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&NA;. "Pill dispenser." Men in Nursing 2, no. 1 (February 2007): 55. http://dx.doi.org/10.1097/01244664-200702000-00015.
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&NA;. "Pill dispenser." Nursing Critical Care 2, no. 1 (January 2007): 62. http://dx.doi.org/10.1097/01244666-200701000-00026.
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Jaison, Albert, Anu Simon, Arun Christin, Neethu John, Nisha Varghese, and Mr Yuvaraj V. "Robotic Pill Dispenser." IOSR Journal of Pharmacy and Biological Sciences 9, no. 4 (2014): 51–54. http://dx.doi.org/10.9790/3008-09455154.
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Cruz, Rui, Nelson Vinagre, Rui Terra, Inácio Fonseca, José Torres Farinha, Amparo Carvas, and José Viana. "Individual Electronic Pill Dispenser - ePillbox." International Journal on Engineering Applications (IREA) 2, no. 5 (September 30, 2014): 142. http://dx.doi.org/10.15866/irea.v2i5.832.
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Boquete, Luciano, Jose Manuel Rodriguez-Ascariz, Irene Artacho, Joaquin Cantos-Frontela, and Nathalia Peixoto. "Dynamically Programmable Electronic Pill Dispenser System." Journal of Medical Systems 34, no. 3 (January 16, 2009): 357–66. http://dx.doi.org/10.1007/s10916-008-9248-3.
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Wirz, Stefan, Stefan Conrad, Ronit Shtrichman, Kai Schimo, and Eva Hoffmann. "Clinical Evaluation of a Novel Technology for Oral Patient-Controlled Analgesia, the PCoA® Acute Device, for Hospitalized Patients with Postoperative Pain, in Pilot Feasibility Study." Pain Research and Management 2017 (2017): 1–12. http://dx.doi.org/10.1155/2017/7962135.
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Background. Acute postoperative pain delays recovery and increases morbidity and mortality. Traditional administration of postoperative analgesics by nurses is often inefficient. The present study evaluated the safety, efficacy, and usability of a novel, patient-controlled analgesic dispenser, the PCoA Acute. Methods. A controlled pilot study was conducted at three medical centers. Patients scheduled for elective surgery were enrolled into two groups, both taking oral analgesics: a control group (n=43), opioids dispensed by nurses, and a test group (n=27), opioids dispensed via the PCoA Acute. Pill intake data were recorded. Pain ratings at rest and during movement were surveyed. Results. No severe adverse events were recorded. Average pill intake time was reduced from 8 : 58 minutes in the control group to 1 : 17 minutes in the test group (P value < 0.05). The test group took 67% more pills than the control group, indicating enhanced compliance. Pain scores were significantly lower for patients in the test group (P value < 0.05). Over 90% of PCoA Acute users were satisfied with its use. Conclusions. The study confirmed that PCoA Acute is safe and effective. It is well accepted by patients and medical staff. Its use can optimize pain medication administration.
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DEEPIKA, SHARMA, NAYAK RAJEEV RANJAN, PRAKASH SURAJ, SAHU PREKSHA, CHOUHAN NIKITA, and CHANDRAKAR MUKESH KUMAR. "ASSISTANCE TO ISOLATED COVID PATIENTS USING PILL DISPENSER." i-manager’s Journal on Embedded Systems 9, no. 2 (2021): 36. http://dx.doi.org/10.26634/jes.9.2.18038.
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Patil, Jayesh. "The Autonomous Pill Dispenser with Alarm and Mobile Notifications." International Journal for Research in Applied Science and Engineering Technology 7, no. 4 (April 30, 2019): 2502–8. http://dx.doi.org/10.22214/ijraset.2019.4457.
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Tellier, M., L. Demers, and C. Auger. "ENGAGING PEOPLE WITH DEMENTIA IN USING AN ELECTRONIC PILL DISPENSER: RESEARCH PROTOCOL." Innovation in Aging 1, suppl_1 (June 30, 2017): 487–88. http://dx.doi.org/10.1093/geroni/igx004.1732.
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Guevremont, Catherine, Juliette Sablier, Philippe Vincent, Millie Lum, Constantin Tranulis, and Marie Villeneuve Emmanuel. "DoPill, an electronic pill dispenser, helping control medication adherence in patients with schizophrenia." International Clinical Psychopharmacology 26 (September 2011): e83. http://dx.doi.org/10.1097/01.yic.0000405772.13339.1a.
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Dong, Hua, and Natalie Vanns. "Designing an Innovative Pill Dispenser: An Undergraduate Level Case Study of Inclusive Design." Design Journal 12, no. 1 (March 2009): 95–115. http://dx.doi.org/10.2752/175630609x391587.
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Guevremont, Catherine, Juliette Sablier, Millie Lum, Philippe Vincent, Constantin Tranulis, Frédérique Nadeau Marcotte, and Emmanuel Stip. "DOPILL, AN ELECTRONIC PILL DISPENSER, HELPING EVALUATE AND CONTROL MEDICATION ADHERENCE IN PATIENTS WITH SCHIZOPHRENIA." Schizophrenia Research 117, no. 2-3 (April 2010): 278. http://dx.doi.org/10.1016/j.schres.2010.02.450.
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Patel, Tejal, Jessica Ivo, Sadaf Faisal, Aidan McDougall, Jillian Carducci, Sarah Pritchard, and Feng Chang. "A Prospective Study of Usability and Workload of Electronic Medication Adherence Products by Older Adults, Caregivers, and Health Care Providers." Journal of Medical Internet Research 22, no. 6 (June 2, 2020): e18073. http://dx.doi.org/10.2196/18073.
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Background A decreased capacity to self-manage medications results in nonadherence, medication errors, and drug-related problems in older adults. Previous research identified 80 electronic medication adherence products available to assist patients with self-management of medications. Unfortunately, the usability and workload of these products are unknown. Objective This study aimed to examine the usability and workload of a sample of electronic medication adherence products. Methods In a prospective, mixed methods study, a sample of older adults, health care professionals, and caregivers tested the usability and workload of 21 electronic medication adherence products. Each participant tested 5 products, one at a time, after which they completed the system usability scale (SUS) and NASA-task load index (NASA-TLX), instruments that measure the usability and workload involved in using a product. Higher SUS scores indicate more user-friendliness, whereas lower NASA-TLX raw scores indicate less workload when using a product. Results Electronic medication adherence products required a mean of 12.7 steps (range 5-20) for the appropriate use and took, on average, 15.19 min to complete the setup tasks (range 1-56). Participants were able to complete all steps without assistance 55.3% of the time (103 out of the 186 tests were completed by 39 participants; range 0%-100%). The mean SUS and NASA-TLX raw scores were 52.8 (SD 28.7; range 0-100) and 50.0 (SD 25.7; range 4.2-99.2), respectively, revealing significant variability among the electronic medication adherence products. The most user-friendly products were found to be TimerCap travel size (mean 78.67, SD 15.57; P=.03) and eNNOVEA Weekly Planner with Advanced Auto Reminder (mean 78.13, SD 14.13; P=.049) as compared with MedReady 1700 automated medication dispenser (mean 28.63, SD 21.24). Similarly, MedReady (72.92, SD 18.69) was found to be significantly more work intensive when compared with TimerCap (29.35, SD 20.35; P=.03), e-pill MedGlider home medication management system (28.43, SD 20.80; P=.02), and eNNOVEA (28.65, SD 14.97; P=.03). The e-pill MedTime Station automatic pill dispenser with tipper (71.77, SD 21.98) had significantly more workload than TimerCap (P=.04), MedGlider (P=.03), and eNNOVEA (P=.04). Conclusions This study demonstrated that variability exists in the usability and workload of different electronic medication adherence products among older adults, caregivers, and clinicians. With few studies having investigated the usability and workload of electronic medication adherence products, no benchmarks exist to compare the usability and workload of these products. However, our study highlights the need to assess the usability and workload of different products marketed to assist with medication taking and provides guidance to clinicians regarding electronic medication adherence product recommendations for their patients. Future development of electronic medication adherence products should ensure that the target populations of patients are able to use these products adequately to improve medication management.
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Harrison, Michael D., Paolo Masci, and José Creissac Campos. "Balancing the formal and the informal in user-centred design." Interacting with Computers 33, no. 1 (January 2021): 55–72. http://dx.doi.org/10.1093/iwcomp/iwab012.
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Abstract This paper explores the role of formal methods as part of the user-centred design of interactive systems. An iterative process is described, developing prototypes incrementally, proving user-centred requirements while at the same time evaluating the prototypes that are executable forms of the developed models using ‘traditional’ techniques for user evaluation. A formal analysis complements user evaluations. This approach enriches user-centred design that typically focuses understanding on context and producing sketch designs. These sketches are often non-functional (e.g. paper) prototypes. They provide a means of exploring candidate design possibilities using techniques such as cooperative evaluation. This paper describes a further step in the process using formal analysis techniques. The use of formal methods provides a systematic approach to checking plausibility and consistency during early design stages, while at the same time enabling the generation of executable prototypes. The technique is illustrated through an example based on a pill dispenser.
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Knapkiewicz, Pawel. "Alkali Vapor MEMS Cells Technology toward High-Vacuum Self-Pumping MEMS Cell for Atomic Spectroscopy." Micromachines 9, no. 8 (August 16, 2018): 405. http://dx.doi.org/10.3390/mi9080405.
