Document reviewers: Hind Beheiry (Sudan), Irina Chazova (Russia), Albertino Damasceno (Mozambique), Anna Dominiczak (UK), Anastase Dzudie (Cameroon), Stephen Harrap (Australia), Hiroshi Itoh (Japan), Tazeen Jafar (Singapore), Marc Jaffe (USA), Patricio Jaramillo-Lopez (Colombia), Kazuomi Kario (Japan), Giuseppe Mancia (Italy), Ana Mocumbi (Mozambique), Sanjeevi N.Narasingan (India), Elijah Ogola (Kenya), Srinath Reddy (India), Ernesto Schiffrin (Canada), Ann Soenarta (Indonesia), Rhian Touyz (UK), Yudah Turana (Indonesia), Michael Weber (USA), Paul Whelton (USA), Xin Hua Zhang, (Australia), Yuqing Zhang (China).

https://repository.nwu.ac.za/bitstream/10394/34842/1/2020%20International%20Society%20of%20Hypertension.pdf

2020 International Society of Hypertension global hypertension practice guidelines

DOCUMENT REVIEWERS\nHind Beheiry (Sudan), Irina Chazova (Russia), Albertino Damasceno (Mozambique), Anna Dominiczak (UK), Anastase Dzudie (Cameroon), Stephen Harrap (Australia), Hiroshi Itoh (Japan), Tazeen Jafar (Singapore), Marc Jaffe (USA), Patricio Jaramillo-Lopez (Colombia), Kazuomi Kario (Japan), Giuseppe Mancia (Italy), Ana Mocumbi (Mozambique), Sanjeevi N.Narasingan (India), Elijah Ogola (Kenya), Srinath Reddy (India), Ernesto Schiffrin (Canada), Ann Soenarta (Indonesia), Rhian Touyz (UK), Yudah Turana (Indonesia), Michael Weber (USA), Paul Whelton (USA), Xin Hua Zhang, (Australia), Yuqing Zhang (China).

/pdf/2020-international-society-of-hypertension-global-3pxw0w3zuf.pdf

2020 International Society of Hypertension global hypertension practice guidelines.

Background
Lipid-lowering drugs are widely underused, despite strong evidence indicating they improve cardiovascular end points. Poor patient adherence to a medication regimen can affect the success of lipid-lowering treatment.

Objectives
To assess the effects of interventions aimed at improving adherence to lipid-lowering drugs, focusing on measures of adherence and clinical outcomes.

Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO and CINAHL up to 3 February 2016, and clinical trials registers (ANZCTR and ClinicalTrials.gov) up to 27 July 2016. We applied no language restrictions.

Selection criteria
We evaluated randomised controlled trials of adherence-enhancing interventions for lipid-lowering medication in adults in an ambulatory setting with a variety of measurable outcomes, such as adherence to treatment and changes to serum lipid levels. Two teams of review authors independently selected the studies.

Data collection and analysis
Three review authors extracted and assessed data, following criteria outlined by the Cochrane Handbook for Systematic Reviews of Interventions. We assessed the quality of the evidence using GRADEPro.

Main results
For this updated review, we added 24 new studies meeting the eligibility criteria to the 11 studies from prior updates. We have therefore included 35 studies, randomising 925,171 participants. Seven studies including 11,204 individuals compared adherence rates of those in an intensification of a patient care intervention (e.g. electronic reminders, pharmacist-led interventions, healthcare professional education of patients) versus usual care over the short term (six months or less), and were pooled in a meta-analysis. Participants in the intervention group had better adherence than those receiving usual care (odds ratio (OR) 1.93, 95% confidence interval (CI) 1.29 to 2.88; 7 studies; 11,204 participants; moderate-quality evidence). A separate analysis also showed improvements in long-term adherence rates (more than six months) using intensification of care (OR 2.87, 95% CI 1.91 to 4.29; 3 studies; 663 participants; high-quality evidence). Analyses of the effect on total cholesterol and LDL-cholesterol levels also showed a positive effect of intensified interventions over both short- and long-term follow-up. Over the short term, total cholesterol decreased by a mean of 17.15 mg/dL (95% CI 1.17 to 33.14; 4 studies; 430 participants; low-quality evidence) and LDL-cholesterol decreased by a mean of 19.51 mg/dL (95% CI 8.51 to 30.51; 3 studies; 333 participants; moderate-quality evidence). Over the long term (more than six months) total cholesterol decreased by a mean of 17.57 mg/dL (95% CI 14.95 to 20.19; 2 studies; 127 participants; high-quality evidence). Included studies did not report usable data for health outcome indications, adverse effects or costs/resource use, so we could not pool these outcomes. We assessed each included study for bias using methods described in the Cochrane Handbook for Systematic Reviews of Interventions. In general, the risk of bias assessment revealed a low risk of selection bias, attrition bias, and reporting bias. There was unclear risk of bias relating to blinding for most studies.

