tag:blogger.com,1999:blog-84980744157332085642024-03-13T19:31:25.891+01:00The Therapeutic Non-adherence Blog"Keep watch also on the faults of the patients which often make them lie about the taking of things prescribed.” HippocratesTamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.comBlogger24125tag:blogger.com,1999:blog-8498074415733208564.post-1339319708578614392012-03-10T20:43:00.000+01:002012-03-10T20:43:33.849+01:00Adherence to Therapy in Chronic Obstructive Pulmonary DiseaseI'm glad to inform you that my review regarding adherence in COPD was published in the book entiteld <a href="http://www.intechopen.com/books/chronic-obstructive-pulmonary-disease-current-concepts-and-practice" title="Chronic Obstructive Pulmonary Disease - Current Concepts and Practice">Chronic Obstructive Pulmonary Disease - Current Concepts and Practice</a>. <br />
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<div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-9gt4f9EacSM/T1utQyEqTvI/AAAAAAAAAEU/SEPDWssNofg/s1600/1841.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-9gt4f9EacSM/T1utQyEqTvI/AAAAAAAAAEU/SEPDWssNofg/s1600/1841.jpg" /></a></div><br />
It is an open access book so readers can access it free of charge!<br />
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Please find my publication on this link:<br />
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<div class="subtitle"><a href="http://www.intechopen.com/books/chronic-obstructive-pulmonary-disease-current-concepts-and-practice/adherence-to-therapy-in-chronic-obstructive-pulmonary-disease">Adherence to Therapy in Chronic Obstructive Pulmonary Disease</a></div><div class="subtitle">By Tamas Agh and Agnes Meszaros</div><div class="subtitle"><br />
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</div>Tamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.com0tag:blogger.com,1999:blog-8498074415733208564.post-8751294796606639202011-11-21T22:13:00.000+01:002011-11-21T22:13:19.928+01:00The first publication of ABC Project<div style="text-align: justify;"><a href="http://abcproject.eu/index.php" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="Ascertaining Berries for Compliance" id="logo" src="http://abcproject.eu/img/logo.gif" title="Ascertaining Berries for Compliance" /></a>The ABC project (<span>Ascertaining Barriers for Compliance) is funded by the European Commission within the Seventh Framework Programme for research and technological development. The first ABC Project article entitled Management of patient adherence to medications: protocol for an online survey of doctors, pharmacists and nurses in Europe has been published by BMJ Open. At this tiem, it has been the largest survey of European healthcare professionals' medication adherence perceptions, beliefs and behaviours. </span></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><span>The article can be accessed <a href="http://bmjopen.bmj.com/content/1/1/e000355.full">here.</a> </span></div>Tamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.com0tag:blogger.com,1999:blog-8498074415733208564.post-72846569518327168632011-11-16T22:13:00.001+01:002011-11-16T22:18:00.159+01:00Predictors of Primary Medication Nonadherence<h2>Fischer et al. Trouble Getting Started: Predictors of Primary Medication Nonadherence</h2><h2>The American Journal of Medicine 124(11);1081.e9-22</h2><h2>Abstract </h2><h3 style="text-align: justify;">Background</h3><div style="text-align: justify;">Patient nonadherence to prescribed medication is common and limits the effectiveness of treatment for many conditions. Most adherence studies evaluate behavior only among patients who have filled a first prescription. The advent of electronic prescribing (e-prescribing) systems provides the opportunity to track initial prescriptions and identify nonadherence that may have previously been undetected.</div><h3 style="text-align: justify;">Methods</h3><div style="text-align: justify;">We analyzed e-prescribing data and filled claims for all patients with CVS Caremark (Woonsocket, RI) drug coverage who received e-prescriptions from the iScribe e-prescribing system in calendar 2008. We matched e-prescriptions with filled claims by using data on the drug name, date of e-prescription, and date of filled claims, allowing up to 180 days for patients to fill e-prescriptions. We evaluated the rate of primary nonadherence to newly prescribed medications across multiple characteristics of patients, prescribers, and prescriptions and developed multivariable models to identify predictors of nonadherence.</div><h3 style="text-align: justify;">Results</h3><div style="text-align: justify;"><a href="http://t2.gstatic.com/images?q=tbn:ANd9GcR9v4hMtyXy-i14PWtzn5U-wJab0Rac00BJDl_5o-ETTQlRmhotuA" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="" border="0" class="rg_hi" data-height="159" data-width="240" height="159" id="rg_hi" src="http://t2.gstatic.com/images?q=tbn:ANd9GcR9v4hMtyXy-i14PWtzn5U-wJab0Rac00BJDl_5o-ETTQlRmhotuA" style="height: 159px; width: 240px;" width="240" /></a>We identified 423,616 e-prescriptions for new medications, with 3634 prescribers and 280,081 patients. The primary nonadherence rate was 24.0%. Several factors were associated with nonadherence to e-prescriptions, including nonformulary status of medications (odds ratio [OR] 1.31 compared with preferred medications; 95% confidence interval [CI], 1.26-1.36; <i>P<img alt="" height="1" src="http://www.amjmed.com/webfiles/images/transparent.gif" title="" width="2" /><<img alt="" height="1" src="http://www.amjmed.com/webfiles/images/transparent.gif" title="" width="2" />.</i>001) and residence in a low-income ZIP code (OR 1.23 compared with high-income ZIP code; 95% CI, 1.17-1.30; <i>P<img alt="" height="1" src="http://www.amjmed.com/webfiles/images/transparent.gif" title="" width="2" /><<img alt="" height="1" src="http://www.amjmed.com/webfiles/images/transparent.gif" title="" width="2" />.</i>001) Nonadherence occurred less often when e-prescriptions were transmitted directly to the pharmacy rather than printed to give to patients (OR 0.54; 95% CI, 0.52-0.57; <i>P<img alt="" height="1" src="http://www.amjmed.com/webfiles/images/transparent.gif" title="" width="2" /><<img alt="" height="1" src="http://www.amjmed.com/webfiles/images/transparent.gif" title="" width="2" />.</i>001).</div><h3 style="text-align: justify;">Conclusion</h3><div style="text-align: justify;">24% of e-prescriptions for new medications were not filled. Our results suggest that interventions to address economic barriers and increase electronic integration in the healthcare system may be promising approaches to improve medication adherence.<br />
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To read more <a href="http://www.amjmed.com/article/S0002-9343(11)00490-6/abstract">click here</a>.Tamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.com0tag:blogger.com,1999:blog-8498074415733208564.post-45160189850809553612011-11-15T21:43:00.000+01:002011-11-15T21:43:20.515+01:00Free Medications Could Improve Adherence: MI FREEE trial<div style="text-align: justify;">Eliminating drug copayments for patients following a myocardial infarction reduced vascular events without increasing overall costs for insurers in the prospective randomized MI FREEE trial. </div><div style="text-align: justify;"> </div><div class="bodytext" style="text-align: justify;">Although the Post-Myocardial Infarction Free Rx Event and Economic Evaluation trial had only a "modest" impact on medication adherence and missed its primary end point, the findings were dramatic enough that study sponsor Aetna has announced it will waive copayments for its post-MI patients beginning January 2013, lead author Dr. Niteesh Choudhry said at the annual scientific sessions of the American Heart Association. </div><div class="bodytext"><br />
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</div><div class="bodytext">To read more click here: <a href="http://www.internalmedicinenews.com/news/cardiovascular-disease/single-article/free-meds-boost-post-mi-outcomes-rx-adherence/b3963d4826.html">Internal Medicine News</a> </div>Tamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.com0tag:blogger.com,1999:blog-8498074415733208564.post-10911882030643114452011-07-25T21:37:00.000+02:002011-07-25T21:37:23.659+02:00Patient Adherence: The Next Frontier in Patient Care<div style="text-align: justify;"><span style="color: black;">Each year, Capgemini publishes an in-depth analysis of a major life sciences issue. In their 9<sup>th</sup> edition of Vision & Reality, entitled “Patient Adherence: The Next Frontier in Patient Care," they focus on patient adherence – or rather the lack thereof. </span><span style="color: black;">There is growing recognition that non-adherence to prescribed treatment is a major public health issue. In the US, it is estimated that additional care for non-adherent patients results in more than $300 billion of unnecessary costs to the healthcare industry each year.</span></div><div style="text-align: justify;"><span style="color: black;">For pharmaceutical companies, improvement in patient adherence represents a significant revenue opportunity that is largely untapped today. In this report, they analyze the current state of patient adherence and the challenges and key success factors involved in improving it.</span></div><br />
<div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-Nbmt6lqtYK4/Ti3FGwSoLkI/AAAAAAAAAEQ/B3FoCGNFxYA/s1600/capgemini.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="http://1.bp.blogspot.com/-Nbmt6lqtYK4/Ti3FGwSoLkI/AAAAAAAAAEQ/B3FoCGNFxYA/s320/capgemini.png" width="223" /></a></div><br />
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<a href="http://www.capgemini.com/services-and-solutions/by-industry/life-sciences/vision-and-reality/"><span style="color: #3d85c6;">To read the full report please click here.</span></a>Tamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.com1tag:blogger.com,1999:blog-8498074415733208564.post-67077555506645431922011-07-12T21:38:00.000+02:002011-07-12T21:38:46.102+02:00High tech tools: enhancing adherence with a car<span style="color: black;">Ford and WellDoc have collaborated on in-car accessibility to WellDoc's comprehensive cloud-based personalized solutions for those with asthma and diabetes through SYNC Services providing real-time patient coaching, behavioral education and medication adherence support based on their historic and current disease information.</span><br />
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<div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/HKS0Fhxg6gA?feature=player_embedded' frameborder='0'></iframe></div><div class="separator" style="clear: both; text-align: center;"><br />
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</div><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/UImjhHbi4lw?feature=player_embedded' frameborder='0'></iframe></div>Tamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.com1tag:blogger.com,1999:blog-8498074415733208564.post-77168776492581351062011-06-26T14:41:00.001+02:002011-06-26T14:42:05.233+02:00Forms of medication non-adherence<span style="color: black;">The following is a brief overview of the different forms of medication non-adherence.</span><br />
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<span style="color: black;">Primary non-adherence: </span><br />
<ul><li><span style="color: black;">failure to fill prescriptions.</span></li>
</ul><span style="color: black;">Since primary adherence is based on refill rates, it represents the maximum possible level of adherence. Thus, it may overestimate the patient's drug taking behaviour.</span><br />
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<div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-xm_l8gUDArU/Tgck6QCiCfI/AAAAAAAAADk/iOfMXPpdpjo/s1600/drug_advertising_comics_1.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="color: black;"><img border="0" height="143" i$="true" src="http://3.bp.blogspot.com/-xm_l8gUDArU/Tgck6QCiCfI/AAAAAAAAADk/iOfMXPpdpjo/s400/drug_advertising_comics_1.bmp" width="400" /></span></a></div><br />
<span style="color: black;">Secondary non-adherence:</span><br />
<ul><li><span style="color: black;">overuse,</span></li>
<li><span style="color: black;">underuse,</span></li>
<li><span style="color: black;">alteration of schedules or doses,</span></li>
<li><span style="color: black;">premature discontinuation of drug therapy.</span></li>
</ul><span style="color: black;">Non-adherence not only mean underuse of the prescribed medication, symptom-relieving drugs such as short term bronchodilators are often overused. </span>Tamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.com1tag:blogger.com,1999:blog-8498074415733208564.post-58775363166499544032011-05-15T20:59:00.000+02:002011-06-15T21:01:45.906+02:00A Droid based Medication Adherence Screening Tool<div class="separator" style="clear: both; text-align: justify;"><span style="color: black;">Medication Adherence Individual Review-Screening Tool (MedAdhIR) is a reliable and valid instrument for screening adherence and now it is available for android too. </span></div><div class="separator" style="clear: both; text-align: center;"><br />
</div><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/4VgNU5aRiIE?feature=player_embedded' frameborder='0'></iframe></div>Tamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.com0tag:blogger.com,1999:blog-8498074415733208564.post-44728191272408135782011-04-26T07:41:00.001+02:002011-04-26T10:03:30.434+02:00Novartis invested 50 billion in “smart-pill” technology<div style="line-height: 115%; text-align: justify;"><span style="color: black;"><span lang="EN-US"><span style="font-family: Arial,Helvetica,sans-serif;">According to a report in the </span><a href="http://www.economist.com/node/15276730?story_id=E1_TVNSGSPD&CFID=169257335&CFTOKEN=3507953"><span style="color: #0b5394; font-family: Arial,Helvetica,sans-serif;">Economist</span></a><span style="font-family: Arial,Helvetica,sans-serif;">, </span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="border: 1pt none windowtext; padding: 0cm;">NOVARTIS, the Swiss pharmaceuticals giant invested </span>$50 billion in Alcon (<span style="border: 1pt none windowtext; padding: 0cm;">an American eye-care firm)</span> and <span style="border: 1pt none windowtext; padding: 0cm;">spent </span>$24m to secure exclusive licences and options on drug-delivery technologies developed by </span><a href="http://nonadherence.blogspot.com/2011/01/chip-in-pill.html"><span style="color: #0b5394; font-family: Arial,Helvetica,sans-serif;">Proteus</span></a><span style="font-family: Arial,Helvetica,sans-serif;"> Biomedical. It made Novartis the biggest pharmaceuticals firm to embrace “smart-pill” technology.</span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-DnwL3q5Xh-0/TUCH6wthXLI/AAAAAAAAACk/BoCe9UzW_hA/s1600/protesu+pill.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="213" i8="true" src="http://3.bp.blogspot.com/-DnwL3q5Xh-0/TUCH6wthXLI/AAAAAAAAACk/BoCe9UzW_hA/s320/protesu+pill.jpg" width="320" /></a></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; line-height: 115%;"><span style="color: black;"><span style="font-family: Arial,Helvetica,sans-serif;">Reasons for the deal:</span></span></span></div><ul type="disc"><li class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; line-height: 115%;"><span style="color: black;"><span style="font-family: Arial,Helvetica,sans-serif;">Proteus’ technology points to “a promising new strategy” for a “troubled” industry.</span></span></span></li>
<li class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; line-height: 115%;"><span style="color: black;"><span style="font-family: Arial,Helvetica,sans-serif;">Patents on many lucrative drugs are set to expire soon and most pharma companies have not discovered enough treatments to replace them.</span></span></span></li>
<li class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; line-height: 115%;"><span style="color: black;"><span style="font-family: Arial,Helvetica,sans-serif;">With an eye toward maintaining fiscal stability, some drugmakers are tinkering with the idea of selling ancillary services tied to their offerings — like Proteus’ advanced medication adherence.</span></span></span></li>