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The high-vacuum self-pumping MEMS cell for atomic spectroscopy presented here is the result of the technological achievements of the author and the research group in which he works. A high-temperature anodic bonding process in vacuum or buffer gas atmosphere and the influence of the process on the inner gas composition inside a MEMS structure were studied. A laser-induced alkali vapor introduction method from solid-state pill-like dispenser is presented as well. The technologies mentioned above are groundbreaking achievements that have allowed the building of the first European miniature atomic clock, and they are the basis for other solutions, including high-vacuum optical MEMS. Following description of the key technologies, high-vacuum self-pumping MEMS cell construction and preliminary measurement results are reported. This unique solution makes it possible to achieve a 10−6 Torr vacuum level inside the cell in the presence of saturated rubidium vapor, paving the way to building a new class of optical reference cells for atomic spectroscopy. Because the level of vacuum is high enough, experiments with cold atoms are potentially feasible.
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Singh, Paramjit, Kanchan Gupta, Gagandeep Singh, and Sandeep Kaushal. "Simultaneous Use of Two Different Tools to Assess Compliance with Antiepileptic Drugs: Experience in A Community-Based Study." Journal of Neurosciences in Rural Practice 11, no. 04 (September 4, 2020): 636–39. http://dx.doi.org/10.1055/s-0040-1715991.
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Abstract Objective Antiepileptic drug (AED) therapy remains the primary form of treatment for epilepsy, noncompliance to which can result in breakthrough seizure, emergency department visits, fractures, head injuries, and increased mortality. Various tools like self-report measures, pill-counts, medication refills, and frequency of seizures can assess compliance with varying extent. Thus, assessment of compliance with AEDs is crucial to be studied. Materials and Methods Compliance was assessed using pill-count and Morisky medication adherence scale (MMAS) during home visits. A pill-count (pills dispensed–pills remaining)/(pills to be consumed between two visits) value of 0.85 to ≤1.15 was recorded as appropriate compliance. Underdose (<0.85) and overdose (>1.15) was labeled as noncompliance. Score of 1 was given to each positive answer in MMAS. Score of ≥1 was labeled as noncompliance.Statistical analysis: Relationship of demographic factors between compliant and noncompliant patients was analyzed using Chi-square test (SPSS version 21.0, IBM). Rest of the data was analyzed with the help of descriptive statistics using Microsoft Excel. p< 0.05 was considered statistically significant. Results Out of 105 patients, 54 patients were noncompliant with both pill-count and MMAS. 10 patients were noncompliant with pill-count only, while 10 were noncompliant with MMAS. Conclusion Both tools complement each other when used in combination, as use of a single tool was not able to completely detect compliance.
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Singh, Shreya, and Sheela Shivamonga Rangappa. "Self-administered medical abortion pills: evaluation of the clinical outcome and complications among women presenting with unsupervised pill intake to a tertiary care hospital: a cross-sectional study." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 10, no. 9 (August 26, 2021): 3424. http://dx.doi.org/10.18203/2320-1770.ijrcog20213463.
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Background: In India, it is becoming a public health problem due to easy over-the-counter abortion pill availability despite the legal ban, widespread misuse by non-allopath doctors, dais and quacks, and ignorance on part of women. The pills are being dispensed blindly without proper medical evaluation and even without ruling out the contraindications. In India, abortion facility is available legally under the MTP act, 1971.Methods: Its cross-section study including 81 patients presenting to outpatients and emergency department of obstetrics and Gynecology, in RL Jalapa Hospital and Research Centre affiliated to Sri Deva Raj Urs Academy of Higher Education and Research, Kolar between December 2020 and February 2021, a study conducted among women with a history of unsupervised pills abortion pill intake.Results: In the study 35% were in the age group 19 to 20 years, 45% were in the age group 21 to 25 years and 20% were in the age group 26 to 30 years. 55% were from joint family and 45% were from nuclear family, 76.2% were multigravida and 23.8% were primigravida.Conclusions: This study shows strict legislation and restriction required the sale of abortion pills for public use. The drug should be available only via health care facilities under the super version during an abortion. Creating awareness regarding contraception and effective method to fulfil the unmet need for contraception will be useful avoid the harmful practice of self-administered abortion pills and reducing maternal mortality.
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Singh, Paramjit, Kanchan Gupta, Gagandeep Singh, and Sandeep Kaushal. "A prospective observational study to assess compliance and factors influencing compliance with antiepileptic drugs among patients with epilepsy." International Journal of Basic & Clinical Pharmacology 8, no. 8 (July 23, 2019): 1838. http://dx.doi.org/10.18203/2319-2003.ijbcp20193187.
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Background: The primary treatment for epilepsy is Antiepileptic drug (AED) therapy. Non-compliance to AEDs can result in break-through seizure, emergency department visits, hospitalizations, fractures, head injuries and increased mortality. Thus, compliance to AEDs is crucial to be studied. Objective is to study compliance and factors influencing compliance with AEDs among patients with epilepsy.Methods: This observational study was conducted in 105 patients with epilepsy on AED therapy in community in Ludhiana (Punjab) after approval from Institutional Ethics Committee. Demographic data and drug history was collected. Monthly follow up for 6 months was done by paying home visits and data regarding type, dose, frequency of administration of AED was recorded on a semi-structured performa. Pill count was done by recording number of pills dispensed and number of pills remaining with patient. Response to Morisky’s Medication Adherence Scale (MMAS) was also recorded. Results were correlated with patient demographics, type, frequency and number of AEDs.Results: Out of 105 patients, 65 were males and 40 were females. Fifty-four patients were non-compliant with both pill-count and MMAS. Non-compliance was high in first month and decreased gradually. Poly-therapy, lower socio-economic status and multiple dosing regimens were most commonly associated with non-compliance.Conclusions: Under-dosing was more common among non-compliers, which explains the high reporting of forgetfulness to take medicine in MMAS. Both pill count and MMAS are effective non-invasive tools to study compliance.
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Spillinger, Avishag, Yael Auerbach-Shpak, and Noemi Bitterman. "The Pill: Time for a New Look." Ergonomics in Design: The Quarterly of Human Factors Applications 16, no. 2 (April 2008): 24–27. http://dx.doi.org/10.1518/106480407x312400.
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Based on the popularity of the birth control pill (“The Pill”), its economic importance, and its role as a daily component of the modern woman's environment and lifestyle, we decided to study pill usage habits and the cognitive and behavioral causes of noncompliance. Our findings led us to suggest design solutions to promote consistency of use and improve attitudes toward the pill. We conducted a field study of birth control pill dispensers, performed a task analysis of pill taking, and distributed a detailed questionnaire among 380 Israeli women. Our suggestions for improving compliance include incorporating memory aids, creating better packaging design, and reducing the medical stigma of the pill by positioning it as a designed, daily lifestyle item.
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Sokil, Laura E., Ryan Rogero, Elizabeth McDonald, Daniel Fuchs, Brian S. Winters, David I. Pedowitz, Joseph N. Daniel, Steven M. Raikin, and Rachel J. Shakked. "Self-Reported Pain Tolerance and Opioid Pain Medication Use after Foot and Ankle Surgery." Foot & Ankle Orthopaedics 4, no. 4 (October 1, 2019): 2473011419S0040. http://dx.doi.org/10.1177/2473011419s00402.
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Category: Opioid/Pain Management Introduction/Purpose: As one of the top prescribing groups of opioid pain medication, orthopaedic surgeons must tailor post- surgical pain control to minimize the potential for prescription opioid abuse. Patients generate an idea of their own pain threshold relative to others’ based on how they tolerate similar painful experiences, but current literature suggests that there is not a significant correlation between an individual’s perceived pain threshold and their actual tolerance for pain stimulus. The purpose of this study was to determine whether there is a correlation between a patient’s self-reported pain tolerance and their actual prescription opioid medication usage after foot and ankle surgery. Methods: This is a retrospective follow-up of a prospective cohort study of adult patients that underwent outpatient foot and ankle surgeries performed by 5 fellowship-trained foot and ankle surgeons at a multispecialty orthopaedic practice over a one-year period. Number of opioid pills dispensed, pills consumed at the first postoperative visit, patient demographic data, and procedural data were obtained. Patients were contacted via email or telephone postoperatively and asked to respond to the qualitative statement “Pain doesn’t bother me as much as it does most people” by choosing “strongly disagree”, “disagree”, “neither”, “agree” or “strongly agree”. Patients also scored their quantitative pain threshold on a scale of 0-100 with 0 being “very pain intolerant” and 100 a “very high pain tolerance” and rated their expectations of postoperative pain and satisfaction with pain management on five-point Likert scales. Data was analyzed using various tests, including Spearman’s correlations and bivariate and multivariate analyses. Results: Of 700 patients responding, the average age was 50.8 years and 34.7% were male. There was a significant, weakly negative (p=0.003, r=-.112) correlation between a higher qualitative assessment of pain threshold and number of pills consumed; patients with higher perceived pain thresholds took fewer opioid pills after surgery. Logistic bivariate regression predicting the top 25% of opioid pill consumers showed that higher qualitative assessment of pain threshold was negatively predictive of being among the top 25% of opioid pill consumers (OR 0.839, p=0.041). Multivariate analyses among the total cohort demonstrated a significant, negative association (p=0.005) between qualitative assessment of pain threshold and opioid pill consumption, while past narcotic usage time positively predicted the top 25% of opioid pill consumers (OR 1.224, p=.006). Conclusion: Prediction of patients’ postoperative narcotic requirement is complex and dependent on many patient-derived and systemic factors, but our study has shown that there is a negative association between patients’ self-reported qualitative pain tolerance with postoperative opioid consumption after foot and ankle surgery. This study presents a useful preoperative strategy for clinicians to customize postoperative pain management, further educate patients on responsible use of opioid medication, and reduce overall opioid prescriptions.
