medwireNews: A Japanese study reports that inadequate medication-taking habits, such as inadvertently missing a dose, can greatly increase risk of poor adherence in patients with chronic myeloid leukaemia (CML) receiving ABL tyrosine kinase inhibitors.
Such habits “may represent a potential target to improve and maximize adherence in CML patients”, say Shinya Kimura (Saga University) and colleagues in the International Journal of Clinical Oncology.
As per the tenets of failure mode and effects analysis, the researchers identified four factors that can lead to poor adherence and assigned severity (of failure), frequency and detectability scores to each factor on the basis of a survey of 54 CML patients. The product of the three scores gave a risk priority number, “which pinpointed the factors most likely to contribute to poor adherence”, they explain.
Careless slips in taking medication had the highest risk priority number, at 7.0, followed by inadequate understanding of treatment outcomes, adverse effects and high medication cost, at 4.9, 3.8 and 2.2, respectively.
High medication cost had a significantly lower severity score and risk priority number than the other factors, a finding that contradicts reports from other countries whereby “patients with high prescription co-payments have reduced adherence”, say the researchers.
“Although we anticipated that high medication costs would be a risk factor for reduced adherence in our study, the relatively widespread use of the high cost medical care benefit system in Japan, including in the Saga Prefecture, may explain our contradictory findings.”
Compared with patients with perfect adherence, those who forgot their medication at least once had significantly higher scores for the frequency of careless slips (2.1 vs 1.1) and for the risk priority number for careless slips (13.6 vs 4.0) and inadequate understanding (7.3 vs 3.9).
Detectability scores were also significantly higher – with higher scores indicating a lower possibility of detecting failure – in patients with less than perfect compared with perfect adherence for careless slips (2.3 vs 1.3) and inadequate understanding (2.3 vs 1.2), with a trend to significance for adverse events (1.6 vs 1.0).
Noting that several methods, such as counselling and a change in drug packaging, have been used to improve adherence, Kimura et al conclude that as “patients have different lifestyles, personalised detailed medication administration methods and strategies to improve adherence are likely more effective than generalised instructions.”
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