Sunya-Lee Antoine

Adherence-enhancing interventions for highly active antiretroviral therapy in HIV-infected patients – a systematic review

The objective of this systematic review was to evaluate the effectiveness of adherence‐enhancing interventions for highly active antiretroviral therapy (HAART) in HIV‐infected patients in developed countries.

Adherence enhancing interventions for oral anticancer agents: A systematic review

BACKGROUND The use of oral anticancer agents has increased in the last decades. Adherence is a crucial factor for the success of oral anticancer agent therapy. However, many patients are non-adherent. OBJECTIVE The objective was to evaluate the effectiveness of adherence interventions in patients taking oral anticancer agents. METHODS A systematic literature search was performed in Medline and Embase. Titles and abstracts and in case of potential relevance, full-texts were assessed for eligibility according to the predefined inclusion criteria. The study quality was evaluated. Both process steps were carried out independently by two reviewers. Relevant data on study design, patients, interventions and results were extracted in standardized tables by one reviewer and checked by a second reviewer. RESULTS Six controlled studies were included. Only one study was randomized. The study quality was moderate to low. One study showed statistically significant results in favor of the adherence intervention, two studies showed a tendency in favor of the intervention, one study showed an inconsistent result depending on the adherence definition and one study showed almost identical adherence rates in both groups. One study showed a tendency in favor of the control group. CONCLUSIONS Although most of the interventions are not very effective, it appears that certain adherence enhancing interventions could have a promising effect. One crucial point is the consideration of the baseline adherence when choosing patients to avoid ceiling effects. The evidence is limited due to lack of sufficient studies and partly inconsistent results. Further high quality studies are needed.

Commentary: Europe needs a central, transparent, and evidence based regulation process for devices

Last September, the European Commission published proposals to update regulations for medical devices in order to improve patient safety.1 The proposals are being discussed by the European parliament where critical debate is being led by the Committee on Environment, Public Health and Food Safety. Medical devices range from bandages to life support machines, and manufacturers classify them into four risk categories from low (such as urine drainage bags) to high risk (such as drug eluting cardiac stents) according to EU rules.2 The risk associated with the device depends on the duration of contact with the body, invasiveness, and whether it has a local or a systemic effect. Medium and high risk devices must be certified by one of the notified bodies, organisations that are accredited to assess a product’s compliance with EU legislation (CE mark). At a …

Adherence influencing factors in patients taking oral anticancer agents: a systematic review.

BACKGROUND The use of oral anticancer agents increased steadily in the last decades. Although oral anticancer agent adherence is important for a successful treatment, many patients are insufficiently adherent. PURPOSE To evaluate adherence influencing factors in patients taking oral anticancer agents. METHODS A systematic literature search was performed in Medline and Embase. Titles and abstracts and in case of relevance, full-texts were screened according to predefined inclusion criteria. The risk of bias was assessed. Both were carried out independently by two reviewers. Relevant data on study characteristics and results were extracted in standardized tables by one reviewer and checked by a second. A meta-analysis was not performed because of clinical and methodological heterogeneity between the studies to avoid misleading results. Data were synthesized in narrative way using a standardized procedure. RESULTS Twenty-two relevant studies were identified. The study quality was moderate. Especially the risk of bias regarding the measurement of influencing factors and adherence was mostly unclear. Social support, intake of aromatase inhibitors, and lower out-of-pocket costs for OACA seem to have a positive effect on adherence. Depression and the number of different medications seem to have a negative effect on adherence. Low age and very high age seem to be associated with lower adherence. The remaining factors showed either mostly no influence or were heterogeneous regarding the effect direction and statistical significance. CONCLUSIONS There are some factors that seem to have influence on adherence in patients taking OACA. However, due to the heterogeneity no general conclusions can be made also for these factors that can be applied to all indications, medications, settings, countries etc. The results should rather be considered as indications for factors that can have an influence on adherence to OACA.

