Anno I – Numero 1 – Settembre 2020
Comitato scientifico editoriale: Antonio Magi, Pierluigi Bartoletti, Fernando De Benedetto, Giovanbattista Desideri, Francesco Cognetti, Roberto Messina
Editore: Intermedia – Direttore Responsabile: Mauro Boldrini – ciat@ciatnews.it


EDITORIALE

Il problema della mancata aderenza alla terapia sta assumendo dimensioni sempre più importanti e sempre più gravi. Mentre fino a pochi anni fa era di appannaggio esclusivo di alcune patologie come l’ipertensione, pian piano si sta allargando ad altre malattie croniche con costi socio-sanitari particolarmente rilevanti. Le ragioni della mancata aderenza sono diverse: difficoltà di somministrazione per chi è colpito da polipatologie e quindi con continue somministrazioni ad orari diversi, età media del paziente in continua crescita, scarso rapporto con il medico. Ma anche, ed è emerso in questi ultimissimi anni, va sempre più sottolineato il ruolo importante che può svolgere il medico, il clinico, nell’insistere su un tema come quello della necessità di rispettare l’aderenza. Per questo motivo nasce CIAT News la prima newsletter che sarà inviata alle diverse figure mediche attraverso le Società scientifiche che partecipano al CIAT, che intende fornire cultura raccogliendo mensilmente i principali lavori pubblicati nelle riviste scientifiche che possono fornire momenti di dibattito, di riflessione, di approfondimento, ma anche di analisi su best practice, su progetti pilota che hanno consentito di ridurre questo pericoloso fenomeno. Tutti i mesi quindi ci rivolgeremo a pneumologici, cardiologi, esperti di ipertensione, reumatologi, oculisti, medici di medicina generale, farmacisti, oncologi, infermieri, per proporre uno strumento di approfondimento che potrà diventare una vera e propria platea virtuale in cui i medici potranno crearsi una più approfondita cultura su questo tema. Perché un medico bene informato è un medico che più nella pratica clinica quotidiana potrà intervenire per sensibilizzare il paziente , i caregiver, all’assoluta necessità di rispettare l’aderenza alla terapia.

Buona lettura a tutti

Mauro Boldrini, Direttore di CIAT News


ARTICOLI DALLA LETTERATURA SCIENTIFICA

Medication non-adherence: an overlooked target for quality improvement interventions

Bryony Dean Franklin, Gary Abel, Kaveh G Shojania

Quality improvement initiatives often focus on closing the gap between routine practice and the care recommended in guidelines—ensuring, for instance, that patients with chronic conditions receive prescriptions for medications demonstrated to improve health outcomes. However, this focus often ignores the even more basic problem: that many patients prescribed medicines for chronic conditions take them inconsistently or not at all. In one US study,1 patients who had recently experienced a myocardial infarction took key medicines intended to prevent further cardiac events only 35%–50% of the time, depending on the class of medication. Perhaps surprisingly, providing the medicines for free improved adherence by only a few percentage points. Other studies also report adherence rates of around 50% or less. Medication adherence thus constitutes one of the ‘big hairy problems’ or ‘big hairy audacious goals’6 of healthcare. As well as affecting patients’ long-term outcomes, non-adherence can increase healthcare costs through consumption of medicines below the threshold of adherence required for clinical benefit, as well as contributing to healthcare resource use such as hospital admissions. Disposal of what can amount to significant quantities of unused medication also…. 
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Determinants, consequences and potential solutions to poor adherence to anti-osteoporosis treatment: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Osteoporosis Foundation (IOF)
M. Hiligsmann, D. Cornelissen, B. Vrijens, B. Abrahamsen, N. Al-Daghri, E. Biver, M.L. Brandi, O. Bruyère, N. Burlet, C. Cooper, B. Cortet, E. Dennison, A. Diez-Perez, A. Gasparik, A. Grosso, P. Hadji, P. Halbout, J.A. Kanis,1 J.M. Kaufman, A. Laslop, S. Maggi, R. Rizzoli, T. Thomas, S. Tuzun, M. Vlaskovska, and J.Y. Reginster

