A look at adherence with subcutaneous immunotherapy without out-of-pocket patient costs.

BACKGROUND: Subcutaneous Immunotherapy (SCIT) provides long-lasting benefits when administered for 3 to 5 years. OBJECTIVE: We evaluated SCIT adherence and factors associated with adherence in a military health care system with no out-of-pocket expenses. METHODS: We performed a combined retrospective and prospective observational electronic medical record review of SCIT from 2005 to 2012 to determine the start of therapy, time to maintenance dose (MD), duration of MD, and associated factors. RESULTS: We enrolled 897 patients selected for SCIT. A total of 421/897 (47%) were of male sex, 269/897 (30%) had asthma, and 113/897 (13%) had a systemic reaction. Ages ranged from 1 to 74 years (mean 34.8). There were 751/897 (84%) who were on aeroallergen immunotherapy, 108/897 (12%) on imported fire ant immunotherapy, and 54/897 (6%) on venom immunotherapy. Therapy was not initiated in 130/897 (14%) patients. There were 538/897(60%) who received at least 1 MD; 307/897 (34%) completed 3 or more years of MD SCIT, 26% completed 4 or more years of MD SCIT, and 19% completed 5 years or more of MD SCIT. For those reaching MD, the mean total duration was 4.23 years and the mean time on MD was 3.17 years. Men were 271/421 (64%) more likely to reach MD (P = .01). The presence of asthma, age, venom immunotherapy/fire ant immunotherapy vs aeroallergen immunotherapy, and systemic reaction were not associated with reaching MD. After achieving MD, none of the identified factors were associated with SCIT duration. CONCLUSION: Even with no out-of-pocket expenses, adherence to an adequate course of SCIT was 34%. Only the male sex was significantly associated with reaching MD. No factors were associated with the duration of SCIT after MD.

Prism adaptation magnitude has differential influences on perceptual versus manual responses.

Previous research has indicated that rightward prism adaptation can reduce symptoms of spatial neglect following right brain damage. In addition, leftward prism adaptation can create "neglect-like" patterns of performance in healthy adults on tasks that measure attention and spatial biases. Although a great deal of research has focused on which behaviors are influenced by prism adaptation, very few studies have focused directly on how the magnitude of visual shift induced by prisms might be related to the observed aftereffects, or the effects of prisms on measures of attentional and spatial biases. In the current study, we examined these questions by having groups of healthy adult participants complete manual line bisection and landmark tasks prior to and following adaptation to either 8.5° (15 diopter; n = 22) or 17° (30 diopter; n = 25) leftward shifting prisms. Our results demonstrated a significantly larger rightward shift in straight-ahead pointing (a measure of prism aftereffect) following adaptation to 17°, compared to 8.5° leftward shifting prisms. In addition, only 17° leftward shifting prisms resulted in a significant rightward shift in line bisection following adaptation. However, there was a significant change in performance on the landmark task pre- versus post-adaptation in both the 8.5° and 17° leftward shifting prism groups. Interestingly, correlation analyses indicated that changes in straight-ahead pointing pre- versus post-adaptation were positively correlated with changes in performance on the manual line bisection task, but not the landmark task. These data suggest that larger magnitudes of prism adaptation seem to have a greater influence on tasks that require a response with the adapted hand (i.e., line bisection), compared to tasks that only require a perceptual judgment (i.e., the landmark task). In addition, these data provide further evidence that the effects of prisms on manual and perceptual responses are not related to one another.