<li class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; line-height: 115%;"><span style="color: black;"><span style="font-family: Arial,Helvetica,sans-serif;">Medication adherence is a huge problem: One study pinpoints the costs of medication adherence-related, needless hospitalizations at costing $100 billion each year in the U.S.</span></span></span></li>
<li class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; line-height: 115%;"><span style="color: black; font-family: Arial,Helvetica,sans-serif;">Leslie Saxon, chief of cardiology at the University of Southern California, thinks patients will clamor for more data about their own health.</span></span></li>
<span lang="EN-US" style="font-family: "Times New Roman","serif"; line-height: 115%;">
<li class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; line-height: 115%;"><span style="color: black; font-family: Arial,Helvetica,sans-serif;">Governments, including the U.S., are beginning require drugmakers to first prove the efficacy of expensive new pills in practice as well as in theory, which might drive more of them to use technology like Proteus.</span></span></li>
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</div><span lang="EN-US" style="font-family: "Times New Roman","serif"; line-height: 115%;"><div style="line-height: 115%; text-align: justify;"><span lang="EN-US"><span style="color: black; font-family: Arial,Helvetica,sans-serif;">The Economist report also includes a metric from research from Kalorama, which predicts that sales of wireless health services will leap from $4.3 billion last year to $9.6 billion by 2012.</span></span></div><div style="line-height: 115%; text-align: justify;"><br />
</div><div style="line-height: 115%; text-align: justify;"><span lang="EN-US"><span style="color: black;"><span style="color: black; font-family: "Times New Roman","serif"; line-height: 115%;"><span style="font-family: Arial,Helvetica,sans-serif;">The above story is reprinted from materials provided by:<span style="color: #3d85c6;"> </span></span><a href="http://www.economist.com/"><span style="color: #0b5394; font-family: Arial,Helvetica,sans-serif;">www.economist.com</span></a><span style="font-family: Arial,Helvetica,sans-serif;"> , </span><a href="http://mobilhealthnews.com/"><span style="color: #0b5394; font-family: Arial,Helvetica,sans-serif;">mobilhealthnews.com</span></a><span style="font-family: Arial,Helvetica,sans-serif;"> .</span></span></span></span></div></span><br />
<ul type="disc"></ul>Tamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.com0tag:blogger.com,1999:blog-8498074415733208564.post-35698266423938165872011-04-21T21:53:00.004+02:002011-04-21T22:08:27.481+02:00Pfizer wins the compliance enhancing packaging design's award in 2011<div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span class="inline11"><span style="line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-latin;"><span style="color: black; font-family: Arial, Helvetica, sans-serif;">Pfizer Manufacturing Deutschland GmbH is awarded the HCPC Alliance Columbus trophy for compliance enhancing packaging design 2011.</span></span></span></div><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-klGq9oGZJnk/TbCJwLNBm9I/AAAAAAAAADc/qqUvsrMnuKQ/s1600/untitled.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="color: black; font-family: Arial, Helvetica, sans-serif;"><img border="0" height="320" i8="true" src="http://3.bp.blogspot.com/-klGq9oGZJnk/TbCJwLNBm9I/AAAAAAAAADc/qqUvsrMnuKQ/s320/untitled.bmp" width="215" /></span></a></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span class="inline11"><span style="line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="color: black; font-family: Arial, Helvetica, sans-serif;"> </span></span></span></span><span style="line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-latin;"><br />
</span><span class="inline11"><span style="line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="color: black; font-family: Arial, Helvetica, sans-serif;">At Fleming Europe's Pharma packaging & labelling compliance conference 2011, which took place in Barcelona on March 23rd and 24th, the HCPC Alliance¹ presented for the first time the Columbus Award for compliance enhancing packaging design. Innovative packaging solutions with elements to help patients to take their medications as prescribed were presented and the Columbus Award was given to the solution that, according to the jury, offered the most comprehensive support.</span></span></span></div><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/--ORJ_ae4iZA/TbCJ6QDo9MI/AAAAAAAAADg/CrTGjQwC9Sg/s1600/Pfizer2_n.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="color: black; font-family: Arial, Helvetica, sans-serif;"><img border="0" height="124" i8="true" src="http://2.bp.blogspot.com/--ORJ_ae4iZA/TbCJ6QDo9MI/AAAAAAAAADg/CrTGjQwC9Sg/s320/Pfizer2_n.jpg" width="320" /></span></a></div><span style="line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"></span><span style="font-family: Arial, Helvetica, sans-serif;"><span style="line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"> </span> </span><br />
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<span class="inline11"><span style="color: black; font-family: Arial, Helvetica, sans-serif;">The Champix/Chantix wallet packaging portfolio, from Pfizer Manufacturing Deutschland GmbH is an answer to the question how to enhance compliance for products marketed on a global scale by customized packaging solutions. It provides a multi-dimensional solution for the essential product medication scheme, regional packaging requirements but also important prescription and reimbursement regulations. </span></span></div><span style="color: black; font-family: Arial, Helvetica, sans-serif;"></span><br />
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<span class="inline11"><span style="color: black; font-family: Arial, Helvetica, sans-serif;">Compliance delivered through an innovative packaging platform is a critical success factor due to the treatment regime: </span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span class="inline11"><span style="line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="color: black; font-family: Arial, Helvetica, sans-serif;">• Patients needs to set a date to stop smoking</span></span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span class="inline11"><span style="line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="color: black; font-family: Arial, Helvetica, sans-serif;">• Begin of treatment one week before that date</span></span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span class="inline11"><span style="line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="color: black; font-family: Arial, Helvetica, sans-serif;">• Titration dose (day 1-3 0,5 mg once a day, day 4-7 0,5 mg twice a day, continuing weeks 1 mg twice daily for a total of 12 weeks).</span></span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><span class="inline11"><span style="font-family: Arial, Helvetica, sans-serif; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"></span></span><br />
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</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="color: black; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">The above story is reprinted from materials provided by </span><a href="http://www.hcpc-europe.net/"><span style="font-family: Arial, Helvetica, sans-serif;">http://www.hcpc-europe.net/</span></a><span style="font-family: Arial, Helvetica, sans-serif;">.</span></span><span style="line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"></div>Tamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.com0tag:blogger.com,1999:blog-8498074415733208564.post-40094540780638939872011-04-10T22:28:00.002+02:002011-04-10T22:32:55.093+02:00Factors associated with adherence in patients with COPD<span style="color: black;">I'm pleased to inform you that my article "</span><a href="http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ArtikelNr=324453&Ausgabe=0&ProduktNr=224278"><span style="color: #3d85c6;">Factors Associated with Medication Adherence in Patients with Chronic Obstructive Pulmonary Disease</span></a><span style="color: #3d85c6;">"</span> <span style="color: black;">has been e-published by Respiration.</span><br />
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<h1 class="title"><span style="color: black; font-size: small;">Factors Associated with Medication Adherence in Patients with Chronic Obstructive Pulmonary Disease.</span></h1><div class="auth_list"><a _sg="true" href="http://www.blogger.com/pubmed?term=%22Agh%20T%22%5BAuthor%5D"><span style="color: black;">Agh T</span></a><span style="color: black;">, </span><a _sg="true" href="http://www.blogger.com/pubmed?term=%22Inotai%20A%22%5BAuthor%5D"><span style="color: black;">Inotai A</span></a><span style="color: black;">, </span><a _sg="true" href="http://www.blogger.com/pubmed?term=%22Meszaros%20A%22%5BAuthor%5D"><span style="color: black;">Meszaros A</span></a><span style="color: black;">.</span></div><div class="aff"><span style="color: black;">University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary.</span></div><div class="abstract_text"><h3 class="abstract_label"><span style="color: black; font-size: small;">Abstract</span></h3><div style="text-align: justify;"><span style="color: black;">Background: Predictors of medication adherence are not well known in chronic obstructive pulmonary disease (COPD). It is therefore necessary to identify factors associated with adherence to improve the effectiveness of COPD management within real-world situations. Objectives: The goals of this study were to estimate adherence to respiratory medication and to identify factors related to adherence in COPD patients. Methods: This was an observational, cross-sectional study conducted on a sample of COPD outpatients. The following information was obtained: adherence to respiratory therapy (Morisky Medication Adherence Scale), age, gender, smoking status, COPD severity [Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage], lung function [post-bronchodilator forced expiratory volume in 1 s (FEV(1))], treatment regimen for COPD, COPD medication costs per month paid by the patient and health-related quality of life (EuroQol 5-dimension questionnaire). A multivariate logistic regression analysis was performed to identify the independent predictors of adherence. Results: Of the 170 participants (mean age 63.8 years, 41.8% male), 58.2% reported optimal adherence. Adherence to respiratory therapy was associated with age, current smoking status, number of respiratory drugs, number of daily respiratory drug doses and quality of life (p < 0.005). Adherence to respiratory therapy was not related to gender, GOLD stage, FEV(1) or COPD medication costs. Conclusions: Adherence to COPD medication regimens is poor. Less frequent dosing regimens could be an effective method to enhance adherence to respiratory therapy. Quality-of-life monitoring within clinical practice settings could facilitate improved medication adherence.</span></div><span style="color: black;">Copyright © 2011 S. Karger AG, Basel.</span></div><div class="rprtid"><span class="pmid" style="color: black;">PMID: 21454953 [PubMed - as supplied by publisher]</span></div>Tamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.com0tag:blogger.com,1999:blog-8498074415733208564.post-13130186624031198492011-03-16T21:23:00.003+01:002011-03-17T13:54:32.886+01:00Association between ethnicity and medication adherence<span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"></span><br />
<div style="text-align: justify;"><span style="color: black;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; line-height: 150%;">Medication adherence is a multidimensional phenomenon. It </span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: Calibri;">is occurred for a variety of reasons</span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; line-height: 150%;">, such as disease-related, treatment-related and socio-economic factors etc.. But what about ethnicity? Is ethnicity related with adherence? Little is known about the association between these factors, however it would be important <span lang="EN-GB" style="font-family: "Times New Roman", "serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US;">to identify factors related to adherence </span></span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: Calibri;">in order to develop more effective strategies that can improve</span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; line-height: 150%; mso-fareast-font-family: AdvTrebu-R;"> medication-taking behavior</span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; line-height: 150%;">. E.g. What about ethnic-specific approaches, are these needed to improve adherence?</span></span></div><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://lh5.googleusercontent.com/-2QjGLPxYCgU/TYEaqoKVivI/AAAAAAAAADY/KPnuitvT240/s1600/wda1787l.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="color: black;"><img border="0" height="320" r6="true" src="https://lh5.googleusercontent.com/-2QjGLPxYCgU/TYEaqoKVivI/AAAAAAAAADY/KPnuitvT240/s320/wda1787l.jpg" width="316" /></span></a></div><div class="separator" style="clear: both; text-align: center;"><br />
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<h1 style="background: white; margin: auto 0cm;"><span style="font-size: 12pt; font-weight: normal;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/21309834"><span style="color: #3d85c6;">Factors associated with medication adherence to oral hypoglycaemic agents in different ethnic groups suffering from type 2 diabetes: a systematic literature review and suggestions for further research.</span></a></span></h1><div class="authlist" style="background: white; line-height: 21.6pt; margin: auto 0cm;"><a _sg="true" href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Peeters%20B%22%5BAuthor%5D"><span style="color: windowtext; text-decoration: none; text-underline: none;"><span style="color: black;">Peeters B</span></span></a><span style="color: black;">, </span><a _sg="true" href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Van%20Tongelen%20I%22%5BAuthor%5D"><span style="color: windowtext; text-decoration: none; text-underline: none;"><span style="color: black;">Van Tongelen I</span></span></a><span style="color: black;">, </span><a _sg="true" href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Boussery%20K%22%5BAuthor%5D"><span style="color: windowtext; text-decoration: none; text-underline: none;"><span style="color: black;">Boussery K</span></span></a><span style="color: black;">, </span><a _sg="true" href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Mehuys%20E%22%5BAuthor%5D"><span style="color: windowtext; text-decoration: none; text-underline: none;"><span style="color: black;">Mehuys E</span></span></a><span style="color: black;">, </span><a _sg="true" href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Remon%20JP%22%5BAuthor%5D"><span style="color: windowtext; text-decoration: none; text-underline: none;"><span style="color: black;">Remon JP</span></span></a><span style="color: black;">, </span><a _sg="true" href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Willems%20S%22%5BAuthor%5D"><span style="color: windowtext; text-decoration: none; text-underline: none;"><span style="color: black;">Willems S</span></span></a><span style="color: black;">.</span></div><div class="MsoNormal" style="background: white; line-height: 21.6pt; margin: 0cm 0cm 0pt; text-align: justify;"><span style="color: black;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;">AIMS: </span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;">To synthesize knowledge regarding the different factors that may influence adherence to oral hypoglycaemic agents in different ethnic groups through a systematic review of the literature.