Many patients at increased risk of fractures do not take their medication appropriately, resulting in a substantial decrease in the benefits of drug therapy. Improving medication adherence is urgently needed but remains laborious, given the numerous and multidimensional reasons for non-adherence, suggesting the need for measurement-guided, multifactorial and individualized solutions.
Introduction: Poor adherence to medications is a major challenge in the treatment of osteoporosis. This paper aimed to provide an overview of the consequences, determinants and potential solutions to poor adherence and persistence to osteoporosis medication.
Methods: A working group was organized by the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal diseases (ESCEO) to review consequences, determinants and potential solutions to adherence and to make recommendations for practice and further research…
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Sex-differences in factors and outcomes associated with adherence to statin therapy in primary care: Need for customisation strategies
Elena Olmastroni, Mezio T.Boccalari, ElenaTragni, Federico Rea, Luca Merlino, Giovanni Corrao, Alberico L.Catapano, Manuela Casula

Despite the invaluable efficacy of statins, adherence to therapy is extremely poor in clinical practice. Improvement interventions should be as personalized as possible, but it is necessary to know factors that most influence adherence, and sex seems to be a key determinant. Thus, we aimed at exploring potential areas of sex-differences in statin adherence in a real-world population. For this purpose, we assessed adherence (as proportion of days covered) on a wide cohort of new statin users aged >40 years, and we evaluated its association with several covariates through sex-stratified log-binomial regression models. In addition, to compare also the benefits of optimal statin adherence in primary prevention of cardiovascular disease between men and women, we implemented sex-stratified Cox proportional hazard models. Our study showed that women are more likely to stop or be less adherent to statin treatment than men. Moreover, we observed significant sex-differences on effect size of several factors associated with adherence that should be taken into consideration for the management of patients. Finally, we observed no significant difference between men and women regarding statin efficacy in terms of  reduction of incident hospitalization for ischemic heart disease and/or non-haemorrhagic cerebrovascular disease…..
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Adherence to Medication, Physical Activity and Diet in Older Adults With Diabetes: Its Association With Cognition, Anxiety and Depression
Rosa Mendes,Sonia Martins, Lia Fernandesb

Adherence to medication, physical activity (PA) and diet in diabetes mellitus (DM) patients is crucial for its good management, avoiding acute and chronic complications. There are several risk factors associated with non-adherence, including cognitive impairment, depression and anxiety. Nevertheless, studies on therapeutic adherence in older patients with DM are scarce. In this context, the present study aimed to analyze whether adherence to medication, PA and diet are associated with cognitive impairment, anxiety and depression. It also aimed to identity predictors of medication non-adherence.
Methods:  a cross-sectional study of older patients (≥ 65 years old) with DM was carried out in the Outpatient Department of Internal Medicine Service of CHUSJ-Porto, Portugal. Those unable to communicate were excluded. Cognition (mini-mental state examination), anxiety and depression (hospital anxiety and depression scale) were assessed. Adherence to medication, PA and diet was measured, based on self-reporting patient/family, questionnaires, physician clinical opinion, hemoglobin test and pharmacy records…. 
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Knowledge about Disease, Medication Therapy, and Related Medication Adherence Levels among Patients with Hypertension
Anna Gavrilova, Dace Bandere, Ieva Rutkovska, Dins Šmits  Baiba Mauriņa, Elita Poplavska, Inga Urtāne

A particular problem in cardiology is poor adherence to pharmacological treatment among patients with hypertension. It is known that approximately half of these patients do not use their medications as prescribed by their doctor. Patients may choose not to follow the doctor’s recommendations and regularly do not control their blood pressure, owing to many factors. A convenient method for measuring the level of adherence is the Morisky Medication Adherence Scale, which also provides insight into possible remedies for low adherence. We investigated their therapy, knowledge about the disease and its control, and demographic differences to assess the adherence of patients with hypertension. 
Materials and Methods: this was a cross-sectional observational study. Data were collected through a survey of 12 pharmacies in Latvia. The study involved 187 participants with hypertension. Results: The prevalence of non-adherence was 46.20% in Latvia. The oldest patients were the most adherent (p = 0.001, β = 0.27). The higher the self-rated extent from 0 to 10, to which the patient takes their antihypertensives exactly as instructed by their physician, the higher the level of adherence (p < 0.0001, β = 0.38), where at “0” the patient does not follow physician….
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