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Langer, Bernhard, Sophia Grimm, Gwenda Lungfiel, Franca Mandlmeier, and Vanessa Wenig. "The Quality of Counselling for Oral Emergency Contraceptive Pills—A Simulated Patient Study in German Community Pharmacies." International Journal of Environmental Research and Public Health 17, no. 18 (September 15, 2020): 6720. http://dx.doi.org/10.3390/ijerph17186720.
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Background: In Germany, there are two different active substances, levonorgestrel (LNG) and ulipristal acetate (UPA), available as emergency contraception (the “morning after pill”) with UPA still effective even 72 to 120 h after unprotected sexual intercourse, unlike LNG. Emergency contraceptive pills have been available without a medical prescription since March 2015 but are still only dispensed by community pharmacies. The aim of this study was to determine the counselling and dispensing behaviour of pharmacy staff and the factors that may influence this behaviour in a scenario that intends that only the emergency contraceptive pill containing the active substance UPA is dispensed (appropriate outcome). Methods: A cross-sectional study was carried out in the form of a covert simulated patient study in a random sample of community pharmacies stratified by location in the German state of Mecklenburg-Vorpommern and reported in accordance with the STROBE statement. Each pharmacy was visited once at random by one of four trained test buyers. They simulated a product-based request for an emergency contraceptive pill, stating contraceptive failure 3.5 days prior as the reason. The test scenario and the evaluation forms are based on the recommended actions, including the checklist from the Federal Chamber of Pharmacies. Results: All 199 planned pharmacy visits were carried out. The appropriate outcome (dispensing of UPA) was achieved in 78.9% of the test purchases (157/199). A significant correlation was identified between the use of the counselling room and the use of a checklist (p < 0.001). The use of a checklist led to a significantly higher questioning score (p < 0.001). In a multivariate binary logistic regression analysis, a higher questioning score (adjusted odds ratio [AOR] = 1.41; 95% CI = 1.22–1.63; p < 0.001) and a time between 12:01 and 4:00 p.m. (AOR = 2.54; 95% CI = 1.13–5.73; p = 0.024) compared to 8:00 to 12:00 a.m. were significantly associated with achieving the appropriate outcome. Conclusions: In a little over one-fifth of all test purchases, the required dispensing of UPA did not occur. The use of a counselling room and a checklist, the use of a checklist and the questioning score as well as the questioning score and achieving the appropriate outcome are all significantly correlated. A target regulation for the use of a counselling room, an explicit guideline recommendation about the use of a checklist, an obligation for keeping UPA in stock and appropriate mandatory continuing education programmes should be considered.
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Chai, Peter R., Georgia Goodman, Majo J. Bustamante, Yassir Mohamed, Jose Castillo-Mancilla, Edward W. Boyer, Kenneth H. Mayer, et al. "Long-Term Stability of the Electronic Sensor Component of a Digital Pill System in Real-World Storage Settings." Journal of Pharmacy Technology 37, no. 3 (January 6, 2021): 135–39. http://dx.doi.org/10.1177/8755122520985219.
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Background: Digital pill systems comprise an ingestible sensor integrated into a gelatin capsule that overencapsulates medication allowing real-time measures of medication ingestion. These systems may improve the manner in which medication adherence can be assessed and supported. Objective: In this investigation, we tested the durability of the ingestible sensor as part of a clinical trial to measure the feasibility and acceptability of the system to measure adherence to once daily tenofovir disoproxil fumarate/emtricitabine (NCT03842436). Methods: Digital pills not dispensed during the study were stored in a pharmacy. Seventeen sensors were selected from digital pills stored for at least 12 months and activated in a simulated gastric environment. A radiofrequency spectrum analyzer and the reader device used in the clinical trial to capture ingestion events were used to measure activation of emitters. A passing evaluation was defined as an energized emitter within 30 minutes of immersion, ability to broadcast a signal for 10 minutes, and successful acquisition by the reader. Results: All ingestible sensors passed the stability test. Mean activation time in simulated gastric fluid was 3.33 minutes (SD = 1.47); emitters remained active for a mean of 47.72 minutes (SD = 1.78). These parameters matched guidelines defined in the ID-Cap system requirements for use in patients. Conclusions: Ingestible sensor components of the ID-Cap system were therefore stable after long-term storage.
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Shulman, L. P. "Number of Oral Contraceptive Pill Packages Dispensed and Subsequent Unintended Pregnancies." Yearbook of Obstetrics, Gynecology and Women's Health 2011 (January 2011): 296–97. http://dx.doi.org/10.1016/j.yobg.2011.05.078.
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Foster, Diana Greene, Ram Parvataneni, Heike Thiel de Bocanegra, Carrie Lewis, Mary Bradsberry, and Philip Darney. "Number of Oral Contraceptive Pill Packages Dispensed, Method Continuation, and Costs." Obstetrics & Gynecology 108, no. 5 (November 2006): 1107–14. http://dx.doi.org/10.1097/01.aog.0000239122.98508.39.
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Foster, Diana Greene, Denis Hulett, Mary Bradsberry, Philip Darney, and Michael Policar. "Number of Oral Contraceptive Pill Packages Dispensed and Subsequent Unintended Pregnancies." Obstetrics & Gynecology 117, no. 3 (March 2011): 566–72. http://dx.doi.org/10.1097/aog.0b013e3182056309.
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Foster, D., D. Hulett, M. Bradsberry, P. Darney, and M. Policar. "Number of oral contraceptive pill packages dispensed and subsequent unintended pregnancies." Contraception 82, no. 2 (August 2010): 202. http://dx.doi.org/10.1016/j.contraception.2010.04.096.
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Rogero, Ryan, Daniel Fuchs, Kristen Nicholson, Rachel J. Shakked, Brian S. Winters, David I. Pedowitz, Steven M. Raikin, and Joseph N. Daniel. "Comparison of Postoperative Opioid Consumption Following Hallux Valgus Correction Procedures." Foot & Ankle Orthopaedics 4, no. 4 (October 1, 2019): 2473011419S0036. http://dx.doi.org/10.1177/2473011419s00365.
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Category: Bunion Introduction/Purpose: Postoperative pain management following orthopaedic surgeries is challenging, and the opioid epidemic has made it essential to better individualize opioid prescriptions by patient and procedure. Previous studies have looked at modifications to intraoperative protocols to reduce postoperative pain and opioid analgesia following hallux valgus (HV) surgery, but to our knowledge, no previous study has compared HV procedure types in terms of postoperative narcotic consumption. The purpose of this subgroup analysis of a prospective study was to compare postoperative opioid pill consumption between 4 common HV correction procedures and to identify any patient factors associated with consumption levels. Methods: Patients undergoing outpatient HV correction procedures with 5 fellowship-trained foot & ankle surgeons over a 1- year period were included. Patients were excluded if they were <18 years of age, prescribed chronic opioid analgesics prior to date of surgery, or if they underwent concomitant non-forefoot procedures. The type of opioid prescribed and the number of opioid pills dispensed were recorded. At the first postoperative visit, the patient was asked how many prescribed opioid pills were consumed. Number of consumed pills was confirmed by a member of the research team. Opioid pills were standardized to morphine equivalent units (MEUs) and back-converted to an equivalent number of 5 mg oxycodone pills. Linear regression analysis was performed to determine if any of the 4 procedure categories, with or without concomitant lesser toe procedures, preoperative Visual Analog Scale (VAS) for pain, or patient factors (age, sex, BMI, smoking, comorbidities) were independently associated with postoperative opioid consumption. Results: One-hundred thirty-seven patients (86% female) were included in the study, with a mean age of 53.1 years and mean BMI of 26.7 kg/m2. 53% of patients received single-shot nerve blocks and 34% continuous nerve catheters. Overall, patients were prescribed a median 50 pills and consumed a median 27 pills. Thirty-six patients (26%) underwent primary chevron osteotomies, 78 (56%) underwent primary proximal osteotomies (Ludloff, scarf), 10 (7%) underwent soft tissue-only procedures and/or proximal phalanx osteotomies (modified McBride, Akin), and 13 (9%) underwent 1st MTP arthrodeses. There was no significant difference in opioid intake between the 4 procedures, including when subdivided into those with and without lesser toe procedures. Higher preoperative VAS pain score (p=.028) and younger age (p=.042) were associated with higher opioid pill consumption. Conclusion: Our study has demonstrated a lack of difference between hallux valgus procedures in terms of postoperative opioid consumption, which is important for surgeons to recognize when prescribing for a commonly performed forefoot surgery. Patients reporting higher pain levels prior to surgery were more likely to take greater postoperative pain medication. Additionally, in accordance with previous results in foot and ankle surgery, younger patient age is associated with higher postoperative opioid consumption. In light of our results, we cannot recommend differential opioid prescribing based on the specific type of hallux valgus procedure performed.