</span></span></div><div class="MsoNormal" style="background: white; line-height: 21.6pt; margin: 0cm 0cm 0pt; text-align: justify;"><span style="color: black;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;">METHODS: </span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;">Thirteen databases were searched and 1201 articles were screened by two authors independently from each other. Different quantitative study designs were included if the study population included at least one ethnic group other than White people, medication adherence was a dependent variable and a clear description was given of the method used to measure medication adherence.</span></span></div><div class="MsoNormal" style="background: white; line-height: 21.6pt; margin: 0cm 0cm 0pt; text-align: justify;"><span style="color: black;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;">RESULTS: </span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;">Demographic, disease-related and treatment-related, socio-economic and cultural factors were associated with medication adherence in the populations that were studied. However, to synthesize results, the number of studies was too small and the included studies differed too much with respect to their study designs and the ethnic groups that were studied. We discuss several methodological challenges with respect to measuring medication adherence, measuring ethnicity and study designs that need to be resolved to make future studies comparable. We propose methodological improvements for future research.</span></span></div><div class="MsoNormal" style="background: white; line-height: 21.6pt; margin: 0cm 0cm 10pt; text-align: justify;"><span style="color: black;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;">CONCLUSION: </span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;">Although medication adherence is an essential part of the diabetic regimen, little is known about the association between ethnicity and medication adherence and the underlying factors that could explain this association. More research is needed in which important methodological challenges will have to be faced.</span></span></div>Tamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.com0tag:blogger.com,1999:blog-8498074415733208564.post-65554816464842434122011-03-07T22:07:00.001+01:002011-03-07T22:08:41.085+01:00New medical package offering improved opportunities for real-time adherence control - Stora Enso Pharma DDSi Wireless<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 10pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="color: black;"><span lang="EN" style="color: black; font-family: "Times New Roman", "serif"; font-size: 12pt; mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;">Healthcare efficiency and patient treatment will take a major step forward when the new <span style="mso-bidi-font-style: italic;">Stora Enso Pharma DDSi Wireless</span> is made available to the healthcare and pharmaceutical industry at the <a href="http://www.canontradeshows.com/expo/pharmafr10/"><span style="color: #3d85c6;">Pharmapack</span></a> 2011 exhibition and conference in Paris on 23-24 February 2011. </span><span lang="EN" style="color: black; font-family: "Times New Roman", "serif"; font-size: 12pt; mso-ansi-language: EN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;"></span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 10pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span lang="EN" style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-ansi-language: EN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;"><span style="color: black;">The <span style="mso-bidi-font-style: italic;">Stora Enso Pharma DDSi Wireles<span style="mso-bidi-font-weight: bold;">s </span></span>package is based on conductive ink on a carton board based blister inlay, which is connected to a cellular module embedded in the package. This enables the tracking of one pill at the time on removal from the blister, whereby data is sent to the cellular module and then forwarded wirelessly, even instantaneously if required, using GSM or GPRS cellular networks, to electronic health record systems. This allows real-time tracking and intervention by a physician and also enables physicians to make timely changes to patients' medication. </span></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://lh3.googleusercontent.com/-PlfT7h1-dSo/TXVGUsn32lI/AAAAAAAAADU/wNaelmiQnGs/s1600/110208CB02_of.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="color: black;"><img border="0" height="213" q6="true" src="https://lh3.googleusercontent.com/-PlfT7h1-dSo/TXVGUsn32lI/AAAAAAAAADU/wNaelmiQnGs/s320/110208CB02_of.jpg" width="320" /></span></a></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 10pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 10pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span lang="EN" style="color: black; font-family: "Times New Roman", "serif"; font-size: 12pt; mso-ansi-language: EN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;"><span style="color: black;">The blister inlay connected to the cellular module in the Pharma DDSi Wireless is made of environment-friendly, recyclable carton board with no metal components. The cellular module is equipped with a chargeable battery enabling up to several months of lifetime without recharging.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 10pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span lang="EN" style="color: black; font-family: "Times New Roman", "serif"; font-size: 12pt; mso-ansi-language: EN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;"><span style="color: black;">The principal benefits derive from the numerous possibilities that this solution provides to healthcare service providers: sending voice-call reminders or text messages (SMS) to patients, or making personal visits when important prescribed medication has not been taken in time. Patients can also elect to have the data provided to relatives, pharmacists, physicians and healthcare providers so that they can treat the patient more effectively and intervene if treatment changes are required.</span></span></div><div class="separator" style="clear: both; text-align: center;"><br />
</div><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/tE7nPGEmWAY?feature=player_embedded' frameborder='0'></iframe></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 10pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 10pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="color: black; font-family: "Times New Roman", "serif"; font-size: 12pt;"><span style="color: black;">The above story is reprinted from materials provided by</span><span style="color: #3d85c6;"> </span></span><span lang="EN" style="color: black; font-family: "Times New Roman", "serif"; font-size: 12pt; mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU; mso-font-kerning: 18.0pt;"><a href="http://www.storaenso.com/media-centre/product-news/2011/02/Pages/stora-enso-pharma-ddsi-wireless-en.aspx"><span style="color: #3d85c6;">Stora Enso Pharma</span></a>.</span><span lang="EN" style="color: black; font-family: "Times New Roman", "serif"; font-size: 12pt; mso-ansi-language: EN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;"></span></div>Tamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.com0tag:blogger.com,1999:blog-8498074415733208564.post-25372144561068911732011-02-28T21:20:00.000+01:002011-02-28T21:20:20.304+01:00Integral medicine<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-ansi-language: EN-US;"><span style="color: black;">Integral medicine /AQAL- All Quadrants All Levels/ observes medicine from four different dimensions: intentional, behavioral, social, and cultural. The integral medicine that is rapidly developing today is more than ”holistic” medicine. It integrates both ”conventional” medicine and ”alternative” medicine. Conventional medicine treats the illness and alternative medicine treats the person; but integral medicine goes one step further: it treats the illness, the person, and the physician. Integral medicine is a way to help patients more effectively and efficiently; but it is first a way to help the health-care professional handle pressing problems, such as compliance.</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none; text-align: justify;"><br />
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</div><div class="separator" style="clear: both; text-align: center;"><a href="https://lh3.googleusercontent.com/-UpDLfg5d6U4/TWwBCcWxaRI/AAAAAAAAADQ/ZHqtTP_cer0/s1600/integral_health_care400.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="color: black;"><img border="0" height="214" l6="true" src="https://lh3.googleusercontent.com/-UpDLfg5d6U4/TWwBCcWxaRI/AAAAAAAAADQ/ZHqtTP_cer0/s320/integral_health_care400.jpg" width="320" /></span></a></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none; text-align: justify;"><br />
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</div><div style="text-align: justify;"><span style="color: black;"><span lang="EN-US" style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">„An integrally informed medical practice changes the practitioner first; he or she can then decide which of the treatments-</span><span lang="EN-US" style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">conventional, alternative, complementary, and/or holistic-that he or she wishes to utilize when practicing medicine with integrity. It may include adding new treatments, conventional and alternative; or more conscientiously referring patients to otherquadrant practitioners when an integral diagnosis so indicates. The only item that is constant in all of those is the transformed practitioner. It is the physician who is healed and wholed first, not merely by learning new and complementary techniques, but by inhabiting a new consciousness that makes room for new techniques; and how that integrity then expresses itself in an integrally informed medical practice might vary considerably.” <a href="http://en.wikipedia.org/wiki/Ken_Wilber"><span style="color: #3d85c6;">Ken Wilber</span></a> /developer of the AQAL approach/.</span></span></div>Tamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.com0tag:blogger.com,1999:blog-8498074415733208564.post-86565683185085150992011-02-10T21:35:00.001+01:002011-02-10T21:36:22.294+01:00Compliance-enhancing interventions<div class="NormlSorkizrt" style="margin: 0cm 0cm 0pt; mso-line-height-alt: 5.0pt; text-align: justify;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><span style="color: black;">Many studies have been published about strategies to improve compliance. Seventy-six compliance interventions were evaluated in the systematic review by Petrilla and Benner. </span></span></div><div class="NormlSorkizrt" style="margin: 0cm 0cm 0pt; mso-line-height-alt: 5.0pt; text-align: justify;"><br />
</div><div class="NormlSorkizrt" style="margin: 0cm 0cm 0pt; mso-line-height-alt: 5.0pt; text-align: justify;"><span style="color: black;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">They </span><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-fareast-font-family: Arial;">divided the compliance-enhancing interventions in the following categories:</span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; text-autospace: ideograph-numeric; text-indent: -18pt;"><span style="color: black;"><span lang="EN-GB" style="font-family: Symbol; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-family: "Times New Roman";"> </span></span></span><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-fareast-font-family: Arial;">coordination of healthcare: improved linkages between primary care physicians, clinicians and other health professionals;</span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; text-autospace: ideograph-numeric; text-indent: -18pt;"><span style="color: black;"><span lang="EN-GB" style="font-family: Symbol; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-family: "Times New Roman";"> </span></span></span><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-fareast-font-family: Arial;">live consultation and education;</span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; text-autospace: ideograph-numeric; text-indent: -18pt;"><span style="color: black;"><span lang="EN-GB" style="font-family: Symbol; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-family: "Times New Roman";"> </span></span></span><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-fareast-font-family: Arial;">the changes of the therapy dose, dosage and packaging for the convenient drug taking;</span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; text-autospace: ideograph-numeric; text-indent: -18pt;"><span style="color: black;"><span lang="EN-GB" style="font-family: Symbol; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-family: "Times New Roman";"> </span></span></span><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-fareast-font-family: Arial;">patient education materials;</span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; text-autospace: ideograph-numeric; text-indent: -18pt;"><span style="color: black;"><span lang="EN-GB" style="font-family: Symbol; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-family: "Times New Roman";"> </span></span></span><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-fareast-font-family: Arial;">disease management programs by clinicians;</span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; text-autospace: ideograph-numeric; text-indent: -18pt;"><span style="color: black;"><span lang="EN-GB" style="font-family: Symbol; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-family: "Times New Roman";"> </span></span></span><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-fareast-font-family: Arial;">reminders: medication refill reminders delivered by mail or telephone;</span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; text-autospace: ideograph-numeric; text-indent: -18pt;"><span style="color: black;"><span lang="EN-GB" style="font-family: Symbol; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-family: "Times New Roman";"> </span></span></span><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-fareast-font-family: Arial;">self-monitoring;</span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; text-autospace: ideograph-numeric; text-indent: -18pt;"><span style="color: black;"><span lang="EN-GB" style="font-family: Symbol; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-family: "Times New Roman";"> </span></span></span><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-fareast-font-family: Arial;">social support programs;</span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; text-autospace: ideograph-numeric; text-indent: -18pt;"><span style="color: black;"><span lang="EN-GB" style="font-family: Symbol; mso-ansi-language: EN-GB; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-family: "Times New Roman";"> </span></span></span><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-fareast-font-family: Arial;">and the combination of these interventions.</span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; text-autospace: ideograph-numeric; text-indent: -18pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-line-height-alt: 5.0pt; text-align: justify;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-fareast-font-family: Arial;"><span style="color: black;">Common attributes of successful programs included simplified treatment regimens, facilitation of doctor-patient relationships, and patient education methods, clear up from their review.</span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-line-height-alt: 5.0pt; text-align: justify;"><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-8VojLLnR7D4/TVRIzPtYtwI/AAAAAAAAADM/uA1retWqKAw/s1600/cartoon.