Improving the adherence of type 2 diabetes mellitus patients with pharmacy care: a systematic review of randomized controlled trials

BackgroundOral medication for patients with type 2 diabetes mellitus plays an important role in diabetes care and is associated with a high level self-care behavior and self-management. However, poor adherence to diabetes treatment is common which causes severe health complications and increased mortality. Barriers to adherence may consist of complex treatment regimens often along with long-term multi-therapies, side effects due to the medication as well as insufficient, incomprehensible or confusing information or instructions provided by the health care provider. Multidisciplinary approaches can support adherence success and can enable a more effective management of diabetes care. One approach in diabetes care can be the involvement of a pharmacist. The aim was to analyze the effectiveness of adherence-enhancing pharmacist interventions for oral medication in type 2 diabetes mellitus.MethodsA systematic review of randomized controlled trials. The study quality was assessed with the Cochrane risk of bias tool.ResultsOf 491 hits, six publications were included. Two studies mainly examining educational interventions showed a significant improvement in adherence. Moreover, the quality of the included studies was deficient.ConclusionAlthough pharmacist interventions might potentially improve adherence to type 2 diabetes mellitus medication, high-quality studies are needed to assess effectiveness.

Factors influencing adherence in Hepatitis-C infected patients: a systematic review

BackgroundAdherence is a crucial point for the successful treatment of a hepatitis-C virus infection. Studies have shown that especially adherence to ribavirin is important.The objective of this systematic review was to identify factors that influence adherence in hepatitis-C infected patients taking regimes that containing ribavirin.MethodsA systematic literature search was performed in Medline and Embase in March 2014 without limits for publication date. Titles and abstracts and in case of relevance, full-texts were screened according to predefined inclusion criteria. The risk of bias was assessed. Both process steps were carried out independently by two reviewers. Relevant data on study characteristics and results were extracted in standardized tables by one reviewer and checked by a second. Data were synthesized in a narrative way using a standardized procedure.ResultsNine relevant studies were identified. The number of analyzed patients ranged between 12 and 5706 patients. The study quality was moderate. Especially the risk of bias regarding the measurement of influencing factors was mostly unclear.“Psychiatric disorders” (N = 5) and having to take “higher doses of ribavirin” (N = 3) showed a negative influence on adherence. In contrast, a “HIV co-infection” (N = 2) and the “hemoglobin level” (N = 2) were associated with a positive influence on adherence. Furthermore, there is the tendency that male patients are more adherent than female patients (N = 6). “Alcohol consumption” (N = 2), “education”, “employment status”, “ethnic group“,”hepatitis-C virus RNA” (N = 4), “genotype” (N = 5), “metavir activity” (N = 1) and “weight” (N = 3) showed mostly no effect on adherence. Although, some studies showed statistically significant results for “age”, “drug use” , “genotype”, “medication dose interferon“, and “treatment experience” the effect is unclear because effect directions were partly conflicting.The other factors were heterogeneous regarding the effect direction and/or statistical significance.ConclusionThere are some factors that seem to show an influence on adherence. However, due to the heterogeneity (e.g. patient characteristics, regimes, settings, countries) no general conclusions can be made. The results should rather be considered as indications for factors that can have an influence on adherence in hepatitis-C infected patients taking regimes that containing ribavirin.

Up-to-dateness of reviews is often neglected in overviews: a systematic review

BACKGROUND AND OBJECTIVE As systematic reviews may run out of date, it might be necessary to update them. Out-of-date reviews may jeopardize the comparability when used in the context of overviews (review of reviews). METHODS Seven electronic databases were searched for overviews up to November 2012. We first aimed to analyze whether the authors of overviews additionally searched for primary studies or alternatively explained why they did not. Second, we sought to analyze the actual publication lag (publication date of the overview - publication date of the review) in overviews and to develop recommendations for authors of overviews. RESULTS We included 147 overviews. The mean publication lag in overviews was more than 5 years. A median of 36% of the reviews were published more than 6 years ago. Only one in four reviews considered up-to-dateness. The methods for updating reviews were heterogeneous. We found no overview that systematically investigated whether an update was necessary. CONCLUSION The issue of up-to-dateness when conducting overviews seems to be neglected by most authors of overviews. Authors should assess the quality of evidence, based on their included reviews first.

