Higher odds of cognitive impairment were observed among ACH users compared with the nonusers (OR = 1.26, 95% CI 1.01-1.58). In our class-level analyses, only antidepressant users (OR = 1.60, 95% CI 1.14-2.25) showed a significant association with cognitive impairment in the fully adjusted model. CONCLUSIONS: We observed demographic and socioeconomic differences in ACH use and in cognitive impairment, individually.

Building Implementation Science Capacity in Academic Pharmacy: Report of the 2020-2021 AACP Research and Graduate Affairs Committee.

EXECUTIVE SUMMARY The 2020-2021 AACP Research and Graduate Affairs Committee (RGAC) continued the work begun by the 2019-2020 RGAC to increase awareness of and capacity for implementation research to advance practice transformation in academic pharmacy. AACP President Anne Lin charged the RGAC with developing resources and programs for training faculty and graduate students in implementation science. The committee was further charged with developing a mechanism to pair pharmacy faculty and implementation experts on practice advancement projects. In its work, the committee focused on generating near-term opportunities for pharmacy practice faculty to pursue projects while developing programs that would support ongoing career development and future implementation practice and research by pharmacy faculty and trainees.

Psychometric properties of the diabetes skills checklist for adolescents with type 1 diabetes and their parents.

OBJECTIVE: Among adolescents with type 1 diabetes, research has found that their perception of their diabetes management is an important predictor of actual diabetes management. There is a need for measures that assess adolescents' perception of their ability to independently complete daily diabetes self-care tasks. The current study examined the psychometric properties of the Diabetes Skills Checklist Teen-Report (DSC-T) and DSC Parent of Teen-Report (DSC-PT), which assess perceived independence in diabetes self-care skills. RESEARCH DESIGN AND METHODS: Data were from 1450 adolescents aged 12 to 18 years and their parents who participated in the Diabetes Camp Matters Study. Families completed the DSC as well as other questionnaires online assessing demographic and diabetes-related information, diabetes strengths, and diabetes-specific emotional distress. RESULTS: Exploratory factor analysis revealed a 14-item DSC-T and 12-item DSC-PT, both with excellent internal consistency and concurrent validity. Both the DSC-T and DSC-PT were found to be positively correlated with diabetes strengths and negatively correlated with HbA1c, and the DSC-PT was significantly correlated with parent-reported diabetes distress. Adolescents who used insulin pumps and continuous glucose monitoring reported higher perceived independence in diabetes self-care skills compared to adolescents who used insulin pens/syringes or blood glucose meters. No differences were found based on demographic characteristics. CONCLUSIONS: The DSC-T and DSC-PT have strong potential to be used during diabetes clinic visits to spark discussion regarding adolescents' self-care, which would allow for a more successful transfer of diabetes care from parent to adolescent, and eventually, the transition from pediatric to adult healthcare.

Perceived appropriateness of medication adherence incentives.

BACKGROUND: 50% of prescriptions dispensed in the United States are not taken as prescribed, leading to approximately 125,000 deaths and 10% of hospitalizations per year. Incentives are effective in improving medication adherence; however, information about patient perceptions regarding incentives is lacking. OBJECTIVES: To (1) explore perceived appropriateness of incentives among patients prescribed at least 1 medication for chronic hypertension, hyperlipidemia, heart disease, diabetes, and/or asthma/chronic obstructive pulmonary disease and (2) examine associations between perceived appropriateness and patient characteristics. METHODS: A cross-sectional online survey was administered via Qualtrics Panels to US adults taking at least 1 prescription medication for a chronic condition. The results describe patient preference for financial or social recognition-based incentive, perceived appropriateness of adherence incentives (5-point Likert scale), self-reported adherence (Medometer), and demographics. Analyses included descriptive statistics with chi-square and independent t-tests comparing characteristics between participants who perceived incentives as being appropriate or inappropriate and logistic regression to determine predictors of perceived appropriateness. RESULTS: 1,009 individuals completed the survey. Of the 1,009 total survey participants, 933 (92.5%) preferred to receive a financial (eg, cash, gift card, or voucher) rather than a social recognition-based incentive (eg, encouraging messages, feedback, individual recognition, or team competition) for medication adherence. 740 participants (73%) perceived medication adherence incentives as being appropriate or acceptable as a reward given for taking medications at the right time each day, whereas 95 (9%) perceived incentives as being inappropriate. Remaining participants were neutral. Hispanic ethnicity (OR = 0.57; 95% CI = 0.37-0.89); income under $75,000 (OR = 0.48; 95% CI = 0.28-0.84); no college degree (OR = 0.60; 95% CI = 0.37-0.96); and adherence (OR = 0.99; 95% CI = 0.98-0.99) were significant predictors. CONCLUSIONS: The majority of patients perceived incentives as appropriate and preferred financial incentives over social recognition-based incentives. Perceived appropriateness for medication adherence incentives was less likely among certain groups of patients, such as those with Hispanic ethnicity, lower annual income, no college degree, and higher levels of adherence. These characteristics should be taken into account when structuring incentives. DISCLOSURES: This study was funded by the Auburn University's Intramural Grants Program. Hansen, Qian, and Garza are affiliated with Auburn University. Hansen has provided expert testimony for Daiichi Sankyo and Takeda on unrelated matters. The other authors have no potential conflicts of interest to declare. This study was presented as a poster presentation at the American Association of Colleges of Pharmacy Annual Meeting held July 2018 in Boston, MA.