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" h5="true" height="303" src="http://2.bp.blogspot.com/-8VojLLnR7D4/TVRIzPtYtwI/AAAAAAAAADM/uA1retWqKAw/s320/cartoon.jpg" width="320" /></a></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-line-height-alt: 5.0pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="color: black;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Effective treatment need a good clinician-patient relationship. Spending time on patient education and answering patient's questions is worth the time. Patients should be educated about the most important features and complications of their disease. Compliance </span>may<span lang="EN-GB" style="mso-ansi-language: EN-GB;"> be enhanced, if the medical check-up and the therapy is known by the patient. </span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="color: black;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;"></span></span><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-fareast-font-family: Arial;"></span></div><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><span style="font-size: 10pt;"></span></span><br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-GB" style="font-size: 10pt; mso-ansi-language: EN-GB;"><span style="color: black;"><span style="font-family: Times, "Times New Roman", serif;">Reference:</span></span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-GB" style="font-size: 10pt; mso-ansi-language: EN-GB;"><span style="color: black;"><span style="font-family: Times, "Times New Roman", serif;">Petrilla, A.A., Benner, J.S.: Critical evaluation of interventions to enhance patient compliance with chronic medications. Value in Health, 2003, 6, 200.</span></span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"></div><div align="justify" class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"></div>Tamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.com0tag:blogger.com,1999:blog-8498074415733208564.post-16319668954382471162011-02-06T14:14:00.001+01:002011-02-06T14:15:34.018+01:00Electronic pillbox for the Baby Boomer Generation<div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/_56US_7jsR8Y/TU6dbGf4ZeI/AAAAAAAAADI/qNVOSdsI3IU/s1600/medfolio.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" h5="true" height="212" src="http://3.bp.blogspot.com/_56US_7jsR8Y/TU6dbGf4ZeI/AAAAAAAAADI/qNVOSdsI3IU/s320/medfolio.jpg" width="320" /></a></div><div style="text-align: justify;"></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><span lang="EN" style="font-family: "Times New Roman", "serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><a href="http://www.medfoliopillbox.com/"><span style="background-color: white; color: #3d85c6;">MedFolio</span></a> <span style="color: black;">developed a new innovative pillbox. </span></span></div><div style="text-align: justify;"><span lang="EN" style="font-family: "Times New Roman", "serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"></span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="color: black;">The features of the MedFolio device address the needs of patients, caregivers, and their healthcare providers. The unique built-in pill identification system is a portfolio of every medication stored in the device, thereby giving the patient/caregiver the confidence to engage in medication discussions with their healthcare providers. In order to help patients in remembering to take the “right dose at the right time”, advanced medication reminder systems have been incorporated into the device. The device connects to a personal computer by USB and installed software allows the patient/caregiver to easily customize the device to their specific medication regimens and dosing times. The medication information stored into the memory of the device will initiate audio alert and visual lighting reminders from the device. Additionally, the software program will communicate with a secure website to offer the option of receiving electronic messaging reminders (e-mail and text message) for each scheduled medication dosing time.</span></span></div><div style="text-align: justify;"><br />
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</div><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/lfUni2Ldt1g?feature=player_embedded' frameborder='0'></iframe></div><div style="text-align: justify;"><br />
</div>Tamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.com0tag:blogger.com,1999:blog-8498074415733208564.post-76472961223047490142011-02-01T16:52:00.003+01:002011-02-01T19:42:54.728+01:00Gaps between patients and physicians understanding of osteoporosis<span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="color: black;">The survey findings </span><a href="http://www.springerlink.com/content/q7878758w8128834/"><span style="color: #3d85c6;">‘The gaps between patient and physician understanding of the emotional and physical impact of osteoporosis’</span></a><span style="color: black;"> have been published in Archives of Osteoporosis.</span></span><br />
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<div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/_56US_7jsR8Y/TUggBzPuLEI/AAAAAAAAACw/9pBVAHSrse4/s1600/osteoporsis2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" s5="true" src="http://3.bp.blogspot.com/_56US_7jsR8Y/TUggBzPuLEI/AAAAAAAAACw/9pBVAHSrse4/s1600/osteoporsis2.jpg" /></a></div><div class="separator" style="clear: both; text-align: center;"><br />
</div><div style="text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="color: black;">This multinational survey conducted on behalf of the <span style="color: windowtext; text-decoration: none; text-underline: none;"><a href="http://www.iofbonehealth.org/"><span style="color: #3d85c6;">International Osteoporosis Foundation</span></a> (IOF)</span> show clear disparities between patients’ and doctors’ perceptions of osteoporosis and its management.</span></span></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="color: black;">The 13-country survey of 844 postmenopausal patients over 55 years of age and 837 doctors investigated gaps between patient and doctor understanding of the emotional and physical impact of osteoporosis; identified barriers to patient adherence; and sought to understand the ways in which osteoporotic patients can better share and obtain information about the management of the disease.</span></span></span></div><div style="text-align: justify;"><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/_56US_7jsR8Y/TUggTsIavTI/AAAAAAAAAC0/p-F8-9JiPQ4/s1600/osteoporosis3.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="180" s5="true" src="http://2.bp.blogspot.com/_56US_7jsR8Y/TUggTsIavTI/AAAAAAAAAC0/p-F8-9JiPQ4/s200/osteoporosis3.jpg" width="200" /></a></div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; text-align: justify;"><a href="http://2.bp.blogspot.com/_56US_7jsR8Y/TUggTsIavTI/AAAAAAAAAC0/p-F8-9JiPQ4/s1600/osteoporosis3.jpg" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="color: black;"></span></a><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><strong><span style="color: black;">Key findings showed:</span></strong></span></span></div><ul><li><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"></span></span><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="color: black;">Patients are not as well informed as they believe themselves to be</span></span></span></span></div></li>
<li><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"></span></span></span><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="color: black;">Patients fear fractures and worry about their quality of life, but do not always adhere to treatment</span></span></span></span></span></div></li>
<li><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"></span></span></span></span><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="color: black;">Doctors consistently underestimate their patients adherence to treatment</span></span></span></span></span></span></div></li>
<li><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"></span></span></span></span></span><span style="color: black;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">Doctors underestimate patients’ concerns about fracture, the impact of osteoporosis on their quality of life and fear of dependency.</span></span></span></span></span></span> </span></div></li>
</ul><div style="text-align: justify;"><span style="color: black;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">Adherence and persistence to osteoporosis therapy is a serious problem, with studies showing that fewer than 50% of patients still take their prescribed medication after 1 year. This can be attributed to underestimation of personal risk, uncertainty of benefits versus risks of treatment, side-effects, and a belief in the efficacy of lifestyle measures alone. Patients who drop their prescribed treatment unknowingly leave themselves at high risk of fracture.</span></span></span></span></span></span></span></span></div><div style="text-align: justify;"><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/_56US_7jsR8Y/TUgg5StTgrI/AAAAAAAAAC4/uQFObGkD0WY/s1600/osteoporosis4.jpg" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="color: black;"><img border="0" s5="true" src="http://1.bp.blogspot.com/_56US_7jsR8Y/TUgg5StTgrI/AAAAAAAAAC4/uQFObGkD0WY/s1600/osteoporosis4.jpg" /></span></a></div><div style="text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="color: black;">The survey also showed the willingness of doctors to support initiatives that would improve patient adherence to treatment: 80% of doctors surveyed would be willing to hand out educational materials to increase adherence and 76% would recommend patient programmes that encourage better communication on osteoporosis management.</span></span></span></span></span></span></span></span></span></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;"><span style="color: black;">"As this survey revealed, patient and doctor misconceptions exist on a number of levels," noted IOF CEO Patrice McKenney. "Community-based online support programmes have a great potential to fill these information gaps. They can help patients share their concerns, improve patient-doctor dialogue, allow patient-to-patient contact, encourage long-term adherence to prescribed treatment and help patients to maintain or improve quality of life."</span></span></span></span></span></span></span></span></span></span></div><div style="text-align: justify;"><br />
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</div><div style="text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;"><span style="color: black;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;">The International Osteoporosis Foundation, in cooperation with national </span><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="color: windowtext; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU; text-decoration: none; text-underline: none;">osteoporosis</span></span><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;"> societies in four pilot countries (Austria, Germany, Sweden and Switzerland), is currently developing a novel community-based platform called '<a href="http://www.iofbonehealth.org/about-iof/iof-programs/outreach-education/osteolink.html"><span style="color: #3d85c6;">OsteoLink</span></a>'. 'OsteoLink' aims to improve communications and facilitate dialogue among patients and between patients and doctors, providing personal networking opportunities and new tools that respond to current unmet needs.</span></span></span></span></span></span></span></span></span></span></span></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;"><span style="color: black;">The above story is reprinted from materials provided by International Osteoporosis Foundation (</span><a href="http://www.iofbonehealth.org/news/news-detail.html?newsID=394"><span style="color: #3d85c6;">http://www.iofbonehealth.org/news/news-detail.html?newsID=394</span></a><span style="color: black;">).</span></span></span></span></span></span></span></span></span></span></span></span></div>Tamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.com0tag:blogger.com,1999:blog-8498074415733208564.post-67310215519036374342011-01-26T22:04:00.010+01:002011-01-27T09:39:26.306+01:00Chip in the pill<div style="text-align: justify;"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt; line-height: 115%;"><span style="color: black;">Next-generation pills are being developed by scientists, the <a href="http://www.latimes.com/health/la-he-future-pills-20110110,0,5506221,full.story">Los Angeles Times</a> and the <a href="http://www.ft.com/cms/s/0/7da09a78-a710-11de-bd14-00144feabdc0.html#ixzz1C51wYSrL">Financial Times</a> report.</span></span></div><div style="text-align: justify;"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt; line-height: 115%;"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt; line-height: 115%;"><span style="color: black;">These high-tech pills are equipped with microchips, that report back exactly when, what kind of and how much medicine the patient has taken.</span></span></span></div><div style="text-align: justify;"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt; line-height: 115%;"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt; line-height: 115%;"><span lang="EN-US" style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt; line-height: 115%;"><span style="color: black;">The main goals of these new devices are to help the patients adhere to their medication regimen and to improve adherence to medication in clinical trials.</span></span></span></span></div><div style="text-align: justify;"><br />
</div><span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt; line-height: 115%;"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt; line-height: 115%;"><span lang="EN-US" style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt; line-height: 115%;"><span lang="EN-US" style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt; line-height: 115%;"><span style="color: black;"><b>Examples for the high-tech pills</b></span></span></span></span></span><br />
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<span style="font-family: "Arial","sans-serif"; font-size: 10pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 10pt; line-height: 115%;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 10pt; line-height: 115%;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 10pt; line-height: 115%;"><span lang="EN-US" style="color: blue; font-family: "Arial","sans-serif"; font-size: 10pt; line-height: 115%;"><a href="http://ieeexplore.ieee.org/xpl/freeabs_all.jsp?arnumber=4373298">Magne Trace</a></span></span></span></span></span><br />
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<div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/_56US_7jsR8Y/TUCHPeL-FPI/AAAAAAAAACg/xPwkldh_swY/s1600/1.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="color: black;"><img border="0" s5="true" src="http://4.bp.blogspot.com/_56US_7jsR8Y/TUCHPeL-FPI/AAAAAAAAACg/xPwkldh_swY/s1600/1.bmp" /></span></a></div><br />
<div style="text-align: justify;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 10pt; line-height: 115%;"><span style="color: black;">Investigators from Georgia Tech developed an electronic necklace that can detect magnetized pills as they pass through the esophagus. The necklace (or a patch attached to the chest) contains a magnetic sensor that could be used to detect when specially-designed medication containing a tiny magnet – three millimeters in diameter and about one millimeter thick – passes through the patient’s esophagus. The date and time the user swallowed the pill can be recorded on a handheld wireless device, such as a smart phone, carried on the user’s body. The information can then be sent to the patient’s doctor over the internet. The device can notify both the patient and the patient’s doctor if the prescribed dosage is not taken at the proper time.</span></span></div><br />
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<span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 10pt; line-height: 115%;"><span lang="EN-US" style="color: blue; font-family: "Arial","sans-serif"; font-size: 10pt; line-height: 115%;"><a href="http://medgadget.com/archives/2010/11/novartis_pill_microchip_enables_remote_monitoring_of_drug_dosage_and_efficacy.html">Proteus</a></span></span><br />