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Geletko, Sandra M., Marisel Segarra, Donna S. Ravin, and Mark P. Babich. "Zidovudine Compliance as Measured by Different Methods in an HIV Ambulatory Clinic." Journal of Pharmacy Technology 12, no. 3 (May 1996): 105–8. http://dx.doi.org/10.1177/875512259601200309.
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Objective: To measure and compare medication compliance by patient reports, pill counts, physician assessments, and electronic monitoring with the Medication Event Monitoring System (MEMS) in patients infected with HIV. Methods: Five patients monitored in a Veterans Affairs Medical Center HIV clinic were dispensed zidovudine for 3 months in MEMS vials. Zidovudine was refilled every month, at which time MEMS data were retrieved and pill counts were performed. Medication compliance surveys requesting the number of missed doses were also administered to patients and their physicians every month for 3 months. Results: Compliance assessments were as follows: patient report 80–100%, physician assessment less than 30–100%, pill counts 50–100%, and MEMS 9–100%. MEMS identified one patient's misunderstanding of zidovudine dosing. Three patients removed zidovudine from MEMS vials and placed the medication in a smaller vial for easy transport, thereby decreasing the usefulness of MEMS data. Conclusions: A combination of compliance assessment tools produces a more accurate representation of zidovudine dosing and facilitates identification of patient dosing errors. Use of multiple compliance tools, including MEMS data, during patient counseling may be an effective strategy for enhancing medication compliance.
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Mulleners, WM, TE Whitmarsh, and TJ Steiner. "Noncompliance May Render Migraine Prophylaxis Useless, But Once-Daily Regimens Are Better." Cephalalgia 18, no. 1 (January 1998): 52–56. http://dx.doi.org/10.1046/j.1468-2982.1998.1801052.x.
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Medicines work better if taken, which must be true of migraine prophylaxis. There is evidence that compliance with regular medication can be badly deficient. To assess how serious the problem might be in routine migraine management, we undertook a covert observational 2-month survey in a specialist headache clinic using objective measures of compliance. Subjects were 38 patients needing prophylaxis with medication prescribed once (od), twice (bd), or three times daily (tds). Medication was dispensed, unknown to them, in Medication Event Monitoring Systems (MEMS) to record openings in real time. Number, timing, and pattern of actual openings were compared with what was expected. Compliance rates averaged 66%, although returned pill counts indicated 91%. A substantial and significant difference was shown between od and bd or tds regimens. Measures of dosing interval—used-on-schedule rate and therapeutic coverage—averaged between 44% and 71%. Once-daily treatment was associated with a used-on-schedule rate more than double those of multiple daily dosing, but still only 66%. We conclude that routine use of drug prophylaxis in migraine may be so seriously undermined by poor compliance that it has little chance of efficacy. Returned-pill counting is inadequate for compliance assessment.
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Hajewski, Christina J., Robert W. Westermann, Andrew Holte, Alan Shamrock, Matthew Bollier, and Brian R. Wolf. "Impact of a Standardized Multimodal Analgesia Protocol on Opioid Prescriptions After Common Arthroscopic Procedures." Orthopaedic Journal of Sports Medicine 7, no. 9 (September 1, 2019): 232596711987075. http://dx.doi.org/10.1177/2325967119870753.
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Background: Excessive prescription of opioids has become a national problem. Providers must attempt to decrease the amount of opioids prescribed while still providing patients with adequate pain relief after surgery. Hypothesis: Implementing a standardized multimodal analgesic protocol will decrease the amount of opioids prescribed at the time of surgery as well as the total amount of opioids dispensed postoperatively. Study Design: Case series; Level of evidence, 4. Methods: Patients who had undergone meniscectomy, rotator cuff repair (RCR), or anterior cruciate ligament (ACL) reconstruction at our institution were identified by Current Procedural Terminology code 12 months prior to and 6 months after the initiation of a standardized multimodal postoperative pain protocol. Records were reviewed to extract demographic data, amount of opioids prescribed at the time of surgery, amount and frequency of opioid refills, and call-ins regarding pain medication or its side effects. A Wilcoxon rank-sum test was used to evaluate differences in opioid prescriptions between pre- and postprotocol, and significance was set to P < .05. Results: The mean amount of opioids prescribed at the time of surgery decreased from 63.5 to 22.3 pills ( P < .0001) for meniscectomy, from 73.3 to 39.7 ( P < .0001) for ACL reconstruction, and from 75.6 to 39.8 ( P < .0001) for RCR. The percentage of patients receiving a refill of opioids during the postoperative period also decreased for all groups: from 13% to 4% ( P = .0051) for meniscectomy, 29.2% to 11.4% ( P = .0005) for ACL reconstruction, and 47.3% to 24.4% ( P < .0001) for RCR. There was no significant difference in patient calls regarding pain medication or its side effects. Conclusion: Institution of a standardized multimodal analgesia protocol significantly decreased the amount of opioids dispensed after common arthroscopic procedures. This reduction in the amount of opioids given on the day of surgery did not result in an increased demand for refills. Our study also demonstrated that 20 opioid pills were adequate for patients undergoing meniscectomy and 40 pills were adequate for ACL reconstruction and RCR in the majority of cases. This protocol serves as a way for providers to decrease the amount of opioids dispensed after surgery while providing patients with alternatives for pain relief.
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Schupbach, John, Maria Kaisler, Gregory Moore, and Benjamin Sandefur. "Physician and Pharmacist Liability: Medicolegal Cases That are Tough Pills to Swallow." Clinical Practice and Cases in Emergency Medicine 2, no. 5 (May 10, 2021): 139–43. http://dx.doi.org/10.5811/cpcem.2021.4.51851.
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We present four medicolegal cases involving medication errors, which led to patient harm and subsequent settlements or jury awards to patients. These cases each involved scenarios in which a medication was inappropriately prescribed and/or inappropriately dispensed. In such cases, it is often not obvious whether the physician or pharmacist is at fault. These cases highlight the importance of understanding the roles and responsibilities of the physician and pharmacist in medication prescription and dispensation.
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Amponsah, Alexandria O., Helen Vosper, and Afia F. A. Marfo. "Patient Related Factors Affecting Adherence to Antimalarial Medication in an Urban Estate in Ghana." Malaria Research and Treatment 2015 (February 12, 2015): 1–8. http://dx.doi.org/10.1155/2015/452539.
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Our aim was to measure the adherence to Artemisinin based Combination Therapy and to determine patient related factors that affect adherence. Three hundred (300) patients receiving ACT treatment dispensed from the community pharmacy were randomly selected and followed up on the fourth day after the start of their three-day therapy to assess adherence. Adherence was measured by pill count. Quantitative interviews using a semistructured questionnaire were used to assess patients’ knowledge and beliefs on malaria and its treatment. Adherence levels to the ACTs were 57.3%. Patient related factors that affected adherence to ACTs were patients’ knowledge on the dosage (P=0.007; v=0.457), efficacy (P=0.009; v=0.377), and side effects (P=0.000; v=0.403) of the ACTs used for the management of malaria, patients’ awareness of the consequences of not completing the doses of antimalarial dispensed (P=0.001; v=0.309), and patients’ belief that “natural remedies are safer than medicines” and “prescribers place too much trust in medicines.” There was no significant relationship between adherence and patients’ knowledge on the causes, signs, and symptoms of malaria. There is the need for pharmacy staff to stress on these variables when counseling patients on antimalarials as these affect adherence levels.
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Niehues, Gabriela Danielski, Alexandre Balestieri Balan, Vinicius Brum Prá, Raphaela Santos Pellizzaro, Paulo Roberto Antunes da Silva, Manuela Danielski Niehues, Ana Paula Costa, Marcelo Liborio Schwarzbold, and Alexandre Paim Diaz. "Trends in the prescription of clozapine in a psychiatric hospital: a 5-year observational study." Trends in Psychiatry and Psychotherapy 39, no. 3 (July 31, 2017): 158–64. http://dx.doi.org/10.1590/2237-6089-2016-0053.
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Abstract Introduction Clozapine is a well-recognized effective treatment for some patients with treatment-resistant schizophrenia (TRS). Although it has potential benefits and approximately 30% of patients have a clinical indication for clozapine use, prescription rates are low. Objective To evaluate clozapine prescription trends over a 5-year period in a tertiary psychiatric hospital. Methods In this observational study, data prospectively collected by the Medical and Statistical File Service (Serviço de Arquivo Médico e Estatístico) and the Pharmacy Division of Instituto de Psiquiatria de Santa Catarina between January 2010 and December 2014 were summarized and analyzed by investigators blinded to data collection. The number of 100 mg clozapine pills dispensed by the Pharmacy Division to the inpatient units was the outcome and considered a proxy measure of clozapine prescriptions. The number of occupied inpatient unit beds and the number of patients admitted with F20-F29 (ICD-10) diagnoses during the study period were considered to be possible confounders. Results A multiple linear regression model showed that time in months was independently associated with an increase in the number of clozapine pills dispensed by the Pharmacy Division (β coefficient = 15.82; 95% confidence interval 10.88-20.75). Conclusion Clozapine prescriptions were found to have increased during the 5-year period studied, a trend that is opposite to reports from several other countries.
