Line Guénette

Burden of Diabetes on the Ability to Work: A systematic review

Type 2 diabetes is an increasingly common disease (1) that places a considerable economic burden on society. An estimated 171 million people were suffering from diabetes in 2000, and this number could total 366 million by 2030 (1). Type 2 diabetes accounts for more than 90% of all diabetes cases, and it often appears in middle age (2). In 2010, the prevalence of diabetes in the U.S. was 11.3 and 26.9% among individuals aged 20 years or over and 65 years or older (2), respectively. In 2007, costs related to diabetes in the U.S. were an estimated

Difficulty adhering to antidiabetic treatment: Factors associated with persistence and compliance

174 billion;

Effectiveness of motivational interviewing interventions on medication adherence in adults with chronic diseases: a systematic review and meta-analysis.

116 billion in direct costs and

Effectiveness of an asthma integrated care program on asthma control and adherence to inhaled corticosteroids

58 billion in indirect costs (3). Direct costs include the cost of personal expenditures, drugs, and health care services, whereas indirect costs include lost productivity at work. Lost productivity at work may be measured through absenteeism (time lost from work due to illness), presenteeism (time at work impaired due to illness), productivity (time lost from work due to illness plus time at work impaired due to illness), or early retirement (retirement before the official retirement age due to illness). Lost productivity at work is an important concern for employees, employers, and society. Moreover, the complications related to diabetes are a major cause of disability, reduced quality of life, and death (4). Employees with diabetes may stop working prematurely (5–8) and may experience unemployment (7,9–12), which could translate into a reduction in earned income and savings (13) and loss of self-esteem (14). For employers too, lost productivity due to absenteeism (6,8,13,15–23), presenteeism (17), and early retirement (5–7) is an important economic issue. To the best of our knowledge, there are no published systematic reviews answering the following question: Do individuals …

Elderly people's knowledge of the purpose of their medicines.

AIMS This study aimed to assess the 1-year treatment persistence and compliance of new oral antidiabetic drug (OAD) users with their treatment, and to identify the factors associated with both persistence and compliance. METHODS This population-based cohort study of new OAD users aged 18 years or above used the Quebec health insurance board databases. Those having a prescription filled for antidiabetic treatment during the period leading up to the 1-year anniversary of their first claim were considered to be persistent with their antidiabetic treatment. Of these patients, individuals with a medication possession ratio (MPR) greater or equal to 80% for OAD or insulin were deemed compliant. Also identified were the characteristics associated with both outcomes, using a multivariate logistic regression model. RESULTS Our cohort consisted of 151,173 individuals, 119,832 (79.3%) of whom were considered persistent. Of these, 93,418 (78.0%) were also deemed compliant. Persistence and compliance were associated with older ages, living in a rural region, low socioeconomic status, having the first OAD prescribed by a general practitioner and a history of using five different drugs or more. People were less likely to be persistent and compliant if their initial OAD was a secretagogue and if they had consulted a physician eight times or more during the year prior to starting treatment. CONCLUSION One year after OAD treatment initiation, 21% had discontinued their treatment and 22% of those still being treated were non-compliant. These results could help to tailor interventions aimed at optimizing the use of OAD treatments.

Important Treatment Gaps in Vascular Protection for the Elderly After Type 2 Diabetes Therapy Initiation

Background Medication adherence is frequently suboptimal in adults with chronic diseases, resulting in negative consequences. Motivational interviewing (MI) is a collaborative conversational style for strengthening a persons motivation and commitment to change. We aimed to assess whether MI interventions are effective to enhance medication adherence in adults with chronic diseases and to explore the effect of individual MI intervention characteristics. Methods We searched electronic databases and reference lists of relevant articles to find randomized controlled trials (RCTs) that assessed MI intervention effectiveness on medication adherence in adults with chronic diseases. A random-effects model was used to estimate a pooled MI intervention effect size and its heterogeneity (I 2 ). We also explored the effects of individual MI characteristics on MI intervention effect size using a meta-regression with linear mixed model. Results : Nineteen RCTs were identified, and 16 were included in the meta-analysis. The pooled MI intervention effect size was 0.12 [95% confidence interval (CI) = (0.05, 0.20), I 2 = 1%]. Interventions that were based on MI only [β = 0.183, 95% CI = (0.004, 0.362)] or those in which interventionists were coached during intervention implementation [β = 0.465, 95% CI = (0.028, 0.902)] were the most effective. MI interventions that were delivered solely face to face were more effective than those that were delivered solely by phone [β = 0.270, 95% CI = (0.041, 0.498)]. Conclusions This synthesis of RCTs suggests that MI interventions might be effective at enhancing of medication adherence in adults treated for chronic diseases. Further research is however warranted, as the observed intervention effect size was small.