<div class="separator" style="border: medium none; clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/_56US_7jsR8Y/TUCH8feCn7I/AAAAAAAAACo/ZaM6vkvPisI/s1600/Proteus.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="color: black;"></span></a><a href="http://3.bp.blogspot.com/_56US_7jsR8Y/TUCH6wthXLI/AAAAAAAAACk/Y9hFzQJjGeM/s1600/protesu+pill.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="color: black;"></span></a></div><div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/_56US_7jsR8Y/TUCH8feCn7I/AAAAAAAAACo/ZaM6vkvPisI/s1600/Proteus.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="294" s5="true" src="http://4.bp.blogspot.com/_56US_7jsR8Y/TUCH8feCn7I/AAAAAAAAACo/ZaM6vkvPisI/s320/Proteus.jpg" unselectable="on" width="320" /></a></div><br />
<span style="color: black;"><img height="88" src="http://4.bp.blogspot.com/_56US_7jsR8Y/TUCH8feCn7I/AAAAAAAAACo/ZaM6vkvPisI/s320/Proteus.jpg" style="left: 575px; opacity: 0.3; position: absolute; top: 631px; visibility: hidden;" width="96" /></span><br />
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<div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/_56US_7jsR8Y/TUCH6wthXLI/AAAAAAAAACk/Y9hFzQJjGeM/s1600/protesu+pill.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="213" s5="true" src="http://3.bp.blogspot.com/_56US_7jsR8Y/TUCH6wthXLI/AAAAAAAAACk/Y9hFzQJjGeM/s320/protesu+pill.jpg" width="320" /></a></div><div class="MsoNormal" style="line-height: 150%; margin: 6pt 0cm 10pt; text-align: justify;"><span style="color: black;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 10pt; line-height: 150%;">Proteus Biomedical and Novartis developed a </span>specialized microchip which the company plans to add to pills. When a patient ingests a ”Proteus-pill”, their stomach acids activate the microchip, which then sends data such as heart rate, temperature, and body movements to a dermal patch via Bluetooth connectivity. This patch can then export the data to an EMR (electronic medical record), so that it can be accessed by the patient's doctors. Novartis will bring the "Proteus-pills" to market within two years.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 6pt 0cm 10pt; text-align: justify;"><span lang="EN-US" style="color: purple; font-family: "Arial","sans-serif"; font-size: 10pt; line-height: 115%;"> </span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: black;"></span></div><div class="MsoNormal" style="line-height: 150%; margin: 6pt 0cm 10pt; text-align: justify;"><span lang="EN-US" style="color: purple; font-family: "Arial","sans-serif"; font-size: 10pt; line-height: 115%;"><a href="http://www.etectbio.com/">ID-Cap </a></span><br />
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<div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/_56US_7jsR8Y/TUCJ8H_Hi5I/AAAAAAAAACs/OvhYatbZsts/s1600/2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" s5="true" src="http://3.bp.blogspot.com/_56US_7jsR8Y/TUCJ8H_Hi5I/AAAAAAAAACs/OvhYatbZsts/s1600/2.jpg" /></a></div><br />
<span style="color: black;"><span lang="EN-US" style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt; line-height: 115%;">The ID-Cap is a sticker that is developed by University of Florida electronic engineer Rizwan Bashirullah. The cap contains a microchip, antenna and acid sensor and it sends electronic signals through body tissue to a receiver, worn on the wrist. Bashirullah</span><span lang="EN-US" style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt; line-height: 115%;"> estimates that applying the microchips to medication would cost between 25¢ to $1.00 more per pill, and that a real-world product should be available within two years.</span></span></div>Tamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.com0tag:blogger.com,1999:blog-8498074415733208564.post-22940309224137877602011-01-22T21:31:00.001+01:002011-01-23T20:19:12.719+01:00House M.D. - Patient education and better physician–patient relationship increase the effectiveness of treatments<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none; text-align: justify;"><span style="font-family: Calibri;"><span style="font-family: TimesNewRomanPSMT; font-size: 10pt; mso-bidi-font-family: TimesNewRomanPSMT;">There are many causes of non-adherence in patients with asthma, such as lack of prescription refills, discontinuation of the therapy or incorrect use of the medication (incorrect inhalation technique)</span><span style="font-size: 10pt; mso-ascii-font-family: TimesNewRomanPSMT; mso-bidi-font-family: TimesNewRomanPSMT; mso-fareast-font-family: TimesNewRomanPSMT;">…………</span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none; text-align: justify;"><br />
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</div><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/XjkCl3-PId8?feature=player_embedded' frameborder='0'></iframe></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none; text-align: justify;"><br />
</div>Tamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.com0tag:blogger.com,1999:blog-8498074415733208564.post-7176662994556517972011-01-16T20:23:00.001+01:002011-07-17T14:01:21.535+02:00Secondary database analysis: models for measuring medication adherence and persistence<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none; text-align: justify;"><span lang="EN-GB" style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-ansi-language: EN-GB;">Secondary database analysis is a common used process to evaluate patients’ drug taking behaviour. There are more standardized models for measuring adherence and persistence.</span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none; text-align: justify;"><br />
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<span lang="EN-GB" style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-ansi-language: EN-GB;"><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><u><span lang="EN-GB" style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-GB;">Medication adherence:</span></u></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><b><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%;">Medication Possession Ratio (MPR)</span></b><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-bidi-font-weight: bold;"><b>:</b></span></div><ul><li><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-bidi-font-weight: bold;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPS-ItalicMT; mso-fareast-language: EN-US;"><em>MPR: <span style="mso-tab-count: 1;"> </span></em></span><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;">number of days of medication supplied within the refill interval / number of days in refill interval</span></span></div></li>
<li><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-bidi-font-weight: bold;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;"></span></span><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-bidi-font-weight: bold;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-bidi-font-style: italic; mso-fareast-font-family: TimesNewRomanPS-ItalicMT;">At least two fill dates are needed to calculate this ratio.</span></span></span></div></li>
<li><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-bidi-font-weight: bold;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-bidi-font-style: italic; mso-fareast-font-family: TimesNewRomanPS-ItalicMT;"></span></span></span><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-bidi-font-weight: bold;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-bidi-font-style: italic; mso-fareast-font-family: TimesNewRomanPS-ItalicMT;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">Numerator: total X days of supply </span></span></span></span></div></li>
<li><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-bidi-font-weight: bold;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-bidi-font-style: italic; mso-fareast-font-family: TimesNewRomanPS-ItalicMT;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;"></span><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">Denominator: </span></span></span></span></div></li>
<ul><li><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-bidi-font-weight: bold;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-bidi-font-style: italic; mso-fareast-font-family: TimesNewRomanPS-ItalicMT;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;"></span><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">last refill as the end point </span><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;"></span></span></span></span></div></li>
</ul></ul><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-bidi-font-weight: bold;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-bidi-font-style: italic; mso-fareast-font-family: TimesNewRomanPS-ItalicMT;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 35.25pt; mso-layout-grid-align: none; text-align: justify;"><u><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;"><span style="mso-tab-count: 2;"> </span>total X days of supply<span style="mso-tab-count: 2;"> </span></span></u></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 35.25pt; mso-layout-grid-align: none; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">last X date – fisrt X date + last X days of supply</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"></div><ul><ul><li><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-bidi-font-weight: bold;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-bidi-font-style: italic; mso-fareast-font-family: TimesNewRomanPS-ItalicMT;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">fixed interval (e.g. seasonal diseases)</span></span></span></span></span> </div></li>
</ul></ul><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 35.25pt; mso-layout-grid-align: none; text-align: justify;"><u><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">total X days of supply</span></u></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="mso-tab-count: 1;"> </span>fixed interval (X days)</div><ul><li><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-GB" style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">Dual or triple therapy (e.g. hypertension): the numerator must be / with 2 or 3</span></div></li>
<li><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-GB" style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span lang="EN-GB" style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">MPR is a dichotomous various (adherent / non-adherent).</span></span></div></li>
<li><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-GB" style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span lang="EN-GB" style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span lang="EN-GB" style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">Cut-off value is disease specific.</span></span></span></div></li>
<ul><li><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-GB" style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span lang="EN-GB" style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span lang="EN-GB" style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span lang="EN-GB" style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">Conventional: </span><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;">patients with adherence over 80% (MPR) can be called adherent. </span></span></span></span></div></li>
<li><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-GB" style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span lang="EN-GB" style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span lang="EN-GB" style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;">Overuse: MPR is over 1.0 (100%), these patients are also non-adherent !</span></span></span></span></span></div></li>
</ul></ul><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-GB" style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span lang="EN-GB" style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span lang="EN-GB" style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-font-style: italic; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPS-ItalicMT; mso-fareast-language: EN-US;"><strong>Proportion of days covered (PDC):</strong></span></span></span></span></span></span></div><ul><li><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-font-style: italic; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPS-ItalicMT; mso-fareast-language: EN-US;">PDC: </span><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;">the number of days with all drug(s) on-hand / the number of days in the observation interval.</span></div></li>
<li><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">PDC values range from 0 to 1.</span></span></div></li>
</ul><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;">MPR vs. PDC : Is the patient adherent?</span></div><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;"><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"></div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: currentColor; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-table-layout-alt: fixed; mso-yfti-tbllook: 1184;"><tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;"><td style="background: rgb(247, 150, 70); border: 1pt solid windowtext; mso-background-themecolor: accent6; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 32.95pt;" valign="top" width="44"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">Drug</span></div></td><td colspan="12" style="background: rgb(247, 150, 70); border-color: windowtext windowtext windowtext rgb(240, 240, 240); border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; mso-background-themecolor: accent6; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 170.9pt;" valign="top" width="228"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">Months 1-12</span></div></td><td style="background: rgb(247, 150, 70); border-color: windowtext windowtext windowtext rgb(240, 240, 240); border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; mso-background-themecolor: accent6; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 78pt;" valign="top" width="104"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">Supply (days)</span></div></td></tr>
<tr style="mso-yfti-irow: 1;"><td style="background: rgb(0, 176, 80); border-color: rgb(240, 240, 240) windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 32.95pt;" valign="top" width="44"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">A</span></div></td><td style="background: rgb(0, 176, 80); border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 15pt;" valign="top" width="20"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">x</span></div></td><td style="background: rgb(0, 176, 80); border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">x</span></div></td><td style="background: rgb(0, 176, 80); border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">x</span></div></td><td style="background: rgb(0, 176, 80); border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">x</span></div></td><td style="background: rgb(0, 176, 80); border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">x</span></div></td><td style="background: rgb(0, 176, 80); border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">x</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><br />
</div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><br />
</div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><br />
</div></td><td style="background: rgb(0, 176, 80); border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">x</span></div></td><td style="background: rgb(0, 176, 80); border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">x</span></div></td><td style="background: rgb(0, 176, 80); border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">x</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 78pt;" valign="top" width="104"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">9x30=270</span></div></td></tr>
<tr style="mso-yfti-irow: 2;"><td style="background: yellow; border-color: rgb(240, 240, 240) windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 32.95pt;" valign="top" width="44"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">B</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 15pt;" valign="top" width="20"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><br />
