Improvement in Medication Adherence after Pharmacist Intervention Is Associated with Favorable Clinical Outcomes in Patients with Ulcerative Colitis.

Background/Aims: Although pharmacist intervention for patients with chronic diseases has been shown to improve medication adherence, few studies have evaluated its effects on the objective clinical outcomes. We investigated the impact of pharmacist intervention on medication adherence and clinical outcomes in patients with ulcerative colitis (UC). Methods: Patients with UC and low medication adherence were divided into two groups, based on pharmacist intervention. Their medication possession ratio and nonadherence rate for 6 months before and after the baseline were investigated. The partial Mayo score, flare-up incidence, and factors influencing flare-up events for 1 year after the baseline were analyzed. Results: Of 99 patients, 33 and 66 were included in the intervention and control groups, respectively. The nonadherence rate significantly declined in the intervention group 6 months after the baseline (60.6% before vs 30.3% after; p=0.013). The groups showed a significant difference regarding time-related partial Mayo scores (p=0.002). Intervention was significantly negatively correlated with time and the partial Mayo score (r2=0.035, p=0.013). A significant difference was observed in the flare-up incidence (33.3% in the intervention group vs 54.6% in the control group; p=0.046). Multivariate logistic regression indicated that pharmacist intervention (adjusted odds ratio, 0.370; 95% confidence interval, 0.145 to 0.945; p=0.038) independently reduced the flareup risk. Conclusions: Pharmacist intervention significantly decreased the nonadherence rate, improved the partial Mayo score, and reduced the flare-up incidence compared with the control group in a cohort of UC patients identified to have low medication adherence.

Mixture risk assessment of selected mainstream cigarette smoke constituents generated from low-yield cigarettes in South Korean smokers.

A total of 38 hazardous constituents in mainstream cigarette smoke of low-yield cigarettes sold in Korea were selected and analyzed using established methods. Risk calculations were performed using risk algorithms employed in previous studies and Korean population-based exposure parameters. The median cumulative incremental lifetime cancer risk of male smokers could vary from 828 × 10-6 to 2510 × 10-6, and that of female smokers could range from 440 × 10-6 to 1300 × 10-6, depending on the smoking regimens. The median hazard index as the sum of hazard quotients of male smokers varied from 367 to 1,225, and that of female smokers varied from 289 to 970, depending on the smoking regimens. The sensitivity analysis for this risk assessment indicated that the constituent yields in mainstream cigarette smoke, average number of cigarettes smoked per day or year, and mouth-spill rate are the main risk factors. Statistical positive correlations between the average daily dose calculated by the exposure algorithm used in this study for individual smokers and biomarkers verified the reliability of this assessment. It could be concluded that inhalation of the constituents present in the mainstream of low-yield cigarettes has significant cancer and non-cancer health risks, although its effect on risk reduction is still unknown under the fixed machine-smoking conditions.

Quantitative analysis of menthol and identification of other flavoring ingredients in capsule cigarettes marketed in Korea.

Currently, capsule cigarettes have been introduced by tobacco industries and their sales have increased exponentially. However, the capsule flavoring ingredients and their safety are still unknown. Although the contents of menthol and other ingredients directly added to cigarettes have been determined extensively, no analogous study exists for menthol-containing cigarette capsules. Basic physical properties of capsules in all 31 different capsule cigarettes commercially available in Korea were investigated, and their menthol contents were determined in this study. Other ingredients in these capsules were also qualitatively analyzed; methyl octanoate, menthone and isopulegol as well as menthol were detected in all the capsules. There is considerable variability in basic physical properties and menthol contents of cigarette capsules depending on their brand styles. The menthol contents of capsules and whole cigarettes are similar or higher than those previously reported for conventional menthol cigarettes. This is the first report on the physical properties of capsules and the fact that a wide range of menthol contents in capsule cigarettes, regardless of flavor types, allows smokers to select menthol content to their liking.

Medication Adherence Improvement By Using Administration Timing Simplification Protocol (ATSP) in Cardiovascular Disease Patients.

AIMS: In chronic diseases, keeping adherence to medication is very difficult. The objective of this study was to evaluate the impact of administration timing simplification protocol (ATSP) on medication adherence and clinical parameters of cardiovascular diseases. METHODS: 210 out-patients with cardiovascular disease, who were taking two or more pills of any type of medication per day for more than one year, were enrolled and randomized. The intervention group followed the simplified administration schedule of ATSP with two main strategies: 1) moving medication from "pc" (30 minute after meal) to "stat. pc" (immediately after meal); and 2) moving medication time from "at evening" to "at morning." In contrast, the control group maintained the same medication schedule. Both patient groups were equally educated about the names and effects of the medication. RESULTS: The intervention group had more pills than the control group with marginal statistical significance (5.1±2.3 vs 4.6±1.8, p=0.05). The total frequency of administration was significantly higher in the intervention group than that of the control group (2.9±1.0 vs 2.6±0.9, p=0.03) at the baseline. In the intervention group, the frequency was significantly decreased to 1.5±0.6 times per day after following ATSP application (p＜0.01). In both patient groups, knowledge about the medication was significantly improved by education. However, medication adherence was only improved in the intervention group. Interestingly, total cholesterol was significantly decreased in the intervention group (p＜0.01). The decrease in serum cholesterol concentration was significantly correlated with the improvement in medication adherence evaluated with Morisky Medication Adherence Scale (MMAS)-8 items (r=0.507, p＜0.01). CONCLUSION: ATSP was shown to be an effective strategy to improve medication adherence in chronic cardiovascular disease patients.