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Gudipati, Smitha, Deepak Bajracharya, Lenjana Jimee, Gina Maki, Marcus Zervos, Tyler Prentiss, and Linda Kaljee. "2031. Impact of Education and Antibiotic Guidelines on Dispensing Antibiotics with Community Pharmacists in a Low- and Middle-Income Country." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S682. http://dx.doi.org/10.1093/ofid/ofz360.1711.
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Abstract Background Non-prescription use of antibiotics in low- and middle-income countries has contributed to significant antimicrobial resistance (AMR). Henry Ford Health System has partnered with multinational organizations in Nepal to address the need for increasing awareness of AMR and implementation of effective antimicrobial stewardship. This partnership confirmed the importance of increasing knowledge and awareness regarding AMR and antibiotic use to community pharmacists. The present pilot study assessed if outpatient antibiotic dispensing guidelines given to community pharmacists could result in a reduction of unneeded antibiotic use. Methods Nine community pharmacies from Kathmandu were selected of which two were used as controls. Seven pharmacists were educated on the appropriate use of antibiotics, and outpatient dispensing before and after guidelines at all pharmacies were evaluated. The pharmacists were given guidelines on antibiotic use and duration needed for common bacterial infections encountered. Controls were not given guidelines. At baseline and post-intervention (1 week), pill counts were performed of the top six antibiotics that were dispensed by the pharmacist. Pharmacists were requested to keep a log of how many antibiotics were dispensed for one week. The pharmacists also were requested to fill out a post-intervention educational assessment to evaluate retention. Results Pill count pre-intervention was 15,856 and 1512 and post-intervention was 11,168 and 1,440 in the intervention and control groups respectively (Table 1). A post-intervention educational assessment revealed that both the intervention and control groups believed antibiotics can treat viruses (57% vs. 50%) and that antibiotics do not kill good bacteria that protect the body from infection (57% vs. 50%) (Table 2). Conclusion There was no difference in the dispensing of antibiotics between pre- and post-intervention. The findings of this study show significant room for improvement in continuing education about antibiotic use in outpatient pharmacies. Further studies are needed to target outpatient antibiotic dispensing with education and identifying economic or other incentives in hopes of reducing the burden of AMR in low- and middle-income countries. Disclosures All authors: No reported disclosures.
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Richter, Dana L. "A Hair & a Fungus." American Biology Teacher 75, no. 5 (May 1, 2013): 336–39. http://dx.doi.org/10.1525/abt.2013.75.5.7.
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A simple method is presented to show kids the size of a microbe – a fungus hypha – compared to a human hair. Common household items are used to make sterile medium on a stove or hotplate, which is dispensed in the cells of a weekly plastic pill box. Mold fungi can be easily and safely grown on the medium from the classroom environment. A microscope capable of 200–400× is necessary. Students can use a hair from their own head to view a fungus and a hair side-by-side on the same slide. They will see that a microscopic fungus hypha is 20–50× smaller in diameter than a hair. Older students will also learn that microbes are measured in micrometers, that fungi are ubiquitous, and that decay is an inevitable part of Earth’s processes.
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Hamdan, Muhammad, Marianne Ulcickas Yood, Lynn M. Sanders, Ishan Hirji, Tracey Hoy, and Susan A. Oliveria. "Evaluation of Trends in Imatinib Dosing over Time: A Retrospective Cohort Study." Blood 106, no. 11 (November 16, 2005): 3117. http://dx.doi.org/10.1182/blood.v106.11.3117.3117.
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Abstract Background: The recommended imatinib starting dose is 400mg/day for chronic myelogenous leukemia (CML) patients in chronic phase and 600mg/day for patients in accelerated phase or blast crisis. Some studies have reported improved response rates and progression-free survival in chronic phase patients receiving higher imatinib doses. However, little information is available regarding tolerability of higher doses and the actual initial dosing of imatinib dispensed in the clinical setting. To investigate initial imatinib dosing over time, we conducted a retrospective cohort study using the HealthCore Integrated Database. The data used for this analysis captured pharmacy and medical encounters for a base population of approximately 13 million covered lives. Methods: We identified all patients with an ICD-9 coded diagnosis of CML (205.1) and at least one prescription for imatinib from January 1, 2001 through December 31, 2004. Using the pharmacy database, we identified the first imatinib prescription and calculated the daily dose of that first prescription (based on number of pills dispensed, dose per pill and prescription days supply). Results: A total of 486 patients were exposed to imatinib (N=40 patients with starting dose <400 mg/day; N=356 patients with starting dose 400 mg/day; N=5 patients with starting dose 500mg/day, N=52 patients with starting dose 600 mg/day; and N=33 patients with starting dose >600 mg/day). Figure 1 presents initial dosing by calendar year for patients starting at 400mg/day and >600 mg/day. Imatinib Starting Dose by Year 2001–2004 Imatinib Starting Dose by Year 2001–2004 Among patients receiving imatinib >600mg/day, 15% (95% confidence interval (CI) 5.8–30.4%) had a subsequent dose decrease (defined as a decrease of at least 100 mg/day). Among patients starting imatinib 600mg/day, 22.6% had a dose decrease (95% CI 12.9–35.3%), and 5.8% of the 361 patients receiving imatinib 400mg/day had a dose decrease (95% CI 3.7–8.6%). Conclusions: These data indicate that a greater proportion of CML patients now receive high starting imatinib doses, potentially due to the fact that more aggressive dosing is used in chronic phase patients. Although phase of disease has not been verified at this point, medical record review is underway to determine imatinib indication and reasons for dose changes. Between 15–20% of patients receiving high starting doses of ≥ 600 mg/day underwent dose reduction of at least 100 mg/day.
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Skibicki, Hope, Sundeep Saini, Ryan Rogero, Kristen Nicholson, Rachel J. Shakked, Daniel Fuchs, Brian S. Winters, Steven M. Raikin, David I. Pedowitz, and Joseph N. Daniel. "Opioid Consumption Patterns and the Risk of Prolonged Opioid Use Among Opioid-Naïve Patients Following Ankle Fracture Surgery." Foot & Ankle Orthopaedics 4, no. 4 (October 1, 2019): 2473011419S0006. http://dx.doi.org/10.1177/2473011419s00068.
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Category: Ankle Introduction/Purpose: Over the past two decades, the number of opioids dispensed in the United States has nearly tripled. Previous literature has demonstrated an association between acute opioid exposure and the risk of long-term opioid use. Statewide Prescription Drug Monitoring Programs (PDMPs) have been implemented to deter overprescribing and help monitor information pertaining to suspected abuse. The purpose of this study was to assess the immediate postoperative opioid consumption patterns as well as the incidence of new prolonged opioid use among opioid naïve patients following ankle fracture surgery. Methods: This was a retrospective review of prospectively collected data. Patients were included if they underwent outpatient open reduction and internal fixation of an ankle or tibial plafond fracture between October 2016 and September 2017. Patients were excluded if they received any narcotic prescriptions prior to the date of the initial injury. Patient demographics, medical history, fracture pattern, and opioid prescription and consumption details were collected. The morphine equivalent dose was calculated for each prescription and then converted to the equivalent of a 5-mg oxycodone “pill”. The New Jersey PDMP was used to determine all prescriptions of controlled substances filled up to 1 year postoperatively. Prolonged use was defined as filling a postoperative prescription for a controlled substance 90 days after the index procedure. Linear regression analysis was performed to identify independent factors associated with immediate postoperative opioid consumption and repeated to identify factors associated with prolonged use. Results: One-hundred seventy-one patients were included in this study. At the first postoperative visit, patients consumed a median of 24 pills, whereas the median number prescribed was 40. This resulted in an initial utilization rate of 60% and 2,736 pills left unused. Additionally, we found that 18.7% (n=32) of patients required a narcotic prescription after 90 days from the index procedure. There was no statistically significant difference found between specific fracture type (isolated distal fibula, bimalleolar, trimalleolar) and prolonged opioid consumption, however tibial plafond fractures could not be included due to insufficient sample size (n=5). Patients with a self-reported history of depression (p=.094) or diabetes (p=.097) demonstrated marginal correlation with prolonged narcotic use. Conclusion: Our study demonstrated that patients who underwent outpatient surgical fixation of an ankle or tibial plafond fracture were initially overprescribed narcotics by nearly 67%, leaving a significant quantity of pills unused for potential abuse or diversion. 18.7% of originally opioid naïve patients required continued analgesia 90 days after the index procedure, however large variations in consumption rates make it difficult for physicians to predict prolonged narcotic use.
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Sokil, Laura E., Elizabeth McDonald, Ryan G. Rogero, Daniel J. Fuchs, Steven M. Raikin, Brian S. Winters, David I. Pedowitz, Joseph N. Daniel, and Rachel J. Shakked Birns. "Self-Reported Pain Tolerance and Opioid Pain Medication Use after Foot and Ankle Surgery." Foot & Ankle Orthopaedics 4, no. 2 (April 1, 2019): 2473011419S0000. http://dx.doi.org/10.1177/2473011419s00006.