</div></td><td style="background: yellow; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">x</span></div></td><td style="background: yellow; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">x</span></div></td><td style="background: yellow; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">x</span></div></td><td style="background: yellow; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">x</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><br />
</div></td><td style="background: yellow; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">x</span></div></td><td style="background: yellow; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">x</span></div></td><td style="background: yellow; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">x</span></div></td><td style="background: yellow; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">x</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><br />
</div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><br />
</div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 78pt;" valign="top" width="104"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">8x30=240</span></div></td></tr>
<tr style="mso-yfti-irow: 3;"><td style="background: red; border-color: rgb(240, 240, 240) windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 32.95pt;" valign="top" width="44"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">C</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 15pt;" valign="top" width="20"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><br />
</div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><br />
</div></td><td style="background: red; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">x</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><br />
</div></td><td style="background: red; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">x</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><br />
</div></td><td style="background: red; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">x</span></div></td><td style="background: red; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">x</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><br />
</div></td><td style="background: red; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">x</span></div></td><td style="background: red; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">x</span></div></td><td style="background: red; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">x</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 78pt;" valign="top" width="104"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">7x30=210</span></div></td></tr>
<tr style="mso-yfti-irow: 4;"><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 32.95pt;" valign="top" width="44"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><br />
</div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 15pt;" valign="top" width="20"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><br />
</div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><br />
</div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">↑</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><br />
</div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">↑</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><br />
</div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><br />
</div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><br />
</div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><br />
</div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">↑</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><br />
</div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><br />
</div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 78pt;" valign="top" width="104"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">3x30=90</span></div></td></tr>
<tr style="mso-yfti-irow: 5;"><td colspan="14" style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 281.85pt;" valign="top" width="376"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">MPR: ((270+240+210)/3) / 360 = 0.66</span></div></td></tr>
<tr style="mso-yfti-irow: 6; mso-yfti-lastrow: yes;"><td colspan="14" style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 281.85pt;" valign="top" width="376"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">PDC: 90 / 360 = 0.25</span></div></td></tr>
</tbody></table><br />
<div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><u>Medication peristence:</u></span></div></span><ul><li><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;">The duration of time from the initiation (or at chronic disease from an optional date) to the discontinuation of drug therapy. (Permissible gap: is reported as the maximum allowable period of the refill interval without discontinuation of the therapy.)</span></span></div></li>
<li><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">Percentage of individuals remaining on therapy (persistent) until a specified time interval.</span></span></span></div></li>
</ul><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">Patients persisted x days vs. y patients were persistent for z days</span></span></span></span></div><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: TimesNewRomanPSMT; mso-fareast-language: EN-US;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"></div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: currentColor; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-table-layout-alt: fixed; mso-yfti-tbllook: 1184;"><tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;"><td style="background-color: transparent; border: 1pt solid windowtext; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 41.95pt;" valign="top" width="56"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">Patient</span></div></td><td colspan="12" style="background-color: transparent; border-color: windowtext windowtext windowtext rgb(240, 240, 240); border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 197.35pt;" valign="top" width="263"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none; text-align: center;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">Months 1-12 </span></div><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none; text-align: center;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">(1 month = 30 days)</span></div></td><td style="background-color: transparent; border-color: windowtext windowtext windowtext rgb(240, 240, 240); border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 63.8pt;" valign="top" width="85"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">Days persistent (gap=30 days) *</span></div></td><td style="background-color: transparent; border-color: windowtext windowtext windowtext rgb(240, 240, 240); border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 70.85pt;" valign="top" width="94"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">Persist 180 days (gap=30 days) **</span></div></td></tr>
<tr style="mso-yfti-irow: 1;"><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 41.95pt;" valign="top" width="56"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">A</span></div></td><td style="background: rgb(0, 176, 80); border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 15.8pt;" valign="top" width="21"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">x</span></div></td><td style="background: rgb(0, 176, 80); border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 18.55pt;" valign="top" width="25"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">x</span></div></td><td style="background: rgb(0, 176, 80); border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 15.8pt;" valign="top" width="21"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">x</span></div></td><td style="background: rgb(0, 176, 80); border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 19.65pt;" valign="top" width="26"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">x</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 15.8pt;" valign="top" width="21"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 15.8pt;" valign="top" width="21"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div></td><td style="background: rgb(0, 176, 80); border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 18pt;" valign="top" width="24"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">x</span></div></td><td style="background: rgb(0, 176, 80); border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 15.8pt;" valign="top" width="21"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">x</span></div></td><td style="background: rgb(0, 176, 80); border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 15.8pt;" valign="top" width="21"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">x</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 18pt;" valign="top" width="24"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 63.8pt;" valign="top" width="85"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">120</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 70.85pt;" valign="top" width="94"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">no</span></div></td></tr>
<tr style="mso-yfti-irow: 2;"><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 41.95pt;" valign="top" width="56"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">B</span></div></td><td style="background: yellow; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 15.8pt;" valign="top" width="21"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">x</span></div></td><td style="background: yellow; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 18.55pt;" valign="top" width="25"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">x</span></div></td><td style="background: yellow; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 15.8pt;" valign="top" width="21"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">x</span></div></td><td style="background: yellow; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 19.65pt;" valign="top" width="26"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">x</span></div></td><td style="background: yellow; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 15.8pt;" valign="top" width="21"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">x</span></div></td><td style="background: yellow; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 15.8pt;" valign="top" width="21"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">x</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 18pt;" valign="top" width="24"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div></td><td style="background: white; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-background-themecolor: background1; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 15.8pt;" valign="top" width="21"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div></td><td style="background: white; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-background-themecolor: background1; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 15.8pt;" valign="top" width="21"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div></td><td style="background: yellow; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 18pt;" valign="top" width="24"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">x</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div></td><td style="background: yellow; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">x</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 63.8pt;" valign="top" width="85"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">180</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 70.85pt;" valign="top" width="94"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">yes</span></div></td></tr>
<tr style="mso-yfti-irow: 3;"><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 41.95pt;" valign="top" width="56"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">C</span></div></td><td style="background: red; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 15.8pt;" valign="top" width="21"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">x</span></div></td><td style="background: red; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 18.55pt;" valign="top" width="25"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">x</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 15.8pt;" valign="top" width="21"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 19.65pt;" valign="top" width="26"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 15.8pt;" valign="top" width="21"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div></td><td style="background: red; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 15.8pt;" valign="top" width="21"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">x</span></div></td><td style="background: red; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 18pt;" valign="top" width="24"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">x</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 15.8pt;" valign="top" width="21"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 15.8pt;" valign="top" width="21"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div></td><td style="background: red; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 18pt;" valign="top" width="24"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">x</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.2pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div></td><td style="background: red; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">x</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 63.8pt;" valign="top" width="85"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">60</span></div></td><td style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext rgb(240, 240, 240); border-style: none solid solid none; border-width: medium 1pt 1pt medium; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 70.85pt;" valign="top" width="94"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">no</span></div></td></tr>
<tr style="height: 23.5pt; mso-yfti-irow: 4; mso-yfti-lastrow: yes;"><td colspan="15" style="background-color: transparent; border-color: rgb(240, 240, 240) windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 23.5pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 373.95pt;" valign="top" width="499"><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">*: patients persisted on avarge 120 days ((120+180+60)/3)</span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Arial", "sans-serif"; font-size: 10pt;">**: 33% (1/3) of the patients were persistent for 180 days</span></div></td></tr>
</tbody></table><br />
