Topical Corticosteroids
John Y. M. Koo, Ethan C. Levin, Argentina Leon, Jashin J. Wu, Mark G. Lebwohl in Mild to Moderate Psoriasis, 2014
Steroid receptor–binding characteristics and the physical chemistry of drug delivery affect the potency of topical corticosteroids. However, another key determinant of efficacy is adherence to treatment, also termed “compliance.” A corticosteroid that partitions through the stratum corneum easily and strongly activates corticosteroid receptors may not be very potent if the medication is never applied. Adherence, or compliance, describes the tendency of a patient to apply a medication as prescribed. Nonadherence to topical psoriasis therapy is greater than with oral therapy, phototherapy, or biologic therapy [13,14]. Prescriptions for psoriasis may not even be filled, much less used [15]. Patient compliance is a tremendously complex issue and one that, at best, is only partially understood and appreciated. Numerous factors affect a patient’s willingness to adhere to a given prescribed regimen of topical corticosteroids. Among the most prevalent of these factors are frustration with poor efficacy, inconvenience, and fear of side effects [16].
Disorders
Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson in Pocket Prescriber Psychiatry, 2019
A range of psychosocial interventions can be helpful in psychosis: Enhance medication adherence.↓Expressed emotion among family members. (Behavioural Family Therapy)Patient support groups. (Mind, Rethink, Hearing Voices Network)Psychoeducation. (https://www.rcpsych.ac.uk/mental-health)Engagement in education and employment.Supported living.Care coordination.
Medication Dosing and Adherence in Secondary Prevention
James M. Rippe in Lifestyle Medicine, 2019
Adherence is a complex series of behaviors composed of three phases: beginning a new medication;31 continuing to take a medication as prescribed over time; and stopping a medication for any reason (either when not recommended or at the end of a specific course of treatment).21 The rates of adherence may differ across phases. For example, at the beginning phase, one in five Medicare patients fail to fill their prescriptions within seven days after a percutaneous intervention with a drug-eluting stent.32 Regarding implementation, fewer than 50% of patients are persistent with their statins one year after initiation despite statins being associated with a 45% reduction in risk of mortality.32,33 For patients with diabetes, hypertension, and dyslipidemia, up to 50% of patients stop their medications in the first year of prescription.10,34,35 Across the phases, common barriers for medication adherence include poor quality of provider–patient relationship, poor communication, polypharmacy, low disease-related knowledge, low health literacy, barriers to obtaining medication, forgetfulness, and cost, among others.36–38
Interventions to improve medication adherence in mental health: the update of a systematic review of cost-effectiveness
Published in International Journal of Psychiatry in Clinical Practice, 2020
Lidia García-Pérez, Renata Linertová, Pedro Serrano-Pérez, Mar Trujillo-Martín, Leticia Rodríguez-Rodríguez, Cristina Valcárcel-Nazco, Tasmania del Pino-Sedeño
Medication adherence or compliance can be defined as ‘the extent to which a patient acts in accordance with the prescribed interval and dose of a dosing regimen’ (Cramer et al. 2008). The rates of nonadherence in patients with mental health problems vary widely by methodology, target population and definitions of ‘adherence’ from 20 to 70% (Julius et al. 2009). Most authors concur on substance use comorbidity, negative attitudes to treatment and poor treatment alliance as well as a severe course of illness being common contributors of medication non-adherence across major mental disorders (schizophrenia spectrum, bipolar and depressive disorders) (Demyttenaere 2003; Gibson et al. 2013; Leclerc et al. 2013; Murru et al. 2013; Czobor et al. 2015). Nonadherence to medication affects the health of the person, including the risk of relapse which can favour the appearance of the so-called ‘revolving door’ phenomenon, increase suicidal behaviour and reduce the quality of life, but also causes consequences in terms of violence and legal problems, poor social and occupational functioning (Meehan et al. 2006; Novick et al. 2010; Kane et al. 2013; Di Lorenzo et al. 2016).
Statistical considerations for medication adherence research
Published in Current Medical Research and Opinion, 2020
In the United States, more than half of all adults are on at least one prescription drug1. Patient adherence to medication is defined as the extent to which a patient takes prescribed medications according to the dosage and frequency recommended by the provider2. Medication non-adherence is a widespread problem and has been associated with worse health outcomes, more hospitalizations and increased healthcare costs3–5. Uniform measurements, calculations and operational definitions are not consistently implemented in the area of adherence research, and some adherence-related publications do not carefully define their terminology or methodology, leading to much confusion about the chosen metrics6. Without a uniform conceptual framework, medication adherence research is not generalizable7. Better adherence research is predicated on a standardized definition of adherence, a transparent method of calculation, and robust statistical modeling methods.
Effect of different iron chelation regimens on bone mass in transfusion-dependent thalassemia patients
Published in Expert Review of Hematology, 2019
Mohammadreza Bordbar, Sezaneh Haghpanah, Omid Reza Zekavat, Forough Saki, Asghar Bazrafshan, Haleh Bozorgi
DFP can provide iron hemostasis even in mild to moderate iron overload on account of its specific affinity to iron [20]. Although Di Stefano et al. showed a significant improvement of bone mass during a 3-year survey, consuming DFP for a period of 1 year was associated with an increase of serum ferritin level as oppose of expectations amongst our patients [21]. There are some possible explanations for the mentioned observation. The largest study on DFP revealed the drug could reduce serum ferritin significantly if only the baseline serum ferritin is higher than 4000 µg/L [22]. In our study, patients who were advised to take DFP had the lowest baseline serum ferritin compared to other ICT groups (734.25 ± 601.42). Another important issue is the matter of patients’ compliance and adherence to the prescribed drug. DFP has the highest gastrointestinal side effects amongst all ICT regimens which usually leads to drug discontinuation by the users. In addition, it should be taken 3 times a day which increases the chance of missing doses [20,21].
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