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Category: Pain Management Introduction/Purpose: The opioid epidemic in the United States continues to take lives. As one of the top prescribing groups, orthopaedic surgeons must tailor post-surgical pain control to minimize the potential for harm from prescription opioid use. Patients often reference their own pain threshold as a benchmark for how they will tolerate the pain of surgery, but current literature suggests that there is not a significant correlation between an individual’s perceived pain threshold and their actual threshold for heat stimulus. The purpose of this study was to determine whether there is a correlation between a patient’s self- reported pain tolerance and their actual prescription narcotic medication usage after foot and ankle surgery. Methods: This was a prospective cohort study of adult patients that underwent outpatient foot and ankle surgeries performed by 5 fellowship-trained foot and ankle surgeons at a large, multispecialty orthopaedic practice over a one year period. Demographic data, procedural details and anesthesia type were collected. Narcotic usage data including number of pills dispensed and pill counts performed at the first postoperative visit were obtained. Patients were contacted via email or telephone between 7-19 months postoperatively, and asked to respond to the validated statement “Pain doesn’t bother me as much as it does most people” by choosing “strongly disagree”, “disagree”, “neither”, “agree” or “strongly agree”. Patients scored their pain threshold on a scale of 1- 100 with 0 being “pain intolerant” and 100 a ”high pain threshold" and ranked their expectations of the pain after surgery and satisfaction with pain management on respective five-point Likert scales. Data was analyzed using a Spearman’s correlation. Results: Of the 486 patients who completed surveys, average age was 51.24 years, 32.1% were male and 7.82% current smokers. After controlling for age and anesthesia type, both agreement with the validated statement and higher pain tolerance score had a weak negative correlation with pills taken (r=-0.13, p=0.004 and r=-0.14, p=0.002, respectively); patients with higher perceived pain thresholds took fewer opioid pills after surgery (Table 1). Correlation between high expectations of postoperative pain and pills taken was weakly negative (r=-0.28, p=<0.001) (Table 1). Patients who found surgery more painful than they expected took less pain medication. There was a small, positive correlation between pain tolerance and satisfaction with pain management (r=0.12, p=0.008), indicating that patients with a relatively high pain tolerance had more satisfaction (Table 1). Conclusion: Assessment of both subjective description and quantitative score of a patient’s pain threshold prior to surgery may assist the surgeon in tailoring postoperative pain control regimens. Unexpectedly, patients who found surgery less painful than expected actually took a greater number of opioid pills. This may highlight an educational opportunity regarding postoperative pain management in order to reduce narcotic requirement. Setting expectations on safe utilization of prescribed pain medications may also increase satisfaction. This study provides useful information for surgeons to customize pain management regimens and to perform effective preoperative education and counseling regarding postoperative pain management. [Table: see text]
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Kvarda, Peter, Noortje Hagemeijer, Gregory R. Waryasz, Daniel Guss, Christopher W. DiGiovanni, and A. Holly Johnson. "Opioid Consumption Rate After Foot and Ankle Surgery." Foot & Ankle Orthopaedics 4, no. 2 (April 1, 2019): 2473011419S0000. http://dx.doi.org/10.1177/2473011419s00004.
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Category: Opioid consumption rate and risk factors investigation after foot and ankle surgery Introduction/Purpose: The rapid increase in the consumption of prescription opioids has become one of the leading medical, economical, and sociological burdens in North America. In the United States, orthopedic surgery is the fourth leading specialty in the number of opioids prescribed, and the largest among surgical specialties. There is insufficient evidence to guide surgeons about appropriate opioid prescription amounts after orthopaedic foot and ankle (F&A) procedures. The aim of this study was to determine the opioid consumption rate after foot and ankle procedures, and to identify patient risk factors associated with higher use. Methods: A total of 535 patients who underwent a F&A surgery performed by one orthopedic surgeon from August 2016 to March 2018 were investigated. The study was approved by our IRB. Each patient received a preoperative discussion about postoperative pain and expectations alongside a standardized handout. At the two-week postoperative visit, the patient-reported amount of consumed opioids was recorded. Prescription details, the amount of opioids taken, refill requests, pain-issue related telephone calls, and additional MD/ED visits were also documented. Patient demographics and co-morbidities, use of regional anesthesia, postoperative inpatient hospitalization, surgery type and severity, and pre-operative opioid use were collected retrospectively. Total amounts of morphine equivalents were calculated and converted into oxycodone 5 mg pills for standardization. P-values of <0.05 were considered significant. Results: Two hundred forty-four patients with a mean age of 50 years (±16.3) and a BMI of 29 (±6.1) were included. Sixty-six (27%) patients underwent a soft tissue procedure alone and 178 (73%) underwent a bony procedure. 225 (92.2%) patients received regional block. Patients reported that they consumed only 51.2% of prescribed pills after a bony procedure and 42.4% after a soft tissue procedure, respectively, which resulted in a total of 4,496.2 left over pills that derived from this study amongst only 244 patients enrolled. There were 11 refill requests (4.5%), two (0.8%) additional MD/ED visits, and 19 (7.8%) telephone calls related to pain. BMI, procedure type, and number of opioids prescribed were positively correlated with the consumption rate (P =.002, P<.001, P<0.001, respectively). Conclusion: BMI, surgery type (bony vs. soft tissue), and a higher number of pills dispensed were correlated with higher use in the postoperative period. After an educative discussion on postoperative pain, patients took 42.4% of the prescribed opioid after soft tissue procedures and 51.2% after bony procedures, resulting in a significant number of unused pills now available to the community. Future guidelines are necessary to improve our postoperative pain management, but this study suggests that current amounts of dispensed pills after orthopaedic F&A procedures are approximately twice as high as necessary.
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Fearon, Nkechi, Gregory Thomas Chesnut, Nicole Benfante, Melissa Assel, Shirley Mauzoul, Marcia Levine, Vance Broach, et al. "Decreasing postoperative opioid prescriptions in ambulatory extended recovery patients." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 6621. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.6621.
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6621 Background: Over-prescription of opioids after surgery contributes to the opioid abuse epidemic. Optimum post-operative opioid dosing is not defined. We evaluated prescribing patterns among different surgical services and created a standardized practice to reduce dispensation of unnecessary opioids. Methods: Opioid-naïve patients over 18 who underwent urologic, gynecologic, or breast surgery between March 2018 and January 2019 were eligible. A 4-month pre-intervention evaluation of number of opioid pills prescribed, number of pills taken, additional refills, and pain-control was obtained by contacting patients 7-10 days post-operatively. Findings were used to standardize prescriptions. Following implementation, patients undergoing surgery for the following 4-months were contacted to assess the impact of standardized opioid prescriptions. Data was compared with the institution’s electronic prescription system. Results: Pre-intervention, 368 eligible urology and gynecology patients (75.6%) responded and were prescribed between 6 and 40 opioid pills. Urology patients received median 28 (20, 30) tablets and 33% reported taking none. Gynecology patients received a median 20 (19, 28) tablets and 41% took none. Of 238 mastectomy patients, 176 (74%) reported taking median 3 and 4.9 of 20 prescribed opioid pills and 39% or 61% took no opioid pills (without vs with reconstruction). Prescriptions were standardized to 8, 7, and 10 tablets for urology, gynecology, and breast services. Post-intervention surveys revealed opioid tablets taken to be unchanged with minimal increase in refill requests. Conclusions: Prior to standardization, a large variation in opioids prescribed was observed. Standardizing opioid prescriptions resulted in fewer opioids dispensed without impacting pain control or refill requests.
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Davison, Mark A., Daniel T. Lilly, Shyam A. Desai, Victoria D. Vuong, Jessica Moreno, Carlos Bagley, and Owoicho Adogwa. "Racial Differences in Perioperative Opioid Utilization in Lumbar Decompression and Fusion Surgery for Symptomatic Lumbar Stenosis or Spondylolisthesis." Global Spine Journal 10, no. 2 (May 16, 2019): 160–68. http://dx.doi.org/10.1177/2192568219850092.
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Study Design: Retrospective cohort study. Objectives: To assess for racial differences in opioid utilization prior to and after lumbar fusion surgery for patients with lumbar stenosis or spondylolisthesis. Methods: Clinical records from patients with lumbar stenosis or spondylolisthesis undergoing primary <3-level lumbar fusion from 2007 to 2016 were gathered from a comprehensive insurance database. Records were queried by International Classification of Diseases diagnosis/procedure codes and insurance-specific generic drug codes. Opioid use 6 months prior, through 2 years after surgery was assessed. Multivariate regression analysis was employed to investigate independent predictors of opioid use following lumbar fusion. Results: A total of 13 257 patients underwent <3-level posterior lumbar fusion. The cohort racial distribution was as follows: 80.9% white, 7.0% black, 1.0% Hispanic, 0.2% Asian, 0.2% North American Native, 0.8% “Other,” and 9.8% “Unknown.” Overall, 57.8% patients utilized opioid medications prior to index surgery. When normalized by the number opiate users, all racial cohort saw a reduction in pills disbursed and dollars billed following surgery. Preoperatively, Hispanics had the largest average pills dispensed (222.8 pills/patient) and highest average amount billed ($74.67/patient) for opioid medications. The black cohort had the greatest proportion of patients utilizing preoperative opioids (61.8%), postoperative opioids (87.1%), and long-term opioid utilization (72.7%), defined as use >1 year after index operation. Multivariate logistic regression analysis indicated Asian patients (OR 0.422, 95% CI 0.191-0.991) were less likely to use opioids following lumbar fusion. Conclusions: Racial differences exist in perioperative opioid utilization for patients undergoing lumbar fusion surgery for spinal stenosis or spondylolisthesis. Future studies are needed corroborate our findings.