Methodological approaches in conducting overviews: current state in HTA agencies

OBJECTIVES Overviews search for reviews rather than for primary studies. They might have the potential to support decision making within a shorter time frame by reducing production time. We aimed to summarize available instructions for authors intending to conduct overviews as well as the currently applied methodology of overviews in international Health Technology Assessment (HTA) agencies. METHODS We identified 127 HTA agencies and scanned their websites for methodological handbooks as well as published overviews as HTA reports. Additionally, we contacted HTA agencies by e-mail to retrieve possible unidentified handbooks or other related sources. RESULTS In total, eight HTA agencies providing methodological support were found. Thirteen HTA agencies were found to have produced overviews since 2007, but only six of them published more than four overviews. Overviews were mostly employed in HTA products related to rapid assessment. Additional searches for primary studies published after the last review are often mentioned in order to update results. CONCLUSIONS Although the interest in overviews is rising, little methodological guidance for the conduct of overviews is provided by HTA agencies. Overviews are of special interest in the context of rapid assessments to support policy-making within a short time frame. Therefore, empirical work on overviews needs to be extended. National strategies and experience should be disclosed and discussed.

Adherence-enhancing interventions for active antiretroviral therapy in sub-Saharan Africa: a systematic review and meta-analysis

UNLABELLED Background In sub-Saharan Africa, an estimated 23% of HIV-infected patients are nonadherent. The objective was to evaluate the effectiveness of adherence-enhancing interventions for active antiretroviral therapy (ART) in HIV-infected patients in sub-Saharan Africa. METHODS A systematic literature search was performed with the following inclusion criteria: adult HIV patients treated with ART, an intervention to enhance patient adherence, adherence rate as an outcome, a clinical or patient outcome, a randomised controlled trial and conducted in sub-Saharan Africa. Studies were selected by two reviewers independently. Data on patient characteristics, interventions, adherence definition and measures, and results were extracted. The risk of bias was evaluated by two reviewers independently. A meta-analysis was performed where appropriate. All discrepancies were discussed until consensus. RESULTS Six trials fulfilled all inclusion criteria. One showed statistically significant results in favour of the intervention for adherence rate and clinical outcome. The other studies showed either no significant results for any outcome or heterogeneous results depending on the outcome type. Aside from the clinical outcomes in one study, all outcomes showed a tendency in favour of the intervention groups. In the meta-analysis short message service (SMS) interventions showed a statistically significant effect on adherence (risk difference=-0.10; 95% confidence interval (CI): -0.17 to -0.03) and modified directly observed therapy (DOT) showed a significant effect on mortality (relative risk=0.75; 95% CI: 0.44-1.26). CONCLUSION The adherence-enhancing interventions (DOT, SMS interventions, counselling plus an alarm device) increased adherence only slightly, possibly because the high baseline adherence causes a ceiling effect.

Methods for Systematic Reviews of Health Economic Evaluations: A Systematic Review, Comparison, and Synthesis of Method Literature

Introduction. The quality of systematic reviews of health economic evaluations (SR-HE) is often limited because of methodological shortcomings. One reason for this poor quality is that there are no established standards for the preparation of SR-HE. The objective of this study is to compare existing methods and suggest best practices for the preparation of SR-HE. Methods. To identify the relevant methodological literature on SR-HE, a systematic literature search was performed in Embase, Medline, the National Health System Economic Evaluation Database, the Health Technology Assessment Database, and the Cochrane methodology register, and webpages of international health technology assessment agencies were searched. The study selection was performed independently by 2 reviewers. Data were extracted by one reviewer and verified by a second reviewer. On the basis of the overlaps in the recommendations for the methods of SR-HE in the included papers, suggestions for best practices for the preparation of SR-HE were developed. Results. Nineteen relevant publications were identified. The recommendations within them often differed. However, for most process steps there was some overlap between recommendations for the methods of preparation. The overlaps were taken as basis on which to develop suggestions for the following process steps of preparation: defining the research question, developing eligibility criteria, conducting a literature search, selecting studies, assessing the methodological study quality, assessing transferability, and synthesizing data. Discussion. The differences in the proposed recommendations are not always explainable by the focus on certain evaluation types, target audiences, or integration in the decision process. Currently, there seem to be no standard methods for the preparation of SR-HE. The suggestions presented here can contribute to the harmonization of methods for the preparation of SR-HE.