<div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 8pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">References</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 8pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 8pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><a href="http://www.blogger.com/goog_1087650253"><span style="color: windowtext; text-decoration: none; text-underline: none;">Martin BC</span></a>, <a _sg="true" href="http://www.blogger.com/goog_1087650253"><span style="color: windowtext; text-decoration: none; text-underline: none;">Wiley-Exley EK</span></a>, <a _sg="true" href="http://www.blogger.com/goog_1087650253"><span style="color: windowtext; text-decoration: none; text-underline: none;">Richards S</span></a>, <a _sg="true" href="http://www.blogger.com/goog_1087650253"><span style="color: windowtext; text-decoration: none; text-underline: none;">Domino ME</span></a>, <a _sg="true" href="http://www.blogger.com/goog_1087650253"><span style="color: windowtext; text-decoration: none; text-underline: none;">Carey TS</span></a>, <a _sg="true" href="http://www.blogger.com/goog_1087650253"><span style="color: windowtext; text-decoration: none; text-underline: none;">Sleath BL</span></a>.<span style="mso-bidi-font-weight: bold;">Contrasting measures of adherence with simple drug use, medication switching, and therapeutic duplication.</span> <span style="color: windowtext; text-decoration: none; text-underline: none;">Ann Pharmacother.</span> 2009 Jan;43(1):36-44.</span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 8pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 8pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 8pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Karve%20S%22%5BAuthor%5D"><span style="color: windowtext; text-decoration: none; text-underline: none;">Karve S</span></a>, <a _sg="true" href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Cleves%20MA%22%5BAuthor%5D"><span style="color: windowtext; text-decoration: none; text-underline: none;">Cleves MA</span></a>, <a _sg="true" href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Helm%20M%22%5BAuthor%5D"><span style="color: windowtext; text-decoration: none; text-underline: none;">Helm M</span></a>, <a _sg="true" href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hudson%20TJ%22%5BAuthor%5D"><span style="color: windowtext; text-decoration: none; text-underline: none;">Hudson TJ</span></a>, <a _sg="true" href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22West%20DS%22%5BAuthor%5D"><span style="color: windowtext; text-decoration: none; text-underline: none;">West DS</span></a>, <a _sg="true" href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Martin%20BC%22%5BAuthor%5D"><span style="color: windowtext; text-decoration: none; text-underline: none;">Martin BC</span></a>: <span style="mso-bidi-font-weight: bold;">Prospective validation of eight different adherence measures for use with administrative claims data among patients with schizophrenia.</span> <a href="javascript:AL_get(this,%20'jour',%20'Value%20Health.');" title="Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research."><span style="color: windowtext; text-decoration: none; text-underline: none;">Value Health.</span></a> 2009 Sep;12(6):989-95.</span></span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 8pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 8pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 8pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial", "sans-serif"; font-size: 8pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;"><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Peterson%20AM%22%5BAuthor%5D"><span style="color: windowtext; text-decoration: none; text-underline: none;">Peterson AM</span></a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Nau%20DP%22%5BAuthor%5D"><span style="color: windowtext; text-decoration: none; text-underline: none;">Nau DP</span></a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Cramer%20JA%22%5BAuthor%5D"><span style="color: windowtext; text-decoration: none; text-underline: none;">Cramer JA</span></a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Benner%20J%22%5BAuthor%5D"><span style="color: windowtext; text-decoration: none; text-underline: none;">Benner J</span></a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Gwadry-Sridhar%20F%22%5BAuthor%5D"><span style="color: windowtext; text-decoration: none; text-underline: none;">Gwadry-Sridhar F</span></a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Nichol%20M%22%5BAuthor%5D"><span style="color: windowtext; text-decoration: none; text-underline: none;">Nichol M</span></a>: <span style="mso-font-kerning: 18.0pt;">A checklist for medication compliance and persistence studies using retrospective databases.</span> <a href="javascript:AL_get(this,%20'jour',%20'Value%20Health.');" title="Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research."><span style="color: windowtext; text-decoration: none; text-underline: none;">Value Health.</span></a> 2007 Jan-Feb;10(1):3-12.</span></span></span></span></div></span></span></span></span><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: center;"><br />
</div></span></span></span></span> </span>Tamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.com0tag:blogger.com,1999:blog-8498074415733208564.post-46890739867582482522011-01-13T23:47:00.000+01:002011-01-13T23:47:00.800+01:00Improved medication adherence reduce health care use and costs<div class="MsoNormal" style="margin: 0cm 0cm 10pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;">The study, "<a href="http://content.healthaffairs.org/content/30/1/91">Medication Adherence Leads to Lower Health Care Use and Costs Despite Increased Drug Spending</a>," was released in the January issue of Health Affairs. The pharmacy and medical claims data of 135,000 patients with congestive heart failure, diabetes, hypertension and dyslipidemia were analysed to determine the direct effect of medication adherence on health care costs. </span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 10pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br />
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</div><span style="font-family: "Arial", "sans-serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;"><div class="MsoNormal" style="background: white; margin: 0cm 0cm 10pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;"><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Roebuck%20MC%22%5BAuthor%5D"><span style="color: windowtext; text-decoration: none; text-underline: none;">Roebuck MC</span></a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Liberman%20JN%22%5BAuthor%5D"><span style="color: windowtext; text-decoration: none; text-underline: none;">Liberman JN</span></a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Gemmill-Toyama%20M%22%5BAuthor%5D"><span style="color: windowtext; text-decoration: none; text-underline: none;">Gemmill-Toyama M</span></a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Brennan%20TA%22%5BAuthor%5D"><span style="color: windowtext; text-decoration: none; text-underline: none;">Brennan TA</span></a>.: <span style="mso-font-kerning: 18.0pt;">Medication adherence leads to lower health care use and costs despite increased drug spending.</span> <a href="javascript:AL_get(this,%20'jour',%20'Health%20Aff%20(Millwood).');" title="Health affairs (Project Hope)."><span style="color: windowtext; text-decoration: none; text-underline: none;">Health Aff (Millwood).</span></a> 2011 Jan;30(1):91-9.</span></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 0pt; mso-outline-level: 3; text-align: justify;"><strong>Abstract</strong></div><div class="MsoNormal" style="background: white; margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;">Researchers have routinely found that improved medication adherence-getting people to take medicine prescribed for them-is associated with greatly reduced total health care use and costs. But previous studies do not provide strong evidence of a causal link. This article employs a more robust methodology to examine the relationship. Our results indicate that although improved medication adherence by people with four chronic vascular diseases increased pharmacy costs, it also produced substantial medical savings as a result of reductions in hospitalization and emergency department use. Our findings indicate that programs to improve medication adherence are worth consideration by insurers, government payers, and patients, as long as intervention costs do not exceed the estimated health care cost savings.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><br />
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</div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;">Troyen A. Brennan, MD, MPH, Executive Vice President and Chief Medical Officer of CVS Caremark <a href="http://pharmalive.com/News/index.cfm?articleid=753520&categoryid=10">said</a> about the results of the study: „The annual per person savings for chronically ill patients who were adherent to medications compared to those who were not amounted to $7,823 for those with congestive heart failure, $3,756 for a diabetes patient, $3,908 for hypertension and $1,258 for dyslipidemia or high cholesterol. Across all conditions, adherence was associated with significantly lower annual inpatient hospital days."</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: "Arial", "sans-serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;">"No matter what the intervention, the researchers agreed that actively encouraging medication adherence for chronic disease should be a top priority," <a href="http://pharmalive.com/News/index.cfm?articleid=753520&categoryid=10">noted</a> M. Christopher Roebuck, director of strategic research for CVS Caremark and lead author of the study. "Despite higher pharmacy spending the reduction in hospitalizations and emergency room use resulted in substantial savings."</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-layout-grid-align: none; text-align: justify;"><span lang="EN-GB" style="font-family: "Arial", "sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;">This study highlighted </span><span style="font-family: "Arial", "sans-serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: HU;">that there is a clear need for effective</span><span style="font-family: "Arial", "sans-serif"; font-size: 12pt; line-height: 115%;"> adherence-enhancing interventions to improve patient outcomes and/or reduce health-care costs.</span></div></span>Tamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.com0tag:blogger.com,1999:blog-8498074415733208564.post-57185968803432357802011-01-10T22:07:00.006+01:002011-03-01T21:38:21.547+01:00Human Dynamics<div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;"><span style="color: black;">I've just finished the book ”<span style="mso-bidi-font-weight: bold;">Bursts: The Hidden Pattern Behind Everything We Do” by Barabasi. Great reading, I really enjoyed it! And why is my blog about this book?</span></span></span></span><br />
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<div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/_56US_7jsR8Y/TStz6tsw4pI/AAAAAAAAABQ/aGybJROo0_4/s1600/b.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" n4="true" src="http://1.bp.blogspot.com/_56US_7jsR8Y/TStz6tsw4pI/AAAAAAAAABQ/aGybJROo0_4/s200/b.jpg" width="131" /></a></div></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-US" style="color: black; mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;"><a href="http://en.wikipedia.org/wiki/Albert-L%C3%A1szl%C3%B3_Barab%C3%A1si">Albert-Laszlo Barabasi</a> <span style="color: black;">is one of the world's preeminent researchers on the science of networks. ”Bursts” opens a door into the human dynamics. Before reading the book your life may look random to you. But everything from your visits to a web page to your mobile phone calls are predictable, and happen in bursts.</span></span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: Calibri;"><span style="mso-bidi-font-family: Calibri; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-latin;"><a href="http://en.wikipedia.org/wiki/Human_dynamics"><span id="goog_710925037"></span>Human dynamics<span id="goog_710925038"></span></a></span><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"> <span style="color: black;">is a new branch of </span></span></span><a href="http://en.wikipedia.org/wiki/Complex_systems" title="Complex systems"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; text-decoration: none; text-underline: none;"><span style="color: black; font-family: Calibri;">complex systems</span></span></a><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="color: black; font-family: Calibri;"> research in </span></span><a href="http://en.wikipedia.org/wiki/Statistical_physics" title="Statistical physics"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; text-decoration: none; text-underline: none;"><span style="color: black; font-family: Calibri;">statistical physics</span></span></a><span style="font-family: Calibri;"><span style="color: black; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">. Its main goal is to apply the powerful conceptual toolbox developed by Physicists to study the natural world to the study of human behavior. <span style="font-size: x-small;">(Wikipedia)</span></span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><span lang="EN-US" style="color: black; mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">What about adherence, is it also predictable with a mathematical formula?</span></span></div>Tamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.com0tag:blogger.com,1999:blog-8498074415733208564.post-87672117582050267232011-01-09T00:17:00.002+01:002011-01-17T20:55:49.815+01:00Definitions: adherence, compliance, persistence, concordance<span lang="EN-US" style="font-family: "Calibri", "sans-serif"; font-size: 11pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-bidi-font-style: italic;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"></span></span></span><br />
<div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-fareast-font-family: AdvTTc9c3bd71;">The definitions of the patient co-operation are not uniformed. This causes many difficulties when comparing the results of the studies. </span><span lang="EN-US" style="mso-ansi-language: EN-US;">I searched the net and I found some good summaries about the meaning of adherence, compliance, concordance, persistence etc. </span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-fareast-font-family: AdvTTc9c3bd71;">As follows adherence, compliance, persistence are defined based on the classifications of WHO, NICE, ISPOR and ABC.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><span lang="EN-US" style="font-family: "Calibri", "sans-serif"; font-size: 11pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-bidi-font-style: italic;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><strong><a href="http://www.who.int/chp/knowledge/publications/adherence_report/en/index.html">WHO</a></strong></span></span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><span lang="EN-US" style="font-family: "Calibri", "sans-serif"; font-size: 11pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-bidi-font-style: italic;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><u>Adherence:</u> <span style="mso-bidi-font-style: italic;">the extent to which a person’s behaviour – taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider.</span></span></span></span> </div><br />
<span lang="EN-US" style="font-family: "Calibri", "sans-serif"; font-size: 11pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-bidi-font-style: italic;"><strong><a href="http://www.nice.org.uk/CG76">NICE</a></strong></span></span><br />
<span lang="EN-US" style="font-family: "Calibri", "sans-serif"; font-size: 11pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-bidi-font-style: italic;"><span lang="EN-US" style="mso-ansi-language: EN-US;"></span></span></span><br />
<div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><u>Adherence:</u> ‘the extent to which the patient’s behaviour matches agreed recommendations from the prescriber’. Adherence emphasises the need for agreement and that the patient is free to decide whether or not to adhere to the prescriber’s recommendation.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><u>Concordance:</u> this is a recent term whose meaning has changed. It was initially applied to the consultation process in which prescriber and patient agree therapeutic decisions that incorporate their respective views, but now includes patient support in medicine-taking as well as prescribing communication. Concordance reflects social values but does not address medicine-taking and may not lead to improved adherence.</div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-US" style="mso-ansi-language: EN-US;"><u>Persistence:</u> The length of time from initiation to discontinuation of therapy.</span></div><br />
<strong><a href="http://www.ispor.org/sigs/medcompliance/MedicationComplianceandPersistence.asp">ISPOR</a></strong><br />
<span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><u>Medication compliance (synonym: adherence):</u> refers to the degree or extent of conformity to the recommendations about day-to-day treatment by the provider with respect to the timing, dosage, and frequency. It may be defined as “the extent to which a patient acts in accordance with the prescribed interval, and dose of a dosing regimen.” </span><br />