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Murad Junior, Munir, Suellen Pegnolato, Luiz Adelmo Lodi, Milena Marcolino, and Roberto Porto Fonseca. "Pharmacist assistance for patients on oral oncologic therapy: Impact on adherence and costs." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e19198-e19198. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e19198.
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e19198 Background: Oral cancer treatment has becoming progressively more frequent and its costs are rising. To implement strategies that monitor adverse effects, adherence and manage financial resources is of utmost importance. Our goal is to develop an intervention based on pharmaceutical monitoring that promotes the correct use of medication through the early identification of adverse events, as well as to describe an economic analysis of this intervention. Methods: Quasi-experimental study, which included consecutive patients from a private oncologic clinic in Belo Horizonte, Southeast Brazil, who were taking oral medications for the treatment of cancer. Patients had regular consultations with pharmacists, at the beginning of each treatment cycle. The consultation consisted of the assessment of adherence (if they took at least 80% of the pills on a specific period of time) and adverse effects. The number of pills dispensed in the new cycle was adjusted by the number of pills remaining in the previous cycle. Prices were calculated using Brasindice and the dollar price of Feb/2020. Follow-up period was from Oct/2018 to Nov/2019. Results: Throughout the study, 1224 patients were included: 86% female, mean age 63 years, 37% had at least 7 years education. Breast cancer accounted for 77% and prostate cancer for 6% of the patients, and 23% of all patients were treating stage IV cancer. The most used treatments were tamoxifen (44%) anastrazole (34%) and capecitabine (3%). In total, 10.640 pharmacists consultations were performed, which corresponds, on average, 887 consultations per month and 8.7 per patient. On average, 88.6% were adherent to the medication. In 50% of those consultations, patients reported adverse effects (hot flashes 42%, musculoskeletal syndrome 22%, fatigue 14%, cramps 7%). In that scenario, pharmaceutical care has resulted in total savings of 4067 pills or $ 136,854.89 (Table). Conclusions: Pharmaceutical care was responsible for high rates of adherence, despite the high frequency of adverse effects, and also promoted cost savings. [Table: see text]
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Steenland, Maria W., Maria-Isabel Rodriguez, Polly A. Marchbanks, and Kathryn M. Curtis. "How does the number of oral contraceptive pill packs dispensed or prescribed affect continuation and other measures of consistent and correct use? A systematic review." Contraception 87, no. 5 (May 2013): 605–10. http://dx.doi.org/10.1016/j.contraception.2012.08.004.
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Steinkamp, Jackson M., Nathaniel Goldblatt, Jacob T. Borodovsky, Amy LaVertu, Ian M. Kronish, Lisa A. Marsch, and Zev Schuman-Olivier. "Technological Interventions for Medication Adherence in Adult Mental Health and Substance Use Disorders: A Systematic Review." JMIR Mental Health 6, no. 3 (March 12, 2019): e12493. http://dx.doi.org/10.2196/12493.
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Background Medication adherence is critical to the effectiveness of psychopharmacologic therapy. Psychiatric disorders present special adherence considerations, notably an altered capacity for decision making and the increased street value of controlled substances. A wide range of interventions designed to improve adherence in mental health and substance use disorders have been studied; recently, many have incorporated information technology (eg, mobile phone apps, electronic pill dispensers, and telehealth). Many intervention components have been studied across different disorders. Furthermore, many interventions incorporate multiple components, making it difficult to evaluate the effect of individual components in isolation. Objective The aim of this study was to conduct a systematic scoping review to develop a literature-driven, transdiagnostic taxonomic framework of technology-based medication adherence intervention and measurement components used in mental health and substance use disorders. Methods This review was conducted based on a published protocol (PROSPERO: CRD42018067902) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review guidelines. We searched 7 electronic databases: MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, Web of Science, Engineering Village, and ClinicalTrials.gov from January 2000 to September 2018. Overall, 2 reviewers independently conducted title and abstract screens, full-text screens, and data extraction. We included all studies that evaluate populations or individuals with a mental health or substance use disorder and contain at least 1 technology-delivered component (eg, website, mobile phone app, biosensor, or algorithm) designed to improve medication adherence or the measurement thereof. Given the wide variety of studied interventions, populations, and outcomes, we did not conduct a risk of bias assessment or quantitative meta-analysis. We developed a taxonomic framework for intervention classification and applied it to multicomponent interventions across mental health disorders. Results The initial search identified 21,749 results; after screening, 127 included studies remained (Cohen kappa: 0.8, 95% CI 0.72-0.87). Major intervention component categories include reminders, support messages, social support engagement, care team contact capabilities, data feedback, psychoeducation, adherence-based psychotherapy, remote care delivery, secure medication storage, and contingency management. Adherence measurement components include self-reports, remote direct visualization, fully automated computer vision algorithms, biosensors, smart pill bottles, ingestible sensors, pill counts, and utilization measures. Intervention modalities include short messaging service, mobile phone apps, websites, and interactive voice response. We provide graphical representations of intervention component categories and an element-wise breakdown of multicomponent interventions. Conclusions Many technology-based medication adherence and monitoring interventions have been studied across psychiatric disease contexts. Interventions that are useful in one psychiatric disorder may be useful in other disorders, and further research is necessary to elucidate the specific effects of individual intervention components. Our framework is directly developed from the substance use disorder and mental health treatment literature and allows for transdiagnostic comparisons and an organized conceptual mapping of interventions.
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Daubresse, Matthew, G. Caleb Alexander, Deidra C. Crews, Dorry L. Segev, and Mara A. McAdams-DeMarco. "Trends in Opioid Prescribing Among Hemodialysis Patients, 2007–2014." American Journal of Nephrology 49, no. 1 (December 13, 2018): 20–31. http://dx.doi.org/10.1159/000495353.
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Background: Hemodialysis (HD) patients frequently experience pain. Previous studies of HD patients suggest increased opioid prescribing through 2010. It remains unclear if this trend continued after 2010 or declined with national trends. Methods: Longitudinal cohort study of 484,745 HD patients in the United States Renal Data System/Medicare data. We used Poisson/negative binomial regression to estimate annual incidence rates of opioid prescribing between 2007 and 2014. We compared prescribing rates with the general US population using IQVIA’s National Prescription Audit data. Outcomes included the following: percent of HD patients receiving an opioid prescription, rate of opioid prescriptions, quantity, days supply, morphine milligram equivalents (MME) dispensed per 100 person-days, and prescriptions per person. Results: In 2007, 62.4% of HD patients received an opioid prescription. This increased to 63.2% in 2010 then declined to 53.7% by 2014. Opioid quantity peaked in 2011 at 73.5 pills per 100 person-days and declined to 62.6 pills per 100 person-days in 2014. MME peaked between 2010 and 2012 then declined through 2014. In 2014, MME rates were 1.8-fold higher among non-Hispanic patients and 1.6-fold higher among low-income patients. HD patients received 3.2-fold more opioid prescriptions per person compared to the general US population and were primarily prescribed oxycodone and hydrocodone. Between 2012 and 2014, HD patients experienced greater declines in opioid prescriptions per person (18.2%) compared to the general US population (7.1%). Conclusion: Opioid prescribing among HD patients declined between 2012 and 2014. However, HD patients continue receiving substantially more opioids than the general US population.
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Shields, MD, Lisa B. E., Soraya Nasraty, MD, MMM, CPE, Alisha D. Bell, MSN, RN, CPN, Anil N. Vinayakan, MD, Raghunath S. Gudibanda, MD, Steven T. Hester, MD, MBA, and Joshua T. Honaker, MD, FAAP. "Primary care providers’ prescribing practices of opioid controlled substances." Journal of Opioid Management 12, no. 6 (November 1, 2016): 397. http://dx.doi.org/10.5055/jom.2016.0359.
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Objective: Prescription opioid abuse poses a significant public health concern. House Bill 1 (HB1) was enacted in 2012 to address prescription drug abuse in Kentucky. The authors investigated the impact of HB1 on primary care providers’ (PCPs) prescribing practices of Schedule II controlled substances. Design: Retrospective evaluation of PCPs’ prescribing practices in an adult outpatient setting.Methods: A review of the prescribing practices for Schedule II controlled substances written by 149 PCPs. The number of prescriptions for Schedule II controlled substances written by 149 PCPs was compared to the top 10 PCP prescribers. Attention was focused on providers who wrote for oxycontin and/or opana and prescriptions with > 90 pills dispensed.Results: The top 10 PCP prescribers accounted for 38.4 percent of the Schedule II controlled substances and 47.8 percent of the Schedule II controlled substances with > 90 pills dispensed. Of the 60 PCPs who prescribed opana and/or oxycontin, the average number of prescriptions was 14.7 compared to 51.0 for the top 10 PCP prescribers. The average percentage of Schedule II controlled substance prescriptions compared to the total number of prescriptions was 27.9 percent for the top 10 PCP prescribers and 7.05 percent of all PCPs. The average percentage of office visits with Schedule II controlled substance prescriptions compared to total office visits was 24.8 percent for the top 10 PCP prescribers versus 7.7 percent for all PCPs.Conclusions: Further scrutiny is warranted to more closely analyze provider opioid prescribing habits and ensure that the providers at our Institution are prescribing Schedule II controlled substances in compliance with HB1.
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Campanaro, Celia M., Annemeri Livinalli, Debora Lourenço Souza, Vanessa Rocha Varizano, and Heder Frank Gianotto Estrela. "Evaluation of Treatment Adherence of Sickle Cell Pediatric patients in Use of hydroxyurea." Blood 118, no. 21 (November 18, 2011): 4757. http://dx.doi.org/10.1182/blood.v118.21.4757.4757.