Authors' conclusions
The evidence in our review demonstrates that intensification of patient care interventions improves short- and long-term medication adherence, as well as total cholesterol and LDL-cholesterol levels. Healthcare systems which can implement team-based intensification of patient care interventions may be successful in improving patient adherence rates to lipid-lowering medicines.

Interventions to improve adherence to lipid lowering medication

PREAMBLE The 2015-16 Academic Affairs Standing Committee of the American Association of Colleges of Pharmacy (AACP) was charged by then AACP President Cynthia Boyle to identify the entrustable professional activities (EPAs) for pharmacy graduates as they transition from completion of advanced pharmacy practice experiences into practice and postgraduate opportunities such as residency training. The process for developing the draft EPAs was described in detail in the report of the 2015-16 Academic Affairs Standing Committee. (1) The 2016-17 Academic Affairs Standing Committee was charged by AACP President Joseph DiPiro with the following: (1) Compile comments and input from a broad range of stakeholders regarding the draft EPAs from the 2015-16 Committee (including comments from District meetings) and complete final edits to the document for submission to the November 2016 AACP Board of Directors meeting; (2) Develop potential uses and applications of EPA statements in pharmacy education; and (3) Create a roadmap for implementation of EPAs across the member schools and colleges. The 2016-17 Academic Affairs Committee Standing Committee Report will contain mapping to the CAPE 2013 Educational Outcomes and the JCPP Patient Care Process as well as recommendations to the AACP for broad implementation. (2,3) Entrustable professional activities are units of professional practice or descriptors of work, defined as specific tasks or responsibilities that trainees are entrusted to perform without direct supervision once they have attained sufficient competence. (4,5) EPAs are independently executable, observable, and measurable in their process and outcome. (4,5) Core EPAs for New Pharmacy Graduates are discrete, essential activities and tasks that all new pharmacy graduates must be able to perform without direct supervision upon entering practice or postgraduate training. These statements were labeled as "core" to denote that these EPAs are expected of all graduates independent of practice setting. They serve as a baseline, not a ceiling. There were several points of clarification that arose from feedback received from stakeholders. Three key concepts apply across all core domain statements and example supporting tasks: professionalism, self-awareness, and communication. It is assumed that professionalism must permeate every EPA statement. Without professionalism none of these tasks would be possible. Further, no single task can comprise the entire construct of professionalism. For the same reason, self-awareness and communication skills are inherent within and essential to all EPA core domain statements. The core EPA domain statements are intended to be evaluated. Example supporting tasks offer suggestions to programs on the component parts of each EPA domain. Stakeholders may choose to supplement or modify the tasks to align with programmatic or regional practice. The final EPA Statements for New Pharmacy Graduates are presented in Appendix 1. A glossary is provided in Appendix 2 to help clarify bolded terms within the EPA Statements. REFERENCES (1.) Haines ST, Gleason BL, Kantorovich A, et al. Report of the 2015-2016 Academic Affairs Standing Committee. Am J Pharm Educ. 2016;80(9):Article S20. (2.) Medina MS, Plaza CM, Stowe CD, et al. Center for Advancement of Pharmacy Education 2013 Educational Outcomes. Am J Pharm Educ. 2013;77(8):Article 162 (3.) Joint Commission of Pharmacy Practitioners. Pharmacists' patient care process. https://www.pharmacist.com/sites/default/files/files/PatientCareProcess.pdf. Accessed June 9, 2016. (4.) Mulder H, Ten Cate O, Daalder R, Berkvens J. Building a competency-based workplace curriculum around entrustable professional activities: the case of physician assistant training. Med Teach. 2010;32(10):e453-e459. (5.) Ten Cate O, Chen HC, Hoff RG, Peters H, Bok H, van der Schaaf M. Curriculum development for the workplace using Entrustable Professional Activities (EPAs): AMEE Guide No. …

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Core Entrustable Professional Activities for New Pharmacy Graduates.

Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial

Medication adherence and persistence is recognized as a worldwide public health problem, particularly important in the management of chronic diseases Nonadherence to medical plans affects every level of the population, but particularly older adults due to the high number of coexisting diseases they are affected by and the consequent polypharmacy Chronic disease management requires a continuous psychological adaptation and behavioral reorganization In literature, many interventions to improve medication adherence have been described for different clinical conditions, however, most interventions seem to fail in their aims Moreover, most interventions associated with adherence improvements are not associated with improvements in other outcomes Indeed, in the last decades, the degree of nonadherence remained unchanged In this work, we review the most frequent interventions employed to increase the degree of medication adherence, the measured outcomes, and the improvements achieved, as well as the main limitations of the available studies on adherence, with a particular focus on older persons

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Magda Savin

Papers

Interventional tools to improve medication adherence: review of literature