Patients' beliefs about adherence to oral antidiabetic treatment: a qualitative study

Abstract Objective: To measure the effectiveness of an integrated care program for individuals with asthma aged 12–45 years, on asthma control and adherence to inhaled corticosteroids (ICS). Methods: Researchers used a theoretical model to develop the program and assessed effectiveness at 12 months, using a pragmatic controlled clinical trial design. Forty-two community pharmacists in Quebec, Canada recruited participants with either uncontrolled or mild-to-severe asthma. One group was exposed to the program; another received usual care. Asthma control was measured with the Asthma Control Questionnaire; ICS adherence was assessed with the Morisky medication adherence scale and the medication possession ratio. Program effectiveness was assessed with an intention-to-treat approach using multivariate generalized estimating equation models. Results: Among 108 exposed and 241 non-exposed, 52.2% had controlled asthma at baseline. At 12-months, asthma control had improved in both groups but the interaction between study groups and time was not significant (p = 0.09). The proportion of participants with good ICS adherence was low at baseline. Exposed participants showed improvement in adherence and the interaction between study groups and time was significant (p = 0.02). Conclusion: An integrated intervention, with healthcare professionals collaborating to optimize asthma control, can improve ICS adherence.

Association Between Loyalty to Community Pharmacy and Medication Persistence and Compliance, and the Use of Guidelines-Recommended Drugs in Type 2 Diabetes: A Cohort Study

BACKGROUND It is generally believed that elderly persons know little about the purpose of their medications. However, researchers have reported contradictory results. Moreover, little is known about which patient characteristics are associated with knowledge of a drugs purpose. OBJECTIVES To assess whether community-dwelling elderly persons could correctly identify the general purpose of their prescription and nonprescription drugs and to examine the link between participant and drug characteristics and this knowledge. METHODS During an in-home interview, a random sample of pharmacy clients aged ≥65 years were asked to report all the drugs they had taken over the previous 30 days and to state the reasons for their use. Drugs were classified according to the anatomical therapeutic chemical (ATC) classification system. We looked for any information in the stated reasons that concerned the anatomical system, organs and diseases. We assumed that the person knew the general purpose of the drug if the reason stated referred to the anatomical system targeted by the drug. A multivariate logistic regression model was used to identify participant characteristics that were associated with knowledge. RESULTS We interviewed 193 seniors who reported using 1645 drugs that could be classified according to the ATC classification system. Of those drugs, 1364 (82.9%) were self reported as physician prescribed. Among participants, 134 (69.4%) knew the general purpose of all drugs they reported. Characteristics associated with knowledge of the purpose were female gender (adjusted odds ratios [ORs], 3.3, 95% confidence intervals [CI] 1.5-7.1), normal cognition (adjusted OR, 5.0; 95% CI, 2.0-12.8), and average to superior socioeconomic status (adjusted OR, 2.7, 95% CI, 1.2-6.3). Knowledge was slightly better for nonprescribed drugs than for prescribed drugs (overall proportion of appropriate reasons: 96.1% vs 91.1%; P < 0.01). CONCLUSIONS Community-dwelling elderly persons have a good knowledge of the general purpose of their prescription and nonprescription drugs.

Psychosocial factors associated with adherence to non-insulin antidiabetes treatments

BACKGROUND Canadian practice guidelines recommend the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) for vascular protection in individuals with diabetes who are at high risk of cardiovascular events, including those ≥ 65 years. We estimated the proportion of elderly persons who initiated an ACEI or an ARB in the year after beginning oral antidiabetes (OAD) treatment, and we identified factors associated with this initiation. METHODS Using the Quebec Health Insurance Board (RAMQ) databases, we conducted a population-based cohort study of individuals ≥ 65 years recently prescribed an OAD. We excluded those who were already taking an ACEI or ARB. Factors associated with ACEI or ARB initiation were identified using multivariate logistic regression. RESULTS Among 43,700 individuals, 13,621 (31.2%) initiated an ACEI or ARB in the year after beginning OAD. Individuals were more likely to begin an ACEI or an ARB if they initially received both metformin and a sulfonylurea, lived in a rural region, began OAD treatment between 2001 and 2006, were hospitalized, or had ≥ 22 medical visits in the year before OAD initiation. Individuals ≥ 75 years, those who were prescribed an OAD by a general practitioner, initially received a sulfonylurea, or received ≥ 4 different medications in the year before OAD initiation were less likely to begin an ACEI or ARB. CONCLUSIONS In the elderly not already taking ACEIs or ARBs, a low proportion of those undertaking OAD treatment are prescribed the recommended cardioprotection of an ACEI or ARB in the following year. Interventions are needed to close this treatment gap.

Factors associated with adherence to asthma treatment with inhaled corticosteroids: A cross-sectional exploratory study

Purpose The purpose of this study was to elicit patients’ beliefs about taking their oral antidiabetic drugs (OADs) as prescribed to inform the development of sound adherence-enhancing interventions. Methods A qualitative study was performed. Adults with type 2 diabetes who had been taking an OAD for >3 months were solicited to participate in one of six focus groups. Discussions were facilitated using a structured guide designed to gather beliefs related to important constructs of the theory of planned behavior. Four coders using this theory as the theoretical framework analyzed the videotaped discussions. Results Forty-five adults participated. The most frequently mentioned advantages for OAD-taking as prescribed were to avoid long-term complications and to control glycemia. Family members were perceived as positively influential. Carrying the OAD at all times, having the OAD in sight, and having a routine were important facilitating factors. Being away from home, not accepting the disease, and not having confidence in the physician’s prescription were major barriers to OAD-taking. Conclusion This study elicited several beliefs regarding OAD-taking behavior. Awareness of these beliefs may help clinicians adjust their interventions in view of their patients’ beliefs. Moreover, this knowledge is crucial to the planning, development, and evaluation of interventions that aim to improve medication adherence.