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Abstract Abstract 4757 Background: Sickle cell disease is a genetic and chronic disease prevalent in Brazil. It is believed that about 2500 to 3000 brazilians born a year with sickle cell disease. The most common clinical complication is the vessel occlusive crisis, the blockade of microcirculation, sickling of red blood cells, local hypoxia and ischemia of tissues, resulting in acute painful crises. To control this situation, treatment with analgesics, red blood cell transfusion and hydroxyurea (HU) are recommended.The HU administration has shown excellent results through the significant increase in the hemoglobin F levels, thus contributing to decrease in vessel occlusive crises, reducing the frequency of transfusion and potentially preventing organ damage. The treatment adherence is crucial to maintain the serum level of the drug and achieve the best therapeutic results. Adherence is defined as degree of agreement between the person's behavior in relation to guidance provided by physician or other healthcare professional.Several factors influence adherence and understand them allows the professional to develop tools to assist the patient in understanding its importance.The purpose of this study was to quantify the adherence to treatment with HU and identify related causes to non-adherence in pediatric patients with sickle cell disease. METHODS: quantitative, descriptive and retrospective study involving pediatric patients 3 to 18 years seen at GRENDACC- Jundiai-SP.The information was obtained from a questionnaire applied to 19 caregivers and pharmacotherapeutic follow-up recording form (PH) available at the pharmacy for the period from may/2010 to september/2010.PH served as an instrument to measure adherence by the method pill count. Each patient has a form that is filled with information: date and amount of medication dispensed and dosage.At each visit to pharmacy, the caregiver has the bottle for refill and pill count.During the research, the form provided information to apply the formula to verify the adherence rate: quantify dispensed – number on the bottle/treatment period × 100.It was considered a good adherence who have demonstrated a adherence rate of ≥ 90%. RESULTS: The caregivers were represented mostly by mothers (68%).The caregiver's educational level varied from illiterate (1/19), complete or incomplete elementary (10/19), complete or incomplete secondary (7/19) and university (1/19). Asked about the administration of HU, 95% of caregivers reported giving the medication in correct schedule and 42% forgot to give the medicine sometime during the treatment, the reason was accumulation of tasks and concerns with other family members. In the evaluation of adherence 17 PH were viable and showed that 58.8% (10/17) of patients had an rate ≥90%. The lowest rate was 63% and ocurred in only 1 patient. CONCLUSIONS: Although there is no consensus regarding the optimal rate to consider a good adherence, the papers present that rates below 80% is worrying and needs intervention. In the group evaluated, 82% presented more than 80% adherence. Pharmacotherapeutic follow-up allows rapid detection of drug related problems, with immediate intervention through guidance, and if necessary, medical or psychosocial intervention. Although there are few studies about this issue in pediatric patient, the small group of subjects studied and the short period of assessment, we believe the results support the importance of a rigorous monitoring pharmacotherapeutic by visits to pharmacy to follow-up consultations. We suggest further studies with a larger sample and longer period to confirm the importance of monitoring pharmacotherapeutic tool in improving the adherence, evaluate the impact and variables that affect the non-adherence. Disclosures: No relevant conflicts of interest to declare.
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Yakasai, Ahmad M., Muhammad Hamza, Mahmood M. Dalhat, Musa Bello, Muktar A. Gadanya, Zuwaira M. Yaqub, Daiyabu A. Ibrahim, and Fatimah Hassan-Hanga. "Adherence to Artemisinin-Based Combination Therapy for the Treatment of Uncomplicated Malaria: A Systematic Review and Meta-Analysis." Journal of Tropical Medicine 2015 (2015): 1–11. http://dx.doi.org/10.1155/2015/189232.
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Adherence to artemisinin-based combination therapy (ACT) is not clearly defined. This meta-analysis determines the prevalence and predictors of adherence to ACT. Twenty-five studies and six substudies met the inclusion criteria. The prevalence of ACT adherence in the public sector was significantly higher compared to retail sector (76% and 45%, resp.,P<0.0001). However, ACT adherence was similar across different ACT dosing regimens and formulations. In metaregression analysis prevalence estimates of adherence significantly decrease with increasing year of study publicationP=0.046. Factors found to be significant predictors of ACT adherence were years of education ≥ 7{odds ratio (OR) (95% CI) = 1.63 (1.05–2.53)}, higher income{2.0 (1.35–2.98)}, fatty food{4.6 (2.49–8.50)}, exact number of pills dispensed{4.09 (1.60–10.7)}, and belief in traditional medication for malaria{0.09 (0.01–0.78)}. The accuracy of pooled estimates could be limited by publication bias, and differing methods and thresholds of assessing adherence. To improve ACT adherence, educational programs to increase awareness and understanding of ACT dosing regimen are interventions urgently needed. Patients and caregivers should be provided with an adequate explanation at the time of prescribing and/or dispensing ACT.
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Nyondo-Mipando, Alinane Linda, Leticia Suwedi Kapesa, Sangwani Salimu, Thokozani Kazuma, and Victor Mwapasa. "“Dispense antiretrovirals daily!” restructuring the delivery of HIV services to optimize antiretroviral initiation among men in Malawi." PLOS ONE 16, no. 2 (February 22, 2021): e0247409. http://dx.doi.org/10.1371/journal.pone.0247409.
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Background Gender disparities exist in the scale-up and uptake of HIV services with men being disproportionately under-represented in the services. In Eastern and Southern Africa, of the people living with HIV infection, more adult women than men were on treatment highlighting the disparities in HIV services. Delayed initiation of antiretroviral treatment creates a missed opportunity to prevent transmission of HIV while increasing HIV and AIDS-associated morbidity and mortality. The main objective of this study was to assess the strategies that men prefer for Antiretroviral Therapy (ART) initiation in Blantyre, Malawi. Methods This was a qualitative study conducted in 7 Health facilities in Blantyre from January to July 2017. We selected participants following purposive sampling. We conducted 20 in-depth interviews (IDIs) with men of different HIV statuses, 17 interviews with health care workers (HCWs), and 14 focus group discussions (FGDs) among men of varying HIV statuses. We digitally recorded all the data, transcribed verbatim, managed using NVivo, and analysed it thematically. Results Restructuring the delivery of antiretroviral (ARVs) treatment and conduct of ART clinics is key to optimizing early initiation of treatment among heterosexual men in Blantyre. The areas requiring restructuring included: Clinic days by offering ARVs daily; Clinic hours to accommodate schedules of men; Clinic layout and flow that preserves privacy and establishment of male-specific clinics; ARV dispensing procedures where clients receive more pills to last them longer than 3 months. Additionally there is need to improve the packaging of ARVs, invent ARVs with less dosing frequency, and dispense ARVs from the main pharmacy. It was further suggested that the test-and-treat strategy be implemented with fidelity and revising the content in counseling sessions with an emphasis on the benefits of ARVs. Conclusion The success in ART initiation among men will require a restructuring of the current ART services to make them accessible and available for men to initiate treatment. The inclusion of people-centered approaches will ensure that individual preferences are incorporated into the initiation of ARVs. The type, frequency, distribution, and packaging of ARVs should be aligned with other medicines readily available within a health facility to minimize stigma.
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Wolf, Michael S., Michael S. Taitel, Jenny Z. Jiang, Laura M. Curtis, Guisselle A. Wismer, Amisha Wallia, and Ruth M. Parker. "Prevalence of Universal Medication Schedule prescribing and links to adherence." American Journal of Health-System Pharmacy 77, no. 3 (January 24, 2020): 196–205. http://dx.doi.org/10.1093/ajhp/zxz305.
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Abstract Purpose A Universal Medication Schedule (UMS) that uses explicit language to describe when to take medicine has been proposed as a patient-centered prescribing and dispensing standard. Despite widespread support, evidence of its actual use and efficacy is limited. We investigated the prevalence of UMS instructions and whether their use was associated with higher rates of medication adherence. Methods National pharmacy records were analyzed for a cohort of type 2 diabetic adults ≥18 years old (N = 676,739) new to ≥1 oral diabetes medications between January and June 2014. Prescription instructions (N = 796,909) dispensed with medications were classified as UMS or non-UMS. Instructions coded as UMS were further categorized as either providing precise UMS language (tier 1: “take 1 pill at morning, noon, evening, or bedtime”) or offering some explicit guidance (tier 2: “take 1 tablet by mouth before breakfast”; tier 3: “take 1 tablet twice daily with a meal”). Adherence over 12 months was measured by proportion of days covered. Results One-third of instructions (32.4%, n = 258,508) were classified as UMS (tier 1: 12.6%, n = 100,589; tier 2: 6.0%, n = 47,914; tier 3: 13.8%, n = 110,005). In multivariable analyses, UMS instructions (all tiers) exhibited better adherence compared to non-UMS instructions (relative risk [RR], 1.01; 95% confidence interval [CI], 1.00-1.02; P = 0.01). Patients older than 65 years who were less educated and taking medication more than once daily received greater benefit from tier 1 UMS instructions (RR, 1.14; 95% CI, 1.07-1.21; P < 0.001). Conclusion While infrequently used, the UMS could help older, less-educated patients adhere to more complex regimens with minimal investment.