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</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none; text-align: justify;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><u>Medication persistence:</u> refers to the act of continuing the treatment for the prescribed duration. It may be defined as “the duration of time from initiation to discontinuation of therapy.” Persistence analyses must include a prespecified limit on the number of days allowed between refills, considered the “permissible gap.”<span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"></span></span><br />
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</div><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/_56US_7jsR8Y/TSjsowkGWgI/AAAAAAAAABI/kBqmzM-F32E/s1600/2.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="267" n4="true" src="http://1.bp.blogspot.com/_56US_7jsR8Y/TSjsowkGWgI/AAAAAAAAABI/kBqmzM-F32E/s400/2.png" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none; text-align: justify;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><strong><a href="http://www.abcproject.eu/img/2010_taxonomy_ABC_ESC_CCNAP_poster_March2010.pdf">ABC</a></strong></span></div><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"></span><br />
<div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><u><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Medication adherence:</span></u><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"> is the process by which patients take their medication as prescribed. It consists of three parts: </span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"></span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Initiation: occurs when the patient takes the first dose of the prescribed medication. </span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"></span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Discontinuation: occurs when the patient stops taking the prescribed medication. </span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"></span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Execution: <span style="mso-bidi-font-weight: bold;">patients’ accuracy in following the day-to-day dosing regimen while still actively taking the medication. It </span>is the multidimensional outcome of the comparison of two time series: the prescribed drug dosing regimen and the patient’s drug dosing history while he or she is still engaged with treatment. Evaluation is disease/treatment specific.</span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"></span><span lang="EN-US" style="font-family: "Calibri", "sans-serif"; font-size: 11pt; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-style: italic; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Persistence</span><span lang="EN-US" style="font-family: "Calibri", "sans-serif"; font-size: 11pt; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">: the length of time that the patient continues to be engaged with the prescribed dosing regimen. </span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-US" style="font-family: "Calibri", "sans-serif"; font-size: 11pt; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"></span><span lang="EN-US" style="font-family: "Calibri", "sans-serif"; font-size: 11pt; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Medication adherence is best quantified using two parameters: execution and persistence.</span></div><div class="Default" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-US" style="font-family: "Calibri", "sans-serif"; font-size: 11pt; line-height: 150%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"></span><span lang="EN-US" style="font-family: "Calibri", "sans-serif"; font-size: 11pt; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><u><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Medication therapy management</span></u><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">: <span style="mso-bidi-font-weight: bold;">The overall process of assisting patients in the initiation and conduct of their drug therapies.</span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-bidi-font-weight: bold;"></span></span><u><span lang="EN-US" style="font-family: "Calibri", "sans-serif"; font-size: 11pt; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-style: italic; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Adherence-Related Behavioral Science</span></u><span lang="EN-US" style="font-family: "Calibri", "sans-serif"; font-size: 11pt; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">: the many disciplines concerned with patients’ and providers’ decision-making, acceptance of, and ability to effectively adhere to a medication regimen.</span></div><div class="Default" style="margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-US" style="font-family: "Calibri", "sans-serif"; font-size: 11pt; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none; text-align: justify;"><u><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-font-style: italic; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-latin;">Pharmionics</span></u><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-latin;">: The discipline concerned with the quantitative assessment of what patients do with prescribed medicines. </span><span lang="EN-US" style="font-family: "Calibri", "sans-serif"; font-size: 11pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">It </span><span lang="EN-US" style="font-family: "Calibri", "sans-serif"; font-size: 11pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">is concerned with the study of how prescribed medications are used by ambulatory patients. Pharmionics (ion=to go) means “the going of the pharmaceutical(s)” and constitutes thus a link to the biomedical field as a natural input to pharmacokinetic and pharmacodynamic models for quantitative analysis of pharmacometric and economic consequences of dosing errors.</span></div><br />
<div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/_56US_7jsR8Y/TSjs8bFCD6I/AAAAAAAAABM/-UpM_nX9_wY/s1600/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" n4="true" src="http://2.bp.blogspot.com/_56US_7jsR8Y/TSjs8bFCD6I/AAAAAAAAABM/-UpM_nX9_wY/s400/1.png" width="400" /></a></div></div>Tamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.com1tag:blogger.com,1999:blog-8498074415733208564.post-22263994018177242452011-01-05T22:23:00.001+01:002011-01-10T22:32:04.361+01:00Introduction: the impact of therapeutic non-adherence<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span lang="EN-US" style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-ansi-language: EN-US;">Non-adherence to treatment is a world-wide problem and the </span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: Tiepolo-Black;">impact of poor adherence grows as the burden of chronic diseases grows world wide.</span></div><ul><ul><li><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: Tiepolo-Black;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: Tiepolo-Book;">Adherence to long-term therapy for chronic illnesses in developed countries averages 50%.<sup>1</sup></span></span></div></li>
<li><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: Tiepolo-Black;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: Tiepolo-Book;"><sup></sup><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: TimesNewRomanPSMT;">Hypertension,dyslipidaemia and diabetes mellitus:67-76% (MPR)<sup>2</sup></span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-bidi-font-style: italic; mso-fareast-font-family: TimesNewRomanPS-ItalicMT;"> </span></span></span></div></li>
<li><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: Tiepolo-Black;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: Tiepolo-Book;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-bidi-font-style: italic; mso-fareast-font-family: TimesNewRomanPS-ItalicMT;"></span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: TimesNewRomanPSMT;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: TimesNewRomanPSMT;">COPD:44% (MPR)<sup>3</sup></span></span></span></span></div></li>
</ul></ul><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-layout-grid-align: none; mso-list: l1 level2 lfo1; text-indent: -18pt;"><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;"></span></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: Tiepolo-Black;">Therapeutic non-adherence </span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt;">is a major issue in health care.</span><span style="font-family: "TimesNRMT", "serif"; font-size: 9pt; mso-bidi-font-family: TimesNRMT;"> </span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: Tiepolo-Black;">The consequences of non-adherence to long-term therapies: poor health outcomes and increased health care costs.<sup>1</sup></span><span style="font-family: "Times New Roman", "serif"; font-size: 10pt; mso-no-proof: yes;"></span></div><ul><li><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0pt 53.4pt; mso-add-space: auto; mso-layout-grid-align: none; mso-list: l0 level1 lfo2; text-indent: -18pt;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: Tiepolo-Book;">Non-adherence may contribute to: </span></div></li>
<ul><li><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0pt 53.4pt; mso-add-space: auto; mso-layout-grid-align: none; mso-list: l0 level1 lfo2; text-indent: -18pt;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: Tiepolo-Book;"></span><br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 89.4pt; mso-add-space: auto; mso-layout-grid-align: none; mso-list: l0 level2 lfo2; text-indent: -18pt;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: Tiepolo-Book;">48% of asthma deaths</span></div></div></li>
<li><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0pt 53.4pt; mso-add-space: auto; mso-layout-grid-align: none; mso-list: l0 level1 lfo2; text-indent: -18pt;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: Tiepolo-Book;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: Tiepolo-Book;"></span></span><br />
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0pt 89.4pt; mso-add-space: auto; mso-layout-grid-align: none; mso-list: l0 level2 lfo2; text-indent: -18pt;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: Tiepolo-Book;">80% increase risk of death in diabetes</span></div></div></li>
<li><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0pt 53.4pt; mso-add-space: auto; mso-layout-grid-align: none; mso-list: l0 level1 lfo2; text-indent: -18pt;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: Tiepolo-Book;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: Tiepolo-Book;"></span></span><br />
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0pt 89.4pt; mso-add-space: auto; mso-layout-grid-align: none; mso-list: l0 level2 lfo2; text-indent: -18pt;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: Tiepolo-Book;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Tiepolo-Book; mso-fareast-language: EN-US;">3.8 times increased risk of death in the year following an MI <sup>4</sup></span></span></div></div></li>
</ul></ul><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: HU; mso-bidi-language: AR-SA; mso-fareast-font-family: Tiepolo-Book; mso-fareast-language: EN-US;"></span><br />
<div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/_56US_7jsR8Y/TSR0JEhXv7I/AAAAAAAAAAk/wX1tU3qRp40/s1600/t.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="256" n4="true" src="http://1.bp.blogspot.com/_56US_7jsR8Y/TSR0JEhXv7I/AAAAAAAAAAk/wX1tU3qRp40/s400/t.png" width="400" /></a></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: Tiepolo-Black;">Increasing the effectiveness of adherence interventions may have far greater impact on the health of the population than any improvement in specific medical treatments.<sup>5</sup></span><span style="font-family: "Times New Roman", "serif"; font-size: 10pt; mso-fareast-font-family: Tiepolo-Book;"></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; mso-layout-grid-align: none;"><sup><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: Tiepolo-Book;">1<span style="mso-tab-count: 1;"> </span></span></sup><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: Tiepolo-Book;"></span><span style="font-family: "Times New Roman", "serif"; font-size: 10pt; mso-fareast-font-family: Tiepolo-Book;">WHO</span><span style="font-family: "Times New Roman", "serif"; font-size: 10pt; mso-no-proof: yes;">: Adherence to long-term therapies: Evidence for action. 2003</span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 35.25pt; mso-layout-grid-align: none; text-indent: -35.25pt;"><sup><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: TimesNewRomanPSMT;">2</span></sup><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-bidi-font-style: italic; mso-fareast-font-family: TimesNewRomanPS-ItalicMT;"> <span style="mso-tab-count: 1;"> </span></span><span style="font-family: "Times New Roman", "serif"; font-size: 10pt; mso-bidi-font-style: italic; mso-fareast-font-family: TimesNewRomanPS-ItalicMT;">Cramer JA et al.: </span><span style="font-family: "Times New Roman", "serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">The signifi cance of compliance and persistence in the treatment of diabetes, hypertension and dyslipidaemia: a review. Int J Clin Pract 2008;</span><span style="font-family: "Times New Roman", "serif"; font-size: 10pt; mso-bidi-font-style: italic; mso-fareast-font-family: TimesNewRomanPS-ItalicMT;">62:</span><span style="font-family: "Times New Roman", "serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">76–87.</span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 35.25pt; mso-layout-grid-align: none; text-indent: -35.25pt;"><sup><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: TimesNewRomanPSMT;">3</span></sup><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-bidi-font-style: italic; mso-fareast-font-family: TimesNewRomanPS-ItalicMT;"> <span style="mso-tab-count: 1;"> </span></span><span style="font-family: "Times New Roman", "serif"; font-size: 10pt; mso-bidi-font-style: italic; mso-fareast-font-family: TimesNewRomanPS-ItalicMT;">Jung E et al.: </span><span style="font-family: "Times New Roman", "serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">Medication adherence and persistence in the last year of life in COPD patients. Respir Med 2009;</span><span style="font-family: "Times New Roman", "serif"; font-size: 10pt; mso-bidi-font-style: italic; mso-fareast-font-family: TimesNewRomanPS-ItalicMT;">103:</span><span style="font-family: "Times New Roman", "serif"; font-size: 10pt; mso-fareast-font-family: TimesNewRomanPSMT;">525–534.</span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: TimesNewRomanPSMT;"></span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 35.25pt; mso-layout-grid-align: none; text-indent: -35.25pt;"><sup><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: Tiepolo-Book;">4<span style="mso-tab-count: 1;"> </span></span></sup><span style="font-family: "Times New Roman", "serif"; font-size: 10pt; mso-fareast-font-family: Tiepolo-Book;">Elliott R:</span><span style="font-family: "Times New Roman", "serif"; font-size: 10pt;"> Non-adherence to medicines: not solved but solvable. J Health Serv Res Policy.2009;14: 58-61.</span></div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt 35.25pt; mso-layout-grid-align: none; text-indent: -35.25pt;"><sup><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: Tiepolo-Black;">5</span></sup><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; mso-fareast-font-family: Tiepolo-Black;"> <span style="mso-tab-count: 1;"> </span></span><span style="font-family: "Times New Roman", "serif"; font-size: 10pt; mso-fareast-font-family: Tiepolo-Book;">Haynes RB et al.: Interventions for helping patients follow prescriptions for medications. </span><span style="font-family: "Times New Roman", "serif"; font-size: 10pt; mso-bidi-font-style: italic; mso-fareast-font-family: Tiepolo-BookItalic;">The Cochrane Library 2001</span><span style="font-family: "Times New Roman", "serif"; font-size: 10pt; mso-fareast-font-family: Tiepolo-Book;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0pt 89.4pt; mso-add-space: auto; mso-layout-grid-align: none; mso-list: l0 level2 lfo2; text-indent: -18pt;"></div>Tamas Agh MD MSchttp://www.blogger.com/profile/04586803284998616165noreply@blogger.com0