Introduction: The existing scale solely evaluate nonadherence to medication without providing any understanding of specific barriers that hinder adherence, particularly barriers that occur in Low-Middle-Income-Countries (LMICs) that may differ from those found in High-Income-Countries (HICs). Thus, they offered limited utility in developing focused intervention approaches to improve medication adherence.

Aims: to develop and validate a new scale to identify patients’ medication adherence and medication-taking barrier in patients with chronic diseases in Indonesia

Methods: The initial phase involved conceptualization framework and item generation. Subsequently, the items underwent preliminary evaluation, involving an Item Content Validity Index (I-CVI) assessment. The third phase encompassed the evaluation of psychometric properties and item reduction, along with an assessment of agreement with clinical outcomes and comparison with a Validated Questionnaire (MARS-5) using 447 chronic disease patients. We were using confirmatory factor analysis (CFA), goodness-of-fit index (GFI), comparative fit index (CFI), and root mean square error of approximation (RMSEA). We determined the reliability test using Cronbach's alpha and test-retest reliability using intraclass correlation.

Results: The initial draft included 35 question items, each with an I-CVI score of one. Then 12 items were selected based on factor loadings which were then grouped into 3 dimensions: patient, external, and medication-related factors. The CFA showed that the data was fit for the model (Chi-square 148.858, P<0.001, RMSEA = 0.067, CFI = 0.958, GFI = 0.948). The reliability test shows a good internal consistency (Cronbach’s α 0.83) and test-retest reliability (intraclass correlation 0.76). Concurrent validity was demonstrated through correlations with MARS-5 showed moderate correlation (r 0.54; p<0.001). However, this scale did not show a correlation with clinical measures of objective measurement (r 0.14; p 0.021).

Conclusion: These 12 items demonstrated favorable validity and internal consistency and can be utilized to identify barriers to adherence across a range of chronic conditions.

Introduction. Adherence to antihypertensives is key for blood pressure control. Most people with hypertension have several comorbidities and require multiple medicines, leading to complex care pathways. Strategies for coordinating medicine use can improve adherence, but the cumulative benefits of multiple strategies are unknown.
Aims. To assess the effects of multiple measures of coordinated care on adherence to antihypertensives among people using a large number of medicines.
Methods. Using dispensing claims for a 10% sample of eligible Australians, we identified adult users of antihypertensives during July/2018-June/2019 who experienced polypharmacy (≥5 unique medicines). We measured medicine use reflecting coordinated medicine management in 3 months before and including the first observed dispensing, including: the use of simple regimens for each cardiovascular medicine; prescriber continuity; and coordination of dispensings at the pharmacy. We measured adherence (proportion of days covered) to antihypertensive medicines in the following 12 months, and used logistic regression to assess independent associations and interactions of adherence with these measures of care.
Results. We identified 202,708 people, of which two-thirds (66.6%) had simple cardiovascular medicine regimens (one tablet per day for each medicine), two-thirds (63.3%) were prescribed >75% of medicines from the same prescriber, and two-thirds (65.5%) filled >50% of their medicine on the same day. One-third (28.4%) of people experienced all three measures of coordinated care. While all measures were significantly associated with higher adherence, adherence was greatest among people experiencing all three measures (odds ratio=1.63; 95% confidence interval: 1.55-1.72). This interaction was driven primarily by the effects of prescriber continuity and dispensing coordination.
Discussion. Coordinating both the prescribing and dispensing of medicines can improve adherence to antihypertensives, which supports strategies consolidating both the prescribing and supply of patients’ medicines.

Introduction. Polycystic Ovarian Syndrome (PCOS) is one of the most common and prevalent endocrine diseases among reproductively active women. Assessing medication adherence and identifying barriers that lead to medication non-adherence play a crucial role in effective patient care.
Aim. To assess the medication adherence and the impact of patient education on medication adherence among PCOS patients.
Methods. A prospective interventional study was conducted at the Department of Obstetrics and Gynaecology in a tertiary care hospital over a period of six months to assess medication adherence amongst PCOS patients using Morisky Medication Adherence Scale 8-Item (MMAS-8) and validated barrier questionnaire for medication adherence. The effectiveness of clinical pharmacist-assisted patient counselling in enhancing medication adherence was re-evaluated by using the MMAS-8 scale; post addressing the barriers to medication adherence. A paired t-test was used to compare the difference between the medication adherence score means of baseline and follow-up.
Results. A total of 137 participants above the age of 18 years were enrolled in the study, of which, 120[87.59%] participants were prescribed with medications. Based on the MMAS-8 questionnaire, only 32[26.67%] were highly adherent to their medication during the baseline interview. After the patient education and medication counselling, a follow-up was conducted at one month revealing an improvement in adherence, with 64[53.33%] participants showing high adherence. In comparing the mean scores from baseline[mean=6.320±1.65] to follow-up[mean=7.133±1.31], the paired t-test revealed a significant difference[(mean difference=0.813, SD=1.342); (p<0.0001)]. The primary factors responsible for non-adherence were consistently linked to forgetfulness[40.0%], believing that medications are not helping their condition[30.0%], and feeling that medications do not compliment their lifestyle[29.17%].
Conclusion. This study reveals that with clinical pharmacist-led intervention, medication adherence among PCOS patients can be improved. Individualized medication counselling addressing various adherence barriers along with patient education can improve the medication adherence.
Keywords. PCOS Medication Adherence, Adherence Interventions

Introduction: Even with the extensive use of lipid-lowering treatments in primary care, trajectories of medication adherence and related risk factors remain unclear.
Aims: To identify trajectories and predictors of medication adherence for the adult population prescribed lipid-lowering treatment in Australian primary care.
Methods: A retrospective cohort study used data from adults prescribed lipid-lowering treatment between January 2013 and March 2023. Adherence was defined as having at least one record of a prescription every six months. Group-based trajectory analyses and multinomial logistic regression were used to define medication adherence trajectories and their predictors over 5 years.
Results: Four distinct trajectories were identified in 51,504 individuals (mean age 62 years, 53.1% males) and included persistent adherence (20%), gradual decline (10%), rapid decline (29%), and early discontinuation (41%). Compared to the persistent-adherence group, individuals in the early discontinuation group were more likely to be younger (adjusted relative risk [aRR] 0.97, 95% confidence interval [CI] 0.97, 0.97), females (aRR 0.91, 95% CI 0.84, 1.00), non-smokers (aRR 0.76, 95% CI 0.70, 0.84), urban residents (aRR 1.20, 95% CI 1.09, 1.33), with a total cholesterol ratio>4 (aRR 1.11, 95% CI 1.00, 1.22), and with no history of diabetes (aRR 0.66, 95% CI 0.57, 0.75). Similar characteristics were found in the rapid decline group, except for sex. Younger age, females, a high total cholesterol ratio, and no history of hypertension were associated with the gradual decline group compared to the persistent adherence group.
Discussion/Conclusion: Distinct risk profiles were identified for individuals prescribed lipid-lowering treatment with different medication adherence trajectories, which can be used to implement targeted strategies to improve medication adherence and cardiovascular health in primary care.

Introduction:
Inconsistencies exist between real-world evidence and randomized trials regarding early initiation of antiretroviral therapy (ART) and care retention among human immunodeficiency virus (HIV)-infected patients. In line with WHO recommendations, Taiwan initiated same-week ART in 2018 and same-day ART in 2021.

Aims:
To investigate the effects of same-day versus same-week ART initiation on care and medication discontinuation among HIV-infected and AIDS patients in Taiwan.

Methods:
This population-based cohort study analyzed AIDS and HIV patients in Taiwan who began ART within 7 days of diagnosis between 2017 and 2019, using data from the National Health Insurance claims database. Care and medication discontinuation were defined as 90 days from the last clinical visit and 30 days from the last medication date, respectively. A doubly robust weighted Cox regression model estimated the average hazard ratio for same-day versus same-week ART initiation, focusing on a 12-month risk of care and medication discontinuation.

Results:
Among the study population, 83% of 1,024 HIV-infected patients and 80% of 3,452 AIDS patients received same-day ART. One-year care discontinuation rates were nearly 30% for both groups, while ART discontinuation rates exceeded 80% in both groups. Same-day ART initiation showed a statistically insignificant reduced risk of care discontinuation in both the HIV (aAHR = 0.94, 95% CI: 0.68-1.31) and AIDS groups (aAHR = 0.86, 95% CI: 0.73-1.01). However, it was associated with an increased risk of medication discontinuation in both the HIV (aAHR = 1.22, 95% CI: 0.99-1.49) and AIDS groups (aAHR = 1.06, 95% CI: 0.93-1.22).

Conclusion:
Same-day ART initiation shows varied effects on care and medication continuation. While it may enhance care retention, caution is warranted due to high medication discontinuation rates among HIV and AIDS patients, emphasizing the need to consider broader care contexts.

Keywords: same-day ART initiation, care discontinuation, medication discontinuation, HIV/AIDS

Introduction. Medication Treatment Satisfaction (M-TS) from the patients’ perspective is important for comprehensively evaluating the effect of medicines. However, there is no generic and validated instrument for paediatric patients’ M-TS.
Aims. To develop and pre-validate a self-report and generic Medication Treatment Satisfaction Instrument for Children and Adolescents aged 8-18 with chronic disease (MTSI-CA).
Methods. A three phase, mixed-methods, observational study was performed. Patients (8-18 years old) with a chronic disease and treated with medication for more than one week were eligible to participate. Phase I involved systematic reviews and semi-structured interviews to establish a conceptual framework and item pools. Phase II utilized the Delphi method and the cognitive interview to assess the relevance, comprehensibility, and comprehensiveness of the initial instrument. Phase III involves testing the instrument on a larger sample of pediatric patients to confirm its measurement properties and feasibility.
Results. The review identified 69 M-TS PROMs (four generic, 32 disease-specific, and 33 drug-specific; 60 for adults). We conducted semi-structured interviews with 15 patients and 11 experts (pediatricians, pharmacists, nurses, psychologists, and PROM methodologists), Delphi methods with 14 experts and cognitive interviews with 10 patients. We conducted a single-center, pre-validation study in China and recruited 113 pediatric patients met the inclusion criteria. The instrument achieved a response rate and completion rate of 100%, with a completion time of 2-8 minutes, indicating good feasibility. Exploratory factor analysis was conducted on the 22 items, resulting in a proposed model consisting of 8 domains. The instrument demonstrated sufficient content validity (high-quality evidence) and internal consistency (high-quality evidence). Discriminate validity was demonstrated between the 25% of subjects with the lowest scores and the 25% with the highest scores. The MTSI-CA had six multi-item domains (effectiveness, safety, impact on health-related quality of life, ease and convenience, information and Involvement in treatment decision-making, and access and cost) and two single items (medication shame and global satisfaction). We are conducting further multicenter validation studies to assess the validity and reliability of the MTSI-CA.
Discussion. The MTSI-CA had good feasibility (i.e., the MTSI-CA is easy to accept and complete), content validity (i.e., the MTSI-CA can accurately reflect the purpose and content of the assessment), and internal reliability (i.e., the MTSI-CA has good internal consistency among the items within the instrument), making it useful for promoting rational medication use in pediatrics in both clinical and academic settings.